Current strategies for the restoration of adequate lordosis during lumbar fusion

Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioningon the operating table, release maneuvers, type of instrumentation used(rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery.

A Case of Thoracic Lordosis in a Cat

A 1.8 kg, seven months old, intact, female, mix-breed cat was referred with dyspnea and paresis. Since the patient was in such a condition that she was too incapable of the operation, treatment for dyspnea was performed. The patient has abdominal enlargement. When the respiratory stress of the patient decreased, a radiograph was taken and lordosis was found. Medical treatment was applied, because the general condition was impaired. Lordosis is the excessive curvature of a certain number of vertebrae in the neck and back region. Congenital thoracic lordosis has been described as a highly progressive and low vital capacity disease in humans and cats. Because it compresses the lung, it can cause dyspnea in patients and rhythm disturbances in the heart. This case represents a severe example of untreatable and unmanageable lordosis encountered in a cat.

Evaluation of lordosis recovery after lumbar arthrodesis and its clinical impact

Background Posterior lumbar arthrodesis has become a widely used therapeutic option to correct sagittal imbalances in patients suffering from degenerative lumbar conditions.However,in western Africa,there is no study have reported long-term outcome of posterior lumbar arthrodesis.The aim of this study was to investigate the relationship between the restoration of adequate lordosis and the patient’s postoperative quality of life.Method The study was retrospective.From January 2012 to December 2019,80 patients who underwent posterior lumbar arthrodesis for lumbar degenerative diseases were included with a mean follow-up of 43.2 months.Mean age was 50.8 years(SD=12.2).Preoperative and postoperative patients'symptoms were assessed by the visual analog scale(VAS),Oswestry Disability Index(ODI),and 12-item Short Form(SF-12).Pre-and post-operative radiographic evaluation included lumbar lordosis measured(LLm),pelvic incidence(PI),sacral slope(SS),and pelvic stilt(PS).Theoretical lumbar lordosis(LLt)was defined by the following:LL=0.54×PI+27.6.Data analysis was done using the statistical software"R."The risk of error was 5%(p<0.05).Result The mean pelvic incidence was 57.23°.There was no statistically significant difference between preoperative and postoperative lumbar lordosis(p=0.2567).There was no statistical difference between preoperative and post-operative PI-LL(p=0.179).There was a statistically significant difference between the pre and postoperative clinical scores(p<0.001).Statistical analysis showed a correlation between recovery of lumbar lordosis and improvement in physical component of SF-12(PCS)(p<0.05)and lumbar and radicular VAS(p<0.05)for the subgroup of narrow lumbar spine.There was a statistical relationship between the restoration of lumbar lordosis and improvement in PCS(p=0.004)and VAS(p=0.003)for the subgroup of isthmic lysis spondylolisthesis.Discussion The root decompression performed in most patients could explain the clinical improvement regardless of recovery of lordosis.The failure to consider spinal parameters and sagittal balance of patients in the surgery could explain no restoration of lumbar lordosis.Our study had limitations inherent to its retrospective character such as the classic selection bias.Conclusion Satisfactory correction of spinopelvic alignment may improve long-term clinical signs.

The Relationship between Neck and Shoulder Pain and the Sagittal Alignment of the Spine in Standing in Younger Generation

Background: The relationship between chronic neck and shoulder pain and posture remains controversial. The purpose of this study was to investigate the relationship between chronic neck and shoulder pain and spinal sagittal alignment in standing posture in younger generation. Methods: Subjects included 57 females and 32 males (average age, 29.9 ± 5.7 years). All subjects were 20s or 30s. Spinal curvature was assessed using SpinalMouse. The subjects were also divided into a normal group (VAS zero group) and a pain group by VAS results. Statistical analysis was performed by Student’s t-test. Significance was defined as p < 0.05. Results: The normal group and pain group included 29 and 60 subjects, respectively. In terms of location of pain, thirty-one subjects felt neck pain, 50 felt pain above the scapula, and 17 felt pain between the thoracic spine and scapula. Thoracic kyphosis and lumbar lordosis in the pain group were significantly higher than those in the normal group (p = 0.013 and p = 0.020, respectively). Thoracic kyphosis in subjects with neck pain or pain above scapula was significantly higher than that in subjects without pain (p = 0.0075 and p = 0.025, respectively). Lumbar lordosis in subjects with pain above the scapula or interscapula was significantly higher than that in subjects without pain (p = 0.016).

Photogrammetry as a tool for the postural evaluation of the spine:A systematic review

AIM:To evaluate the use of photogrammetry and identify the mathematical procedures applied when evaluating spinal posture.METHODS:A systematic search using keywords was conducted in the Pub Med,EMBASE,Scopus,Science and Medicine&#174;databases.The following inclusion criteria adopted were:(1)the use of photogrammetry as a method to evaluate spinal posture;(2)evaluations of spinal curvature in the sagittal and/or frontal plane;(3)studies published within the last three decades;and(4)written entirely in English.The exclusion criteria were:(1)studies which objective involved the verification of some aspect of validation of instruments;(2)studies published as abstracts and those published in scientific events;and(3)studies using evaluation of the anteriorization of the head to determine the angular positioning of the cervical spine.The articles in this review were included and evaluated for their methodological quality,based on the Downs and Black scale,by two independent reviewers.RESULTS:Initially,1758 articles were found,76 of which were included upon reading the full texts and 29 were included in accordance with the predetermined criteria.In addition,after analyzing the references in those articles,a further six articles were selected,so that 35 articles were included in this review.This systematic review revealed that the photogrammetry has been using in observational studies.Furthermore,it was also found that,although the data collection methodologies are similar across the studies,in relation to aspects of data analysis,the methodologies are very different,especially regarding the mathematical routines employed to support different postural evaluation software.CONCLUSION:With photogrammetry,the aim of the assessment,whether it is for clinical,research or collective health purposes,must be considered when choosing which protocol to use to evaluate spinal posture.

Refining the Reference Values of Diers 4D Formetric System and Introducing a Qualitative Spine Profile Based on Percentile Ranking

Background: In order to detect possible abnormalities of the spine posture of an individual patient, it is mandatory to dispose of adequate reference values based on measurements in a normal, symptom-free population. The Diers formetric?system allows for non-invasive and accurate assessment of the vertebral column based on the registration of external aspect of the back surface using the Moiré principle. Objective: To create a qualitative spine profile based on the percentile ranking of measurements obtained by the Diers formetric system taking into account possible confounding factors. Materials and Methods: Statistical analysis of formetric recordings in 216 symptom-free volunteers. Results: Maximal kyphotic angle, maximal scoliotic angle, sagittal imbalance, flèche cervicale, and pelvic inclination are significantly influenced by gender and by body mass index (BMI). A synoptic chart was created presenting the percentile ranking taking into account gender and BMI. The percentile ranking was summarized in both a table with colour code and depicted in a histogram of the individual’s Qualitative Spine Profile (QSP). Clinical Significance: Percentile ranking and the Quantitative Spine Profile taking into account gender and BMI should permit a more precise and reliable assessment of possible posture deviations related to the patient’s complaints, and may assist the therapist in selecting the best mode of treatment.

Spinal deformities in a wild line of Poecilia wingei bred in captivity:report of cases and review of the literature

Objective:To describe the occurrence of various spinal deformations in a captive-bred wild line of Poecilia wingei(P.wingei).Methods:Fish belonging to a wild line of P.wingei caught from Laguna de Los Patos,Venezuela,were bred in an aquarium home-breeding system during a period of three years(2006-2009).The spinal curvature was observed to study spinal deformities in P.wingei.Results:Out of a total of 600 fish,22 showed different types of deformities(scoliosis,lordosis,kyphosis),with a higher incidence in females.Growth,swimming and breeding of deformed fish were generally normal.Conclusions:Possible causes for spinal curvature in fish are discussed on the basis of the current literature.While it is not possible to determine the exact cause(s)of spinal deformities observed in the present study,traumatic injuries,nutritional imbalances,genetic defects or a combination of these factors can be supposed to be involved in the pathogenesis of such lesions.

用四象体质辨识调查问卷（QSCC）Ⅱ来腰痛患者疾病亲和度，腰椎前凸角度及肥胖度相观性研究

腰痛是全人口80％的人曾有过患病的历史，寻找家庭医生仅次于感冒的临床上多发常见病”，众所周知导致腰痛的根本原因是姿势不良，分析脊椎弯曲以诱导良好的姿势是可能有助于腰痛治疗。谈及影响腰痛发生的因素之一是肥胖，肥胖是不但各种成人病的原因，而且引起心理不安，忧郁等情绪方面的问题，又引起因体重负荷的腰痛，关节痛等各种肌肉骨骼系统疾病发生密切相关，

Vertebral column deformity in six species of wild fish at the Coromandel coast,Bay of Bengal India

This study reports radiological deformities in the vertebral column of six fishes viz,Scomberomorus commerson,Chanos chanos,Sillago sihama,Pampus chinensis,Rastrelliger kanagurta and Netuma thalassina that were collected from the Coromandel coast,Bay of Bengal.Four main different types of vertebral column deformities were found:(i)whole body kypho-lordo-kyphosis(Sillago sihama,Rastrelliger kanagurta,Netuma thalassina);(ii)tail region kypho-lordosis(Scomberomorus commerson);(iii)tail region lordo-kyphosis(Chanos chanos);(iv)platyspondyly(Pampus chinensis).Seven types of vertebra body deformities,describing the pathology of single vertebrae,were present;reduced intervertebral space,compression,fusion,compresion&fusion,fusion center,dorsal wedge-shaped and compressed&dorsal wed-shaped.The present documentation of deformities in six different species that are also very different with regard to habitat,diet and swimming activity may suggest that fish deformities are widespread in the study area.

Functional outcome of surgical management of low mid-grade lumbar spondylolisthesis when considering the sagittal balance parameters preoperatively:a prospective study

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.

Flexion/extension cervical spine views in blunt cervica trauma

Objective： To examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma, who show loss of cervical lordosis and neck pain. Methods： All patients who presented to our emer- gency department following blunt trauma were enrolled in this study, except those with schiwora, neurological defi- cits or fracture demonstrated on cross-table cervical spine X-rays, and those who were either obtunded or presented after cervical spine surgery. Adequacy of flexion and exten- sion views was checked by the neurosurgery and radiology team members. All these patients underwent cross-table cervical spine view followed by flexion/extension views based on the loss of lordosis on cross-table imaging and the presence of neck pain. Results： A total of 200 cases were reviewed, of whom 90 （45%） underwent repeat X-rays because of either inadequate exposure or limited motion. None of the patients with loss of lordosis on cross-table view had positive flexion and extension views of cervical spine for instability. Conclusions： Our results show that in patients who underwent acute radiographic evaluation of blunt cervical spine trauma, flexion and extension views of the cervical spine are unlikely to yield positive results in the presence of axial neck pain and/or loss of cervical lordosis. We can also hypothesize that performing flexion and extension views will be more useful once the acute neck pain has settled.