Objective:To explore the influence of the changes of sagittal balance index of lumbar spine on the natural absorption after lumbar disc rupture and protrusion.Methods:From August 2016 to August 2017,64 patients with r...Objective:To explore the influence of the changes of sagittal balance index of lumbar spine on the natural absorption after lumbar disc rupture and protrusion.Methods:From August 2016 to August 2017,64 patients with ruptured lumbar disc herniation and treated with natural absorption in our hospital were selected as the research subjects.According to the size of the herniated discs after 2 years,the subjects were divided into the reabsorption lumbar disc herniation group(group 1,2,3,and 4)and the non-reabsorption group(group 0).The pelvic incidence angle(PI),the sacral slope(SS),the pelvic tilting(PT),and the lumbar lordosis(LL)were measured and compared at the time of admission and 2 years after follow-up.Results:There were no significant differences in the PI value and the change of PI value during the entry and re-examination of different groups.There was no significant difference in the PT,SS,and LL values among the patients in each group;At the time of reexamination,the PT had a decreasing trend and the SS and LL had an increasing trend.With the increase of the patient's score,the changes in PT,SS,and LL values showed an increasing trend.Conclusion:The PT,SS and LL values of patients with lumbar intervertebral disc herniation had significant changes before and after treatment.Changes in the sagittal balance index of the lumbar spine were important factors affecting the natural absorption of lumbar disc herniation.展开更多
Background:Prospective study objectives.A sagittal balance is a good tool to improve the functional outcome of spine spondylolisthesis surgeries,primarily noted that it has a good impact in deformity surgery and then ...Background:Prospective study objectives.A sagittal balance is a good tool to improve the functional outcome of spine spondylolisthesis surgeries,primarily noted that it has a good impact in deformity surgery and then applied to every spine surgery and the aim of this study is to evaluate its functional outcome when considered in preoperative planning for non-dysplastic low-and mid-grade spondylolisthesis surgeries.Method:Forty patients diagnosed as low-or mid-grade non-dysplastic spondylolisthesis had undergone surgery at Cairo University after failed medical treatment had been evaluated preoperatively by measuring the sagittal balance parameters which include SVA,spinopelvic angles,lumbar lordosis,pelvic tilt,sacral slope,and pelvic incidence and then measure it along a follow-up period of 1 year postoperatively started from February 2018 and correlate it with functional outcome using Oswestry score(ODI)and VAS.Correction of parameters has been estimated preoperatively by manual estimation and Surgimap application then applied during the operation.Results:All patients were treated by surgical treatment through posterior transpedicular screw fixation with conventional or reduction screws and fusion±TLIF cages.The mean of lumbar lordosis and mean spinopelvic angles were increased in a statistically significant manner.Pelvis tilt was decreased in a statistically insignificant manner.The mean of pelvic incidence was not changed and statistically insignificant,and this is matching the fact that pelvic incidence is a constant parameter.The sacral slope was increased in a statistically insignificant manner.Final results showed that 37 had a statistically significant improvement in their ODI>20%at the last visit.Three patients had a poor clinical outcome with ODI scorFinal results showed that 37 had a statistically significant improvement in their ODI>20%at the last visit.Three patients had a poor clinical outcome with ODI score of>20%improvement,and we noticed that the level of pathology was at the level of L4L5,SVA was positive and worsen postoperatively,and also,it is accompanied by decreased lumbar lordosis.Change in ODI means statistically significant improvement when considering sagittal parameters preoperation and during operation.Conclusion:Sagittal balance parameters should be considered in the surgical management of low-grade spondylolisthesis cases to improve their functional outcome.展开更多
AIM To describe,using gait analysis,the development of spinal motion in the growing child.METHODS Thirty-six healthy children aged from 3 to 16 years old were included in this study for a gait analysis(9m-walk).Variou...AIM To describe,using gait analysis,the development of spinal motion in the growing child.METHODS Thirty-six healthy children aged from 3 to 16 years old were included in this study for a gait analysis(9m-walk).Various kinematic parameters were recorded and analyzed such as thoracic angle(TA),lumbar angle(LA)and sagittal vertical axis(SVA).The kinetic parameters were the net reaction moments(N.m/kg)at the thoracolumbar and lumbosacral junctions.RESULTS TA and LA curves were not statistically correlated to the age(respectively,P=0.32 and P=0.41).SVA increased significantly with age(P<0.001).Moments in sagittal plane at the lumbosacral junction were statistically correlated to the age(P=0.003),underlining the fact that sagittal mechanical constraints at the lumbosacral junction increase with age.Moments in transversal plane at the thoracolumbar and lumbosacral junctions were statistically correlated to the age(P=0.0002and P=0.0006),revealing that transversal mechanical constraints decrease with age.CONCLUSION The kinetic analysis showed that during growth,a decrease of torsional constraint occurs while an increase of sagittal constraint is observed.These changes in spine biomechanics are related to the crucial role of the trunk for bipedalism acquisition,allowing stabilization despite lower limbs immaturity.With the acquisition of mature gait,the spine will mainly undergo constraints in the sagittal plane.展开更多
Background There has been an increasing recognition of the importance of sagittal spinopelvic alignment in patients with scoliosis as it relates to clinical outcomes. However, the changes seen in sagittal spinopelvic ...Background There has been an increasing recognition of the importance of sagittal spinopelvic alignment in patients with scoliosis as it relates to clinical outcomes. However, the changes seen in sagittal spinopelvic alignment in adult idiopathic scoliosis patients is poorly defined. This study was conducted to evaluate the sagittal alignment of pelvis and spine in adult idiopathic scoliosis patients.Methods The sagittal parameters of the spine and pelvis were analyzed in lateral standing radiographs of 124 patients （mean age 47.4 years） with adult idiopathic scoliosis, including thoracic kyphosis （TK）, thoracolumbar junction kyphosis （TLJ）, lumbar lordosis （LL）, pelvic incidence （PI）, sacrum slope （SS）, pelvic tilt （PT） and C7 plumb line （C7PL）. The patients were divided into three groups according to the age： 20-40 years, 41-64 years, and ≥65 years. The parameters were compared with those in normal adults and adolescent idiopathic scoliosis （AIS） patients. The relationship between all parameters as well as age and sagittal parameters were analyzed.Results The PI in patients with adult idiopathic scoliosis was 58.1°±13.0°, which was significantly higher than that in normal adults. The PT （19.9°±10.6°） was also higher than that in both normal adults and AIS patients, while the SS （38.1°±12.0°） was similar or smaller. As age increased, C7PL, PT and TJL increased while LL decreased. There was no relationship between age and both PI and TK. PT had the strongest statistical association with the C7PL.Conclusions PI is higher in adult idiopathic scoliosis than normal subjects. The PT is the most relevant pelvic parameter to the global sagittal alignment of the spine. Age significantly influences sagittal parameters of the spine and pelvis except the PI and TK.展开更多
Background： Thoracolumbar junction （TLJ） is the transitional area between the lower thoracic spine and the upper lumbar spine. Vertebral compression fractures and proximal junctional kyphosis following spine surger...Background： Thoracolumbar junction （TLJ） is the transitional area between the lower thoracic spine and the upper lumbar spine. Vertebral compression fractures and proximal junctional kyphosis following spine surgery often occur in this area. Therefore, the study of development and mechanisms of thoracolumbar junctional degeneration is important for planning surgical management. This study aimed to review radiological parameters of thoracolumbar junctional degenerative kyphosis （TLJDK） in patients with lumbar degenerative kyphosis and to analyze compensatory mechanisms of sagittal balance. Methods： From January 2016 to March 2017, patients with lumbar degenerative kyphosis were enrolled in this radiographic study. Patients were divided into two groups according to thoracolumbar junctional angle （TLJA）： the non-TLJDK （NTLJDK） group （TLJA 〈10°） and the TLJDK group （TLJA≥10°）. Complete spinopelvic radiographic parameters were analyzed and compared between two groups. Pearson or Spearman correlation coefficients and independent two-sample t-test or Mann-Whitney U-test were used. Results： Atotal of 77 patients with symptomatic sagittal imbalance due to lumbar degenerative kyphosis were enrolled in this study. There were 34 patients in NTLJDK group （TLJA 〈10°） and 43 patients in TLJDK group （TLJA ≥10°）. The median angle of lumbar lordosis （LL） in the NTLJDK or TLJDK groups was 23.40° （18.50°, 29.48°） or 19.50° （13.30°, 24.55°）, respectively. The median TLJAs in all patients and both groups were -11.20° （-14.60°, -4.80°）, -3.70° （-7.53°, -1.73°）, and -14.30° （-17.45°, -13.00°）, respectively. In the NTLJDK group, LLwas correlated with thoracic kyphosis （TK; r = -0.400, P = 0.019）, sacral slope （SS; r = 0.681, P 〈 0.001）, and C7-sagittal vertical axis （r = -0.402, P = 0.018）. In the TLJDK group, LL was correlated with TK （r = -0.345, P = 0.024）, SS （r = 0.595, P 〈 0.001）, and pelvic tilt （r = -0.363, P = 0.017）. There were significant differences in LL, TLJA, TK, SS, and pelvic incidence （PI） between two groups. Conclusions：Although TLJDK is common in patients with lumbar degenerative kyphosis, it might be generated by special characteristics of morphology and biomechanics of the TLJ. To maintain sagittal balance, pelvis back tilt might be more important in patients with TLJDK, whereas thoracic curve changes might be more important in patients without TLJDK.展开更多
基金Scientific research project of Sichuan health and Family Planning Commission(No.16pj389)
文摘Objective:To explore the influence of the changes of sagittal balance index of lumbar spine on the natural absorption after lumbar disc rupture and protrusion.Methods:From August 2016 to August 2017,64 patients with ruptured lumbar disc herniation and treated with natural absorption in our hospital were selected as the research subjects.According to the size of the herniated discs after 2 years,the subjects were divided into the reabsorption lumbar disc herniation group(group 1,2,3,and 4)and the non-reabsorption group(group 0).The pelvic incidence angle(PI),the sacral slope(SS),the pelvic tilting(PT),and the lumbar lordosis(LL)were measured and compared at the time of admission and 2 years after follow-up.Results:There were no significant differences in the PI value and the change of PI value during the entry and re-examination of different groups.There was no significant difference in the PT,SS,and LL values among the patients in each group;At the time of reexamination,the PT had a decreasing trend and the SS and LL had an increasing trend.With the increase of the patient's score,the changes in PT,SS,and LL values showed an increasing trend.Conclusion:The PT,SS and LL values of patients with lumbar intervertebral disc herniation had significant changes before and after treatment.Changes in the sagittal balance index of the lumbar spine were important factors affecting the natural absorption of lumbar disc herniation.
文摘Background:Prospective study objectives.A sagittal balance is a good tool to improve the functional outcome of spine spondylolisthesis surgeries,primarily noted that it has a good impact in deformity surgery and then applied to every spine surgery and the aim of this study is to evaluate its functional outcome when considered in preoperative planning for non-dysplastic low-and mid-grade spondylolisthesis surgeries.Method:Forty patients diagnosed as low-or mid-grade non-dysplastic spondylolisthesis had undergone surgery at Cairo University after failed medical treatment had been evaluated preoperatively by measuring the sagittal balance parameters which include SVA,spinopelvic angles,lumbar lordosis,pelvic tilt,sacral slope,and pelvic incidence and then measure it along a follow-up period of 1 year postoperatively started from February 2018 and correlate it with functional outcome using Oswestry score(ODI)and VAS.Correction of parameters has been estimated preoperatively by manual estimation and Surgimap application then applied during the operation.Results:All patients were treated by surgical treatment through posterior transpedicular screw fixation with conventional or reduction screws and fusion±TLIF cages.The mean of lumbar lordosis and mean spinopelvic angles were increased in a statistically significant manner.Pelvis tilt was decreased in a statistically insignificant manner.The mean of pelvic incidence was not changed and statistically insignificant,and this is matching the fact that pelvic incidence is a constant parameter.The sacral slope was increased in a statistically insignificant manner.Final results showed that 37 had a statistically significant improvement in their ODI>20%at the last visit.Three patients had a poor clinical outcome with ODI scorFinal results showed that 37 had a statistically significant improvement in their ODI>20%at the last visit.Three patients had a poor clinical outcome with ODI score of>20%improvement,and we noticed that the level of pathology was at the level of L4L5,SVA was positive and worsen postoperatively,and also,it is accompanied by decreased lumbar lordosis.Change in ODI means statistically significant improvement when considering sagittal parameters preoperation and during operation.Conclusion:Sagittal balance parameters should be considered in the surgical management of low-grade spondylolisthesis cases to improve their functional outcome.
文摘AIM To describe,using gait analysis,the development of spinal motion in the growing child.METHODS Thirty-six healthy children aged from 3 to 16 years old were included in this study for a gait analysis(9m-walk).Various kinematic parameters were recorded and analyzed such as thoracic angle(TA),lumbar angle(LA)and sagittal vertical axis(SVA).The kinetic parameters were the net reaction moments(N.m/kg)at the thoracolumbar and lumbosacral junctions.RESULTS TA and LA curves were not statistically correlated to the age(respectively,P=0.32 and P=0.41).SVA increased significantly with age(P<0.001).Moments in sagittal plane at the lumbosacral junction were statistically correlated to the age(P=0.003),underlining the fact that sagittal mechanical constraints at the lumbosacral junction increase with age.Moments in transversal plane at the thoracolumbar and lumbosacral junctions were statistically correlated to the age(P=0.0002and P=0.0006),revealing that transversal mechanical constraints decrease with age.CONCLUSION The kinetic analysis showed that during growth,a decrease of torsional constraint occurs while an increase of sagittal constraint is observed.These changes in spine biomechanics are related to the crucial role of the trunk for bipedalism acquisition,allowing stabilization despite lower limbs immaturity.With the acquisition of mature gait,the spine will mainly undergo constraints in the sagittal plane.
文摘Background There has been an increasing recognition of the importance of sagittal spinopelvic alignment in patients with scoliosis as it relates to clinical outcomes. However, the changes seen in sagittal spinopelvic alignment in adult idiopathic scoliosis patients is poorly defined. This study was conducted to evaluate the sagittal alignment of pelvis and spine in adult idiopathic scoliosis patients.Methods The sagittal parameters of the spine and pelvis were analyzed in lateral standing radiographs of 124 patients （mean age 47.4 years） with adult idiopathic scoliosis, including thoracic kyphosis （TK）, thoracolumbar junction kyphosis （TLJ）, lumbar lordosis （LL）, pelvic incidence （PI）, sacrum slope （SS）, pelvic tilt （PT） and C7 plumb line （C7PL）. The patients were divided into three groups according to the age： 20-40 years, 41-64 years, and ≥65 years. The parameters were compared with those in normal adults and adolescent idiopathic scoliosis （AIS） patients. The relationship between all parameters as well as age and sagittal parameters were analyzed.Results The PI in patients with adult idiopathic scoliosis was 58.1°±13.0°, which was significantly higher than that in normal adults. The PT （19.9°±10.6°） was also higher than that in both normal adults and AIS patients, while the SS （38.1°±12.0°） was similar or smaller. As age increased, C7PL, PT and TJL increased while LL decreased. There was no relationship between age and both PI and TK. PT had the strongest statistical association with the C7PL.Conclusions PI is higher in adult idiopathic scoliosis than normal subjects. The PT is the most relevant pelvic parameter to the global sagittal alignment of the spine. Age significantly influences sagittal parameters of the spine and pelvis except the PI and TK.
文摘Background： Thoracolumbar junction （TLJ） is the transitional area between the lower thoracic spine and the upper lumbar spine. Vertebral compression fractures and proximal junctional kyphosis following spine surgery often occur in this area. Therefore, the study of development and mechanisms of thoracolumbar junctional degeneration is important for planning surgical management. This study aimed to review radiological parameters of thoracolumbar junctional degenerative kyphosis （TLJDK） in patients with lumbar degenerative kyphosis and to analyze compensatory mechanisms of sagittal balance. Methods： From January 2016 to March 2017, patients with lumbar degenerative kyphosis were enrolled in this radiographic study. Patients were divided into two groups according to thoracolumbar junctional angle （TLJA）： the non-TLJDK （NTLJDK） group （TLJA 〈10°） and the TLJDK group （TLJA≥10°）. Complete spinopelvic radiographic parameters were analyzed and compared between two groups. Pearson or Spearman correlation coefficients and independent two-sample t-test or Mann-Whitney U-test were used. Results： Atotal of 77 patients with symptomatic sagittal imbalance due to lumbar degenerative kyphosis were enrolled in this study. There were 34 patients in NTLJDK group （TLJA 〈10°） and 43 patients in TLJDK group （TLJA ≥10°）. The median angle of lumbar lordosis （LL） in the NTLJDK or TLJDK groups was 23.40° （18.50°, 29.48°） or 19.50° （13.30°, 24.55°）, respectively. The median TLJAs in all patients and both groups were -11.20° （-14.60°, -4.80°）, -3.70° （-7.53°, -1.73°）, and -14.30° （-17.45°, -13.00°）, respectively. In the NTLJDK group, LLwas correlated with thoracic kyphosis （TK; r = -0.400, P = 0.019）, sacral slope （SS; r = 0.681, P 〈 0.001）, and C7-sagittal vertical axis （r = -0.402, P = 0.018）. In the TLJDK group, LL was correlated with TK （r = -0.345, P = 0.024）, SS （r = 0.595, P 〈 0.001）, and pelvic tilt （r = -0.363, P = 0.017）. There were significant differences in LL, TLJA, TK, SS, and pelvic incidence （PI） between two groups. Conclusions：Although TLJDK is common in patients with lumbar degenerative kyphosis, it might be generated by special characteristics of morphology and biomechanics of the TLJ. To maintain sagittal balance, pelvis back tilt might be more important in patients with TLJDK, whereas thoracic curve changes might be more important in patients without TLJDK.
