Search Results (109)

Background/Objectives: Correction surgery for adult spinal deformity (ASD) reduces disability but may lead to spinal stiffness. Cultural diversity may also influence how this stiffness affects daily life. We aimed to evaluate the impact of correction surgery on Japanese patients with ASD using a newly developed questionnaire and to clarify how these patients adapt to their living environment postoperatively in response to spinal stiffness. Methods: This retrospective study included 74 Japanese patients with operative ASD (mean age: 68.2 ± 7.5 years; fusion involving >5 levels) with a minimum follow-up of 1 year. Difficulties in performing various activities of daily living (ADLs) were assessed using a novel 20-item questionnaire tailored to the Oriental lifestyle. The questionnaire also evaluated lifestyle and environmental changes after surgery. Sagittal and coronal spinal parameters were measured using whole-spine radiographs, and clinical outcomes were assessed using the ODI and SRS-22 scores. Results: Coronal and sagittal alignment significantly improved postoperatively. Although the total ADL score remained unchanged, four trunk-bending activities showed significant deterioration. The lower instrumented vertebrae level and pelvic fusion were associated with lower scores in 11 items closely related to trunk bending or the Oriental lifestyle. After surgery, 61% of patients switched from a Japanese-style mattress to a bed, and 72% swapped their low dining table for one with chairs. Both the ODI and SRS-22 scores showed significant postoperative improvements. Conclusions: Trunk-bending activities worsened postoperatively in Japanese patients with ASD, especially those who underwent pelvic fusion. Additionally, patients often modified their living environment after surgery to accommodate spinal stiffness. Full article

Background: Multisegmental lumbar degenerative disease (ms-LDD) is a common condition in older adults, often requiring surgical intervention. While rigid stabilization remains the gold standard, it is associated with complications such as adjacent segment disease (ASD), higher blood loss, and longer recovery times. The Dynesys dynamic stabilization system offers an alternative by preserving motion while stabilizing the spine. However, data comparing Dynesys with fusion in multisegmental cases are limited. Objective: This study evaluates the clinical and radiographic outcomes of Dynesys dynamic stabilization versus rigid stabilization in the treatment of ms-LDD. Methods: A retrospective analysis was conducted on 53 patients (mean age: 62.25 ± 15.37 years) who underwent either Dynesys dynamic stabilization (n = 27) or PLIF (n = 26) for ms-LDD involving at least seven motion segments. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), while radiological parameters such as lumbar lordosis (LL), sagittal vertical axis (SVA), and spinopelvic parameters (pelvic incidence, pelvic tilt and, sacral slope) were analyzed. A two-stage surgical approach was employed in the Dynesys group to enhance osseointegration, particularly in elderly osteoporotic patients. Results: Both groups showed significant improvements in VAS and ODI scores postoperatively (p < 0.001), with no significant differences between them. However, the Dynesys group demonstrated superior sagittal alignment correction, with a significant increase in LL (p < 0.002) and a significant decrease in SVA (p < 0.0015), whereas changes in the rigid stabilization group were not statistically significant. Additionally, the Dynesys group had fewer complications, including a lower incidence of ASD (0 vs. 6 cases). The two-stage technique facilitated improved screw osseointegration and reduced surgical risks in osteoporotic patients. Conclusions: Dynesys dynamic stabilization is an effective alternative to rigid stabilization in ms-LDD, offering comparable pain relief and functional improvement while preserving motion and reducing ASD risk. The two-stage approach enhances long-term stability, making it particularly suitable for elderly or osteoporotic patients. Further long-term studies are needed to confirm these findings. Full article

Background: A precise radiographic evaluation of adolescent idiopathic scoliosis (AIS) is essential for effective treatment planning and follow-up. The pelvic axial rotation (PAR) and horizontal balance of the pelvis are critical factors to consider throughout the treatment and monitoring of AIS. While some previous studies have examined spinal curvature in relation to PAR direction and the direction of the major curve (DMC) in AIS patients, this study aims to explore the relationship between scoliosis morphology, pelvic axial rotation (PAR), and the direction of the major curve in patients with adolescent idiopathic scoliosis. Methods: Radiographic images of 397 patients diagnosed with AIS between 2023 and 2024 at a Tertiary Referral Hospital were retrospectively evaluated. Morphological and morphometric measurements, including sex, Lenke and Risser classifications, lower leg discrepancy, Cobb angle, PAR direction, and major curvature direction, were performed. Results: The mean age of the 397 patients (246 female, 151 male) was 14.47 ± 2.29. There is no significant correlation between PAR and DMC (p = 0.919). No significant differences were found in terms of sex (p = 0.603). Regardless of the PAR direction, major curvature was more common on the left side (57.7%). Furthermore, a positive correlation was noted between the Cobb angle and LLD. Conclusions: Our study contributes to a growing body of literature questioning the deterministic role of PAR in AIS. While previous reports have emphasized the directional correlation between the pelvis and spinal curvature, our findings suggest that pelvic rotation may not be a reliable indicator of curve direction in all patients. This highlights the complexity of AIS biomechanics and underscores the need for individualized radiographic and clinical evaluation rather than a reliance on generalized compensatory models. Full article

Background: Sexual dimorphism in Asian elephants (Elephas maximus) is evident in external features, but skeletal differences remain underexplored. This study aimed to examine the skull, scapula, and pelvis using traditional morphometric methods to assess sex-related variation. Methods: Eleven skeletal specimens were analyzed, including nine skulls, eleven pelves, and eighteen scapulae. Linear measurements were obtained using measuring tape and calipers. Statistical analyses included Mann–Whitney U tests, Pearson’s correlation, and logistic regression for sex prediction. Results: No significant differences were found in skull measurements between sexes. However, the pelvis and scapula exhibited notable variation. Significant pelvic parameters included pelvic girdle length (p = 0.024), symphysis length (p = 0.012), and pubis shaft perimeter (p = 0.048). Scapular differences were observed in diagonal breadth, mediolateral width, and spine length. Logistic regression using pelvic measurements yielded 100% accuracy for female classification and 66.67% for males, with an overall prediction accuracy of 90.91%. Conclusions: The pelvis demonstrated the highest reliability for sex determination. These findings enhance the anatomical understanding of Asian elephants and support applications in conservation, forensic science, and population studies. Future research with larger sample sizes and advanced imaging may improve the precision of morphometric sex prediction models. Full article

Background: Adrenal glands are situated cranially and in close proximity to both kidneys. The rabbit is a preferred animal pet species and is also used as an experimental model in research. The aim of this study was to investigate the CT anatomical features of the rabbit adrenal glands, using the CT device SOMATOM. Methods: Ten sexually mature clinically healthy rabbits, with body weights from 2.5 to 3.0 kg were used. They were separated into two groups—five males and five females. CT algorithm: Transverse, sagittal, and dorsal CT studies were performed. The animals were positioned in supine recumbency. They were anesthetized with 15 mg/kg Zoletil^® 50. Helical CT was carried out. The body was scanned from the intrathoracic part of the abdominal cavity to the pelvic inlet. CCD, DVD, and MLD dimensions were measured. Results: Transverse CT scans at the Th12 and L1 level visualized the topography of the right and left adrenal glands. Sagittal CT scans of Regio abdominis, 10 mm to the right and to the left of the median plane, showed the right and left adrenal glands as findings with intermediate attenuation. The dorsal CT investigation of Regio abdominis 30 mm and 45 mm ventral to the spine demonstrated both glands in the vicinity of abdominal organs and large blood vessels. CCD of the right adrenal gland was 6.9 ± 0.5 mm, DVD of the same gland was 5.7 ± 0.7 mm, and MLD was—3.9 ± 0.3 mm. CCD of the left adrenal gland was 5.4 ± 0.6 mm, DVD was—4.0 ± 1.1 mm, and MLD was—4.1 ± 0.9 mm. Conclusions: CCD and DVD of the right adrenal gland were greater than the same parameters of the left gland. MLD of the right adrenal gland was lower than the same parameter measured for the left one. Full article

In this article, we present a case of a 49-year-old woman presenting with a recurrent metastatic neuroendocrine tumor. Background: Insulinomas are neuroendocrine tumors derived from beta cells of the pancreas that secrete insulin. Usually, they are benign tumors; however, metastatic insulinomas are an extremely rare malignant form of these tumors, carrying a significantly worse prognosis. Case Presentation: A 49-year-old woman, a patient in the University Hospital in Wroclaw in the Department of Endocrinology, Diabetes and Isotope Therapy, first presented with abdominal pain in 2009, when ultrasound and further examination led to the diagnosis of a tumor in the pancreas (a solid pseudopapillary tumor of the pancreas—meta NET G2), and the patient underwent distal pancreatectomy with splenectomy. For ten years, she was under observation, and her symptoms, such as abdominal pain, nausea, weight loss, and general weakness, reappeared in 2019. Then, magnetic resonance imaging (MRI) showed a lesion in the liver, and further histopathology revealed neuroendocrine tumor (NET) metastasis to the liver. In 2022, the patient presented with loss of consciousness and convulsion, loss of weight, and hypoglycemia after meals. In April 2022, the daily glycemic profile was recorded and a 72 h fasting test was performed; however, their results excluded insulinoma. Positron emission tomography–computed tomography (PET-CT) with 18F-fluorodeoxyglucose (18F-FDG) and PET with gallium-68-DOTA-(Tyr3)-octreotate (68Ga-DOTA-TATE) showed a metastatic proliferative process in the liver. Persistent hypoglycemia led to another hospitalization in May 2022, and repeated tests allowed for the diagnosis of insulinoma. Treatment with somatostatin analogs and diazoxide was started. A CT scan in November 2022 and a PET scan in January 2023 showed new metastases to the liver, bones, and cervical lymph nodes, and it was decided to intensify the treatment. In May 2023, the patient was qualified for Lutathera treatment for insulinoma at the University Clinical Hospital in Poznań. In June 2023, another disturbing symptom was reported by the patient, a painful lump in the breast. During diagnostics, metastases with high proliferation markers were found in both breasts. Two months later, in August 2023, the patient received another dose of Lutathera. In October 2023, significant progression of liver lesions, metastases to bones of the spine, ribs, and pelvis, and periaortic and pelvic lymphadenopathy were found as well as elevated values of neuron-specific enolase and calcitonin. The patient was also referred to the Palliative Medicine Home Hospice. In consultation with the Lower Silesian Cancer Center, the decision was made to forgo further treatment with PRRT and initiate systemic chemotherapy. Despite the chosen treatment, the patient died on 27/DEC/2023. Conclusions: This case report can serve clinicians, as it presents a case of an extremely rare and insidious tumor, metastatic insulinoma. Full article

Background: The anatomic pathways of the lateral femoral cutaneous nerve (LFCN) have primarily been reported in adult in vitro populations with limited branching patterns. Children with hip disorders may require surgical treatment with an anterior approach, and the LFCN is a structure at risk. The aim of our study was to photographically verify the initial six-centimeter pathway of the LFCN in children measured from its appearance at the anterior superior iliac spine (ASIS). Method: A total of 31 children underwent pelvic osteotomy, including three bilateral. The nerve was identified and isolated in the subcutaneous layer. Standardized photographs were obtained. Our outcome parameters were type of pelvic exit, branching pattern, distance from the pelvic exit to the ASIS, and nerve thickness and appearance, categorized as straight or curved. Results: 91.3% of nerves passed medially to the ASIS. A total of 74% of the nerves showed a splitting branching pattern, and 9% had a branching pattern of more than four. The mean distance from pelvic exit to the ASIS was 17 mm, and the mean nerve thickness was 2.7 mm. Conclusions: In contrast to adult anatomy, our study shows that the LFCN has two or more branches in 74% of patients. Thus, based on our observations, surgeons should carefully dissect the subcutaneous tissue around the LCFN due to the numerous anatomical variations to avoid iatrogenic damage to the nerve. Full article

Background/Objectives: The preschool period plays an essential role in shaping a child’s overall development, which influences physical, emotional, social, and cognitive growth. At this stage, establishing proper postural habits is essential, as it can have lasting effects on health, well-being, helps to prevent future issues, and supports overall development. Therefore, the present work aims to determine the differences in postural status between boys and girls of preschool age. Methods: The sample of participants consisted of 92 children (n = 46 boys and n = 46 girls); the average age for girls was 5.41 ± 0.30 years and for boys it was 5.53 ± 0.31 years. Data were collected using licensed state-of-the-art diagnostic equipment, Contemplas 3D Posture Compact, using 16 variables to assess postural status with a Mann–Whitney U test. Results: The results of this study indicate that boys have more pronounced deformities in the following variables: shoulder displacement (p = 0.047), pelvic obliquity (p = 0.000), sag. distance cervical spine–sacrum (p = 0.029), sag. distance thoracic spine–sacrum (SDTS) (p = 0.016), and sag. distance lumbar spine–sacrum (SDLS) (p = 0.005). Conclusions: This study confirmed gender differences in postural characteristics in preschool children. Boys showed a greater tendency towards postural deviations, indicating the necessity for specific interventions and programs to improve their posture. On the basis of the results of this research, it is recommended to carry out cross-cultural research that would enable the comparison of results among children from different environments and cultural contexts in order to determine possible differences and particularities in the development of postural characteristics. Future research should include larger and more diverse samples of participants, including children from rural and urban areas, in order to ensure the representativeness and generalizability of the results. In addition, conducting a longitudinal study that would monitor the postural characteristics of children through different developmental stages is suggested, aiming to identify critical periods for intervention and to determine, more precisely, development trends within the context of gender differences. Full article

Background/Objectives: Pelvic incidence (PI) is deeply related to spinal sagittal alignment. Previous reports have demonstrated a deep association between PI and anatomical sacral slope (a-SS), underscoring the utility of a-SS in estimating PI. The investigation of temporal changes in pelvic and spinal alignment in healthy individuals is crucial for conducting surgical interventions such as total hip arthroplasty; however, these changes remain undocumented. There have been a few Japanese reports on this topic. This study explores the relationship between aging-related changes and pelvic and spinal sagittal alignment. Methods: By employing the methodology from a study by Imai et al., we analyzed the anterior pelvic plane (APPA), PI, pelvic tilt (PT), sacral slope (SS), a-SS, anatomical pelvic tilt (a-PT), thoracic kyphosis angle (TK), and lumbar kyphosis angle (LL), to determine the degree of kyphosis in healthy individuals. Results: APPA decreased over time, SS altered gradually, and PT underwent more pronounced variations with age; however, PI did not change significantly. a-SS changed early and was lower in the younger group than in the older group. Moreover, a-PT decreased with age. Spinal sagittal alignment was similar between the younger and older groups, changing gradually in LL and earlier in TK than in LL. Conclusions: Pelvic changes are compensated for by the pelvis, and TK changes, i.e., spinal alignment changes, are compensated for by the LL. The posterior pelvic tilt progresses with age, moving from compensation at the sacroiliac joint to compensation at the sacrum. Full article

Background/Objectives: Chordomas are rare primary osseous tumors of the spine and skull base that may portend significant morbidity and mortality. Gender disparities in the management and outcomes of spinal and pelvic chordomas have been sparsely studied. This study aimed to examine the effect of gender on the treatment utilization and outcomes in patients with vertebral column and sacrum/pelvis chordomas. Methods: A retrospective cohort study was performed using the 2000 to 2020 Surveillance, Epidemiology, and End Results (SEER) Registry, a U.S. population-based cancer registry database. Patients with histologically confirmed chordoma of the vertebral column or the sacrum/pelvis were identified using ICD-O-3 codes. The study population was divided into gender-based cohorts: male and female. The patient demographics, tumor characteristics, treatment variables, and mortality were assessed. Results: A total of 791 patients were identified and stratified by gender: 485 (61.3%) male and 306 (38.7%) female. The mean tumor size was similar between the cohorts (p = 0.377), as was the tumor location, with most arising from the pelvic bones/sacrum/coccyx (p = 0.953). While the treatment characteristics did not significantly vary, among patients who received both radiotherapy and surgery, neo-adjuvant radiotherapy was utilized at higher frequencies in the male patients (p = 0.011). For vertebral column chordomas, the median (p = 0.230) and five-year survival (p = 0.220) was similar between cohorts, and gender was not a predictor of survival (p = 0.239). Similarly, for pelvic chordomas, the median (p = 0.820) and five-year survival (p = 0.820) was similar between cohorts, and gender was not associated with survival (p = 0.816). Conclusions: Our study suggests that gender may influence treatment utilization but not mortality in patients with chordomas of the spine and sacrum. 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

Study Design: This is an observational study. Objectives: In general practice, it is noted that some people can deal more easily with a prominent belly than others. Recent use of spinopelvic parameters in the analysis of the spine might explain this observation. This study aimed to determine the correlation between pelvic incidence (PI), waist circumference (WC), and body mass index (BMI) in patients with non-specific chronic low back pain. We hypothesized that people with a low PI (non-pronounced lumbar lordosis) have significantly lower WC values than those with a high PI (pronounced lumbar lordosis). Methods: Adult patients presenting to the outpatient neurosurgery clinic with non-specific chronic low back pain who had undergone full spine radiography were included. The PI, BMI, and WC were measured in all cases. Results: We included 272 patients (male–female ratio, 1.08) with a mean age of 54 years. There was a statistically significant difference (p < 0.05) in the mean PI according to BMI group. The mean PI in our population was 57.8° (range 28.4–97.2°, SD 12.1°). A significant correlation coefficient of 0.271 (p < 0.001; 95%CI 0.157–0.377) was found between BMI and PI and 0.410 (p-value < 0.001; 95%CI 0.262–0.539). Conclusions: We found a significant correlation between PI, BMI, and WC. This finding is the first step in confirming our hypothesis that a patient with a high PI might be able to tolerate being overweight and a high WC better than patients with a low PI, possibly because of their ability to retrovert the pelvis to a greater extent. Further research is warranted to investigate whether people with a high pelvic PI can better cope with obesity, especially those with a higher waist circumference and abdominal weight. Full article

Background/Objectives: Instability is a major reason for revision after total hip arthroplasty (THA), and acetabular cup placement in the “traditional” safe zone does not protect against dislocations. Spinopelvic mobility may play a role in impingement and dislocation after THA. Personalized acetabular cup placement that incorporates spinopelvic mobility is currently lacking in the literature. Methods: The spinopelvic motion of 116 patients was evaluated during preoperative planning. All patients underwent radiological assessments with an anteroposterior pelvis radiograph in the standing and supine positions and a lateral view of the lumbar spine and pelvis in the standing and sitting positions. The pelvic incidence, pelvic tilt, sacral slope, standing anterior pelvic plane tilt, sitting anterior pelvic plane tilt, and lumbar lordosis angle were measured, and the degree of pelvic motion from standing to sitting was calculated. The development of the patient-specific target for the acetabular cup was based on the mean mobility of the whole group and the specific posture of each patient. Results: The average pelvic incidence was 51.0 ± 13.1 degrees, the sacral slope was 35.0 ± 10.3 degrees, the pelvic tilt was 16.0 ± 13.3 degrees, the standing anterior pelvic plane tilt was 3.4 ± 12 degrees backward, and the degree of lumbar lordosis was 39.5 ± 11.3 degrees. The mean spinopelvic mobility was 27.3 ± 13.4 degrees. The measurements had good to excellent interobserver and intraobserver reliability. On the basis of these measurements, we developed a novel algorithm for a patient-specific target for acetabular cup placement. Conclusions: the evaluation of spinopelvic mobility has good to excellent interobserver and intraobserver reliability and can be used for personalized acetabular cup placement. Full article

Background: Sagittal alignment in the lumbar spine is essential for spinal stability and functionality, with significant implications in surgical planning for spinal deformity correction. However, standardized lumbar partitioning, particularly identifying a critical sagittal alignment zone, remains underdefined. This study aims to establish a reliable lumbar partition to guide surgical decisions and optimize clinical outcomes. Methods: A systematic review of four major biomedical databases yielded 32 studies, of which 4 met the inclusion criteria. Studies on asymptomatic adults with segmental lordosis data stratified by pelvic incidence were analyzed. Lumbar lordosis values were converted to percentages, allowing for cross-study comparison. Sensitivity analysis and bias assessment were performed to ensure methodological rigor. Results: The findings identified the L3–L5 interval, especially around the L4 vertebra, as a critical biomechanical zone across various populations and pelvic incidence groups. Individuals with higher pelvic incidence had concentrated lordosis in lower segments, while those with lower pelvic incidence had greater lordosis in upper segments, underscoring the L3–L5 region’s stability as a surgical reference. Conclusions: The L3–L5 interval serves as a key partition zone for sagittal alignment, providing a stable reference for lumbar spine fusion. These findings offer a foundational clinical reference, potentially improving alignment outcomes and reducing postoperative complications. Full article

Background/Objectives: The aim of this study was to evaluate changes in trunk height and variations in spino-pelvic parameters during trunk self-elongation. Two populations were studied: non-athletes and gymnasts, who differ in their engagement with core-strengthening exercises. Methods: EOS biplanar radiographs were taken on 14 non-athletes and 24 gymnasts in both neutral and trunk self-elongation positions. Three-dimensional reconstructions of the pelvis and spine were used to calculate effective trunk height, thoracic and lumbar contributions, and spino-pelvic parameters. Results: Trunk self-elongation resulted in a significant increase in trunk height for both groups (7 mm on average, range: −1 to 14 mm), accompanied by a reduction in thoracic kyphosis for all participants (−10° for non-athletes and −17° for gymnasts, on average) and a reduction in lumbar lordosis in most participants (−5° for non-athletes and −7° for gymnasts, on average). However, some individuals in both groups exhibited an increase in lumbar lordosis, which reduced the contribution of the lumbar region to overall trunk height. Conclusions: Trunk self-elongation instruction effectively increases trunk height, but additional instructions, such as pelvic retroversion, may enhance its effectiveness. Full article