Search Results (83)

Objectives: To comprehensively examine the association between spinopelvic alignment and muscle shortening in healthy young men, focusing on the individual and interactive effects of thoracic kyphosis, lumbar lordosis, and anterior pelvic tilt using SHapley Additive exPlanation (SHAP) analysis. Methods: Forty-one healthy young adult men participated in this cross-sectional study. Thoracic kyphosis, lumbar lordosis, and anterior pelvic tilt were measured using a flexible curve ruler and inclinometer. Muscle length indices for six muscles (iliopsoas, rectus femoris, gluteus maximus, hamstrings, back extensors, and abdominals) were assessed via standardized physical examinations and image analysis. A machine learning model was developed, and SHAP analysis applied to determine individual and interactive contributions of spinopelvic angles to each muscle length index. Results: SHAP analysis showed that hip-related muscle shortening (iliopsoas, rectus femoris, hamstrings, gluteus maximus) was influenced by both individual alignments and interactions, especially between thoracic kyphosis and lumbar lordosis. Lumbar lordosis was most associated with iliopsoas shortening (SHAP = −0.09), while anterior pelvic tilt was linked to hamstring shortening (SHAP = −0.30). Thoracic kyphosis was the key factor for rectus femoris shortening (SHAP = −0.05). Interactive effects exceeded individual contributions for the rectus femoris, gluteus maximus, and hamstrings. In contrast, spinal alignment had minimal influence on the back extensors and abdominals. Conclusions: Both individual and intersegmental spinal alignments are associated with muscle shortening, particularly in hip-related muscles. The interaction between thoracic kyphosis and lumbar lordosis plays a pivotal role. These findings underscore the importance of evaluating segmental spinal interactions when assessing muscle flexibility and posture. Full article

Background/Objectives: Rapidly progressive osteoarthritis of the hip (RPOH) has unique diagnostic and surgical challenges due to rapid joint degeneration and acetabular structural alterations. This study aimed to investigate correlations between preoperative spinopelvic geometry and anterior acetabular wall bone stock deficiency in RPOH patients and introduce an advanced imaging measurement techniques for cases with amputated femoral heads. Methods: A prospective observational study was conducted that enrolled 85 patients, comprising 40 with unilateral RPOH (Zazgyva Grade II or III) and 45 controls with primary osteoarthritis (OA). Preoperative spino-pelvic parameters (pelvic tilt—PT, sacral slope—SS, lumbar lordosis—LL, and T1 pelvic angle) and acetabular anterior wall characteristics (anterior center edge angle—ACEA, anterior wall index—AWI, and anterior acetabular surface area—AASA) were measured using standardized radiographic and CT imaging protocols, including a new methodology for acetabular center estimation in femoral head-amputated cases. Results: Significant differences were identified between RPOH and primary OA patients in the PT (22.5° vs. 18.9°, p = 0.032), SS (37.8° vs. 41.1°, p = 0.041), T1 pelvic angle (14.3° vs. 11.8°, p = 0.018), and anterior center edge angle (25.3° vs. 29.7°, p = 0.035). RPOH patients exhibited pronounced spinopelvic misalignment and anterior acetabular deficiencies. Conclusions: RPOH is associated with spinopelvic misalignment and anterior acetabular wall deficiency. Accurate preoperative diagnosis imaging and personalized surgical approaches specifically addressing acetabular bone stock deficiencies are mandatory in these cases. Full article

Background: Lateral lumbar or thoracic interbody fusion (LLIF) is increasingly considered for anterior column reconstruction and restoring segmental lordosis in degenerative, infectious, or deformity conditions. Reports about using LLIF with expandable interbody spacers for spine trauma are scarce. Methods: In this retrospective, single-center observational cohort study, we reviewed all patients treated by an expandable LLIF interbody spacer (ELSA^® Expandable Integrated LLIF Spacer, Globus Medical Inc) for trauma indication at our spine center between September 2018 and January 2024. The primary outcome measures were fusion rate at 12 months, change in segmental sagittal Cobb angle, and clinical outcome according to the MacNab criteria. Secondary outcomes included adverse events and complications. Results: We identified n = 21 patients with a mean age of 48.3 (standard deviation (SD) 15.7), 47.6% were female. LLIF was mostly performed at T11/12 (n = 4; 19.1%) and T12/L1 (n = 10; 47.5%). Indications were AO Spine type A2 (n = 4, 19.1%), A3 (n = 14; 66.7%) or A4 fractures (n = 3; 14.3%) with ligamentous (B2-type) in eight (38.1%) and hyperextension (B3-type) injury in one patient (4.8%). Surgery included the release of the anterior longitudinal ligament in four cases (19.1%). Intraoperative AEs were noted in n = 1 (4.8%), postoperative AEs in n = 3 (14.3%) at discharge, n = 4 (19.1%) at three, and n = 2 (9.5%) at twelve months. Segmental sagittal Cobb angle changed from 1.3° (preoperative) to 13.3° at twelve months (p < 0.001). Functional outcome was excellent/good in n = 15 (71.4%; four missing) at 12 months. The fusion rate at the LLIF level was 100% at the 12-month follow-up. Conclusions: LLIF with expandable interbody spacers for spine trauma (off-label use) is safe, promotes solid fusion (100% fusion rate at 12 months), and enables correction of sagittal segmental Cobb angle (mean improvement of 12°), with good or excellent clinical outcomes in most patients (71.4%). Full article

The aim of the study was to verify the relationship between musculoskeletal pain of elite Polish goalball players and selected physique and posture characteristics. We examined 12 players. The mean age was 21.8 ± 6.0 years, and a mean training experience of 6.3 ± 3.4 years. Physique (body mass, body height, waist circumference, fat tissue, fat-free soft tissue) and posture (thoracic kyphosis and lumbar lordosis) and range of motion (in the thoracic and lumbar regions) were assessed. The incidences and locations of musculoskeletal pain were identified using the Nordic Musculoskeletal Questionnaire, covering the period from the last seven days (NMQ-7) and six months (NMQ-6). Due to the small group size, non-parametric tests (Spearman’s rank correlation) were used. The significance level was set at p < 0.05. Players were more likely to report musculoskeletal pain in the last six months than in the previous week. Pain reported in both NMQ6 and NMQ7 was most common in the wrists/hands and lower back, and, in NMQ6, also in the shoulders and ankles/feet. There were significant negative correlations of total NMQ7 with lumbar lordosis angle in the habitual standing position (R = −0.6; p = 0.04), trunk flexion (R = −0.8, p = 0.002), and trunk extension (R = −0.6; p = 0.03), and a positive correlation with thoracic kyphosis angle in trunk flexion (R = 0.8, p = 0.005). There was a statistically significant, inversely proportional relationship of thoracic kyphosis angle values in the habitual position (R = −0.58; p = 0.049) and thoracic kyphosis angle THA in trunk flexion (R = −0.6; p = 0.038) with time of disability. Relationships between some body posture parameters and musculoskeletal pain in the studied athletes were also noted. Full article

Background and Objectives: Angular modifications in the physiological curvatures of the spine have been associated with spinal dysfunction and altered biomechanics, which may contribute to musculoskeletal complaints. The main objective of this experimental study was to investigate the association between lumbar lordosis and thoracic kyphosis angles and muscle activations during three different lower back exercises. Materials and Methods: Participants were divided into a hyperlordotic lumbar angle group—with increased thoracic kyphosis (n = 11)—and a normal lordotic lumbar thoracic angle group (n = 11). Thoracolumbar muscular activities during three different exercises were measured by surface electromyography. Results: Muscular activity was less in almost all exercises (except iliocostalis lumborum-pars lumborum) in the hyperlordotic lumbar angle/increased thoracic kyphosis group (p < 0.05). The unstable superman exercise was the exercise that produced the most muscular activity in both groups (p < 0.05). Conclusions: The study analyzed the association between lumbar lordosis, increased thoracic kyphosis, and muscle activations during specific lower back exercises. These findings highlight the relationship between spinal alignment and muscular responses during functional tasks, which may inform future biomechanical research or rehabilitation strategies. Full article

Background/Objectives: Proximal junctional kyphosis (PJK) is one of the most frequently discussed complications following corrective surgery in patients with neuromuscular scoliosis (NMS). Despite its clinical relevance, the etiology of PJK remains incompletely understood and appears to be multifactorial. Biomechanical and limited clinical studies suggest that preoperative hyperkyphosis, resection of the spinous processes with consequent disruption of posterior ligamentous structures, and rod contouring parameters may contribute as risk factors. Methods: To validate these findings, we retrospectively analyzed 99 NMS patients who underwent posterior spinal fusion using a standardized screw-rod system between 2009 and 2017. Radiographic assessments were conducted at three time points: preoperatively (preOP), postoperatively (postOP), and at a mean follow-up (FU) of 29 months. Clinical variables collected included patient age, weight, height, sex, and Risser sign. Radiographic evaluations encompassed Cobb angles, thoracic kyphosis (TK), lumbar lordosis, the levels of the upper (UIV) and lower (LIV) instrumented vertebrae, the total number of fused segments, parameters of sagittal alignment, the rod contour angle (RCA), and the postoperative mismatch between RCA and the proximal junctional angle (PJA). Based on the development of proximal junctional kyphosis, patients were categorized into PJK and non-PJK groups. Results: The overall incidence of PJK was 23.2%. In line with previous biomechanical findings, spinous process resection was significantly associated with PJK development. Furthermore, the PJK group demonstrated significantly higher preoperative TK (59.3° ± 29.04° vs. 34.5° ± 26.76°, p < 0.001), greater RCA (10.2° ± 4.01° vs. 7.7° ± 4.34°, p = 0.021), and a larger postoperative mismatch between PJA and RCA (PJA−RCA: 3.8° ± 6.76° vs. −1.8° ± 6.55°, p < 0.001) compared to the non-PJK group. Conclusions: Spinous process resection, a pronounced mismatch between postoperative PJA and RCA (odds ratio [OR] = 1.19, p = 0.002), excessive rod bending (i.e., high RCA), and severe preoperative thoracic hyperkyphosis with an expected increase in the risk of PJK of approximately 6.5% per degree of increase in preoperative TK are significant risk factors for PJK. These variables should be carefully considered during the surgical planning and execution of deformity correction in NMS patients. Full article

Background/Objectives: One of the surgical treatments for lumbar foraminal stenosis, full endoscopic foraminotomy, is known for its numerous advantages and favourable clinical outcomes. While previous studies have analyzed preoperative radiological risk factors associated with recurrence within one year after endoscopic foraminal decompression, no research has investigated postoperative radiological changes. The aim of this study is to analyze the radiological changes occurring in cases of early recurrence within six months after endoscopic foraminal decompression. Methods: A retrospective review was conducted on patients with unilateral lumbar foraminal stenosis who underwent full endoscopic foraminotomy at a single institution. The study included 11 recurrent patients who initially experienced symptomatic improvement and sufficient neural decompression on radiological evaluation, but exhibited recurrent radicular pain and radiological restenosis within six months postoperatively. Additionally, 33 control patients with favourable clinical outcomes and no evidence of restenosis were analyzed. Preoperative and postoperative plain X-ray imaging was used to evaluate sagittal and coronal parameters reflecting spinal anatomical characteristics, including disc height, foraminal height, disc wedging, coronal Cobb’s angle, total lumbar lordosis angle, segmental lumbar lordosis angle, and dynamic segmental lumbar lordosis angle. The study aimed to analyze postoperative changes in these parameters between the recurrent and control groups. Clinical outcomes were assessed using the Visual Analog Scale (VAS). Results: There were no significant differences between the groups in terms of age, sex distribution, presence of adjacent segment disease, or existence of Grade 1 spondylolisthesis. Analysis of preoperative and postoperative radiological changes revealed that, in the recurrent group, disc height and foraminal height showed a significant decrease postoperatively, while disc wedging and the coronal Cobb’s angle demonstrated a significant increase. In contrast, the control group exhibited a significant postoperative increase in the total lumbar lordosis angle and segmental lumbar lordosis angle. Conclusions: Progressive worsening of disc wedging and the coronal Cobb’s angle, and reductions in disc and foraminal height, along with minimal improvement in lumbar lordosis following TELF, suggest the presence of irreversible preoperative degenerative changes. Careful radiologic assessment and close postoperative monitoring are essential to identify patients at risk of early recurrence. Full article

Background/Objectives: There are many concerns regarding adjacent segment disease after lumbar spinal fusion. However, there are few studies that analyze risk factors by classifying adjacent segment disease (ASD) by onset. This study aimed to investigate related factors according to the period of occurrence of ASD in mid- to long-term follow-up patients after lumbar spinal fusion. Methods: We analyzed 139 patients who underwent ≤3-segment lumbar fusion for degenerative disease with a minimum 5-year follow-up from a consecutive series of 457 patients. Risk factors for adjacent segment disease (ASD) and early ASD (E-ASD, occurring ≤5 years) were evaluated, including patient factors (age, sex, BMI), preoperative factors (diagnosis, Pfirrmann grade), surgical factors (fusion method, number of segments), and radiological parameters (lumbar lordosis, fused segment angle, PI-LL mismatch). Multivariable Cox proportional hazards modelling and Kaplan–Meier survival analysis were performed to identify independent risk factors. Results: A total of 28 patients underwent revision surgery for ASD. Among them, 14 patients developed E-ASD. In the analysis of risk factors for ASD, the fusion method, and the postoperative PI-LL were statistically significant (p = 0.003, HR = 4.670, and p = 0.008, HR = 3.102, respectively). Regarding E-ASD, the fusion method was statistically significant (p = 0.038, HR = 5.444). The cumulative survival rate of ASD was 93.7% at 5 years and 76.4% at 10 years. Conclusions: ASD risk factors vary temporally after fusion surgery. Early ASD is primarily associated with the PLIF technique, while long-term risk relates to both the fusion method and sagittal alignment. Surgical planning should consider both the fusion technique and sagittal balance optimization to minimize ASD risk. Full article

Background: Low back pain (LBP) is a widespread and disabling condition affecting many older adults. Methods: This study aimed to establish correlations between LBP, physical activity, body composition, and posture in 114 women (mean age: 67.6 ± 5.68 years). Using a cross-sectional study design, LBP was assessed using the Oswestry Disability Index (ODI). Physical activity (PA) was measured using a pedometer to count the steps taken. Spinal curvatures in the sagittal plane were examined with a Rippstein Plurimeter. Results: Significant correlations were found between ODI and waist circumference (WC) (F(1, 113) = 7.574, p = 0.007), body mass index (BMI) (F(1, 113) = 11.660, p = 0.001), total fat (TF) (F(1, 113) = 8.806, p = 0.004, R² = 0.072), and total steps (F(1, 113) = 4.446, p = 0.037). No associations were found between ODI and hip circumference (HC) (F(1, 113) = 6.257, p = 0.014, R² = 0.52), waist-to-hip ratio (WHR) (F(1, 113) = 6.342, p = 0.013, R² = 0.053), thoracic kyphosis (THK) (F(1, 113) = 0.290, p = 0.591, R² = 0.003), or lumbar lordosis angle (LLA) (F(1, 113) = 0.290, p = 0.591, R² = 0.003). Conclusion: These results of the study findings reveal the multifactorial nature of LBP syndrome and highlight the connection between LBP and ODI, BMI, WC, and TF in older women. Additionally, we emphasize the importance of implementing further prevention and intervention strategies to manage the clinical manifestation of LBP in the geriatric population. Healthcare providers can better support this population’s well-being by focusing on targeted interventions. Full article

This study aimed to establish and assess the reliability of spino-pelvic and sagittal balance parameters measured during walking in patients with back pain, some of whom had radiological signs of sagittal imbalance, reflecting real-world clinical conditions. Dynamic assessment offers an alternative to conventional static measurements, potentially improving the evaluation of sagittal balance. Ten patients aged 56–73 years completed a six-minute walking assessment while being monitored by the optoelectric Qualisys Motion Capture System. Forty-nine reflective markers were placed to measure the spino-pelvic and sagittal balance parameters across five gait phases: pre-walk, initial-walk, mid-walk, end-walk, and post-walk. Test–retest reliability was evaluated using the intraclass correlation coefficient (ICC). The results showed excellent reliability for thoracic kyphosis angle (ICC = 0.97), C7-L5 sagittal trunk shift (ICC = 0.91), and global tilt angle (ICC = 0.99); good reliability for auditory meatus-hip axis sagittal trunk shift (ICC = 0.85); and moderate reliability for pelvic angle (ICC = 0.57), lumbar lordosis angle (ICC = 0.72), and sagittal trunk angle (ICC = 0.73). Despite minor marker placement inconsistencies and variations in body movement across trials, the findings support the use of this dynamic assessment method in research settings. Its clinical application could also enhance diagnostic accuracy and treatment planning for patients with sagittal balance disorders, allowing for better-tailored therapeutic interventions. Full article

Background/Objectives: Autism spectrum disorder (ASD) is a heterogeneous condition with diverse symptoms influenced by factors like gender, severity and the involvement of family and therapists. While many risk factors that contribute to ASD development are known, the exact etiology remains unclear. The relationship between speech ability and postural/gait patterns in ASD has not been extensively studied. This study aimed to verify if the ability to speak can affect body posture and gait patterns. Methods: The study involved 28 boys aged 6–17. The postural assessment used the Adams test, Bunnell scoliometer, goniometer, and inclinometer to measure trunk rotation, joint range of motion, and spinal curvature. Trunk muscle strength was assessed via a flexion test measuring position maintenance time. This study compare body posture parameters in speaking and non-speaking children with Autism Spectrum Disorders. Moreover the parameters were compared to the general norms. Results: The study observed a tendency for speaking children to deviate more from normative body posture. They presented shoulder protraction more often, increased lumbar lordosis angle, and anterior pelvic tilt. Additionally, non-speaking children were more prone to toe-walking, which, according to other studies, is present in approximately 8–9% of all children with autism spectrum disorders. Both groups presented a decreased angle of dorsal flexion in the ankle joint. Conclusions: This study suggests that speaking children with ASD exhibit greater anterior-posterior postural deviations (increased lumbar lordosis, shoulder protraction, anterior pelvic tilt) than non-speaking children. ASD did not affect scoliosis or trunk rotation. Non-speaking children showed a higher incidence of toe-walking. However, the small sample size limits the generalizability of these findings. Full article

Background/Objectives: Body posture is developmentally variable and individually diversified. As a chain of numerous unconditioned and conditioned reflexes, it is, in its essence, a psychomotor habit. The aim of the study was to create an original typology of body posture based on measurements using the Diers Formetric III 4D system. Methods: The research included 303 children aged 10–12. Results: Taking the ranges of standards for the angle of thoracic kyphosis (42–55°) and lumbar lordosis (33–47°) into account, it was shown that there are nine types of body posture. These are as follows: reduced kyphosis, reduced lordosis (K < 42°; L < 33°); reduced kyphosis, normal lordosis (K < 42°; 33° ≤ L ≤ 47°); reduced kyphosis, increased lordosis (K < 42°; L > 47°); normal kyphosis, reduced lordosis (42° ≤ K ≤ 55°; L < 33°); normal kyphosis, normal lordosis (42° ≤ K ≤ 55; 33° ≤ L ≤ 47°); normal kyphosis, increased lordosis (42° ≤ K ≤ 55°; L > 47°); increased kyphosis, reduced lordosis (K > 55°, L < 33°); increased kyphosis, normal lordosis (K > 55°; 33° ≤ L ≤ 47°); and increased kyphosis, increased lordosis (K > 55°; L > 47°). Conclusions: In the final evaluation of the Diers Formetric III 4D examination, the traditional division into round, concave, round-concave, and flat backs should be supplemented and expanded to include the nine posture types mentioned above. This will enable a more precise selection of corrective exercises, which will significantly improve their quality and effectiveness. Full article

Objective: Pars fractures are a common cause of lower back pain, especially among young individuals. Although computed tomography (CT) and magnetic resonance imaging (MRI) scanning are commonly used in developed regions, traditional radiography remains the main diagnostic method in many developing countries. This study assessed whether the standard radiographic angles suggested in textbooks are optimal for an Asian population since Asian groups have lower lumbar lordosis. This study found a 35° angle to be the most effective angle for lumbar oblique X-ray imaging. Additionally, the potential for a customized positioning auxiliary device was examined to improve image quality and reduce patient discomfort in cost-sensitive healthcare settings like Taiwan’s single-payer system. Methods: A total of 100 participants underwent lumbar oblique radiography using a specially designed footboard with angle markings. Radiologists evaluated 600 images based on waist-to-hip ratio (WHR) and body mass index to identify the optimal angulation for various body types. Results: For individuals with a WHR of 0.85, a 35° angle provided superior image quality, while 45° was more effective for slimmer patients. This optimized approach indicates the cost-effectiveness and diagnostic value of traditional X-ray imaging. Conclusions: The 35° angulation standardizes lumbar X-ray imaging for an Asian cohort, reducing repeat scans and improving accuracy. Using a positioning device further enhances image quality and patient comfort, supporting the clinical utility of traditional radiography in resource-limited environments. Full article

Background: While the importance of the upper and lower limbs in locomotion is well understood, the kinematics of the trunk during walking remains largely unexplored. Two decades ago, a casual observation was reported indicating spine lengthening in a small sample of mostly children during walking, but this observation was never replicated. Objectives: This study aims to verify the preliminary observation that spine lengthening occurs during walking and to explore changes in spine kinematics across three different age groups. Methods: A convenience sample of 45 healthy participants was divided into three groups of 15 individuals each: children (ages 5 to 13), young adults (ages 18 to 30), and older adults (ages 50 to 70). The spinal length, defined as the distance between C7 and the coccyx, and other kinematic parameters were analyzed using a motion analysis system while participants stood and walked standing and walking at their natural cadence. Results: In all groups, the length of the spine increased while walking compared to standing. This change was primarily due to a reduction in the inferior spinal angle, which is associated with lumbar lordosis, rather than a change in the superior spinal angle, which is related to thoracic kyphosis. The average change in spinal length during the walking cycle was approximately 7% in children, while it was only about 1% in adults. We also found a reduction in the range of motion for almost all the variables in adults. Conclusions: The increase in the spinal length during walking is related to a reduction in the physiological spine curve. This occurs due to muscle contractions which are needed to stabilize the locomotor system. As people age, the reduction in spinal length changes is associated with decreased spinal mobility and to a natural tendency toward anterior trunk flexion. Full article

Background: Chronic lumbopelvic pain is often linked to sacroiliac joint dysfunction, where the joint’s complex structure and biomechanics complicate diagnosis and treatment. Variability in load distribution and ligament stabilization within the pelvic ring further contributes to challenges in managing this condition. This study aims to develop a finite element model of the “lumbar spine–sacrum–pelvis” system to analyze the effects of lumbar lordosis, pelvic tilt, and asymmetrical articular gaps on stress and strain in the sacroiliac joint. Methods: A three-dimensional model was constructed using CT and MRI data, including key stabilizing ligaments. Sacral slope angles of 30°, 60°, and 85° were used to simulate varying lordosis, while pelvic tilt was introduced through a 6° lateral rotation. Results: The analysis revealed that sacral slope, ligament integrity, and joint symmetry significantly influence stress distribution. Hyperlordosis led to critical stress levels in interosseous and iliolumbar ligaments, exceeding failure thresholds. Asymmetrical gaps and pelvic tilt further altered the sacral rotation axis, increasing stress on sacroiliac joint ligaments. Conclusions: These findings highlight the importance of maintaining sacroiliac joint symmetry and lumbar–pelvic alignment to minimize stress on stabilizing ligaments, suggesting that treatment should focus on restoring alignment and joint symmetry. Full article