Importance of modifiable non-radiographic functional parameters for adult spinal deformity.

We clarified non-radiographic physical parameters associated with the severity of adult spinal deformity (ASD) using community-dwelling adult volunteers. They were subjected to upright entire spine radiographs for standard radiographic parameters and the number of sagittal modifiers of SRS-Schwab ASD classification (Schwab-SM). Clinical evaluations included isometric muscle strength of trunk extensor (TEX), trunk flexor (TFL), quadriceps femoris (QF), gluteus maximus, and iliopsoas; range of motion (ROM) of hip, knee, ankle, and active back extension (BET); SF36 physical component score (PCS), VAS for back and knee pain, and the degree of ambulatory kyphosis (dTIA). Each muscle strength was calibrated by body weight (BW) and expressed as BW ratio. According to our previous study, dTIA ≥ 7.6° was defined as pathological and dTIA ≤ 3.5° as normal. A final total of 409 female volunteers were included, and their demographics were; age 67.0 ± 5.5 years, Schwab-SM 2.1 ± 1.8, TEX 0.90 ± 0.33BW, TFL 0.48 ± 0.15BW, QF 0.45 ± 0.19BW, PCS 33.5 ± 6.5. Subjects were classified as clinical ASD group (cASD, n = 10) with PCS ≤ 27(mean-1SD) and pathological dTIA, robust group (n = 19) with PCS ≥ 40 (mean + 1SD) and normal dTIA, and the rest (non-cASD, n = 338). Statistical analyses showed significant differences in TEX, TFL, QF, knee extension (KEX), and BET between robust and cASD, and the mean values of robust group (TEX ≥ 1.1BW, TFL ≥ 0.5BW, QF ≥ 0.5BW, KEX ≥ 0° and BET ≥ 14 cm) were used as 'ASD-MJ' index. Subjects with fully achieving ASD-MJ goals showed significantly better radiographic and clinical outcomes than those with unmet goals. In conclusion, upon prescribing conservative or physical therapies for ASD patients, modifiable clinical goals should be clarified, and ASD-MJ could be a benchmark.

Physical and radiographic features of degenerative retrolisthesis in Japanese female volunteers: an observational cohort study.

Hundred and twenty four females with spondylolisthesis were divided into three groups (A group: anterolisthesis; P group: retrolisthesis; and AP group: antero-retrolisthesis), We reviewed their whole-spine radiographs and measured their standard sagittal parameters, including thoracic kyphosis (TK), pelvic incidence (PI), lumbar lordosis (LL), pelvic tilt (PT), and sacral slope (SS). The muscle strengths of the trunk flexor, trunk extensor, iliopsoas, and quadriceps were measured. Health-related quality of life was assessed using the Short Form 36-item Health Survey-physical component summary (SF-36 PCS). PI, SS, and LL-TK of participants in the P group were significantly lower than those in the A and AP groups (PI: P group vs. A group, p < 0.001, P group vs. AP group, p = 0.01), (SS: P group vs. A group, p = 0.001, P group vs. AP group, p = 0.003), (LL-TK: P group vs. A group, p < 0.001, P group vs. AP group, p = 0.049). TK of participants in the P and AP groups was greater than that of those in the A group. (P group vs. A group, p = 0.04, AP group vs. A group, p = 0.0025). The SF-36 PCS score in the P group was lower than that in the A and AP groups. (P group vs. A group, p = 0.004, P group vs. AP group, p = 0.012). The muscle strengths of the trunk flexor and trunk extensor and quadriceps in the P group were lower than those in the A groups. (Trunk flexor: P group vs. A group, p = 0.012), (Trunk extensor: P group vs. A group, p = 0.018), (Quadriceps: P group vs. A group, p = 0.011). In conclusion, female participants with degenerative retrolisthesis had a smaller PI and SS and a larger TK, along with decreased physical function and QoL scores than those with anterolisthesis.