The Effects of Sagittal Spino-Pelvic Alignment on the Clinical Symptoms of Thoracolumbar Kyphosis in Osteoporotic Patients

STUDY DESIGN: Retrospective study. OBJECTIVES: The purpose of this study was to assess the effect of sagittal spino-pelvic alignment on the clinical symptoms of thoracolumbar kyphosis (TLK; T10-L2 Cobb's angle >20°) in osteoporotic patients. SUMMARY OF LITERATURE REVIEW: Few studies have investigated the clinical symptoms and radiological features of TLK caused by degenerative changes. There is also controversy over whether clinical symptoms will deteriorate in patients with TLK or which treatment should be chosen according to the degree of TLK. MATERIALS AND METHODS: From May 2005 to May 2016, we reviewed 75 patients who were diagnosed with TLK (T10-L2 Cobb's angle >20°) and osteoporosis. Patients were excluded from the study if they had neurological symptoms, underlying spinal disorders, or unstable vertebral fractures. Fifty patients with TLK due to an osteoporotic vertebral compression fracture (group F) and 25 patients with senile TLK (group S) were assessed by clinical symptoms and radiological parameters. Thoracolumbar kyphosis angle and sagittal vertical axis (SVA) were also analyzed. Clinical symptoms were assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). RESULTS: There were no significant differences in clinical symptoms (VAS, ODI) and radiological parameters between groups F and S, or according to the degree of TLK(20°–30°, 30°–40°, >40°). Clinical symptoms were significantly more severe in patients with sagittal imbalance (SVA >5 cm) than in those with sagittal balance. CONCLUSIONS: Sagittal imbalance is a more important factor affecting clinical symptoms than the cause or the degree of TLK. Therefore, sagittal imbalance should be considered in the management of TLK in osteoporotic patients.

The relationship between pelvic alignment and trunk control in stroke subjects: a cross-sectional study.

Background: Following stroke static as well as dynamic components of postural control were affected. Ability to maintain postural alignment is also a vital component of the postural control system. Pelvic asymmetry is commonly observed in stroke subjects which can influence trunk control. However, there is a paucity of literature that determines the relationship between pelvic alignment and trunk control in subjects with stroke. Aim: To analyze the relationship between pelvic alignments using PALM and trunk control as measured by the Trunk Impairment Scale (TIS). Setting: Inpatient rehabilitation unit, Tertiary Care Hospitals, Mangalore. Design: A cross-sectional study. Subjects: 38 supra-tentorial stroke subjects with more than 3 weeks duration and who can be able to sit independently were recruited. Methods: The medio-lateral pelvic alignment of the stroke subjects was measured in sitting using the PALM™. The deviation in the pelvic tilt on the paretic side in comparison to the non-paretic side was measured in degrees. Following which the trunk control was evaluated using the Trunk Impairment Scale. Results: The correlation between the pelvic tilt and the trunk control in the stroke subjects showed a negative correlation which indicates that a change in the pelvic alignment which affects the trunk control. Pelvic tilt values negatively correlated with all the sub-items of trunk impairment scores (p < 0.00). The pelvic tilt and the items of TIS scores. Brunnstrom’s stage of lower extremity Motor Recovery demonstrated a significant association (p < 0.05), except for the coordination sub score of the TIS. Conclusion: Pelvic alignment influences the trunk control and is also available to be associated significantly with the acute phase of stroke (3 weeks to 3 months). Brunnstrom’s Stage of lower extremity motor recovery is also associated significantly with the static and dynamic sub scores of the TIS, hence trunk control may influence extremity motor recovery.

Analysis of the influence of an articulated seat position for wheelchair on the pressure distribution in the gluteal region

INTRODUCTION: The present study proposes a new scientific project for the seat of a wheelchair, suggesting that, through the properties of a three plan mobile seat, the pelvis of individuals with neuromotor dysfunctions may position themselves adequately, allowing a chain effect, with innumerable benefits to the users, such as prevention of deformities, of muscle shortening, of pressure ulcers and improved functionality. In spite of innumerable wheelchair models available in market, none presents the ample properties resembling the articulated seat, allowing the pelvic alignment that is crucial for the adoption of an adequate posture. METHODS: The articulated seat was set over a ball and socket articulation made of two components, one convex that is fixed in the chair's structure and the other concave, attached to a mobile platform. The property of the articulated seat, to change the pressure distribution in the gluteal region, was tested on 34 typical individuals, without neurological injury, through a measurement system composed by 27 sensors. RESULTS: The significance of the statistic model proposed determined that the articulated seat was capable of altering the pressure distribution in the gluteal region in several positions on the frontal and sagittal planes, in healthy subjects. CONCLUSION: Despite the fact that this equipment is capable of redistributing the pressure in a seating position, future research to examine other parameters such as time of use, the use in subjects with neurological dysfunction, the angle of pelvic inclination, the criterions of indication and non-indication, inter alia, must be conducted to appropriately qualify this device.