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Rev. bras. ortop ; 56(3): 360-367, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1288676


Abstract Objective To measure and document the clinical impact of the waiting time for surgical treatment of patients with spinal deformities in a quaternary center in Brazil. Methods In total, 59 patients with spinal deformity waiting for surgery on our hospital's list were evaluated to observe the impact of the waiting time on the progression of the deformity. Patient evaluation was performed using the SRS-22r questionnaire for health-related quality of life (HRQL) and radiographic images to evaluate the deformity of the spine at the time the patients were included in the waiting list and at the most recent appointment. The radiographic parameters selected for comparison were: Cobb angle of the primary and secondary curves, coronal alignment, apical vertebral translation, pelvic obliquity, sagittal vertebral axis, kyphosis (T5-T12), and lordosis (L1-S1). Results Low HRQL scores according to the SRS-22r questionnaire were observed in patients waiting for surgery. The radiographic parameters showed progression of the deformity on the initial evaluation when compared with the most recent follow-up evaluation. Conclusion The patients waiting for surgical treatment of spinal deformities in our center showed relatively low HRQL scores and radiographic progression of the deformity.

Resumo Objetivo Medir e documentar o impacto clínico do tempo de espera para tratamento cirúrgico de pacientes com deformidades na coluna vertebral em um centro quaternário no Brasil. Métodos No total, 59 pacientes com deformidade espinhal à espera de cirurgia na lista do nosso hospital foram avaliados para observar o impacto dos tempos de espera na progressão da deformidade. A avaliação do paciente foi realizada utilizando o questionário SRS-22r para qualidade de vida relacionada à saúde (QLRS), e imagens radiográficas para avaliar a deformidade da coluna vertebral quando os pacientes foram incluídos na lista de espera e na consulta mais recente. Os parâmetros radiográficos selecionados para comparação foram: ângulo de Cobb de curvas primárias e secundárias, alinhamento coronal, translação de vértebra apical, obliquidade pélvica, eixo vertebral sagital, cifose (T5-T12), e lordose (L1-S1). Resultados Baixos escores de QLRS segundo o questionário SRS-22r foram observados em pacientes que aguardavam cirurgia. Os parâmetros radiográficos mostraram progressão da deformidade na avaliação inicial em comparação com a avaliação de seguimento mais recente. Conclusão Os pacientes que aguardavam tratamento cirúrgico de deformidade espinhal em nosso centro apresentaram os escores de QLRS relativamente baixos e progressão radiográfica da deformidade.

Scoliosis , Spine , Congenital Abnormalities , Surveys and Questionnaires , Waiting Lists , Vertebral Body , Health Policy , Lordosis
Chinese Medical Journal ; (24): 2589-2596, 2021.
Article in English | WPRIM | ID: wpr-921166


BACKGROUND@#Finding an optimal treatment strategy for adolescent idiopathic scoliosis (AIS) patients remains challenging because of its intrinsic complexity. For mild to moderate scoliosis patients with lower skeletal growth potential (Risser 3-5), most clinicians agree with observation treatment; however, the curve progression that occurs during puberty, the adolescent period, and even in adulthood, remains a challenging issue for clinicians. The aim of the study is to investigate the efficacy of Schroth exercise in AIS patients with lower skeletal growth potential (Risser 3-5) and moderate scoliosis (Cobb angle 20°-40°).@*METHODS@#From 2015 to 2017, data of 64 patients diagnosed with AIS in Peking University Third Hospital were reviewed. Forty-three patients underwent Schroth exercise were classified as Schroth group, and 21 patients underwent observation were classified as observation group. Outcomes were measured by health-related quality of life (HRQOL) and radiographic parameters. HRQOL was assessed using the visual analog scale (VAS) scores for back, Scoliosis Research Society-22 (SRS-22) patient questionnaire. Radiographic spinopelvic parameters were obtained from anteroposterior and lateral X-rays. The pre-treatment and post-treatment HRQOL and radiographic parameters were tested to validate Schroth exercise efficacy. The inter-rater reliability of the radiographic parameters was tested using the interclass correlation coefficient (ICC). The paired t test was used to examine HRQOL and radiographic parameters. Clinical relevance between C2-C7 sagittal vertical axis (SVA) and thoracic kyphosis was analyzed using Spearman correlation.@*RESULTS@#In Schroth group, VAS back score, SRS-22 pain, and SRS-22 self-image domain were significantly improved from pre-treatment 3.0 ± 0.8, 3.6 ± 0.5, and 3.5 ± 0.7 to post-treatment 1.6 ± 0.6 (t = 5.578, P = 0.013), 4.0 ± 0.3 (t = -3.918, P = 0.001), and 3.7 ± 0.4 (t = -6.468, P < 0.001), respectively. No significant improvements of SRS-22 function domain (t = -2.825, P = 0.088) and mental health domain (t = -3.174, P = 0.061) were observed. The mean Cobb angle decreased from 28.9 ± 5.5° to 26.3 ± 5.2° at the final follow-up, despite no statistical significance was observed (t = 1.853, P = 0.102). The mean C2-C7 SVA value decreased from 21.7 ± 8.4 mm to 17.0 ± 8.0 mm (t = -1.224 P = 0.049) and mean T1 tilt decreased from 4.9 ± 4.2 ° to 3.5 ± 3.1° (t = 2.913, P = 0.011). No significant improvement of radiographic parameters and HRQOL were observed in observation group.@*CONCLUSIONS@#For AIS patients with a Risser 3-5 and a Cobb angle 20°-40°, Schroth exercises improved HRQOL and halted curve progression during the follow-up period. Both cervical spine alignment and shoulder balance were also significantly improved after Schroth exercises. We recommend Schroth exercises for patients with AIS.

Adolescent , Adult , Cervical Vertebrae , Humans , Kyphosis , Lordosis , Quality of Life , Reproducibility of Results , Retrospective Studies , Scoliosis/therapy , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-879444


OBJECTIVE@#To explore the correlation between the curvature of the cervical spine and the degree of cervical disc bulging in young patients with cervical pain.@*METHODS@#The clinical data of 539 young patients with neck pain from January 2015 to December 2018 were retrospectively analyzed. There were 251 males and 288 females, aged 18 to 40 (32.2±6.3) years old. The cervical curvature and cervical disc bulging were measured by cervical X-ray and MRI. According to cervical curvature, the patients were divided into 175 cases of cervical lordosis group (cervical curvature > 7 mm), 163 cases of cervical erection group (0

Adolescent , Adult , Cervical Vertebrae/diagnostic imaging , Female , Humans , Kyphosis , Lordosis , Male , Neck Pain/diagnostic imaging , Retrospective Studies , Young Adult
Coluna/Columna ; 19(4): 287-292, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1133591


ABSTRACT Objective To present a new principle for correction of the sagittal plane of the spine through the convergent or divergent placement of monoaxial pedicle screws in this plane, associated with compression or distraction, to provide lordotizing or kyphotizing leverage force. Method A statistical mechanical study of twenty-eight fixations in synthetic spine segments was performed. In fifteen pieces, pedicle screws were applied to the ends of the segments with positioning convergent to the center of the fixation. They were attached to the straight rods and subjected to compression force. The other thirteen segments were fixed with pedicle screws in a direction divergent to the center of the fixation, attached to the straight rods, and subjected to distraction force. Results To create kyphosis in the 15 synthetic segments of the spine, the mean pre-fixation Cobb angle was - 0.7° and the mean post-fixation angle was +15°. To create lordosis in the 13 segments, the mean pre-fixation Cobb angle was +1° and the mean post-fixation angle was +18°. The difference was confirmed by statistical mechanical tests and considered significant. However, there is no relevant difference between the mean angles for lordosis and kyphosis formation. Conclusions It was concluded that the correction of the sagittal plane of the spine by applying the new instrumentation method is efficient. A statistical mechanical test confirmed that the difference in Cobb degrees between pre- and post-fixation of the synthetic spine segments was considered significant in the creation of both kyphosis and lordosis. Level of evidence II C; Statistical mechanical study of synthetic spine segments.

RESUMO Objetivo Apresentar um novo princípio para correção do plano sagital da coluna vertebral, posicionando os parafusos pediculares monoaxiais nesse plano de forma convergente ou divergente, associados à compressão ou distração, para proporcionar força em alavanca lordotizante ou cifotizante. Métodos Realizou-se um estudo de mecânica estatística de 28 fixações em segmentos de coluna sintética. Em quinze peças, foram aplicados parafusos pediculares monoaxiais nos extremos dos segmentos abordados com posicionamento no sentido convergente à fixação. Foram agregados às hastes retas e submetidos à força de compressão. Em outros treze segmentos, a fixação foi feita com parafusos pediculares monoaxiais, no sentido divergente ao centro da fixação, integrados às hastes retas e submetidos à força de distração. Resultados Para criar cifose nos 15 segmentos sintéticos da coluna vertebral, a média do ângulo de Cobb na pré-fixação foi de -0,7° e a média pós-fixação foi de +15°. Para cria lordose em 13 segmentos, a média do ângulo de Cobb na pré-fixação foi de +1° e a média pós-fixação foi de +18°. A diferença foi confirmada por testes de mecânica estatística e considerada significativa. Contudo, não existe diferença relevante entre os ângulos médio para formação da lordose e da cifose. Conclusões Conclui-se que a correção do plano sagital da coluna aplicando o novo método de instrumentação é eficiente. Confirmou-se com teste de mecânica estatística que a diferença em graus de Cobb entre o período pré e o pós-fixação dos segmentos de coluna sintética fixados foi considerada significativa, tanto na criação da cifose quanto da lordose. Nível de evidência II C; Estudo mecânico estatístico de segmentos de coluna sintética.

RESUMEN Objetivo Presentar un nuevo principio para corrección del plano sagital de la columna vertebral, posicionando los tornillos pediculares monoaxiales en ese plano de forma convergente o divergente, asociados a la compresión o distracción, para proporcionar fuerza en palanca lordotizante o cifosante. Métodos Se realizó un estudio de mecánica estadística de 28 fijaciones en segmentos de columna sintética. En quince piezas, fueron aplicados tornillos pediculares monoaxiales en los extremos de los segmentos abordados con posicionamiento en el sentido convergente a la fijación. Fueron agregados a las varillas rectas y sometidos a la fuerza de compresión. En otros trece segmentos, la fijación fue hecha con tornillos pediculares monoaxiales, en el sentido divergente del centro de la fijación, integrados a las varillas rectas y sometidos a la fuerza de distracción. Resultados Para crear cifosis en los 15 segmentos sintéticos de la columna vertebral, el promedio del ángulo de Cobb en la prefijación fue de -0,7° y el promedio de postfijación fue de +15°. Para crear lordosis en 13 segmentos, el promedio del ángulo de Cobb en la prefijación fue de +1° y el promedio de postfijación fue de +18°. La diferencia fue confirmada mediante tests de mecánica estadística y considerada significativa. Sin embargo, no existe diferencia relevante entre los ángulos promedios para la formación de lordosis y de cifosis. Conclusiones Se concluye que la corrección del plano sagital de la columna aplicando el nuevo método de instrumentación es eficiente. Se confirmó con test de mecánica estadística que la diferencia en los grados de Cobb entre el período de pre y postfijación de los segmentos de columna sintética fijados fue considerada significativa, tanto en la creación de cifosis como de la lordosis. Nivel de evidencia II C; Estudio mecánico estadístico de segmentos de columna sintética.

Humans , Lordosis , Rotation , Surgical Fixation Devices , Kyphosis
Coluna/Columna ; 19(2): 104-107, Apr.-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1133568


ABSTRACT Objective The objective of this study is to analyze the radiographs of patients who underwent anterior lumbar interbody fusion (ALIF), to compare the values of the lumbopelvic measurements, and to quantify improvements in these parameters achieved through this technique. Methods The radiographs of 42 patients, all submitted to ALIF with a 12° interbody device, were evaluated from a database at a single center. The pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, segmental lordosis, and regional lordosis angles of each patient were measured in pre- and postoperative radiographs. Results We observed a discreet change in the pelvic parameters and a marked increase in regional lordosis with a mean increase of 5.8° (p>0.001). Segmental lordosis also showed a mean increase of 2.43°. The gain in segmental lordosis was even higher in patients with degenerative spondylolisthesis and when the operated level was L5-S1. Conclusions The ALIF technique in the lumbar spine is capable of significantly increase the lordosis of a segment, whether at one or two levels. Greater improvement in the lumbopelvic parameters was observed it the procedures performed in level L5-S1 and in cases that presented spondylolisthesis.

RESUMO Objetivo O presente estudo tem por objetivo analisar as radiografias de pacientes submetidos à artrodese intersomática via anterior (ALIF), comparar os valores das medidas lombopélvicas e quantificar a melhora nesses parâmetros oferecida através dessa técnica. Métodos Foram avaliadas as radiografias de 42 pacientes de um banco de dados de um único centro, todos submetidos à ALIF com dispositivo intersomático de 12º. Foram aferidos os valores dos ângulos de incidência pélvica, inclinação pélvica, inclinação sacral, lordose lombar, lordose segmentar e lordose regional na radiografia pré- e pós-operatória de cada paciente. Resultados Observou-se uma alteração discreta nos parâmetros pélvicos e um aumento expressivo na lordose regional com um aumento médio de 5,8º (p>0,001). A lordose segmentar também demonstrou aumento com uma média de acréscimo de 2,43º. O ganho da lordose segmentar foi ainda maior nos pacientes com espondilolistese degenerativa e quando o nível operado era L5-S1. Conclusões A técnica de ALIF na coluna lombar é capaz de aumentar significativamente a lordose de um segmento, seja em um ou dois níveis. Uma melhora mais expressiva nos parâmetros lombopélvicos foi observada nos procedimentos realizados no nível L5-S1 e em casos que apresentavam espondilolistese.

RESUMEN Objetivo El presente estudio tiene por objetivo analizar las radiografías de pacientes sometidos a la artrodesis intersomática vía anterior (ALIF), comparar los valores de las medidas lumbopélvicas y cuantificar la mejora en esos parámetros ofrecida a través de esa técnica. Métodos Fueron evaluadas las radiografías de 42 pacientes de un banco de datos de un único centro, todos sometidos a la ALIF con dispositivo intersomático de 12º. Fueron medidos los valores de los ángulos de incidencia pélvica, inclinación pélvica, inclinación sacral, lordosis lumbar, lordosis segmentaria y lordosis regional en la radiografía pre y post operatoria de cada paciente. Resultados Se observó una alteración discreta en los parámetros pélvicos y un aumento expresivo en la lordosis regional con un aumento promedio de 5,8º (p>0,001). La lordosis segmentaria también demostró aumento con un promedio de incremento de 2,43º. El aumento de la lordosis segmentaria fue aún mayor en los pacientes con espondilolistesis degenerativa y cuando el nivel operado era L5-S1. Conclusiones La técnica de ALIF en la columna lumbar es capaz de aumentar significativamente la lordosis de un segmento, ya sea en uno o dos niveles. Fue observada una mejora más expresiva en los parámetros lumbopélvicos en los procedimientos realizados en el nivel L5-S1 y en casos que presentaban espondilolistesis.

Humans , Lordosis , Arthrodesis , Radiography
Rev. bras. ciênc. mov ; 28(2): 172-182, abr.-jun. 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1128198


O presente estudo tem como objetivo avaliar o alinhamento post ural e a saúde musculoesquelética de praticantes adultos de natação de Uruguaiana-RS. Trata-se de um estudo transversal, descritivo diagnóstico, quantitativo. Foram incluídos 30 praticantes de natação e coletados dados de: massa corporal e estatura para cálculo do IMC (Índice de Massa Corporal), força/resistência abdominal, mobilidade/flexibilidade lombar, fotogrametria para obter ângulos sagitais da coluna vertebral (torácico e lombar) e possíveis fatores associados, com um questionário. Na análise univariada analisou-se as médias, o desvio padrão, as frequências absolutas e relativas em cada uma das variáveis estudadas, seguidas pelo cálculo do intervalo de confiança de 95% (IC95%). Para a análise bivariada, foi utilizado o teste Qui-Quadrado, no qual cada variável independente foi associada às variáveis dependentes dicotomizadas ("desvio lombar" e "desvio torácico"), sendo considerada significância de 0,05. A maioria dos avaliados apresentou excesso de peso (70%) e dor nas costas (83,3%), desvios nos ângulos lombar (60%) e torácico (66,7%). Verificou-se valores aumentados em 33,3% na lordose lombar e em 63,3% na cifose torácica nesta amostra. Houve associação significativa com os desvios no ângulo lo m bar apenas com IMC (p=0,034), prática em outra atividade física (p=0,049) e flexibilidade (p =0 ,0 47). Apenas o tempo diário na postura em pé apresentou associação significativa com a frequência de desvio sagital torácico (p=0,049). Os praticantes de natação, em sua maioria, relataram sentir dor nas co stas, m as não houve associação significativa com o alinhamento sagital dos avaliados. A hipercifose torácica, encontrada em mais da metade desta amostra, foi a alteração sagital mais comum nesta pesquisa e teve associação significativa com o tempo que os indivíduos passam em pé no seu dia-a-dia...(AU)

The aim of this study is to evaluate postural alignment and musculoskeletal health of adults who practice swimming in Uruguaiana-RS. It is a quantitative and descriptive diagnostic study . Were included 30 participants and collected data about: body mass and height to calculate BMI (Bo dy Mass Index), abdominal strength/endurance, lumbar mobility/flexibility, photogrammetry to acquire the sagittal angles of the spine (thoracic and lumbar) and questionnaire to identify possible asso ciated factors. In univariate analyses were analyzed mean and standard deviations as absolute and relative frequencies (ratios) for each variable, preceded by the calculus of 95% confidence interval (95% CI). For a biv ariate analysis, used the Chi-Square Test, and it was possible to use a parameter of significance o f 0 ,05 . T he majority of the subjects presented overweight (70%) and back pain (83.3%), as well as dev iat io n s in lumbar (60%) and thoracic angles (66.7%). It was possible to verify increased values in 33.3% on lum bar lordosis and 63.3% in thoracic kyphosis in this sample. There was only significant association wit h t he deviations in the lumbar angle only the BMI (p = 0.034), the practice in other physical activity (p = 0.049) and flexibility (p = 0.047). Considering the thoracic angle, only the daily time in standing posture presented a significant association with the frequencies of sagittal deviation (p = 0.049). Most swim m ers reported feeling back pain, but there was no significant association with sagit tal align m en t. Th oracic kyphosis was present in more than half of this sample and was the most common sagittal alteration in this study, having a significant association with the time individuals spend in standing posture daily...(AU)

Humans , Adult , Middle Aged , Scoliosis , Spine , Swimming , Photogrammetry , Exercise , Body Mass Index , Chi-Square Distribution , Surveys and Questionnaires , Back Pain , Kyphosis , Lordosis , Pliability
Rev. colomb. ortop. traumatol ; 34(1): 23-27, 2020. ilus, tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1117474


Introducción Tenemos como objetivo, cuantificar los cambios de la lordosis fisiológica en las distintas posiciones, de pie y en decúbito ventral, sobre el Soporte de Cirugía Espinal (SCE) y evaluar indirectamente los cambios de diámetro de los distintos forámenes, midiendo la distancia interpedicular. Materiales y métodos 20 pacientes de 20 a 40 años. Se tomaron radiografías, en posición de pie y sobre el SCE. Se midió la lordosis lumbar en radiografías de pié, y sobre el SCE en dos posiciones (baja/alta) así como la distancia interpedicular de los forámenes de cada segmento. Resultados Se constata una pérdida de la lordosis en la primera posición de 21,65° (37,00%) y en la segunda posición de 28,75° (49,14%). Encontramos un aumento de la distancia interpedicular en todos los niveles tanto en la posición baja como alta del SCE. Los forámenes que presentaron mayor apertura fueron los segmentos de L4-L5, seguidos por L5-S1. Conclusiones Se encontró una pérdida promedio de la lordosis fisiológica del 37,00% y del 49,14% con la utilización del SCE en las dos posiciones utilizadas. En todos los casos existió un aumento de la distancia interpedicular, que vario entre un 10 y un 15%. Los forámenes que mayor apertura presentaron en las distintas posiciones fueron los segmentos L4-L5 seguido por L5-S1. La cifotización de los segmentos móviles permitirían una mejor liberación sacorradicular al aumentar el diámetro del canal y los forámenes. Nivel de Evidencia: IV

Background The aim of this study is to quantify the changes of the physiological lordosis in the different positions, standing and in ventral decubitus, on a Spinal Surgery Table (SST), and indirectly evaluate the changes in diameter of the different foramina, and measuring the interpedicular distance. Methods The study included 20 patients from 20 to 40 years old. X-rays were taken in standing position and on the SST. Lumbar lordosis was measured using the X-rays in the standing position, and on the SST in two positions (low/high), as well as the interpedicular distance of the foramina of each segment. Results A loss of lordosis was found in the first position of 22.65° (37.00%) and in the second position of 28.75° (49.14%). An increase was found in the interpedicular distance at all levels in both the low and high position of the SST. The foramina with the greatest opening were the L4-L5 segments, followed by L5-S1. Discussion A mean loss of 37.00% and 49.14%, respectively, was found in the physiological lordosis with the use the SST in the two positions used. In all cases there was an increase in the interpedicular distance, which varied between 10% and 15%. The foramina with the greatest openness in the different positions were segments L4-L5 followed by L5-S1. The kyphotisation of the mobile segments would allow a better sacrum-radicular release when increasing the diameter of the channel and the foramina. Evidence Level: IV

Humans , Adult , Low Back Pain , Failed Back Surgery Syndrome , Lordosis
Fisioter. Mov. (Online) ; 33: e003328, 2020. tab
Article in English | LILACS | ID: biblio-1133905


Abstract Introduction: Hyperlordosis can cause several degenerative spinal pathologies in children and adolescents. Objective: Determine whether body mass index, age and sexual maturation predict the occurrence of hyperlordosis in children and adolescents. Method: The study analyzed 380 students aged between 10 and 18 years. Body mass index was evaluated using the reference values suggested by the Fitnessgram test battery, and sexual maturation through Tanner's scale of self-assessed pubic hair growth. Postural assessment was conducted using the DIPA photogrammetry method, version 3.1. (Digital Image Based Postural Assessment) The SPSS 24.0 program was used to analyze the data, and the following statistical tests were applied: chi-squared, Mann-Whitney, Fisher's exact and binary logistic regression. Results: There was statistical significance between hyperlordosis, girls' age and puberty in boys (p <0.05). The adjusted binary logistic regression for the girls (OR = 0.656) indicated that this disorder declined by 34% with advancing age and for stage P2 of puberty in boys (OR = 4.292), and the likelihood of boys' presenting with hyperlordosis at this stage is approximately 4-fold higher. There was no statistical significance between body mass index and hyperlordosis (p> 0.05). Conclusion: The girls' age and boys' stage of puberty were associated with the occurrence of hyperlordosis.

Resumo Introdução: A Hiperlordose lombar pode ocasionar diversas patologias degenerativas na coluna vertebral de crianças e adolescentes. Objetivo: Identificar se o Índice de Massa Corporal, a Idade e a Maturação Sexual são previsores da ocorrência da hiperlordose lombar em crianças e adolescentes. Método: O estudo analisou 380 estudantes entre 10 e 18 anos. O Índice de Massa Corporal foi avaliado por meio dos valores de referência sugeridos pela bateria de testes Fitnessgram e a maturação sexual por meio da auto-avaliação da pilosidade pubiana de Tanner. A avaliação postural foi realizada pelo método de fotogrametria DIPA versão 3.1. (Avaliação Postural Baseada em Imagem Digital). Para análise dos dados foi utilizado o programa SPSS 24.0, tendo sido aplicados os testes estatísticos: Qui-Quadrado, Mann Whitney, Exato de Fisher e Regressão Logística Binária. Resultados: Observou-se que houve significância estatística entre a Hiperlordose lombar e a idade das meninas e a puberdade dos meninos (p<0,05). A regressão logística binária ajustada para o grupo das meninas (OR=0,656) apresentou a posssibilidade de que com o avanço da idade esta patologia diminui sua ocorrência em 34% e no grupo dos meninos (OR=4,292), a puberdade foi significativa na fase P2, verificando-se que a chance dos meninos apresentarem a hiperlordose lombar nesta fase é aproximadamente 04 vezes maior. Não houve significância estatística entre o Índice de Massa Corporal, a Idade e a Maturação Sexual e a hiperlordose lombar (p>0,05). Conclusão: A idade das meninas e a puberdade dos meninos foi associada à ocorrência da hiperlordose lombar.

Humans , Male , Female , Child , Adolescent , Students , Body Mass Index , Puberty , Lordosis , Posture , Sexual Maturation , Spine
Rev. bras. ortop ; 54(6): 657-664, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057949


Abstract Objective To prospectively analyze the radiographic variables of lumbosacral sagittal balance in the pre- and postoperative period of patients submitted to total hip arthroplasty (THA). Methods A prospective, observational, comparative study that evaluated pre- and postoperative radiographic parameters of 71 patients, submitted to 72 total hip arthroplasties in a 3-year period (2014-2017) for primary coxarthrosis, of whom 28 performed late postoperative control (6 months) through the Surgimap Spine software (Surgimap, New York, NY, USA). Statistical analysis was performed using the Student t-test, the analysis of covariance (ANCOVA) model, and the Kolmogorov-Smirnov test. The data were analyzed using the IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA). A p-value < 0.05 indicated statistical significance. Results A total of 72 cases, presenting a mean age of 57.9 years old, predominantly females (60.6%) and patients > 50 years old (71.8%). There was an overall decrease in lumbar lordosis values in the immediate postoperative period, without major global changes in late evolution. It was found that patients with a pelvic incidence ≥ 60° tended to have their other sagittal balance parameters elevated. Conclusion There was no significant difference between the radiographic variables of sagittal lumbopelvic balance in the evaluated periods. Lumbar lordosis and pelvic incidence were the main modifying factors. Improvement of low back pain after THA, without changes in parameters, suggests different pathology mechanisms still to be clarified.

Resumo Objetivo Analisar prospectivamente as variáveis radiográficas do equilíbrio sagital da coluna lombossacral no pré e pós-operatório dos pacientes submetidos a artroplastia total de quadril (ATQ). Métodos Estudo prospectivo, observacional e comparativo que avaliou parâmetros radiográficos pré e pós-operatórios imediatos de 71 pacientes submetidos a 72 ATQs em três anos (2014-2017) por coxartrose primária, dos quais 28 fizeram controle pós-operatório tardio (6 meses), através do programa Surgimap Spine (Surgimap, Nova York, NY, EUA). A análise estatística foi feita com o teste t de Student, o modelo de análise de covariância (ANCOVA, na sigla em inglês) e o teste de Kolmogorov-Smirnov. Os dados foram analisados com o programa IBM SPSS Statistics for Windows, Versão 20.0 (IBM Corp., Armonk, NY, EUA). Valores de p < 0,05 indicaram significância estatística. Resultados Os 72 casos avaliados apresentaram uma idade média de 57,9 anos, com predominância do sexo feminino (60,6%) e de pacientes > 50 anos (71,8%). Houve uma diminuição global nos valores da lordose lombar no pós-operatório imediato, sem grandes alterações globais na evolução tardia. Aferiu-se que pacientes com uma incidência pélvica ≥ 60° tendem a ter os demais parâmetros do equilíbrio sagital elevados. Conclusão Não houve diferença significativa entre as variáveis radiográficas do equilíbrio sagital lombopélvico nos períodos avaliados. A lordose lombar e a incidência pélvica foram os principais fatores modificantes. A melhoria da lombalgia pós-ATQ sem alterações desses parâmetros sugere diferentes mecanismos da patologia ainda a serem esclarecidos.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Spine , Osteoarthritis, Hip , Low Back Pain , Arthroplasty, Replacement, Hip , Hip , Lordosis
Coluna/Columna ; 18(4): 283-288, Oct.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055993


ABSTRACT Post-operative lumbar pain is related to alterations in the sagittal and spinopelvic parameters. A lumbar fusion that fails to maintain, or that worsens the physiological lordosis alters the sagittal balance. Objective: To analyze spinopelvic variation in different surgical positions. Methods: A prospective, analytical and comparative study of spinograms, lumbosacral radiographs in the surgical position over a 4-pole quadratus lumborum, and lumbosacral radiographs with quadratus lumborum and support in the knees. A sample of 129 patients, of both sexes, aged between 18 and 60 years, and presenting with lower back pain. Lumbar Lordosis (LL), Pelvic Tilt (PT), Pelvic Incidence (PI) and Sacral Slope (SS) were measured. Results: PI was the most stable parameter. With quadratus lumborum, a slight increase in PT, a decrease in SS and a significant reduction in LL were found. With quadratus lumborum and support in the knees, a decrease in PT and a slight increase in SS were found, while the LL value remained similar to that of the spinogram. Conclusion: The intraoperative position with hip flexion of between 40° and 45° over quadratus lumborum reduced LL to 10.52° in men and 16.21° in women, increased PT, and decreased SS. The intraoperative position with hip flexion of between 0° and 10° showed the same values as the reference spinogram. Level of Evidence II; Prospective comparative study.

RESUMO A dor lombar pós-operatória está relacionada a alterações nos parâmetros sagitais e espinopélvicos. Uma fusão lombar que não mantém ou piora a lordose fisiológica altera o equilíbrio sagital. Objetivo: Analisar a variação espinopélvica em diferentes posições cirúrgicas. Métodos: Estudo prospectivo, analítico e comparativo de espinogramas, radiografias lombossacrais na posição cirúrgica em um quadrado lombar de quatro pólos e radiografias lombossacrais com quadrado lombar e apoio para os joelhos. Foi feito um estudo com 129 pacientes, de ambos os sexos, entre 18 e 60 anos que apresentavam dor lombar. A lordose lombar (LL), a inclinação pélvica (PT), a incidência pélvica (PI) e a inclinação sacral (SS) foram medidas. Resultados: A PI foi o parâmetro mais estável. Com o quadrado lombar, um pequeno aumento na PT, uma diminuição na SS e uma redução significativa na LL foram observados. Com o quadrado lombar e o apoio para os joelhos, houve diminuição na PT e um leve aumento na SS, enquanto o valor da LL permaneceu semelhante ao valor do espinograma. Conclusão: A posição intraoperatória com flexão do quadril entre 40° e 45° no quadrado lombar reduziu a LL para 10,52° nos homens e 16,21° nas mulheres, aumentou a PT e diminuiu a SS. A posição intraoperatória com flexão do quadril entre 0° e 10° apresentou os mesmos valores do espinograma de referência. Nível de Evidência II; Estudo prospectivo comparativo.

RESUMEN El dolor lumbar postoperatorio está relacionado con alteraciones de los parámetros sagitales y espinopélvicos. Una fusión lumbar que no mantiene o empeora la lordosis fisiológica altera el balance sagital. Objetivo: Analizar la variación espinopélvica en diferentes posiciones quirúrgicas. Métodos: Estudio prospectivo, analítico, comparativo, de espinogramas, radiografías lumbosacras en posición quirúrgica sobre cuadrado lumbar de 4 postes y lumbosacra con cuadrado lumbar y soporte para las rodillas. Fue hecho un estudio con 129 pacientes, de ambos sexos, entre 18 y 60 años que presentaban dolor lumbar. Fueron medidas la lordosis lumbar (LL), la inclinación pélvica (PT), la incidencia pélvica (PI) y la inclinación sacral (SS). Resultados: La PI fue el parámetro más estable. Con el cuadrado lumbar, se observó pequeño aumento en la PT, una disminución en la SS y una reducción significativa en la LL. Con cuadrado lumbar y soporte para las rodillas hubo disminución en la PT y ligero aumento en la SS, mientras que el valor de la LL se mantuvo similar al valor del espinograma. Conclusión: La posición intraoperatoria con flexión de cadera entre 40° y 45° sobre el cuadrado lumbar, redujo la LL para 10,52° en hombres y 16,21° en mujeres, aumentó la PT y disminuyo la SS. La posición intraoperatoria con flexión de cadera entre 0° y 10° presentó los mismos valores del espinograma de referencia. Nivel de Evidencia II. Estudio prospectivo comparativo.

Humans , Postural Balance , Patient Positioning , Lordosis
Fisioter. Pesqui. (Online) ; 26(2): 178-184, abr.-jun. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1012135


RESUMO O objetivo deste estudo foi identificar se existe correlação entre a severidade da disfunção temporomandibular (DTM) e postura corporal, bem como evidenciar as diferenças existentes na postura corporal nos diferentes graus de severidade. Foram avaliadas 71 mulheres de 18 a 35 anos quanto à severidade da DTM e à postura corporal, sendo divididas em grupo sem DTM e grupo com DTM. Foram utilizados o questionário Mandibular Function Impairment Questionnaire e o software Digital Image-Based Postural Assessment de avaliação postural por fotogrametria. Foi realizada análise estatística com ANOVA de um fator e teste de correlação Tau B de Kendall (α<0,05). Os grupos com e sem DTM apresentaram diferenças estatísticas, com tamanho de efeito grande (ŋ2>0,528), para: lordose cervical, pulsão e inclinação da pelve. Quanto à correlação da postura com a severidade da DTM, índices fracos, mas significativos, foram encontrados: ângulo da lordose cervical (τ=0,250), ângulo da cifose dorsal (τ=0,192), ângulo de inclinação pélvica (τ=−0,222) e medida de pulsão da pelve (τ=0,283). Esses resultados indicam que a lordose cervical e a pulsão da pelve se apresentam em aumento da lordose e da pulsão conforme o acréscimo da severidade da DTM, enquanto o ângulo de inclinação se apresenta em menor grau, tendendo à retroversão. Apesar das correlações fracas, os resultados evidenciam alguma relação da postura corporal com a DTM.

RESUMEN El objetivo de este estudio fue identificar si existe una correlación entre la gravedad de la disfunción temporomandibular (DTM) y la postura corporal, así como mostrar las diferencias en la postura corporal en diferentes grados de gravedad. Se evaluó la la postura corporal de 71 mujeres de 18 a 35 años, divididas en dos grupos: sin DTM y con DTM. Se utilizó el cuestionario Mandibular Function Impairment Questionnaire y el software Digital Image-Based Postural Assessment de evaluación postural por fotogrametría. Se realizó análisis estadístico con Anova de un factor y prueba de correlación Tau B de Kendall (α<0,05). Los grupos con y sin DTM presentaron diferencias estadísticas, con tamaño de efecto grande (ŋ2>0,528) para: lordosis cervical, pulsión e inclinación de la pelvis. En cuanto a la correlación de la postura con la gravedad de la DTM, índices débiles pero significativos fueron encontrados: ángulo de la lordosis cervical (τ=0,250), ángulo de la cifosis dorsal (τ=0,192), ángulo de inclinación pélvica (τ=−0,222) y medida de pulsión de la pelvis (τ=0,283). Estos resultados indican que la lordosis cervical y la pulsión de la pelvis aumentan según la gravedad de la DTM, mientras que el ángulo de inclinación se presenta en menor grado, tendiendo a la retroversión. A pesar de las correlaciones débiles, los resultados evidencian cierta relación de la postura corporal con la DTM.

ABSTRACT This study aimed to identify if there is a correlation between temporomandibular dysfunction (TMD) severity and body posture, as well as to show the differences in body posture in different degrees of severity. Seventy-one women aged 18-35 years were assessed for TMD severity and body posture and were divided into: Group without TMD and Group with TMD. We used the Mandibular Function Impairment Questionnaire and the Digital Image-Based Postural Assessment software for postural evaluation by photogrammetry. Statistical analysis was performed with one-way ANOVA and Kendall's Tau B correlation test (α<0.05). The groups with and without TMD presented statistical differences, with large effect size (ŋ2>0.528), for: cervical lordosis, drive and pelvic tilt. Regarding the correlation of posture with TMD severity, weak but significant indexes were found: cervical lordosis angle (τ=0.250), dorsal kyphosis angle (τ=0.192), pelvic tilt angle (τ=−0.222) and pelvic drive measurement (τ=0.283). These results indicate that cervical lordosis and pelvic drive are increased according to the severity of the TMD, while the pelvic tilt angle decreases, tending to a retroversion. Despite the weak correlations, the results show some relationship between body posture and TMD.

Humans , Female , Adult , Posture/physiology , Temporomandibular Joint Dysfunction Syndrome/complications , Spinal Curvatures/complications , Severity of Illness Index , Photogrammetry , Facial Asymmetry/complications , Kyphosis/complications , Lordosis/complications
Rev. bras. ciênc. mov ; 27(1): 62-69, jan.-mar.2019. ilus, tab
Article in Portuguese | LILACS | ID: biblio-998217


O objetivo deste estudo foi verificar a relação entre a flexibilidade da cadeia posterior, os ângulos das curvas sagitais da coluna vertebral e a presença de dor nas costas com a graduação de praticantes de Jiu-jítsu. Oitenta e dois homens com idade entre 14 e 55 anos que praticavam Jiu-jítsu duas vezes por semana com duração mínima 1 hora e 30 minutos, e com prática ininterrupta por pelo menos um mês, foram submetidos a três avaliações: (1) curvaturas sagitais da coluna vertebral por meio do flexicurva; (2) flexibilidade da cadeia posterior por meio do banco de Wells; e (3) dor nas costas por meio do questionário BackPEI adaptado. De acordo com o tempo de prática, os participantes foram divididos em dois grupos: grupo faixa branca, composto por atletas faixa branca; e grupo faixa graduada, composto pelas demais graduações. No Software SPSS 20.0 foi realizada estatística descritiva com média, desviopadrão e frequências e análise inferencial com teste de correlação de Spearman e o teste t independente (α=0,05). Os praticantes apresentaram, em média, curvaturas dentro da normalidade. Em relação à flexibilidade, a mesma foi classificada como fraca com valores semelhantes ao da população em geral. Quanto à dor nas costas, dos 82 praticantes de Jiu-jítsu, 57,3% (n=47) apresentaram dor. Foi encontrada apenas correlação fraca, positiva e significativa entre a intensidade da dor nas costas com a graduação do praticante. Foi possível verificar que a graduação dos praticantes de Jiu-jítsu se correlaciona com a intensidade de dor nas costas, de modo que quanto maior a graduação, maior é o nível da intensidade da dor...(AU)

The aim of this study was to verify the relationship between the posterior chain flexibility, the spine curvatures sagittal angles, and the presence of back pain with the Jiu-Jitsu practitioners graduation. Eighty two men with age between 14 and 55 years old who practice Jiu-Jitsu twice a week with at least 1 hour and 30 minutes, and practicing uninterruptedly for at least a month, were submitted to three evaluations: (1) sagittal spinel curvatures by using the flexicurva; (2) posterior chain flexibility by using the Wells bench; e (3) back pain by using the BackPEI adapted questionnaire. According to the time of practice, the participants were divided into two groups: white belt group, composed by white belt athletes; and graduated belt group, composed by the other graduations. Descriptive statistics was performed in the SPSS software 20.0 with average, standard deviation and frequency and inferential analysis with the Spearman correlation test and t independent test (α=0,05). The practitioners presented, on average, curvatures inside the normality parameters. About flexibility, it was classified as weak with similar to the general population values. About back pain, from those 82, 57,3% (n=47) referred pain. A significant and positive weak correlation was found between the pain intensity and the practitioners graduation. It was possible to verify that the graduation of Jiu-jítsu practitioners do correlate with the back pain intensity, in such ways that the higher the graduation, higher is the pain intensity...(AU)

Humans , Male , Posture , Pliability , Kyphosis , Lordosis , Physical Education and Training
Article in English | WPRIM | ID: wpr-765378


OBJECTIVE: Minimal data exist regarding non-operative management of suspected pseudarthrosis after pedicle subtraction osteotomy (PSO). This study reports radiographic and clinical outcomes of non-operative management for post-PSO pseudarthrosis at a minimum 5 years post-detection. METHODS: Nineteen consecutive patients with implant breakage indicating probable pseudarthrosis after PSO surgery (13 women/six men; mean age at surgery, 58 years) without severe pain and disability were treated with non-operative management (mean follow-up, 5.8 years; range, 5–10 years). Non-operative management included medication, intermittent brace wearing and avoidance of excessive back strain. Radiographic and clinical outcomes analysis was performed. RESULTS: Sagittal vertical axis (SVA), proximal junctional angle, thoracic kyphosis achieved by a PSO were maintained after detection of pseudarthrosis through ultimate follow-up. Lumbar lordosis and PSO angle decreased at final follow-up. There was no significant change in Oswestry Disability Index (ODI) scores and Scoliosis Research Society (SRS) total score, or subscales of pain, self-image, function, satisfaction and mental health between detection of pseudarthrosis and ultimate follow-up. SVA greater than 11 cm showed poorer ODI and SRS total score, as well as the pain, self-image, and function subscales (p<0.05). CONCLUSION: Non-operative management of implant failure of probable pseudarthrosis after PSO offers acceptable outcomes even at 5 years after detection of implant breakage, provided SVA is maintained. As SVA increased, outcome scores decreased in this patient population.

Animals , Braces , Follow-Up Studies , Humans , Joint Deformities, Acquired , Kyphosis , Lordosis , Male , Mental Health , Osteotomy , Pseudarthrosis , Scoliosis , Spine
Article in English | WPRIM | ID: wpr-765377


OBJECTIVE: Comparing the effects of magnetically controlled growing rod (MCGR) and traditional growing rod (TGR) techniques on the sagittal plane in the treatment of early-onset scoliosis (EOS). METHODS: Twelve patients were operated using dual MCGR technique in one center, while 15 patients were operated using dual TGR technique for EOS in another center. Patients’ demographic characteristics, complications and radiological measurements such as cobb angle, thoracic kyphosis, lumbar lordosis, T1–S1 range (mm), proximal junctional angle, distal junctional angle, sagittal balance, coronal balance, pelvic incidence, sacral slope and pelvic tilt were assessed and compared in preoperative, postoperative and last follow-up period. RESULTS: Age and sex distributions were similar in both groups. The mean number of lengthening in the MCGR group was 12 (8–15) and 4.8 (3–7) in the TGR group. Two techniques were shown to be effective in controlling the curvature and in the increase of T1–S1 distance. In TGR group, four patients had rod fractures, six patients had screw pull-out and four patients had an infection, whereas three patients had screw pull-out and one patient had infection complications in the MCGR group. CONCLUSION: There was no significant difference between the two groups in terms of cobb angle, coronal and sagittal balance and sagittal pelvic parameters. MCGR can cause hypokyphosis and proximal junctional kyphosis in a minimum 2-year follow-up period. The implant-related complications were less in the MCGR group. However, larger case groups and longer follow-up periods are required for the better understanding of the superiority of one method on other in terms of complications.

Animals , Follow-Up Studies , Humans , Incidence , Kyphosis , Lordosis , Methods , Scoliosis , Sex Distribution
Article in Korean | WPRIM | ID: wpr-786068


STUDY DESIGN: Retrospective study of prospectively-collected data.OBJECTIVES: To evaluate the radiological outcomes of direct lateral lumbar interbody fusion (DLIF).SUMMARY OF LITERATURE REVIEW: DLIF, as a minimally invasive spinal surgical procedure, is useful for degenerative spinal diseases. However, few reports have evaluated the clinical and radiological outcomes of DLIF in Korea.MATERIALS AND METHODS: We analyzed 44 patients who underwent DLIF at our hospital from September 2015 to September 2017. Of these patients, 89 segments were included in this study. We measured preoperative and postoperative radiological values including the disc height, central canal area, height of the foramen, and segmental sagittal angle on magnetic resonance imaging. We also measured patients' visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores as clinical parameters.RESULTS: Statistically significant improvements were found in the height of the left and right foramina (20.8% and 25.6%, respectively), the height of the intervertebral discs (86.0% and 84.3%, respectively), the cross-sectional area of the central nervous system (33.1%), lumbar lordosis, and the lumbar segmental angle (2.7° and 8.7°, respectively) after surgery. The VAS and ODI scores also showed significant improvements (65.7% and 67.7%, respectively) when compared with the preoperative level.CONCLUSIONS: DLIF was found to be effective for the treatment of diseases such as foraminal stenosis, degenerative spondylolisthesis, and adjacent segment diseases through indirect neuro-decompression of the bilateral foramina and central vertebrae.

Animals , Central Nervous System , Constriction, Pathologic , Humans , Intervertebral Disc , Korea , Lordosis , Magnetic Resonance Imaging , Retrospective Studies , Spinal Diseases , Spinal Fusion , Spinal Stenosis , Spine , Spondylolisthesis
Clinical Pain ; (2): 8-15, 2019.
Article in Korean | WPRIM | ID: wpr-785686


OBJECTIVE: To determine the relationship between cervical sagittal parameters and the degree of the cervical disc degeneration at each cervical level by using cervical plain radiographs and disc degeneration grading.METHOD: This study analyzed 110 patients with posterior neck pain. Cervical radiographic measurements included the occipito-cervical (O~C2) angle; sagittal Cobb angles of C1~C2, C2~C7; and sagittal vertical axis (SVA) of C1~C7 and C2~C7. The degenerations of cervical discs at each level were evaluated through Pfirrmann grading system by magnetic resonance images of the cervical spine. The correlations between the cervical sagittal measurements and the disc degeneration at each level were analyzed by Spearman's correlation.RESULTS: A significant correlation was found for the C2~C7 angle with disc degenerations at C2~C6 levels. O~C2 angle was correlated significantly with disc degenerations at C2~C4 and C5~C7 levels. There was significant correlation between C1~C2 angle and disc degeneration at C6~C7 level. No significant relationship was found between the cervical SVA and the cervical disc degeneration at all cervical levels.CONCLUSION: Cervical sagittal parameters representing cervical angles (C2~C7, O~C2, and C1~C2 angles) were significantly correlated with the degree of the cervical disc degeneration. These findings suggest that the loss of the natural cervical lordosis rather than loss of natural SVA could be correlated with progression of the cervical disc degeneration.

Animals , Cervical Vertebrae , Female , Humans , Intervertebral Disc Degeneration , Kyphosis , Lordosis , Methods , Neck Pain , Spine
Asian Spine Journal ; : 895-903, 2019.
Article in English | WPRIM | ID: wpr-785498


STUDY DESIGN: Cross-sectional cohort study.PURPOSE: This study aimed to investigate the relationship between hypertension and spino-pelvic sagittal alignment in middle-aged and elderly individuals.OVERVIEW OF LITERATURE: Positive global sagittal alignment is associated with poor health-related quality of life. Hypertension is associated with tissue microcirculation disorders of the skeletal muscle. We hypothesized that hypertension may be involved in positive global sagittal alignment.METHODS: In this institutional review board-approved study, 655 participants (262 men and 393 women; mean age, 72.9 years; range, 50–92 years) who underwent musculoskeletal screening in Toei town, Aichi, Japan were included. Whole spine and pelvic radiographs were taken, and radiographic parameters (thoracic kyphosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and sagittal vertical axis [SVA]) were measured using an image-analysis software. Hypertension was assessed using the standard criteria. The study participants were divided into three subgroups as per age (50–64 years, 65–74 years, and ≥75 years). We examined the differences in the radiographic parameters of those with and without hypertension in each age subgroup.RESULTS: In each age subgroup, there was no significant difference in the age and sex of those with and without hypertension. SVA was significantly shifted forward in the hypertension group than in the non-hypertension group in those aged 50–64 years old (32.4 mm vs. 16.0 mm, p=0.018) and in those aged 65–74 years old (42.7 mm vs. 30.6 mm, p=0.012). There was no significant difference between the hypertension and non-hypertension groups in terms of the alignment of the lumbar and thoracic spine in all the subgroups. In multivariate analysis, hypertension was a significant independent factor of forward-shifted SVA (standardized beta 0.093, p=0.015).CONCLUSIONS: This study showed that hypertension was associated with forward-shifted global sagittal alignment.

Aged , Animals , Cohort Studies , Female , Humans , Hypertension , Incidence , Japan , Kyphosis , Lordosis , Male , Mass Screening , Microcirculation , Multivariate Analysis , Muscle, Skeletal , Quality of Life , Spine
Asian Spine Journal ; : 904-912, 2019.
Article in English | WPRIM | ID: wpr-785497


STUDY DESIGN: Retrospective case-control study.PURPOSE: We aimed to compare radiologic outcomes between posterior (PLIF) and lateral lumbar interbody fusion (LLIF) in short-level spinal fusion surgeries.OVERVIEW OF LITERATURE: Although LLIF enables surgeons to insert large lordotic cages, it is unknown whether LLIF more effectively corrects local and global sagittal alignments compared with PLIF in short-level spinal fusion surgeries.METHODS: Radiographic data acquired from patients with lumbar interbody fusion (≤3 levels) using PLIF or LLIF for degenerative lumbar diseases were analyzed. The following radiographic parameters were evaluated preoperatively and at 2 years postoperatively: segmental lordotic angle, disk height, lumbar lordosis (LL), pelvic tilt (PT), C7 sagittal vertical axis, and thoracic kyphosis (TK).RESULTS: In total, 144 patients with PLIF (193 fused levels) and 101 with LLIF (159 fused levels) were included. Patients’ backgrounds and preoperative radiographic parameters for any level of fusion did not differ significantly between PLIF and LLIF procedures. The LLIF group exhibited significantly greater changes at 1-level fusion compared to the PLIF group in the parameters of segmental lordotic angle (5.1°±5.8° vs. 2.1°±5.0°, p<0.001), disk height (4.2±2.3 mm vs. 2.2±2.0 mm, p<0.001), LL (7.8°±7.6° vs. 3.9°±8.6°, p=0.004), and PI–LL (−6.9°±6.8° vs. −3.6°±10.1°, p=0.03). While, a similar trend was observed regarding 2-level fusion, significantly greater changes were only observed in LL (12.1°±11.1° vs. 4.2°±9.1°, p=0.047) and PI–LL (−11.2°±11.3° vs. −3.0°±9.3°, p=0.043), PT (−6.4°±4.9° vs. −2.5°±5.3°, p=0.049) and TK (7.8°±11.8° vs. −0.3°±9.7°, p=0.047) in the LLIF group at 3-level fusion.CONCLUSIONS: LLIF provides significantly better local sagittal alignment than PLIF in 1- or 2-level fusion cases and improves spinopelvic alignment and local alignment for 3-level fusion cases. Thus, LLIF was demonstrated to be a useful lumbar interbody fusion technique, constituting a powerful tool for achieving sagittal realignment with minimal surgical invasiveness.

Animals , Case-Control Studies , Humans , Kyphosis , Lordosis , Retrospective Studies , Spinal Fusion , Surgeons
Asian Spine Journal ; : 1017-1027, 2019.
Article in English | WPRIM | ID: wpr-785483


STUDY DESIGN: Prospective, single-center study.PURPOSE: The current trend of operative treatment for adult spinal deformity (ASD) is combined anterior-posterior staged surgery. When anterior surgery was first performed, oblique lumbar interbody fusion (OLIF) was employed; this method became increasing popular. This study aimed to determine the lordosis correction that can be achieved using OLIF and assess whether we can preoperatively predict the lordosis correction angle achieved using OLIF.OVERVIEW OF LITERATURE: Many previous studies on OLIF have shown improved clinical and radiologic outcomes. With the increase in the popularity of OLIF, several surgeons have started using larger cages to attain greater lordosis correction. Moreover, some studies have reported complications of OLIF because of immoderate cage insertion. To our knowledge, this is the first prospective study that attempted to determine whether it is possible to predict the lordosis correction angle achieved with OLIF preoperatively, using fullextension lateral view (FELV).METHODS: Forty-six patients with ASD were enrolled. All the operations were performed by a single surgeon in two stages (first, anterior and second, posterior) with a 1-week interval. Radiological evaluation was performed by comparing the Cobb’s angle of the segmental and regional lordosis obtained using preoperative and postoperative simple radiography (including the FELV) and magnetic resonance imaging (MRI).RESULTS: Regional lordosis (L1–S1) in the whole-spine standing lateral radiograph was −3.03°; however, in the supine lateral MRI, it was 20.92°. The regional lordosis of whole-spine standing lateral and supine lateral (MRI) was significantly different. In the FELV, regional lordosis was 25.72° and that in the postoperative supine lateral (MRI) was 25.02°; these values were not significantly different.CONCLUSIONS: Although OLIF offers many advantages, it alone plays a limited role in ASD treatment. Lordosis correction using OLIF as well as lordosis determined in the FELV was possible. Hence, our results suggest that FELV can help predict the lordosis correction angle preoperatively and thus aid the selection of the appropriate technique in the second staged operation.

Adult , Animals , Congenital Abnormalities , Humans , Leukemia Virus, Feline , Lordosis , Magnetic Resonance Imaging , Methods , Prospective Studies , Radiography , Surgeons
Asian Spine Journal ; : 630-637, 2019.
Article in English | WPRIM | ID: wpr-762964


STUDY DESIGN: Prospective case series study. PURPOSE: Description of the outcome of stand-alone cervical cages for single and multilevel cervical degenerative spine disease. OVERVIEW OF LITERATURE: The aim of anterior cervical discectomy and fusion (ACDF) for cervical spine disease is to improve patient symptoms and spine stability and restore lordosis. Locking stand-alone cages were developed with the goal of minimizing soft tissue disruption anterior to the vertebrae and reducing the profile of the construct by avoiding an anterior plate, thereby maximizing ACDF benefits. METHODS: This study comprises a case series of patients surgically treated between July 2015 and February 2018 who received single or multilevel ACDF with a zero-profile stand-alone cervical cage. Surgical and clinical preoperative evaluation and surgical outcomes were evaluated using pre- and postoperative Nurick, Visual Analog Scale (VAS), Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) score for myelopathy scales, cervical Cobb angles, postoperative surgical complications, and fusion and subsidence rates. RESULTS: Fifty-three patients underwent ACDF; the mean age of these patients was 58.8 years, and their preoperative VAS, NDI, and JOA scores were 8.1, 31.6, and 15.3, respectively. The preoperative Cobb angle was 30.7°. Forty-five percent of patients had one-level, 54.7% had two-level, and 13.2% had three-level procedures. On preoperative magnetic resonance imaging, foraminal stenosis was present in 94.3% of patients, whereas medullar stenosis was present in 41.5%. The rate of complications was 5.7%: two patients had postoperative dysphagia (3.7%), and one patient had a surgical site hematoma. Mean postoperative follow-up time was 6.7 months; postoperative VAS, NDI, and JOA scores were 2.4, 15.9, and 15.8, respectively. Postoperative Cobb angle was 35.9°, fusion rate was 84.9%, and subsidence rate was 11.3%. CONCLUSIONS: ACDF with zero-profile stand-alone cervical devices is an excellent option for cervical degenerative disc disease of one, two, and three levels, with similar results reported when using ACDF with either cage or plate.

Animals , Asian Continental Ancestry Group , Constriction, Pathologic , Deglutition Disorders , Diskectomy , Follow-Up Studies , Hematoma , Humans , Lordosis , Magnetic Resonance Imaging , Neck , Orthopedics , Prospective Studies , Spinal Cord Compression , Spinal Cord Diseases , Spine , Spondylosis , Visual Analog Scale , Weights and Measures