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 sa...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).展开更多
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 curre...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.展开更多
Background: Recent studies suggest a correlation between spinal sagittal alignment and different types of lumbar pathologies due to different load patterns on the lumbar spine. The main objective of this study was to ...Background: Recent studies suggest a correlation between spinal sagittal alignment and different types of lumbar pathologies due to different load patterns on the lumbar spine. The main objective of this study was to investigate the preoperative spinal sagittal alignment in young patients (Methods: Information regarding preoperative clinical examinations was collected from the patient medical charts. Preoperative MRI examinations were used to classify lumbar types according to four sagittal spinal alignment groups (1: a long thoracic kyphosis, 2: a flat back, 3: a normal spine and 4: an increased thoracic kyphosis). Other MRI findings were also noted. Classification of lumbar types was performed independently by three spine surgeons. To compare two sample proportions the 2-sample z-test was performed. Results: The distribution of lumbar curve types was: Type 1, 17% (9 patients);Type 2, 62% (33 patients);Type 3, 17% (9 patients) and Type 4, 4% (2 patients). The distribution of operated levels was: L3 - L4, 2% (1 patient);L4 - L5, 47% (25 patients);L5 - S1, 42% (22 patients) and L4 - L5 + L5 - S1, 9% (5 patients). Conclusions: A majority of the young patients (62%) that underwent surgery due to herniated disc in the lumbar spine were classified as Type 2 indicating a flat back. Future studies are needed to increase the knowledge about spinopelvic sagittal alignment and the correlation to spinal pathologies.展开更多
目的:探讨无症状中国年轻人颈椎矢状位曲度的正常值及其与全脊柱平衡的关系。方法:2011年11月—2014年12月招募并选择年龄18~30岁的志愿者行全脊柱侧位X线检查,在X线片上测量指标包括C_(0)-C_(2)角、从C_(2)-C_(3)到C_(6)-C_(7)的间盘...目的:探讨无症状中国年轻人颈椎矢状位曲度的正常值及其与全脊柱平衡的关系。方法:2011年11月—2014年12月招募并选择年龄18~30岁的志愿者行全脊柱侧位X线检查,在X线片上测量指标包括C_(0)-C_(2)角、从C_(2)-C_(3)到C_(6)-C_(7)的间盘角、从C_(3)到C_(7)的椎体角、T_(1)倾斜角、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、C_(2)-C_(7)矢状轴向垂线(C_(2)-C_(7)sagittal vertical axis,C_(2)-C_(7)SVA)、头重心至C_(7)的矢状位轴向垂线(center of gravity of head to C_(7)SVA,CGH-C_(7)SVA)、C_(7)到S 1的矢状位轴向垂线(C_(7)-S 1SVA)。依据脊柱骨盆矢状位形态进行Roussouly分型,比较不同Roussouly分型下的颈椎曲度及形态。结果:共纳入126名志愿者参与研究,其中男性67名,女性59名,平均年龄(21.4±2.3)岁。C_(0)-C_(7)前凸角平均为26.0°±12.8°,其中C_(0)-C_(2)前凸角平均为15.2°±6.7°,C_(2)-C_(3)到C_(6)-C_(7)间盘前凸角总和平均为9.1°±12.1°,C_(3)到C_(7)的椎体前凸角总和平均仅为1.4°±10.2°。C_(2)-C_(7)SVA(18.6±7.9)mm和CGH-C_(7)SVA[(22.9±12.3)mm]由C_(7)-S 1SVA[(-21.6±31.0)mm]完美代偿。不同的Roussouly分型间颈椎曲度差异有统计学意义(P<0.01)。颈椎曲度与T_(1)倾斜角(P<0.01)、胸椎后凸角(P<0.01)有显着相关性。从T_(1)倾斜角到C_(0)-C_(2)角,相邻节段间盘角之间存在显著相关性(P<0.05)。结论:测量并计算了无症状中国年轻人颈椎椎体角和间盘角的正常值,发现颈椎前凸主要发生在C_(0)-C_(2)和椎间盘水平,这些角度受到其他脊柱部位形态(T_(1)倾斜角、胸椎后凸角和Roussouly分型)的影响,且相邻间盘角之间存在显著的相关性。展开更多
文摘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).
文摘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.
文摘Background: Recent studies suggest a correlation between spinal sagittal alignment and different types of lumbar pathologies due to different load patterns on the lumbar spine. The main objective of this study was to investigate the preoperative spinal sagittal alignment in young patients (Methods: Information regarding preoperative clinical examinations was collected from the patient medical charts. Preoperative MRI examinations were used to classify lumbar types according to four sagittal spinal alignment groups (1: a long thoracic kyphosis, 2: a flat back, 3: a normal spine and 4: an increased thoracic kyphosis). Other MRI findings were also noted. Classification of lumbar types was performed independently by three spine surgeons. To compare two sample proportions the 2-sample z-test was performed. Results: The distribution of lumbar curve types was: Type 1, 17% (9 patients);Type 2, 62% (33 patients);Type 3, 17% (9 patients) and Type 4, 4% (2 patients). The distribution of operated levels was: L3 - L4, 2% (1 patient);L4 - L5, 47% (25 patients);L5 - S1, 42% (22 patients) and L4 - L5 + L5 - S1, 9% (5 patients). Conclusions: A majority of the young patients (62%) that underwent surgery due to herniated disc in the lumbar spine were classified as Type 2 indicating a flat back. Future studies are needed to increase the knowledge about spinopelvic sagittal alignment and the correlation to spinal pathologies.
文摘目的:探讨无症状中国年轻人颈椎矢状位曲度的正常值及其与全脊柱平衡的关系。方法:2011年11月—2014年12月招募并选择年龄18~30岁的志愿者行全脊柱侧位X线检查,在X线片上测量指标包括C_(0)-C_(2)角、从C_(2)-C_(3)到C_(6)-C_(7)的间盘角、从C_(3)到C_(7)的椎体角、T_(1)倾斜角、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、C_(2)-C_(7)矢状轴向垂线(C_(2)-C_(7)sagittal vertical axis,C_(2)-C_(7)SVA)、头重心至C_(7)的矢状位轴向垂线(center of gravity of head to C_(7)SVA,CGH-C_(7)SVA)、C_(7)到S 1的矢状位轴向垂线(C_(7)-S 1SVA)。依据脊柱骨盆矢状位形态进行Roussouly分型,比较不同Roussouly分型下的颈椎曲度及形态。结果:共纳入126名志愿者参与研究,其中男性67名,女性59名,平均年龄(21.4±2.3)岁。C_(0)-C_(7)前凸角平均为26.0°±12.8°,其中C_(0)-C_(2)前凸角平均为15.2°±6.7°,C_(2)-C_(3)到C_(6)-C_(7)间盘前凸角总和平均为9.1°±12.1°,C_(3)到C_(7)的椎体前凸角总和平均仅为1.4°±10.2°。C_(2)-C_(7)SVA(18.6±7.9)mm和CGH-C_(7)SVA[(22.9±12.3)mm]由C_(7)-S 1SVA[(-21.6±31.0)mm]完美代偿。不同的Roussouly分型间颈椎曲度差异有统计学意义(P<0.01)。颈椎曲度与T_(1)倾斜角(P<0.01)、胸椎后凸角(P<0.01)有显着相关性。从T_(1)倾斜角到C_(0)-C_(2)角,相邻节段间盘角之间存在显著相关性(P<0.05)。结论:测量并计算了无症状中国年轻人颈椎椎体角和间盘角的正常值,发现颈椎前凸主要发生在C_(0)-C_(2)和椎间盘水平,这些角度受到其他脊柱部位形态(T_(1)倾斜角、胸椎后凸角和Roussouly分型)的影响,且相邻间盘角之间存在显著的相关性。
