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Journal of Pediatric Orthopedics 1988
Topics: Adolescent; Biomechanical Phenomena; Humans; Kyphosis; Lordosis; Male; Radiography
PubMed: 3335627
DOI: 10.1097/01241398-198801000-00019 -
Neurosurgery Clinics of North America Jul 2018The pelvic incidence defines the amount of lordosis required in the lumbar spine, and a lumbar lordosis within 11° of the pelvic incidence defines alignment of the... (Review)
Review
The pelvic incidence defines the amount of lordosis required in the lumbar spine, and a lumbar lordosis within 11° of the pelvic incidence defines alignment of the lumbo-pelvic region. Pelvic tilt is a compensatory mechanism that allows patients to achieve sagittal balance in the setting of decreased lumbar lordosis with the primary compensatory mechanisms being hip extension and knee flexion. Planning an adult lumbar deformity operation requires a comprehensive history and physical examination and thorough radiographic evaluation with the goal of restoring alignment between the pelvic incidence and lumbar lordosis and restoring a normal pelvic tilt.
Topics: Humans; Lordosis; Lumbar Vertebrae; Lumbosacral Region; Pelvis; Preoperative Care
PubMed: 29933800
DOI: 10.1016/j.nec.2018.03.003 -
European Spine Journal : Official... Sep 2011Standing in an erect position is a human property. The pelvis anatomy and position, defined by the pelvis incidence, interact with the spinal organization in shape and... (Comparative Study)
Comparative Study Review
INTRODUCTION
Standing in an erect position is a human property. The pelvis anatomy and position, defined by the pelvis incidence, interact with the spinal organization in shape and position to regulate the sagittal balance between both the spine and pelvis. Sagittal balance of the human body may be defined by a setting of different parameters such as (a) pelvic parameters: pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS); (b) C7 positioning: spino-pelvic angle (SSA) and C7 plumb line; (c) shape of the spine: lumbar lordosis.
BIOMECHANICAL ADAPTATION OF THE SPINE IN PATHOLOGY
In case of pathological kyphosis, different mechanical compensations may be activated. When the spine remains flexible, the hyperextension of the spine below or above compensates the kyphosis. When the spine is rigid, the only way is rotating backward the pelvis (retroversion). This mechanism is limited by the value of PI. Hip extension is a limitation factor of big retroversion when PI is high. Flexion of the knees may occur when hip extension is overpassed. The quantity of global kyphosis may be calculated by the SSA. The more SSA decreases, the more the severity of kyphosis increases. We used Roussouly's classification of lumbar lordosis into four types to define the shape of the spine. The forces acting on a spinal unit are combined in a contact force (CF). CF is the addition of gravity and muscle forces. In case of unbalance, CF is tremendously increased. Distribution of CF depends on the vertebral plate orientation. In an average tilt (45°), the two resultants, parallel to the plate (sliding force) or perpendicular (pressure), are equivalent. If the tilt increases, the sliding force is predominant. On the contrary, with a horizontal plate, the pressure increases. Importance of curvature is another factor of CF distribution. In a flat or kyphosis spine, CF acts more on the vertebral bodies and disc. In the case of important extension curvature, it is on the posterior elements that CF acts more. According to the shape of the spine, we may expect different degenerative evolution: (a) Type 1 is a long thoraco-lumbar kyphosis and a short hyperlordosis: discopathies in the TL area and arthritis of the posterior facets in the distal lumbar spine. In younger patients, L4 S1 hyperextension may induce a nutcracker L5 spondylolysis. (b) Type 2 is a flat lordosis: Stress is at its maximum on the discs with a high risk of early disc herniation than later with multilevel discopathies. (c) Type 3 has an average shape without characteristics for a specific degeneration of the spine. (d) Type 4 is a long and curved lumbar spine: this is the spine for L5 isthmic lysis by shear forces. When the patient keeps the lordosis curvature, a posterior arthritis may occur and later a degenerative L4 L5 spondylolisthesis. Older patients may lose the lordosis curvature, SSA decreases and pelvis tilt increases. A widely retroverted pelvis with a high pelvic incidence is certainly a previous Type 4 and a restoration of a big lordosis is needed in case of arthrodesis.
CONCLUSION
The genuine shape of the spine is probably one of the main mechanical factors of degenerative evolution. This shape is oriented by a shape pelvis parameter, the pelvis incidence. In case of pathology, this constant parameter is the only signature to determine the original spine shape we have to restore the balance of the patient.
Topics: Adaptation, Physiological; Biomechanical Phenomena; Humans; Kyphosis; Lordosis; Pelvis; Postural Balance; Radiography; Spine
PubMed: 21809016
DOI: 10.1007/s00586-011-1928-x -
Minerva Ortopedica Nov 1967
Topics: Adolescent; Age Factors; Cerebral Palsy; Child; Female; Gait; Hip; Humans; Lordosis; Lumbosacral Region; Male; Radiography; Sex Factors
PubMed: 5617763
DOI: No ID Found -
Clinical Spine Surgery Apr 2017A retrospective study.
STUDY DESIGN
A retrospective study.
OBJECTIVE
Our study opted to clarify the remaining issues of lumbar lordosis (LL) with regard to (1) its physiological values, (2) age, (3) sex, and (4) facet joint (FJ) arthritis and orientation using computed tomography (CT) scans.
SUMMARY OF BACKGROUND DATA
Recent studies have questioned whether LL really decreases with age, but study sample sizes have been rather small and mostly been based on x-rays. As hyperlordosis increases the load transferred through the FJs, it seems plausible that hyperlordosis may lead to FJ arthritis at the lower lumbar spine.
METHODS
We retrospectively analyzed the CT scans of 620 individuals, with a mean age of 42.5 (range, 14-94) years, who presented to our traumatology department and underwent a whole-body CT scan, between 2008 and 2010. LL was evaluated between the superior endplates of L1 and S1. FJs of the lumbar spine were evaluated for arthritis and orientation between L2 and S1.
RESULTS
(1) The mean LL was 49.0 degrees (SD 11.1 degrees; range, 11.4-80.1 degrees). (2) LL increased with age and there was a significant difference in LL in our age groups (30 y and below, 31-50, 51-70, and ≥71 y and above) (P=0.02). (3) There was no significant difference in LL between females and males (50 and 49 degrees) (P=0.17). (4) LL showed a significant linear association with FJ arthritis [P=0.0026, OR=1.022 (1.008-1.036)] and sagittal FJ orientation at L5/S1 (P=0.001). In a logistic regression analysis, the cutoff point for LL was 49.4 degrees.
CONCLUSIONS
This is the largest CT-based study on LL and FJs. LL significantly increases with age. As a novelty finding, hyperlordosis is significantly associated with FJ arthritis and sagittal FJ orientation at the lower lumbar spine. Thus, hyperlordosis may present with back pain and patients may benefit from surgical correction, for example, in the setting of trauma.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Arthritis; Female; Humans; Lordosis; Lumbar Vertebrae; Male; Middle Aged; Retrospective Studies; Tomography Scanners, X-Ray Computed; Young Adult; Zygapophyseal Joint
PubMed: 28323692
DOI: 10.1097/BSD.0b013e3182aab266 -
European Spine Journal : Official... Aug 2018Although the Roussouly classification of common variants in spinal sagittal alignment is well accepted, no studies have implemented it in an asymptomatic adult...
PURPOSE
Although the Roussouly classification of common variants in spinal sagittal alignment is well accepted, no studies have implemented it in an asymptomatic adult population. In addition, no study investigated the radiographic features of asymptomatic patients with an anteverted pelvis. The aim of this prospective radiographic study of 296 asymptomatic adults without spinal pathology was to investigate how the Roussouly classification could include the anteverted pelvis concept.
METHODS
Pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), and the lumbar parameters lumbar lordosis (Global LL), lordosis tilt angle (LTA), total number of lordotic vertebra (LL verteb), and C7 plumbline/sacrofemoral distance ratio (C7PL ratio) were evaluated in 296 healthy volunteers (126 males, 170 females; mean age, 27 years; range 18-48 years). Comparison between the five types of the Roussouly classification used Student, ANOVA, and Tukey tests for quantitative variables and χ , Fischer, and Holm tests for qualitative variables.
RESULTS
Mean PI and PT were, respectively, (39°, 10°) for type 1, (41°, 10°) for type 2, (53°, 13°) for type 3, and (62°, 12°) for type 4 (p < 0.0001 and p < 0.01). A sizable portion (16%) of the population (type 3 AP) showed low-grade PI (mean, 48° ± 6°) despite having SS > 35°. PT was low or negative (mean 4° ± 3°). C7PL ratio was >1 (in front of the hip axis) in 13% of all cases, and between 0 and 1 (between sacrum and hip axis) in 49%.
CONCLUSION
Although asymptomatic adults stood with stable global balance, the sagittal spinal alignment of healthy subjects, newly divided in 5 sagittal types, varied significantly. Type 3 AP appears as a new and unusual sagittal shape with low-grade PI, very low or negative PT, and hyperlordosis. Whereas most asymptomatic adults stood with C7PL behind the hip axis, a sizeable portion had C7 in front of the hip axis. This could be a new controversial aspect of ideal spinal balance.
Topics: Adolescent; Adult; Anthropometry; Female; Healthy Volunteers; Humans; Lordosis; Male; Middle Aged; Pelvic Bones; Postural Balance; Prospective Studies; Radiography; Reference Values; Sacrum; Spine; Young Adult
PubMed: 28455623
DOI: 10.1007/s00586-017-5111-x -
Spine Deformity Jul 2021Cerebral palsy (CP) is a static encephalopathy with progressive musculoskeletal pathology. Non-ambulant children (GMFCS IV and V) with CP have high rates of spastic hip...
BACKGROUND
Cerebral palsy (CP) is a static encephalopathy with progressive musculoskeletal pathology. Non-ambulant children (GMFCS IV and V) with CP have high rates of spastic hip disease and neuromuscular scoliosis. The effect of spinal fusion and spinal deformity on hip dislocation following total hip arthroplasty has been well studied, however in CP this remains largely unknown. This study aimed to identify factors associated with worsening postoperative hip status (WHS) following corrective spinal fusion in children with GMFCS IV and V CP.
METHODS
Retrospective review of GMFSC IV and V CP patients in a prospective multicenter database undergoing spinal fusion, with 5 years follow-up. WHS was determined by permutations of baseline (BL), 1 year, 2 years, and 5 years hip status and defined by a change from an enlocated hip at BL that became subluxated, dislocated or resected post-op, or a subluxated hip that became dislocated or resected. Hip status was analyzed against patient demographics, hip position, surgical variables, and coronal and sagittal spinal alignment parameters. Cutoff values for parameters at which the relationship with hip status was significant was determined using receiver operating characteristic curves. Logistic regression determined odds ratios for predictors of WHS.
RESULTS
Eighty four patients were included. 37 (44%) had WHS postoperatively. ROC analysis and logistic regression demonstrated that the only spinopelvic alignment parameter that significantly correlated with WHS was lumbar hyperlordosis (T12-L5) > 60° (p = 0.028), OR = 2.77 (CI 1.10-6.94). All patients showed an increase in pre-to-postop LL. Change in LL pre-to-postop was no different between groups (p = 0.318), however the WHS group was more lordotic at BL and postop (pre44°/post58° vs pre32°/post51° in the no change group). Age, sex, Risser, hip position, levels fused, coronal parameters, global sagittal alignment (SVA), thoracic kyphosis, and reoperation were not associated with WHS.
CONCLUSION
Postoperative hyperlordosis(> 60°) is a risk factor for WHS at 5 years after spinal fusion in non-ambulant CP patients. WHS likely relates to anterior pelvic tilt and functional acetabular retroversion due to hyperlordosis, as well as loss of protective lumbopelvic motion causing anterior femoracetabular impingement.
LEVEL OF EVIDENCE
III.
Topics: Cerebral Palsy; Child; Humans; Lordosis; Prospective Studies; Retrospective Studies; Scoliosis
PubMed: 33523455
DOI: 10.1007/s43390-020-00281-4 -
Journal of Back and Musculoskeletal... 2015There are many types of treatments and recommendations for restoring back deformities depending on doctors' knowledge and opinions. The purpose of the exercises is to... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
There are many types of treatments and recommendations for restoring back deformities depending on doctors' knowledge and opinions. The purpose of the exercises is to reduce pain and to ensure stability of the lower trunk by toning the abdominal muscles, buttocks and hamstrings. Given the duration of flares and relapses rate, it is important to apply an efficient and lasting treatment.
OBJECTIVE
To evaluate the effects of 8 weeks of William's training on flexibility of lumbosacral muscles and lumbar angle in females with Hyperlordosis.
METHODS
Forty female students with lumbar lordosis more than normal degrees (Hyperlordotic) that were randomly divided into exercise and control groups were selected as the study sample. The lumbar lordosis was measured using a flexible ruler, flexibility of hamstring muscles was measured with the active knee extension test, the hip flexor muscles strength was measured using Thomas test, the lumbar muscles flexibility measures by Schober test, abdominal muscles strength measured by Sit-Up test and back pain was measured using McGill's Visual Analogue Scales (VAS) questionnaire. Data were compared before and post-test using independent and paired t-testes.
RESULTS
Results showed that 8 weeks of William's exercise led to significant decreases in lumbar angle and back pain, increases in flexibility of hamstring muscles, hip flexor muscles flexibility, lumbar extensor muscles flexibility and abdominal muscles strength.
CONCLUSION
The findings show that William's corrective training can be considered as a useful and valid method for restoring and refining back deformities like as accentuated back-arc and became wreaked muscles' performance in lumbar areas.
Topics: Abdominal Muscles; Adolescent; Exercise Therapy; Female; Hip; Humans; Lordosis; Low Back Pain; Lumbosacral Region; Muscle, Skeletal; Pain Measurement; Torso
PubMed: 25736954
DOI: 10.3233/BMR-150585 -
Neurosurgery Clinics of North America Jul 2018Lateral anterior column release (ACR) is a powerful extension of the minimally invasive lateral lumbar interbody fusion procedure that incorporates division of the... (Review)
Review
Lateral anterior column release (ACR) is a powerful extension of the minimally invasive lateral lumbar interbody fusion procedure that incorporates division of the anterior longitudinal ligament to allow manipulation of the anterior and middle spinal columns. The resulting surgical control permits restoration of significant segmental lordosis that, when combined with varying posterior column releases, can achieve global sagittal realignment on par with traditional 3-column osteotomies. As a result, ACR is a factor in the growth of minimally invasive strategies for the correction of spinal deformities.
Topics: Bone Lengthening; Humans; Lordosis; Osteotomy; Patient Selection; Treatment Outcome
PubMed: 29933810
DOI: 10.1016/j.nec.2018.03.008 -
JBJS Case Connector Apr 2022The accordion phenomenon is defined as the difference in the disc space observed on x-ray or computed tomography images taken in both standing and supine positions,...
CASE
The accordion phenomenon is defined as the difference in the disc space observed on x-ray or computed tomography images taken in both standing and supine positions, which results in a discrepancy of local spinal alignment. Oblique lateral interbody fusion (OLIF) is a less invasive method of potentially correcting both coronal and sagittal spinal alignment. We present the case of a 66-year-old woman with rheumatoid arthritis treated with OLIF for degenerative disc disease presenting with hyperlordosis and negative sagittal vertical axis (SVA) because of the accordion phenomenon.
CONCLUSION
OLIF for severe degenerative disc disease presenting with hyperlordosis and negative SVA because of the accordion phenomenon may be effective.
Topics: Aged; Female; Humans; Intervertebral Disc Degeneration; Lordosis; Lumbar Vertebrae; Radiography; Spinal Fusion
PubMed: 36099495
DOI: 10.2106/JBJS.CC.22.00039