Cervical spine alignment in the pediatric population: a radiographic normative study of 150 asymptomatic patients.

PubMed

Abelin-Genevois, K; Idjerouidene, A; Roussouly, P; Vital, J M; Garin, C

2014-07-01

To describe the normal cervical sagittal alignment of the pediatric spine in a normal population and to identify the changes during growth period. We randomly selected in PACS database 150 full-spine standing views. Exclusion criteria were: age >18 years, spinal deformity and any disease affecting the spine (medical charts reviewing). For cervical alignment we measured: OC-angle according to Mc Gregor, C1C7 angle, upper cervical angle, inferior cervical angle and C7 tilt. Spino pelvic parameters were analyzed: T1 tilt, thoracic kyphosis, lumbar lordosis, pelvic incidence, sacral slope and pelvic tilt. We compared two age subgroups (juvenile and adolescent). Differences between age groups and gender were tested using Student's t test. Correlations between sagittal spinal parameters were evaluated using Pearson's test. Cervical spine shape was correlated to cranio cervical orientation to maintain horizontal gaze (r = 0.60) and to thoracic kyphosis (r = -0.46). Cervical spine alignment was significantly different between the two age groups except for the global C1C7 cervical lordosis, which remained stable. A significant gender difference was found for all the cervical sagittal angles (p < 0.01) whereas no differences were demonstrated for the spino pelvic parameters, except the lumbar lordosis (p = 0.047). This study is the first to report the cervical spinal alignment in a normal pediatric Caucasian population. Even though cervical lordosis is the common shape, our results showed variability in cervical sagittal alignment. Cervical spine is a junctional area that adjusts its alignment to the head position and to the underlying spinal alignment.

Variations of cervical lordosis and head alignment after pedicle subtraction osteotomy surgery for sagittal imbalance.

PubMed

Cecchinato, R; Langella, F; Bassani, R; Sansone, V; Lamartina, C; Berjano, P

2014-10-01

The variations of the cervical lordosis after correction of sagittal imbalance have been poorly studied. The aim of our study is to verify whether the cervical lordosis changes after surgery for sagittal imbalance. Thirty-nine patients were included in the study. Cervical, thoracic and lumbar spine, pelvic and lower-limb sagittal parameters were recorded. The cranial alignment was measured by the newly described Cranial Slope. The global cervical kyphosis (preop -43°, postop -31.5°) and the upper (preop -24.1°, postop -20.2°) and lower cervical kyphosis (preop -18.1°, postop -9.2°) were significantly reduced after surgical realignment of the trunk. A positive linear correlation was observed between the changes in T1 slope and the lower cervical lordosis, and between T1 slope and the global cervical alignment. The cervical lordosis is reduced by surgical correction of malalignment of the trunk, suggesting an adaptive role to maintain the head's neutral position.

The spatial alignment of time: Differences in alignment of deictic and sequence time along the sagittal and lateral axes.

PubMed

Walker, Esther J; Bergen, Benjamin K; Núñez, Rafael

2017-04-01

People use space in a variety of ways to structure their thoughts about time. The present report focuses on the different ways that space is employed when reasoning about deictic (past/future relationships) and sequence (earlier/later relationships) time. In the first study, we show that deictic and sequence time are aligned along the lateral axis in a manner consistent with previous work, with past and earlier events associated with left space and future and later events associated with right space. However, the alignment of time with space is different along the sagittal axis. Participants associated future events and earlier events-not later events-with the space in front of their body and past and later events with the space behind, consistent with the sagittal spatial terms (e.g., ahead, in front of) that we use to talk about deictic and sequence time. In the second study, we show that these associations between sequence time and sagittal space are sensitive to person-perspective. This suggests that the particular space-time associations observed in English speakers are influenced by a variety of different spatial properties, including spatial location and perspective. Copyright © 2016. Published by Elsevier B.V.

Sagittal alignment after single cervical disc arthroplasty.

PubMed

Guérin, Patrick; Obeid, Ibrahim; Gille, Olivier; Bourghli, Anouar; Luc, Stéphane; Pointillart, Vincent; Vital, Jean-Marc

2012-02-01

Prospective study. To analyze the sagittal balance after single-level cervical disc replacement (CDR) and range of motion (ROM). To define clinical and radiologic parameters those have a significant correlation with segmental and overall cervical curvature after CDR. Clinical outcomes and ROM after CDR with Mobi-C (LDR, Troyes, France) prosthesis have been documented in few studies. No earlier report of this prosthesis has studied correlations between static and dynamic parameters or those between static parameters and clinical outcomes. Forty patients were evaluated. Clinical outcome was assessed using the Short Form-36 questionnaire, Neck Disability Index, and a Visual Analog Scale. Spineview software (Surgiview, Paris, France) was used to investigate sagittal balance parameters and ROM. The mean follow-up was 24.3 months (range: 12 to 36 mo). Clinical outcomes were satisfactory. There was a significant improvement of Short Form-36, Neck Disability Index, and Visual Analog Scale scores. Mean ROM was 8.3 degrees preoperatively and 11.0 degrees postoperatively (P=0.013). Mean preoperative C2C7 curvature was 12.8 and 16.0 degrees at last follow-up (P=0.001). Mean preoperative functional spinal unit (FSU) angle was 2.3 and 5.3 degrees postoperatively (P<0.0001). Mean postoperative shell angle was 5.5 degrees. There was a significant correlation between postoperative C2C7 alignment and preoperative C2C7 alignment, change of C2C7 alignment, preoperative and postoperative FSU angle, and prosthesis shell angle. There was also a significant correlation between postoperative FSU angle and preoperative C2C7 alignment, preoperative FSU angle, change of FSU angle, and prosthesis shell angle. Regression analysis showed that prosthesis shell angle and preoperative FSU angle contributed significantly to postoperative FSU angle. Moreover, preoperative C2C7 alignment, preoperative FSU angle, postoperative FSU angle, and prosthesis shell angle contributed significantly to postoperative C2C7 alignment. No significant correlation was observed between ROM and sagittal parameters. Few correlations were found between sagittal alignment and clinical results. CDR with this prosthesis provided favorable clinical outcomes and maintains ROM of the FSU, overall and segmental cervical alignment. Long-term follow-up will be needed to assess the effectiveness and advantages of this procedure.

Alignment in the transverse plane, but not sagittal or coronal plane, affects the risk of recurrent patella dislocation.

PubMed

Takagi, Shigeru; Sato, Takashi; Watanabe, Satoshi; Tanifuji, Osamu; Mochizuki, Tomoharu; Omori, Go; Endo, Naoto

2017-11-17

Abnormalities of lower extremity alignment (LEA) in recurrent patella dislocation (RPD) have been studied mostly by two-dimensional (2D) procedures leaving three-dimensional (3D) factors unknown. This study aimed to three-dimensionally examine risk factors for RPD in lower extremity alignment under the weight-bearing conditions. The alignment of 21 limbs in 15 RPD subjects was compared to the alignment of 24 limbs of 12 healthy young control subjects by an our previously reported 2D-3D image-matching technique. The sagittal, coronal, and transverse alignment in full extension as well as the torsional position of the femur (anteversion) and tibia (tibial torsion) under weight-bearing standing conditions were assessed by our previously reported 3D technique. The correlations between lower extremity alignment and RPD were assessed using multiple logistic regression analysis. The difference of lower extremity alignment in RPD between under the weight-bearing conditions and under the non-weight-bearing conditions was assessed. In the sagittal and coronal planes, there was no relationship (statistically or by clinically important difference) between lower extremity alignment angle and RPD. However, in the transverse plane, increased external tibial rotation [odds ratio (OR) 1.819; 95% confidence interval (CI) 1.282-2.581], increased femoral anteversion (OR 1.183; 95% CI 1.029-1.360), and increased external tibial torsion (OR 0.880; 95% CI 0.782-0.991) were all correlated with RPD. The tibia was more rotated relative to femur at the knee joint in the RPD group under the weight-bearing conditions compared to under the non-weight-bearing conditions (p < 0.05). This study showed that during weight-bearing, alignment parameters in the transverse plane related to the risk of RPD, while in the sagittal and coronal plane alignment parameters did not correlate with RPD. The clinical importance of this study is that the 3D measurements more directly, precisely, and sensitively detect rotational parameters associated with RPD and hence predict risk of RPD. III.

Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North America Myelopathy study.

PubMed

Smith, Justin S; Lafage, Virginie; Ryan, Devon J; Shaffrey, Christopher I; Schwab, Frank J; Patel, Alpesh A; Brodke, Darrel S; Arnold, Paul M; Riew, K Daniel; Traynelis, Vincent C; Radcliff, Kris; Vaccaro, Alexander R; Fehlings, Michael G; Ames, Christopher P

2013-10-15

Post hoc analysis of prospectively collected data. Development of methods to determine in vivo spinal cord dimensions and application to correlate preoperative alignment, myelopathy, and health-related quality-of-life scores in patients with cervical spondylotic myelopathy (CSM). CSM is the leading cause of spinal cord dysfunction. The association between cervical alignment, sagittal balance, and myelopathy has not been well characterized. This was a post hoc analysis of the prospective, multicenter AOSpine North America CSM study. Inclusion criteria for this study required preoperative cervical magnetic resonance imaging (MRI) and neutral sagittal cervical radiography. Techniques for MRI assessment of spinal cord dimensions were developed. Correlations between imaging and health-related quality-of-life scores were assessed. Fifty-six patients met inclusion criteria (mean age = 55.4 yr). The modified Japanese Orthopedic Association (mJOA) scores correlated with C2-C7 sagittal vertical axis (SVA) (r = -0.282, P = 0.035). Spinal cord volume correlated with cord length (r = 0.472, P < 0.001) and cord average cross-sectional area (r = 0.957, P < 0.001). For all patients, no correlations were found between MRI measurements of spinal cord length, volume, mean cross-sectional area or surface area, and outcomes. For patients with cervical lordosis, mJOA scores correlated positively with cord volume (r = 0.366, P = 0.022), external cord area (r = 0.399, P = 0.012), and mean cross-sectional cord area (r = 0.345, P = 0.031). In contrast, for patients with cervical kyphosis, mJOA scores correlated negatively with cord volume (r = -0.496, P = 0.043) and mean cross-sectional cord area (r = -0.535, P = 0.027). This study is the first to correlate cervical sagittal balance (C2-C7 SVA) to myelopathy severity. We found a moderate negative correlation in kyphotic patients of cord volume and cross-sectional area to mJOA scores. The opposite (positive correlation) was found for lordotic patients, suggesting a relationship of cord volume to myelopathy that differs on the basis of sagittal alignment. It is interesting to note that sagittal balance but not kyphosis is tied to myelopathy score. Future work will correlate alignment changes to cord morphology changes and myelopathy outcomes. SUMMARY STATEMENTS: This is the first study to correlate sagittal balance (C2-C7 SVA) to myelopathy severity. We found a moderate negative correlation in kyphotic patients of cord volume and cross-sectional area to mJOA scores. The opposite (positive correlation) was found for lordotic patients, suggesting a relationship of cord volume to myelopathy that differs on the basis of sagittal alignment.

Anterior Cervical Discectomy and Fusion Alters Whole-Spine Sagittal Alignment

PubMed Central

Kim, Jang Hoon; Yi, Seong; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

2015-01-01

Purpose Anterior cervical discectomy and fusion (ACDF) has become a common spine procedure, however, there have been no previous studies on whole spine alignment changes after cervical fusion. Our purpose in this study was to determine whole spine sagittal alignment and pelvic alignment changes after ACDF. Materials and Methods Forty-eight patients who had undergone ACDF from January 2011 to December 2012 were enrolled in this study. Cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis (SVA), and pelvic parameters were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores and Neck Disability Index (NDI) values. Results Forty-eight patients were grouped according to operative method (cage only, cage & plate), operative level (upper level: C3/4 & C4/5; lower level: C5/6 & C6/7), and cervical lordosis (high lordosis, low lordosis). All patients experienced significant improvements in VAS scores and NDI values after surgery. Among the radiologic parameters, pelvic tilt increased and sacral slope decreased at 12 months postoperatively. Only the high cervical lordosis group showed significantly-decreased cervical lordosis and a shortened SVA postoperatively. Correlation tests revealed that cervical lordosis was significantly correlated with SVA and that SVA was significantly correlated with pelvic tilt and sacral slope. Conclusion ACDF affects whole spine sagittal alignment, especially in patients with high cervical lordosis. In these patients, alteration of cervical lordosis to a normal angle shortened the SVA and resulted in reciprocal changes in pelvic tilt and sacral slope. PMID:26069131

Utility of Routine Outpatient Cervical Spine Imaging Following Anterior Cervical Corpectomy and Fusion.

PubMed

Desai, Atman; Pendharkar, Arjun V; Swienckowski, Jessica G; Ball, Perry A; Lollis, Scott; Simmons, Nathan E

2015-11-23

Construct failure is an uncommon but well-recognized complication following anterior cervical corpectomy and fusion (ACCF). In order to screen for these complications, many centers routinely image patients at outpatient visits following surgery. There remains, however, little data on the utility of such imaging. The electronic medical record of all patients undergoing anterior cervical corpectomy and fusion at Dartmouth-Hitchcock Medical Center between 2004 and 2009 were reviewed. All patients had routine cervical spine radiographs performed perioperatively. Follow-up visits up to two years postoperatively were analyzed.  Sixty-five patients (mean age 52.2) underwent surgery during the time period. Eighteen patients were female. Forty patients had surgery performed for spondylosis, 20 for trauma, three for tumor, and two for infection. Forty-three patients underwent one-level corpectomy, 20 underwent two-level corpectomy, and two underwent three-level corpectomy, using an allograft, autograft, or both. Sixty-two of the fusions were instrumented using a plate and 13 had posterior augmentation. Fifty-seven patients had follow-up with imaging at four to 12 weeks following surgery, 54 with plain radiographs, two with CT scans, and one with an MRI scan. Unexpected findings were noted in six cases. One of those patients, found to have asymptomatic recurrent kyphosis following a two-level corpectomy, had repeat surgery because of those findings. Only one further patient was found to have abnormal imaging up to two years, and this patient required no further intervention. Routine imaging after ACCF can demonstrate asymptomatic occurrences of clinically significant instrument failure. In 43 consecutive single-level ACCF however, routine imaging did not change management, even when an abnormality was discovered. This may suggest a limited role for routine imaging after ACCF in longer constructs involving multiple levels.

Minimally invasive instrumentation without fusion during posterior thoracic corpectomies: a comparison of percutaneously instrumented nonfused segments with open instrumented fused segments.

PubMed

Lau, Darryl; Chou, Dean

2017-07-01

OBJECTIVE During the mini-open posterior corpectomy, percutaneous instrumentation without fusion is performed above and below the corpectomy level. In this study, the authors' goal was to compare the perioperative and long-term implant failure rates of patients who underwent nonfused percutaneous instrumentation with those of patients who underwent traditional open instrumented fusion. METHODS Adult patients who underwent posterior thoracic corpectomies with cage reconstruction between 2009 and 2014 were identified. Patients who underwent mini-open corpectomy had percutaneous instrumentation without fusion, and patients who underwent open corpectomy had instrumented fusion above and below the corpectomy site. The authors compared perioperative outcomes and rates of implant failure requiring reoperation between the open (fused) and mini-open (unfused) groups. RESULTS A total of 75 patients were identified, and 53 patients (32 open and 21 mini-open) were available for followup. The mean patient age was 52.8 years, and 56.6% of patients were male. There were no significant differences in baseline variables between the 2 groups. The overall perioperative complication rate was 15.1%, and there was no significant difference between the open and mini-open groups (18.8% vs 9.5%; p = 0.359). The mean hospital stay was 10.5 days. The open group required a significantly longer stay than the mini-open group (12.8 vs 7.1 days; p < 0.001). Overall implant failure rates requiring reoperation were 1.9% at 6 months, 9.1% at 1 year, and 14.7% at 2 years. There were no significant differences in reoperation rates between the open and mini-open groups at 6 months (3.1% vs 0.0%, p = 0.413), 1 year (10.7% vs 6.2%, p = 0.620), and 2 years (18.2% vs 8.3%, p = 0.438). The overall mean follow-up was 29.2 months. CONCLUSIONS These findings suggest that percutaneous instrumentation without fusion in mini-open transpedicular corpectomies offers similar implant failure and reoperation rates as open instrumented fusion as far out as 2 years of follow-up.

A comparison of short term radiological alignment outcomes of the patient specific and standard instrumentation for primary total knee arthroplasty: A systematic review and meta-analysis.

PubMed

Alcelik, Ilhan; Blomfield, Mark; Öztürk, Cenk; Soni, Ashish; Charity, Richard; Acornley, Alex

2017-05-01

The aim of this study was to review the radiological alignment outcomes of patient Specific (PS) cutting blocks and Standard Instrumentation in Primary Total Knee Arthroplasty. We hypothesized that the use of PS techniques would significantly improve sagittal, coronal and rotational alignment of the prosthesis on short term. We performed a systematic review and a meta-analysis including all the randomised controlled trials (RCT) using PS and standard (ST) total knee arthroplasty to date. A total of 538 PS TKA and 549 ST TKA were included in the study. Statistical analysis of the outliers for femoral component sagittal, coronal and rotational positioning, tibial component sagittal and coronal positioning and the overall mechanical axis were assessed. We found that there was no significant benefit from using PS instrumentation in primary knee arthroplasty to aid in the positioning of either the tibial or femoral components. Furthermore sagittal plane tibial component positioning was worse in the PS than the traditional ST group. Our results suggest that at present PS instrumentation is not superior to ST instrumentation in primary total knee arthroplasty. Level 1, Systematic review of therapeutic studies. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Impact of Cervical Sagittal Alignment on Axial Neck Pain and Health-related Quality of Life After Cervical Laminoplasty in Patients With Cervical Spondylotic Myelopathy or Ossification of the Posterior Longitudinal Ligament: A Prospective Comparative Study.

PubMed

Fujiwara, Hiroyasu; Oda, Takenori; Makino, Takahiro; Moriguchi, Yu; Yonenobu, Kazuo; Kaito, Takashi

2018-05-01

This is prospective observational study. To prospectively investigate the correlation among axial neck pain; a newly developed patient-based quality of life outcome measure, the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ); and cervical sagittal alignment after open-door laminoplasty for cervical myelopathy. Many studies have focused on postoperative axial neck pain after laminoplasty. However, the correlation among cervical sagittal alignment, neck pain, and JOACMEQ has not been investigated. In total, 57 consecutive patients treated by open-door laminoplasty for cervical myelopathy were included (mean age, 63.7 y; 15 women and 42 men) and divided into 2 groups according to diagnosis [cervical spondylotic myelopathy (CSM) group: 35 patients, and ossification of the posterior longitudinal ligament (OPLL) group: 22 patients]. JOA score, a subdomain of cervical spine function (CSF) in the JOACMEQ, and the visual analog scale for axial neck pain were assessed preoperatively and 12 months postoperatively. Radiographic cervical sagittal parameters were measured by C2 sagittal vertical axis (C2 SVA), C2-C7 lordosis, C7 sagittal slope (C7 slope), and range of motion. C2 SVA values in both groups shifted slightly anteriorly between preoperative and 12-month postoperative measurements (CSM: +19.7±10.9 mm; OPLL: +22.1±13.4 mm vs. CSM: +23.2±16.1 mm; OPLL: +28.7±15.4 mm, respectively). Postoperative axial neck pain in the OPLL group showed strong negative correlations with C2 SVA and C7 slope. Strong negative correlations were found between axial neck pain and CSF in both the preoperative CSM and OPLL groups (CSM: r=-0.45, P=0.01; OPLL: r=-0.61, P<0.01) and between axial neck pain and CSF in the postoperative OPLL group (r=-0.51, P=0.05). This study demonstrated a significant negative correlation between neck pain and CSF in both the CSM and OPLL groups preoperatively and in the OPLL group postoperatively. Radiographic cervical sagittal alignment did not significantly correlate with preoperative or postoperative axial neck pain.

A systematic review of the angular values obtained by computerized photogrammetry in sagittal plane: a proposal for reference values.

PubMed

Krawczky, Bruna; Pacheco, Antonio G; Mainenti, Míriam R M

2014-05-01

Reference values for postural alignment in the coronal plane, as measured by computerized photogrammetry, have been established but not for the sagittal plane. The objective of this study is to propose reference values for angular measurements used for postural analysis in the sagittal plane for healthy adults. Electronic databases (PubMed, BVS, Cochrane, Scielo, and Science Direct) were searched using the following key words: evaluation, posture, photogrammetry, and software. Articles published between 2006 and 2012 that used the PAS/SAPO (postural assessment software) were selected. Another inclusion criterion was the presentation of, at least, one of the following measurements: head horizontal alignment, pelvic horizontal alignment, hip angle, vertical alignment of the body, thoracic kyphosis, and lumbar lordosis. Angle samples of the selected articles were grouped 2 by 2 in relation to an overall average, which made possible total average, variance, and SD calculations. Six articles were included, and the following average angular values were found: 51.42° ± 4.87° (head horizontal alignment), -12.26° ± 5.81° (pelvic horizontal alignment), -6.40° ± 3.86° (hip angle), and 1.73° ± 0.94° (vertical alignment of the body). None of the articles contained the measurements for thoracic kyphosis and lumbar lordosis. The reference values can be adopted as reference for postural assessment in future researches if the same anatomical points are considered. Copyright © 2014 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

A Modified Microsurgical Endoscopic-Assisted Transpedicular Corpectomy of the Thoracic Spine Based on Virtual 3-Dimensional Planning.

PubMed

Archavlis, Eleftherios; Schwandt, Eike; Kosterhon, Michael; Gutenberg, Angelika; Ulrich, Peter; Nimer, Amr; Giese, Alf; Kantelhardt, Sven Rainer

2016-07-01

The main difficulties of transpedicular corpectomies are lack of space for vertebral body replacement in the neighborhood of critical structures, the necessity for sacrifice of nerve roots in the thoracic spine. and the extent of hemorrhage due to venous epidural bleeding. We present a modified technique of transpedicular corpectomy by using an endoscopic-assisted microsurgical technique performed through a single posterior approach. A 3-dimensional (3D) preoperative reconstruction could be helpful in the planning for this complex anatomic region. Surface and volume 3D reconstruction were performed by Amira or the Dextroscope. The clinical experience of this study includes 7 cases, 2 with an unstable burst fracture and 5 with metastatic destructive vertebral body disease, all with significant retropulsion and obstruction of the spinal canal. We performed a comparison with a conventional cohort of transpedicular thoracic corpectomies. Qualitative parameters of the 3D virtual reality planning included degree of bone removal and distance from critical structures such as myelon and implant diameter. Parameters were met in each case, with demonstration of optimal positioning of the implant without neurological complications. In all patients, the endoscope was a significant help in identifying the origins of active bleeding, residual tumor, extent of bone removal, facilitating cage insertion in a minimally invasive way, and helping to avoid root sacrifice on both sides. Microsurgical endoscopic-assisted transpedicular corpectomy may prove valuable in enhancing the safety of corpectomy in destructive vertebral body disease. The 3D virtual anatomic model greatly facilitated the preoperative planning. Copyright © 2016 Elsevier Inc. All rights reserved.

Instrumentation Strategies to Reduce the Risks of Proximal Junctional Kyphosis in Adult Scoliosis: A Detailed Biomechanical Analysis.

PubMed

Aubin, Carl-Eric; Cammarata, Marco; Wang, Xiaoyu; Mac-Thiong, Jean-Marc

2015-05-01

Biomechanical analysis of proximal junctional kyphosis (PJK) through numerical simulations. Assessment of the effect of sagittal alignment, the upper instrumented vertebral level (UIV), and 4 other surgical variables on biomechanical indices related to the PJK risks. Despite retrospective clinical studies, biomechanical analysis of individual parameters associated with PJK is lacking to support instrumentation strategies to reduce the PJK risks. Instrumentations of 6 adult scoliosis cases with different operative strategies were simulated (1,152 simulations). Proximal junctional (PJ) angle and flexion loads were evaluated against the sagittal alignment and the proximal instrumentation level. Instrumenting 1 more proximal vertebra allowed the PJ angle, proximal moment, and force to be reduced by 18%, 25%, and 16%, respectively. Shifting sagittal alignment by 20 mm posteriorly increased the PJ angle and proximal moment by 16% and 22%, and increased the equivalent posterior extensor force by 37%. Bilateral complete facetectomy, posterior ligaments resection, and the combination of the 2 resulted in an increase of the PJ angle (by 10%, 28%, and 53%, respectively), flexion forces (by 4%, 12%, and 22%, respectively), and proximal moments (by 16%, 44%, and 83%, respectively). Transverse process hooks at UIV compared with pedicle screws allowed 26% lower PJ angle and flexion loads. The use of proximal transition rods with proximal diameter reduced from 5.5 to 4 mm slightly reduced PJ angle, flexion force, and moment (less than 8%). The increase in sagittal rod curvature from 10° to 40° increased the PJ angle (from 6% to 19%), flexion force (from 3% to 10%), and moment (from 9% to 27%). Simulated posteriorly shifted sagittal alignment was associated with higher PJK risks, whereas extending instrumentation proximally allowed a lower mechanical risk of PJK. Preserving PJ intervertebral elements and using a more flexible anchorage at UIV help reduce the biomechanical risks of PJK. Copyright © 2015 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Sagittal plane tilting deformity of the patellofemoral joint: a new concept in patients with chondromalacia patella.

PubMed

Aksahin, Ertugrul; Aktekin, Cem Nuri; Kocadal, Onur; Duran, Semra; Gunay, Cüneyd; Kaya, Defne; Hapa, Onur; Pepe, Murad

2017-10-01

The aims of this study were to evaluate sagittal plane alignment in patients with chondromalacia patella via magnetic resonance imaging (MRI), analyse the relationships between the location of the patellar cartilaginous lesions and sagittal alignment and finally investigate the relationships between the sagittal plane malalignment and patellofemoral loadings using by finite element analysis. Fifty-one patients who were diagnosed with isolated modified Outerbridge grade 3-4 patellar chondromalacia based on MRI evaluation and 51 control subjects were evaluated. Chondromalacia patella patients were divided into three subgroups according to the chondral lesion location as superior, middle and inferior. The patella-patellar tendon angle (P-PT) was used for evaluation of sagittal alignment of patellofemoral joint. Each subgroup was compared with control group by using P-PT angle. To investigate the biomechanical effects of sagittal plane malpositioning on patellofemoral joint, bone models were created at 30°, 60° and 90° knee flexion by using mean P-PT angles, which obtained from patients with chondromalacia patellae and control subjects. The total loading and contact area values of the patellofemoral joints were investigated by finite element analysis. The mean age of all participants was 52.9 ± 8.2 years. The mean P-PT angle was significantly lower in chondromalacia group (142.1° ± 3.6°) compared to control group (144.5° ± 5.3°) (p = 0.008). Chondral lesions were located in superior, middle and inferior zones in 16, 20 and 15 patients, respectively. The mean P-PT angles in patients with superior (141.8 ± 2.7) and inferior subgroups (139.2 ± 2.3) were significantly lower than the values in the control group (p < 0.05). The contact area values were detected higher in models with chondromalacia than in the control models at the same flexion degrees. There were increased loadings at 30° and 90° flexions in the sagittal patellar tilt models. This study revealed that sagittal plain malpositioning of the patellofemoral joint might be related to chondromalacia, especially in the presence of lesions in the upper and lower part of the patella. This condition leads to supraphysiological loadings on the patellofemoral joint. Sagittal patellar tilt should be considered in the evaluation and management of patellar cartilage defects. Taking sagittal plane malalignment into consideration in patellofemoral joint evaluation will enable us to design new physical and surgical modalities. IV.

Current data do not support routine use of patient-specific instrumentation in total knee arthroplasty.

PubMed

Voleti, Pramod B; Hamula, Mathew J; Baldwin, Keith D; Lee, Gwo-Chin

2014-09-01

The purpose of this systematic review and meta-analysis is to compare patient-specific instrumentation (PSI) versus standard instrumentation for total knee arthroplasty (TKA) with regard to coronal and sagittal alignment, operative time, intraoperative blood loss, and cost. A systematic query in search of relevant studies was performed, and the data published in these studies were extracted and aggregated. In regard to coronal alignment, PSI demonstrated improved accuracy in femorotibial angle (FTA) (P=0.0003), while standard instrumentation demonstrated improved accuracy in hip-knee-ankle angle (HKA) (P=0.02). Importantly, there were no differences between treatment groups in the percentages of FTA or HKA outliers (>3 degrees from target alignment) (P=0.7). Sagittal alignment, operative time, intraoperative blood loss, and cost were also similar between groups (P>0.1 for all comparisons). Copyright © 2014 Elsevier Inc. All rights reserved.

Impact of sagittal spinopelvic alignment on clinical outcomes after decompression surgery for lumbar spinal canal stenosis without coronal imbalance.

PubMed

Hikata, Tomohiro; Watanabe, Kota; Fujita, Nobuyuki; Iwanami, Akio; Hosogane, Naobumi; Ishii, Ken; Nakamura, Masaya; Toyama, Yoshiaki; Matsumoto, Morio

2015-10-01

The object of this study was to investigate correlations between sagittal spinopelvic alignment and improvements in clinical and quality-of-life (QOL) outcomes after lumbar decompression surgery for lumbar spinal canal stenosis (LCS) without coronal imbalance. The authors retrospectively reviewed data from consecutive patients treated for LCS with decompression surgery in the period from 2009 through 2011. They examined correlations between preoperative or postoperative sagittal vertical axis (SVA) and radiological parameters, clinical outcomes, and health-related (HR)QOL scores in patients divided according to SVA. Clinical outcomes were assessed according to Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores. Health-related QOL was evaluated using the Roland-Morris Disability Questionnaire (RMDQ) and the JOA Back Pain Evaluation Questionnaire (JOABPEQ). One hundred nine patients were eligible for inclusion in the study. Compared to patients with normal sagittal alignment prior to surgery (Group A: SVA < 50 mm), those with preoperative sagittal imbalance (Group B: SVA ≥ 50 mm) had significantly smaller lumbar lordosis and thoracic kyphosis angles and larger pelvic tilt. In Group B, there was a significant decrease in postoperative SVA compared with the preoperative SVA (76.3 ± 29.7 mm vs. 54.3 ± 39.8 mm, p = 0.004). The patients in Group B with severe preoperative sagittal imbalance (SVA > 80 mm) had residual sagittal imbalance after surgery (82.8 ± 41.6 mm). There were no significant differences in clinical and HRQOL outcomes between Groups A and B. Compared to patients with normal postoperative SVA (Group C: SVA < 50 mm), patients with a postoperative SVA ≥ 50 mm (Group D) had significantly lower JOABPEQ scores, both preoperative and postoperative, for walking ability (preop: 36.6 ± 26.3 vs. 22.7 ± 26.0, p = 0.038, respectively; postop: 71.1 ± 30.4 vs. 42.5 ± 29.6, p < 0.001) and social functioning (preop: 38.7 ± 18.5 vs. 30.2 ± 16.7, p = 0.045; postop: 67.0 ± 25.8 vs. 49.6 ± 20.0, p = 0.001), as well as significantly higher postoperative RMDQ (4.9 ± 5.2 vs. 7.9 ± 5.7, p = 0.015) and VAS scores for low-back pain (2.68 ± 2.69 vs. 3.94 ± 2.59, p = 0.039). Preoperative sagittal balance was not significantly correlated with clinical or HRQOL outcomes after decompression surgery in LCS patients without coronal imbalance. Decompression surgery improved the SVA value in patients with preoperative sagittal imbalance; however, the patients with severe preoperative sagittal imbalance (SVA > 80 mm) had residual imbalance after decompression surgery. Both clinical and HRQOL outcomes were negatively affected by postoperative residual sagittal imbalance.

Relationship between thoracic hypokyphosis, lumbar lordosis and sagittal pelvic parameters in adolescent idiopathic scoliosis.

PubMed

Clément, Jean-Luc; Geoffray, Anne; Yagoubi, Fatima; Chau, Edouard; Solla, Federico; Oborocianu, Ioana; Rampal, Virginie

2013-11-01

Sagittal spine and pelvic alignment of adolescent idiopathic scoliosis (AIS) is poorly described in the literature. It generally reports the sagittal alignment with regard to the type of curve and never correlated to the thoracic kyphosis. The objective of this study is to investigate the relationship between thoracic kyphosis, lumbar lordosis and sagittal pelvic parameters in thoracic AIS. Spinal and pelvic sagittal parameters were evaluated on lateral radiographs of 86 patients with thoracic AIS; patients were separated into hypokyphosis group (n = 42) and normokyphosis group (n = 44). Results were statistically analyzed. The lumbar lordosis was lower in the hypokyphosis group, due to the low proximal lordosis. The thoracic kyphosis was not correlated with any pelvic parameters but with the proximal lordosis. The pelvic incidence was correlated with sacral slope, pelvic tilt, lumbar lordosis and highly correlated with distal lumbar lordosis in the two groups. There was a significant linear regression between thoracic kyphosis and proximal lordosis and between pelvic incidence and distal lordosis. We can consider that the proximal part of the lordosis depends on the thoracic kyphosis and the distal part depends on the pelvic incidence. The hypokyphosis in AIS is independent of the pelvic parameters and could be described as a structural parameter, characteristic of the scoliotic deformity.

Association of walking speed with sagittal spinal alignment, muscle thickness, and echo intensity of lumbar back muscles in middle-aged and elderly women.

PubMed

Masaki, Mitsuhiro; Ikezoe, Tome; Fukumoto, Yoshihiro; Minami, Seigo; Aoyama, Junichi; Ibuki, Satoko; Kimura, Misaka; Ichihashi, Noriaki

2016-06-01

Age-related change of spinal alignment in the standing position is known to be associated with decreases in walking speed, and alteration in muscle quantity (i.e., muscle mass) and muscle quality (i.e., increases in the amount of intramuscular non-contractile tissue) of lumbar back muscles. Additionally, the lumbar lordosis angle in the standing position is associated with walking speed, independent of lower-extremity muscle strength, in elderly individuals. However, it is unclear whether spinal alignment in the standing position is associated with walking speed in the elderly, independent of trunk muscle quantity and quality. The present study investigated the association of usual and maximum walking speed with age, sagittal spinal alignment in the standing position, muscle quantity measured as thickness, and quality measured as echo intensity of lumbar muscles in 35 middle-aged and elderly women. Sagittal spinal alignment in the standing position (thoracic kyphosis, lumbar lordosis, and sacral anterior inclination angle) using a spinal mouse, and muscle thickness and echo intensity of the lumbar muscles (erector spinae, psoas major, and lumbar multifidus) using an ultrasound imaging device were also measured. Stepwise regression analysis showed that only age was a significant determinant of usual walking speed. The thickness of the lumbar erector spinae muscle was a significant, independent determinant of maximal walking speed. The results of this study suggest that a decrease in maximal walking speed is associated with the decrease in lumbar erector spinae muscles thickness rather than spinal alignment in the standing position in middle-aged and elderly women.

Comparison of Accuracy between Side-Cutting Instruments and Front-Cutting Instruments in Minimally Invasive Total Knee Arthroplasty.

PubMed

Pinsornsak, Piya; Harnroongroj, Thos

2016-11-01

The specialized instrument system used in minimally invasive surgery (MIS) has been developed for reducing soft tissue trauma in total knee arthroplasty (TKA). Compared with front-cutting MIS instruments, side-cutting quadriceps sparing MIS instruments have the advantage of creating a smaller incision and causing fewer traumas to the quadriceps tendon. However, the accuracy of side-cutting instruments concerns surgeons in prosthesis malalignment. To compare the accuracy of side-cutting quadriceps sparing instruments versus front-cutting instruments in MIS-TKA. In this prospective randomized controlled study, we compared the accuracy of side-cutting quadriceps sparing instruments versus the front-cutting instruments used in MIS-TKA. Sixty knees were included in the study, with 30 knees in each group. All the operations were performed by single surgeon. Coronal alignment (tibiofemoral angle, lateral distal femoral angle, and medial proximal tibial angle), and sagittal alignment (femoral component flexion and tibial posterior slope) were measured and compared. Tibiofemoral angle, lateral distal femoral angle, and medial proximal tibial angle, all of which are considered in the assessment of acceptable coronal radiographic alignment, were not different between groups (p = 0.353, 0.500, and 0.177, respectively). However, side-cutting quadriceps sparing instruments produced less acceptable sagittal radiographic alignment, femoral component flexion (63% vs. 93%, p = 0.005), and tibial posterior slope (73% vs. 93%, p = 0.04). Side-cutting quadriceps sparing MIS-TKA instruments had similar accuracy to front-cutting MIS-TKA instruments for coronal alignment but is less accurate for sagittal alignment.

The effect of sagittal rotation of the glenoid on axial glenoid width and glenoid version in computed tomography scan imaging.

PubMed

Gross, Daniel J; Golijanin, Petar; Dumont, Guillaume D; Parada, Stephen A; Vopat, Bryan G; Reinert, Steven E; Romeo, Anthony A; Provencher, C D R Matthew T

2016-01-01

Computed tomography (CT) scans of the shoulder are often not well aligned to the axis of the scapula and glenoid. The purpose of this paper was to determine the effect of sagittal rotation of the glenoid on axial measurements of anterior-posterior (AP) glenoid width and glenoid version attained by standard CT scan. In addition, we sought to define the angle of rotation required to correct the CT scan to optimal positioning. A total of 30 CT scans of the shoulder were reformatted using OsiriX software multiplanar reconstruction. The uncorrected (UNCORR) and corrected (CORR) CT scans were compared for measurements of both (1) axial AP glenoid width and (2) glenoid version at 5 standardized axial cuts. The mean difference in glenoid version was 2.6% (2° ± 0.1°; P = .0222) and the mean difference in AP glenoid width was 5.2% (1.2 ± 0.42 mm; P = .0026) in comparing the CORR and UNCORR scans. The mean angle of correction required to align the sagittal plane was 20.1° of rotation (range, 9°-39°; standard error of mean, 1.2°). These findings demonstrate that UNCORR CT scans of the glenohumeral joint do not correct for the sagittal rotation of the glenoid, and this affects the characteristics of the axial images. Failure to align the sagittal image to the 12-o'clock to 6-o'clock axis results in measurement error in both glenoid version and AP glenoid width. Use of UNCORR CT images may have notable implications for decision-making and surgical treatment. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Correlations between the feature of sagittal spinopelvic alignment and facet joint degeneration: a retrospective study.

PubMed

Lv, Xin; Liu, Yuan; Zhou, Song; Wang, Qiang; Gu, Houyun; Fu, Xiaoxing; Ding, Yi; Zhang, Bin; Dai, Min

2016-08-15

Sagittal spinopelvic alignment changes associated with degenerative facet joint arthritis have been assessed in a few studies. It has been documented that patients with facet joint degeneration have higher pelvic incidence, but the relationship between facet joint degeneration and other sagittal spinopelvic alignment parameters is still disputed. Our purpose was to evaluate the correlation between the features of sagittal spinopelvic alignment and facet joint degeneration. Imaging data of 140 individuals were retrospectively analysed. Lumbar lordosis, pelvic tilt (PT), pelvic incidence (PI), sacral slope, and height of the lumbar intervertebral disc were measured on lumbar X-ray plates. Grades of facet joint degeneration were evaluated from the L2 to S1 on CT scans. Spearman's rank correlation coefficient and Student's t-test were used for statistical analyses, and a P-value <0.05 was considered statistically significant. PI was positively associated with degeneration of the facet joint at lower lumbar levels (p < 0.001 r = 0.50 at L5/S1 and P = 0.002 r = 0.25 at L4/5). A significant increase of PT was found in the severe degeneration group compared with the mild degeneration group: 22.0° vs 15.7°, P = 0.034 at L2/3;21.4°vs 15.1°, P = 0.006 at L3/4; 21.0° vs 13.5°, P = 0.000 at L4/5; 20.8° vs 12.1°, P = 0.000 at L5/S1. Our results indicate that a high PI is a predisposing factor for facet joint degeneration at the lower lumbar spine, and that severe facet joint degeneration may accompany with greater PT at lumbar spine.

Combined modified en bloc corpectomy with replacement of the aorta in curative interdisciplinary treatment of a large osteosarcoma infiltrating the aorta.

PubMed

Pilger, Amrei; Tsilimparis, Nikolaos; Bockhorn, Maximilian; Trepel, Martin; Dreimann, Marc

2016-05-01

We report a case of a large three-level spinal osteosarcoma infiltrating the adjacent aorta. This is the first case in which a combined modified three-level en bloc corpectomy with resection and replacement of the adjacent aorta was successful as a part of interdisciplinary curative treatment. Case report. The surgical procedure was performed as a two-step treatment. A heart lung machine (HLM) was not used, in order to avoid cerebral and spinal ischemia and to decrease the risk of hematogenous tumor metastases. Instead, a bypass from the left subclavian artery the distal descending aorta was used. We modified the en bloc corpectomy procedure, leaving a dorsal segment of the vertebral bodies to enable rapid surgery. The procedure was successful and the en bloc resection of the vertebral body with aortal resection could be achieved. Except for pallhypesthesia in the left dermatomes Th7-Th10, the patient does not have any postoperative neurologic deficits. Combined corpectomy with aortic replacement should be considered as a reasonable option in the curative treatment of osteosarcoma with consideration of the immense surgical risks. The use of an HLM is not necessary, especially considering the inherent risk of hematogenous tumor metastases. Modified corpectomy leaving a dorsal vertebral body segment was considered a reasonable variation since tumor-free margins could still be expected.

Case-related factors affecting cutting errors of the proximal tibia in total knee arthroplasty assessed by computer navigation.

PubMed

Tsukeoka, Tadashi; Tsuneizumi, Yoshikazu; Yoshino, Kensuke; Suzuki, Mashiko

2018-05-01

The aim of this study was to determine factors that contribute to bone cutting errors of conventional instrumentation for tibial resection in total knee arthroplasty (TKA) as assessed by an image-free navigation system. The hypothesis is that preoperative varus alignment is a significant contributory factor to tibial bone cutting errors. This was a prospective study of a consecutive series of 72 TKAs. The amount of the tibial first-cut errors with reference to the planned cutting plane in both coronal and sagittal planes was measured by an image-free computer navigation system. Multiple regression models were developed with the amount of tibial cutting error in the coronal and sagittal planes as dependent variables and sex, age, disease, height, body mass index, preoperative alignment, patellar height (Insall-Salvati ratio) and preoperative flexion angle as independent variables. Multiple regression analysis showed that sex (male gender) (R = 0.25 p = 0.047) and preoperative varus alignment (R = 0.42, p = 0.001) were positively associated with varus tibial cutting errors in the coronal plane. In the sagittal plane, none of the independent variables was significant. When performing TKA in varus deformity, careful confirmation of the bone cutting surface should be performed to avoid varus alignment. The results of this study suggest technical considerations that can help a surgeon achieve more accurate component placement. IV.

Alignment and component position after patient-matched instrumentation versus conventional total knee arthroplasty.

PubMed

Pourgiezis, N; Reddy, S P; Nankivell, M; Morrison, G; VanEssen, J

2016-08-01

To compare patient-matched instrumentation (PMI) with conventional total knee arthroplasty (TKA) in terms of limb alignment and component position. Nine men and 36 women (mean age, 69.5 years) who underwent PMI TKA were compared with 20 men and 25 women (mean age, 69.3 years) who underwent conventional TKA by the same team of surgeons with the same prosthesis and protocols in terms of limb alignment and component position using the Perth protocol computed tomography, as well as bone resection measurements, operating time, and the number of trays used. The PMI and conventional TKA groups were comparable in terms of age, body mass index, tourniquet time, operating time, and the number of trays used. For limb alignment and component position, the 2 groups differed significantly in sagittal femoral component position (2.4º vs. 0.9º, p=0.0008) and the percentage of knees with femoral component internally rotated ≥1° with respect to the transepicondylar axis (20% vs. 55%, p=0.001). The difference was not significant in terms of limb alignment, coronal and rotational femoral component position, or coronal and sagittal tibial component position. Intra-operatively, all patient-matched cutting blocks demonstrated acceptable fit and stability. No instrument-related adverse events or complications were encountered. One (2.2%) femur and 6 (13.3%) tibiae were recut 2 mm for optimal ligament balancing. Two femoral components were upsized to the next size, and 2 tibial components were upsized and 2 downsized to the next size. PMI was as accurate as conventional instrumentation in TKA. There was no significant difference in limb alignment or femoral and tibial component position in the coronal and sagittal planes between PMI and conventional TKA. PMI had a higher tendency to achieve correct femoral component rotation.

Pilot Study for OCT Guided Design and Fit of a Prosthetic Device for Treatment of Corneal Disease.

PubMed

Le, Hong-Gam T; Tang, Maolong; Ridges, Ryan; Huang, David; Jacobs, Deborah S

2012-01-01

Purpose. To assess optical coherence tomography (OCT) for guiding design and fit of a prosthetic device for corneal disease. Methods. A prototype time domain OCT scanner was used to image the anterior segment of patients fitted with large diameter (18.5-20 mm) prosthetic devices for corneal disease. OCT images were processed and analyzed to characterize corneal diameter, corneal sagittal height, scleral sagittal height, scleral toricity, and alignment of device. Within-subject variance of OCT-measured parameters was evaluated. OCT-measured parameters were compared with device parameters for each eye fitted. OCT image correspondence with ocular alignment and clinical fit was assessed. Results. Six eyes in 5 patients were studied. OCT measurement of corneal diameter (coefficient of variation, CV = 0.76%), cornea sagittal height (CV = 2.06%), and scleral sagittal height (CV = 3.39%) is highly repeatable within each subject. OCT image-derived measurements reveal strong correlation between corneal sagittal height and device corneal height (r = 0.975) and modest correlation between scleral and on-eye device toricity (r = 0.581). Qualitative assessment of a fitted device on OCT montages reveals correspondence with slit lamp images and clinical assessment of fit. Conclusions. OCT imaging of the anterior segment is suitable for custom design and fit of large diameter (18.5-20 mm) prosthetic devices used in the treatment of corneal disease.

[Mechanical testing of implant properties of thoracoscopic implantation of ventral spinal stabilizing systems. Comparative study with the ISO/DIS 12189-2 corpectomy model and an improved synthetic model].

PubMed

Grupp, T M; Beisse, R; Potulski, M; Marnay, T; Beger, J; Blömer, W

2002-04-01

A new modular anterior fixation system MACS TL (modular anterior construct system for the thoracic and lumbar spine) has been developed for use in thoracoscopic spondylodesis. This system demonstrates high angular stability and meets the surgical requirements for an endoscopic approach. The objective of the current study was fatigue testing of the MACS TL implant system using a corpectomy model according to ISO/DIS 12189-2 and a synthetic model recently developed by Kotani et al. [6]. The MACS TL system demonstrated good mechanical properties with a high stiffness compared to the published data reviewed. The importance of dynamic testing in a corpectomy model has been demonstrated by comparing the MACS TL plate system with an early prototype, which has not yet been clinically evaluated. The corpectomy model according to Kotani et al. offers an interesting alternative to the ISO/DIS 12189-2 test method for asymmetrically designed and antero-laterally positioned spinal implants due to the unconstrained ball joint.

Posterior only approach for fifth lumbar corpectomy: indications and technical notes.

PubMed

Elnady, Belal; Shawky, Ahmad; Abdelrahman, Hamdan; Elmorshidy, Essam; El-Meshtawy, Mohamed; Said, Galal Zaki

2017-12-01

To evaluate the efficacy and safety of a posterior-only approach for L5 corpectomy, with lumbopelvic fixation for treatment of secondaries, infections, or burst fractures. Between 2010 and 2013, 17 patients with L5 pathology had corpectomy through a posterior-only approach, with reconstruction of the anterior column using titanium cages filled with bone graft. The indication for surgery was presence of secondaries in nine patients, spondylitis and spondylodiscitis in five patients and burst fractures due to high energy trauma in three patients. All patients underwent detailed neurological examination as well as plain radiography, computed tomography, and magnetic resonance imaging studies. This study included 17 patients (8 males and 9 females) with a mean age of 48.3 years. The mean operative time was 186.1 minutes with mean blood loss of 744 ml. No intra-operative or immediate post-operative complications were encountered. Three patients died during follow-up due to advanced malignancy. The remaining 14 patients were followed-up for a mean of 24.9 months. One patient had cut through of L3 screws two years after surgery requiring metal removal. One patient had asymptomatic broken screw, with no need for further intervention. L5 corpectomy is a challenging procedure indicated for treatment of various cases of metastasis, infections, or comminuted fractures. The posterior approach is safe, efficient, and allows both rigid posterior stabilization and anterior reconstruction after L5 corpectomy without the need for an anterior approach and its possible related morbidity.

Reliability of image-free navigation to monitor lower-limb alignment.

PubMed

Pearle, Andrew D; Goleski, Patrick; Musahl, Volker; Kendoff, Daniel

2009-02-01

Proper alignment of the mechanical axis of the lower limb is the principal goal of a high tibial osteotomy. A well-accepted and relevant technical specification is the coronal plane lower-limb alignment. Target values for coronal plane alignment after high tibial osteotomy include 2 degrees of overcorrection, while tolerances for this specification have been established as 2 degrees to 4 degrees. However, the role of axial plane and sagittal plane realignment after high tibial osteotomy is poorly understood; consequently, targets and tolerance for this technical specification remain undefined. This article reviews the literature concerning the reliability and precision of navigation in monitoring the clinically relevant specification of lower-limb alignment in high tibial osteotomy. We conclude that image-free navigation registration may be clinically useful for intraoperative monitoring of the coronal plane only. Only fair and poor results for the axial and sagittal planes can be obtained by image-free navigation systems. In the future, combined image-based data, such as those from radiographs, magnetic resonance imaging, and gait analysis, may be used to help to improve the accuracy and reproducibility of quantitative intraoperative monitoring of lower-limb alignment.

Perception of socket alignment perturbations in amputees with transtibial prostheses.

PubMed

Boone, David A; Kobayashi, Toshiki; Chou, Teri G; Arabian, Adam K; Coleman, Kim L; Orendurff, Michael S; Zhang, Ming

2012-01-01

A person with amputation's subjective perception is the only tool available to describe fit and comfort to a prosthetist. However, few studies have investigated the effect of alignment on this perception. The aim of this article is to determine whether people with amputation could perceive the alignment perturbations of their prostheses and effectively communicate them. A randomized controlled perturbation of angular (3 and 6 degrees) and translational (5 and 10 mm) alignments in the sagittal (flexion, extension, and anterior and posterior translations) and coronal (abduction, adduction, and medial and lateral translations) planes were induced from an aligned condition in 11 subjects with transtibial prostheses. The perception was evaluated when standing (static) and immediately after walking (dynamic) using software that used a visual analog scale under each alignment condition. In the coronal plane, Friedman test demonstrated general statistical differences in static (p < 0.001) and dynamic (p < 0.001) measures of perceptions with angular perturbations. In the sagittal plane, it also demonstrated general statistical differences in late-stance dynamic measures of perceptions (p < 0.001) with angular perturbations, as well as in early-stance dynamic measures of perceptions (p < 0.05) with translational perturbations. Fisher exact test suggested that people with amputation's perceptions were good indicators for coronal angle malalignments but less reliable when defining other alignment conditions.

Is the sagittal postural alignment different in normal and dysphonic adult speakers?

PubMed

Franco, Débora; Martins, Fernando; Andrea, Mário; Fragoso, Isabel; Carrão, Luís; Teles, Júlia

2014-07-01

Clinical research in the field of voice disorders, in particular functional dysphonia, has suggested abnormal laryngeal posture due to muscle adaptive changes, although specific evidence regarding body posture has been lacking. The aim of our study was to verify if there were significant differences in sagittal spine alignment between normal (41 subjects) and dysphonic speakers (33 subjects). Cross-sectional study. Seventy-four adults, 35 males and 39 females, were submitted to sagittal plane photographs so that spine alignment could be analyzed through the Digimizer-MedCalc Software Ltd program. Perceptual and acoustic evaluation and nasoendoscopy were used for dysphonic judgments: normal and dysphonic speakers. For thoracic length curvature (TL) and for the kyphosis index (KI), a significant effect of dysphonia was observed with mean TL and KI significantly higher for the dysphonic speakers than for the normal speakers. Concerning the TL variable, a significant effect of sex was found, in which the mean of the TL was higher for males than females. The interaction between dysphonia and sex did not have a significant effect on TL and KI variables. For the lumbar length curvature variable, a significant main effect of sex was demonstrated; there was no significant main effect of dysphonia or significant sex×dysphonia interaction. Findings indicated significant differences in some sagittal spine posture measures between normal and dysphonic speakers. Postural measures can add useful information to voice assessment protocols and should be taken into account when considering particular treatment strategies. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Individual responses to alignment perturbations in socket reaction moments while walking in transtibial prostheses.

PubMed

Kobayashi, Toshiki; Orendurff, Michael S; Zhang, Ming; Boone, David A

2014-05-01

The alignment of transtibial prostheses has a systematic effect on the mean socket reaction moments in amputees. However, understanding their individual differences in response to alignment perturbations is also important for prosthetists to fully utilize the socket reaction moments for dynamic alignment in each unique patient. The aim of this study was to investigate individual responses to alignment perturbations in transtibial prostheses with solid-ankle-cushion-heel feet. A custom instrumented prosthesis alignment component was used to measure the socket reaction moments while walking in 11 amputees with transtibial prostheses under 17 alignment conditions, including 3° and 6° of flexion, extension, abduction, and adduction of the socket, 5mm and 10mm of anterior, posterior, lateral, and medial translation of the socket, and an initial baseline alignment. Coronal moments at 30% of stance and maximum sagittal moments were extracted for comparisons from each amputee. In the coronal plane, varus moment at 30% of stance was generally reduced by adduction or medial translation of the socket in all the amputees. In the sagittal plane, extension moment was generally increased by posterior translation or flexion of the socket; however, this was not necessarily the case for all the amputees. Individual responses to alignment perturbations are not always consistent, and prosthetists would need to be aware of this variance when addressing individual socket reaction moments during dynamic alignment in clinical setting. Copyright © 2014 Elsevier Ltd. All rights reserved.

Spinal Cord Herniation After Cervical Corpectomy with Cerebrospinal Fluid Leak: Case Report and Review of the Literature.

PubMed

Guppy, Kern H; Silverthorn, James W

2017-04-01

Spinal cord herniation (SCH) is rare, is mostly idiopathic, and occurs predominantly in the thoracic spine. SCH is less common in the cervical spine and has been reported after posterior cervical spine surgery associated with the development of pseudomeningoceles. Two cases of SCH have been reported after anterior cervical corpectomies for ossified posterior longitudinal ligament with cerebrospinal fluid (CSF) leaks. We report the third such case, but the first in a patient without ossified posterior longitudinal ligament (degenerative disc disease and pseudarthrosis). A 56-year-old woman presented with bilateral arm pain and weakness. She had undergone 3 previous anterior cervical spine surgeries at an outside medical center with the most recent 7 years ago with C5 and C6 corpectomies and fusion with a persistent CSF leak. Magnetic resonance imaging and computed tomography myelography showed spinal cord herniation through the mesh cage at C6. The patient underwent a redo C5 and C6 corpectomy with untethering of the spinal cord. The patient was asymptomatic 2 years later. This is the first reported case of anterior cervical SCH in a patient without ossified posterior longitudinal ligament after multiple anterior cervical fusions including a cervical corpectomy for pseudarthrosis with a CSF leak. We hypothesize that persistent CSF leak causes a pressure gradient across the dura mater through the cage to the lower pressure in the retropharyngeal space, which led to herniation of the spinal cord into the anterior cage. We review the literature and discuss the treatment choices for anterior cervical SCH. Copyright © 2017 Elsevier Inc. All rights reserved.

The effect of age on sagittal plane profile of the lumbar spine according to standing, supine, and various sitting positions

PubMed Central

2014-01-01

Background The sagittal alignment of the spine changes depending on body posture and degenerative changes. This study aimed to observe changes in sagittal alignment of the lumbar spine with different positions (standing, supine, and various sitting postures) and to verify the effect of aging on lumbar sagittal alignment. Methods Whole-spine lateral radiographs were obtained for young volunteers (25.4 ± 2.3 years) and elderly volunteers (66.7 ± 1.7 years). Radiographs were obtained in standing, supine, and sitting (30°, 60°, and 90°) positions respectively. We compared the radiological changes in the lordotic and segmental angles in different body positions and at different ages. Upper and lower lumbar lordosis were defined according to differences in anatomical sagittal mobility and kinematic behavior. Results Lumbar lordosis was greater in a standing position (52.79° and 53.90° in young and old groups, respectively) and tended to decrease as position changed from supine to sitting. Compared with the younger group, the older group showed significantly more lumbar lordosis in supine and 60° and 90° sitting positions (P = 0.043, 0.002, 0.011). Upper lumbar lordosis in the younger group changed dynamically in all changed positions compared with the old group (P = 0.019). Lower lumbar lordosis showed a decreasing pattern in both age groups, significantly changing as position changed from 30° to 60° (P = 0.007, 0.007). Conclusions Lumbar lordosis decreases as position changes from standing to 90°sitting. The upper lumbar spine is more flexible in individuals in their twenties compared to those in their sixties. Changes in lumbar lordosis were concentrated in the lower lumbar region in the older group in sitting positions. PMID:24571953

Development and preliminary evaluation of a new anatomically based prosthetic alignment method for below-knee prosthesis.

PubMed

Tafti, Nahid; Karimlou, Masoud; Mardani, Mohammad Ali; Jafarpisheh, Amir Salar; Aminian, Gholam Reza; Safari, Reza

2018-04-20

The objectives of current study were to a) assess similarities and relationships between anatomical landmark-based angles and distances of lower limbs in unilateral transtibial amputees and b) develop and evaluate a new anatomically based static prosthetic alignment method. First sub-study assessed the anthropometrical differences and relationships between the lower limbs in the photographs taken from amputees. Data were analysed via paired t-test and regression analysis. Results show no significant differences in frontal and transverse planes. In the sagittal plane, the anthropometric parameters of the amputated limb were significantly correlated to the corresponding variables of the sound limb. The results served as bases for the development of a new prosthetic alignment method. The method was evaluated on a single subject study. Prosthetic alignment carried out by an experienced prosthetist was compared with such alignment adjusted by an inexperienced prosthetist but with the use of the developed method. In sagittal and frontal planes, the socket angle was tuned with respect to the shin angle, and the position of the prosthetic foot was tuned in relation to the pelvic landmarks. Further study is needed to assess the proposed method on a larger sample of amputees and prosthetists.

Effect of alignment changes on socket reaction moments while walking in transtibial prostheses with energy storage and return feet

PubMed Central

Kobayashi, Toshiki; Arabian, Adam K.; Orendurff, Michael S.; Rosenbaum-Chou, Teri G.; Boone, David A.

2014-01-01

Background Energy storage and return feet are designed for active amputees. However, little is known about the socket reaction moments in transtibial prostheses with energy storage and return feet. The aim of this study was to investigate the effect of alignment changes on the socket reaction moments during gait while using the energy storage and return feet. Methods A Smart Pyramid™ was used to measure the socket reaction moments in 10 subjects with transtibial prostheses while walking under 25 alignment conditions, including a nominal alignment (as defined by conventional clinical methods), as well as angle malalignments of 2°, 4° and 6° (flexion, extension, abduction, and adduction) and translation malalignments of 5mm, 10mm and 15mm (anterior, posterior, lateral, and medial) referenced from the nominal alignment. The socket reaction moments of the nominal alignment were compared with each malalignment. Findings Both coronal and sagittal alignment changes demonstrated systematic effects on the socket reaction moments. In the sagittal plane, angle and translation alignment changes demonstrated significant differences (P<0.05) in the minimum moment, the moment at 45% of stance and the maximum moment for some comparisons. In the coronal plane, angle and translation alignment changes demonstrated significant differences (P<0.05) in the moment at 30% and 75% of stance for all comparisons. Interpretation The alignment may have systematic effects on the socket reaction moments in transtibial prostheses with energy storage and return feet. The socket reaction moments could potentially be a useful biomechanical parameter to evaluate the alignment of the transtibial prostheses. PMID:24315709

Effect of prosthetic alignment changes on socket reaction moment impulse during walking in transtibial amputees

PubMed Central

Kobayashi, Toshiki; Orendurff, Michael S.; Arabian, Adam K.; Rosenbaum-Chou, Teri G.; Boone, David A.

2014-01-01

The alignment of a lower limb prosthesis affects the way load is transferred to the residual limb through the socket, and this load is critically important for the comfort and function of the prosthesis. Both magnitude and duration of the moment are important factors that may affect the residual limb health. Moment impulse is a well-accepted measurement that incorporates both factors via moment–time integrals. The aim of this study was to investigate the effect of alignment changes on the socket reaction moment impulse in transtibial prostheses. Ten amputees with transtibial prostheses participated in this study. The socket reaction moment impulse was measured at a self-selected walking speed using a Smart Pyramid™ in 25 alignment conditions, including a nominal alignment (clinically aligned by a prosthetist), as well as angle malalignments of 2°, 4° and 6° (abduction, adduction, extension and flexion) and translation malalignments of 5 mm, 10 mm and 15 mm (lateral, medial, anterior and posterior). The socket reaction moment impulse of the nominal alignment was compared for each condition. The relationship between the alignment and the socket reaction moment impulse was clearly observed in the coronal angle, coronal translation and sagittal translation alignment changes. However, this relationship was not evident in the sagittal angle alignment changes. The results of this study suggested that the socket reaction moment impulse could potentially serve as a valuable parameter to assist the alignment tuning process for transtibial prostheses. Further study is needed to investigate the influence of the socket reaction moment impulse on the residual limb health. PMID:24612718

Spinal alignment in surgical, multisegmental, transpedicular correction of adolescent idiopathic scoliosis

PubMed Central

Nowakowski, Andrzej; Dworak, Lechosław B.; Kubaszewski, Łukasz; Kaczmarczyk, Jacek

2012-01-01

Summary The objective of this study was to discuss the variables influencing alignment mechanisms of the spine, with particular consideration of post-surgical alignment in adolescent idiopathic scoliosis. The analysis is based on information currently available in the literature, and on the authors’ own experience, which includes surgical material from over 2200 cases of idiopathic scoliosis. Over 50% of cases of adolescent idiopathic scoliosis are decompensated before surgical treatment. Spinal alignment is most significantly influenced by the position of the pelvis. Surgical restoration of lumbar lordosis is more important than attempting to restore thoracic kyphosis in the sagittal plane. The sagittal profile has an essential impact on spinal alignment. The same curves in the coronal plane can have various 3-dimensional configurations. Clinical difficulties in the assessment of thoracic kyphosis and lumbar lordosis result from the fact that they undergo constant change with age. Thoracic hypokyphosis diagnosed before surgery is a very frequent symptom of curve progression. The presence of proximal (thoraco-thoracic) and distal (thoraco-lumbar) junctional kyphosis is very important for planning the scope of spondylodesis. The natural tendency of the spine for alignment (compensation) after surgery nowadays occurs more naturally by applying derotational forces through pedicle screws, compared to the distraction devices (eg, Harrington rod) used in the past. PMID:23229319

Effect of Cervical Sagittal Balance on Laminoplasty in Patients With Cervical Myelopathy

PubMed Central

Namikawa, Takashi; Matsumura, Akira; Konishi, Sadahiko; Nakamura, Hiroaki

2017-01-01

Study Design: Retrospective clinical study. Objective: We evaluated the relationship between cervical sagittal alignment parameters and clinical status in patients with cervical myelopathy and analyzed the effect of cervical sagittal balance on cervical laminoplasty. Methods: Patients with cervical myelopathy (n = 110) who underwent laminoplasty were included in this study. The relationship between cervical sagittal alignment parameters and clinical status was evaluated. The changes in radiographic cervical sagittal parameters and clinical status 2 years after surgery were compared between patients with preoperative C2-7 SVA ≥35 mm (group A) and those with preoperative C2-7 SVA <35 mm (group B). Results: Preoperatively, C2-7 SVA had no correlation with defined health-related quality of life evaluation scores. At 2-year follow-up, the improvement in SF-36 physical component summary was significantly lower in group A than in group B. The postoperative change of C2-7 SVA did not significantly differ in 2 groups. Patients in group A maintained cervical regional balance after laminoplasty but experienced extensive postoperative neck pain. Conclusions: Our patients with a C2-7 SVA of ≥35 mm maintained cervical regional balance after laminoplasty and their improvement in myelopathy was equivalent to that in patients with a C2-7 SVA of <35 mm. However, the patents with a C2-7 SVA of ≥35 mm experienced severe postoperative neck pain. C2-7 SVA is a parameter worth considering because it can lead to poor QOL and axial neck pain after laminoplasty. PMID:28507885

Radiographical predictors for postoperative sagittal imbalance in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis after lumbar pedicle subtraction osteotomy.

PubMed

Qian, Bang-ping; Jiang, Jun; Qiu, Yong; Wang, Bin; Yu, Yang; Zhu, Ze-zhang

2013-12-15

A retrospective radiographical study. To identify the radiographical predictors for sagittal imbalance in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis (AS) after 1-level lumbar pedicle subtraction osteotomy (PSO). Few studies had correlated the preoperative sagittal parameters with postoperative sagittal alignments to determine the radiographical predictors for postoperative sagittal imbalance in patients with AS after 1-level lumbar PSO. Thirty-six patients with thoracolumbar kyphosis secondary to AS who underwent 1-level lumbar PSO were recruited with a minimal follow-up of 24 months (mean = 27.4 mo; range, 24-53 mo). Correlation analysis and subsequent stepwise multiple regression analysis were used to evaluate the correlations between preoperative parameters, including global kyphosis, local kyphosis, thoracic kyphosis, thoracolumbar Cobb angle, lumbar lordosis, pelvic incidence (PI), pelvic tilt, sacral slope, and sagittal vertical axis (SVA), as well as SVA at the last follow-up. All these patients were further divided into 2 groups according to the PI value (group A: PI >50°; group B: PI ≤50°). The correction outcomes were compared between these 2 groups. The preoperative SVA was not significantly different between group A and group B (157.6 mm vs. 124.5 mm; P> 0.05), and both groups had similar magnitudes of kyphosis corrections at the last follow-up (global kyphosis: 42.9° vs. 46.1°; local kyphosis: 42.7° vs. 40.5°; lumbar lordosis: 35.7° vs. 43.0°). However, group A patients had significantly larger SVA at the last follow-up (73.2 mm vs. 28.7 mm; P< 0.05) and a higher incidence of postoperative sagittal imbalance (77.8% vs. 25.9%; P< 0.05) than those in group B. The stepwise multiple regression analysis demonstrated that both preoperative SVA and PI were significant independent predictors of postoperative sagittal alignments, which explained 52.0% and 9.7% of the variability of SVA at the last follow-up, respectively. Patients with AS with either larger preoperative SVA or larger PI are more likely to experience failed sagittal realignments after 1-level lumbar PSO. For these patients, additional osteotomies may be recommended for satisfactory correction outcomes. 4.

Effect of prosthetic alignment changes on socket reaction moment impulse during walking in transtibial amputees.

PubMed

Kobayashi, Toshiki; Orendurff, Michael S; Arabian, Adam K; Rosenbaum-Chou, Teri G; Boone, David A

2014-04-11

The alignment of a lower limb prosthesis affects the way load is transferred to the residual limb through the socket, and this load is critically important for the comfort and function of the prosthesis. Both magnitude and duration of the moment are important factors that may affect the residual limb health. Moment impulse is a well-accepted measurement that incorporates both factors via moment-time integrals. The aim of this study was to investigate the effect of alignment changes on the socket reaction moment impulse in transtibial prostheses. Ten amputees with transtibial prostheses participated in this study. The socket reaction moment impulse was measured at a self-selected walking speed using a Smart Pyramid in 25 alignment conditions, including a nominal alignment (clinically aligned by a prosthetist), as well as angle malalignments of 2°, 4° and 6° (abduction, adduction, extension and flexion) and translation malalignments of 5 mm, 10 mm and 15 mm (lateral, medial, anterior and posterior). The socket reaction moment impulse of the nominal alignment was compared for each condition. The relationship between the alignment and the socket reaction moment impulse was clearly observed in the coronal angle, coronal translation and sagittal translation alignment changes. However, this relationship was not evident in the sagittal angle alignment changes. The results of this study suggested that the socket reaction moment impulse could potentially serve as a valuable parameter to assist the alignment tuning process for transtibial prostheses. Further study is needed to investigate the influence of the socket reaction moment impulse on the residual limb health. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effect of alignment changes on socket reaction moments while walking in transtibial prostheses with energy storage and return feet.

PubMed

Kobayashi, Toshiki; Arabian, Adam K; Orendurff, Michael S; Rosenbaum-Chou, Teri G; Boone, David A

2014-01-01

Energy storage and return feet are designed for active amputees. However, little is known about the socket reaction moments in transtibial prostheses with energy storage and return feet. The aim of this study was to investigate the effect of alignment changes on the socket reaction moments during gait while using the energy storage and return feet. A Smart Pyramid™ was used to measure the socket reaction moments in 10 subjects with transtibial prostheses while walking under 25 alignment conditions, including a nominal alignment (as defined by conventional clinical methods), as well as angle malalignments of 2°, 4° and 6° (flexion, extension, abduction, and adduction) and translation malalignments of 5mm, 10mm and 15mm (anterior, posterior, lateral, and medial) referenced from the nominal alignment. The socket reaction moments of the nominal alignment were compared with each malalignment. Both coronal and sagittal alignment changes demonstrated systematic effects on the socket reaction moments. In the sagittal plane, angle and translation alignment changes demonstrated significant differences (P<0.05) in the minimum moment, the moment at 45% of stance and the maximum moment for some comparisons. In the coronal plane, angle and translation alignment changes demonstrated significant differences (P<0.05) in the moment at 30% and 75% of stance for all comparisons. The alignment may have systematic effects on the socket reaction moments in transtibial prostheses with energy storage and return feet. The socket reaction moments could potentially be a useful biomechanical parameter to evaluate the alignment of the transtibial prostheses. Copyright © 2013 Elsevier Ltd. All rights reserved.

Standing sagittal alignment of the whole axial skeleton with reference to the gravity line in humans.

PubMed

Hasegawa, Kazuhiro; Okamoto, Masashi; Hatsushikano, Shun; Shimoda, Haruka; Ono, Masatoshi; Homma, Takao; Watanabe, Kei

2017-05-01

Human beings stand upright with the chain of balance beginning at the feet, progressing to the lower limbs (ankles, knees, hip joints, pelvis), each of the spinal segments, and then ending at the cranium to achieve horizontal gaze and balance using minimum muscle activity. The details of the alignment and balance of the chain, however, are not clearly understood, due to the lack of information regarding the three-dimensional (3D) orientation of all bony elements in relation to the gravity line (GL). We performed a clinical study to clarify the standing sagittal alignment of whole axial skeletons in reference to the GL using the EOS slot-scanning 3D X-ray imaging system with simultaneous force plate measurement in a healthy human population. The GL was defined as a vertical line drawn through the centre of vertical pressure measured by the force plate. The present study yielded a complete set of physiological alignment measurements of the standing axial skeleton from the database of 136 healthy subjects (a mean age of 39.7 years, 20-69 years; men: 40, women: 96). The mean offset of centre of the acoustic meati from the GL was 0.0 cm. The offset of the cervical and thoracic vertebrae was posterior to the GL with the apex of thoracic kyphosis at T7, 5.0 cm posterior to the GL. The sagittal alignment changed to lordosis at the level of L2. The apex of the lumbar lordosis was L4, 0.6 cm anterior to the GL, and the centre of the base of the sacrum (CBS) was just posterior to the GL. The hip axis (HA) was 1.4 cm anterior to the GL. The knee joint was 2.4 cm posterior and the ankle joint was 4.8 cm posterior to the GL. L4-, L5- and the CBS-offset in subjects in the age decades of 40s, 50s and 60s were significantly posterior to those of subjects in their 20s. The L5- and CBS-offset in subjects in their 50s and 60s were also significantly posterior to those in subjects in their 30s. HA was never posterior to the GL. In the global alignment, there was a positive correlation between offset of C7 vertebra from the sagittal vertical axis (a vertical line drawn through the posterior superior corner of the sacrum in the sagittal plane) and age, but no correlation was detected between the centre of the acoustic meati-GL offset and age. Cervical lordosis (CL), pelvic tilt (PT), pelvic incidence, hip extension, knee flexion and ankle dorsiflexion increased significantly with age. Our results revealed that aging induces trunk stooping, but the global alignment is compensated for by an increase in the CL, PT and knee flexion, with the main function of CL and PT to maintain a horizontal gaze in a healthy population. © 2017 The Authors Journal of Anatomy published by John Wiley & Sons Ltd on behalf of Anatomical Society.

Bilateral sagittal split mandibular osteotomies for enhanced exposure of the anterior cervical spine in children: technical note.

PubMed

Karsy, Michael; Moores, Neal; Siddiqi, Faizi; Brockmeyer, Douglas L; Bollo, Robert J

2017-04-01

The bilateral sagittal split mandibular osteotomy (BSSMO), a common maxillofacial technique for expanding the oropharynx during treatment of micrognathia, is a rarely employed but useful adjunct to improve surgical access to the ventral cervical spine in children. Specifically, it provides enhanced exposure of the craniocervical junction in the context of midface hypoplasia, and of the subaxial cervical spine in children with severe kyphosis. The authors describe their technique for BSSMO and evaluate long-term outcomes in patients. The pediatric neurosurgical database at a single center was queried to identify children who underwent BSSMO as an adjunct to cervical spine surgery over a 22-year study period (1993-2015). The authors retrospectively reviewed clinical and radiographic data in all patients. The authors identified 5 children (mean age 5.3 ± 3.1 years, range 2.1-10.0 years) who underwent BSSMO during cervical spine surgery. The mean clinical follow-up was 3.0 ± 1.9 years. In 4 children, BSSMO was used to increase the size of the oropharynx and facilitate transoral resection of the odontoid and anterior decompression of the craniocervical junction. In 1 patient with subaxial kyphosis and chin-on-chest deformity, BSSMO was used to elevate the chin, improve anterior exposure of the subaxial cervical spine, and facilitate cervical corpectomy. Careful attention to neurovascular structures, including the inferior alveolar nerve, lingual nerve, and mental branch of the inferior alveolar artery, as well as minimizing tongue manipulation and compression, are critical to complication avoidance. The BSSMO is a rarely used but extremely versatile technique that significantly enhances anterior exposure of the craniocervical junction and subaxial cervical spine in children in whom adequate visualization of critical structures is not otherwise possible.

Analysis of sagittal spinopelvic parameters in achondroplasia.

PubMed

Hong, Jae-Young; Suh, Seung-Woo; Modi, Hitesh N; Park, Jong-Woong; Park, Jung-Ho

2011-08-15

Prospective radiological analysis of patients with achondroplasia. To analyze sagittal spinal alignment and pelvic orientation in achondroplasia patients. Knowledge of sagittal spinopelvic parameters is important for the treatment of achondroplasia, because they differ from those of the normal population and can induce pain. The study and control groups were composed of 32 achondroplasia patients and 24 healthy volunteers, respectively. All underwent lateral radiography of the whole spine including hip joints. The radiographic parameters examined were sacral slope (SS), pelvic tilt, pelvic incidence (PI), S1 overhang, thoracic kyphosis, T10-L2 kyphosis, lumbar lordosis (LL1, LL2), and sagittal balance. Statistical analysis was performed to identify significant differences between the two groups. In addition, correlations between parameters and symptoms were sought. Sagittal spinopelvic parameters, namely, pelvic tilt, pelvic incidence, S1 overhang, thoracic kyphosis, T10-L2 kyphosis, lumbar lordosis 1 and sagittal balance were found to be significantly different in the patient and control groups (P < 0.05). In addition, sagittal parameters were found to be related to each other in the patient group (P < 0.05), that is, PI was related to SS and pelvic tilt, and LL was related to thoracic kyphosis. Furthermore, in terms of relations between spinal and pelvic parameters, LL was related to SS and PI, and sagittal balance was related to SS and PI. Furthermore, LL and T10-L2 kyphosis were found to be related to pain (P < 0.05), whereas no other parameter was found to be related to VAS scores. Sagittal parameters and possible relationships between sagittal parameters and symptoms were found to be significantly different in achondroplasia patients and normal healthy controls. The present study shows that sagittal spinal and pelvic parameters can assist the treatment of spinal disorders in achondroplasia patients.

Video raster stereography back shape reconstruction: a reliability study for sagittal, frontal, and transversal plane parameters.

PubMed

Schroeder, J; Reer, R; Braumann, K M

2015-02-01

As reliability of raster stereography was proved only for sagittal plane parameters with repeated measures on the same day, the present study was aiming at investigating variability and reliability of back shape reconstruction for all dimensions (sagittal, frontal, transversal) and for different intervals. For a sample of 20 healthy volunteers, intra-individual variability (SEM and CV%) and reliability (ICC ± 95% CI) were proved for sagittal (thoracic kyphosis, lumbar lordosis, pelvis tilt angle, and trunk inclination), frontal (pelvis torsion, pelvis and trunk imbalance, vertebral side deviation, and scoliosis angle), transversal (vertebral rotation), and functional (hyperextension) spine shape reconstruction parameters for different test-retest intervals (on the same day, between-day, between-week) by means of video raster stereography. Reliability was high for the sagittal plane (pelvis tilt, kyphosis and lordosis angle, and trunk inclination: ICC > 0.90), and good to high for lumbar mobility (0.86 < ICC < 0.97). Apart from sagittal plane spinal alignment, there was a lack of certainty for a high reproducibility indicated by wider ICC confidence intervals. So, reliability was fair to high for vertebral side deviation and the scoliosis angle (0.71 < ICC < 0.95), and poor to good for vertebral rotation values as well as for frontal plane upper body and pelvis position parameters (0.65 < ICC < 0.92). Coefficients for the between-day and between-week interval were a little lower than for repeated measures on the same day. Variability (SEM) was less than 1.5° or 1.5 mm, except for trunk inclination. Relative variability (CV) was greater in global trunk position and pelvis parameters (35-98%) than in scoliosis (14-20%) or sagittal sway parameters (4-8 %). Although we found a lower reproducibility for the frontal plane, raster stereography is considered to be a reliable method for the non-invasive, three-dimensional assessment of spinal alignment in normal non-scoliotic individuals in the sagittal plane and partly for scoliosis parameters, which fulfils scientific as well as practical recommendations for spine shape screening and monitoring, but cross-sectional or follow-up effect analyses should take into account the degree of reliability differing in various spine shape parameters. Further investigations should be conducted to analyse reliability in scoliosis patients with differing spinal deformities.

Sagittal lumbar and pelvic alignment in the standing and sitting positions.

PubMed

Endo, Kenji; Suzuki, Hidekazu; Nishimura, Hirosuke; Tanaka, Hidetoshi; Shishido, Takaaki; Yamamoto, Kengo

2012-11-01

The sitting position has become the most common posture in today's workplace. In relation to this position, kinematic analysis of the lumbar spine is helpful in understanding the causes of low back pain and its prevention. In this study, we investigated the relationship between sagittal lumbar alignment and pelvic alignment in the standing and sitting positions for 50 healthy adults. Lumbar lordotic angle (LLA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured on lateral lumbar spine standing and sitting radiographs. Regarding changes from the standing to sitting positions, average LLA, SS, and PT were -16.6° (-49.8 %), -18.7° (-50.3 %), and 18.3° (284.8 %), respectively (P < 0.01). In the sitting position, lumbar lordosis was reduced and pelvic rotation became posterior. This study showed that LLA decreased by approximately 50 % and PT increased by approximately 25 % in the sitting position compared with the standing position. No significant gender differences were observed for LLA, SS, and PT in the standing position. In the sitting position, however, LLA and SS were markedly larger for women.

Are There Age- and Sex-related Differences in Spinal Sagittal Alignment and Balance Among Taiwanese Asymptomatic Adults?

PubMed

Yeh, Kuang-Ting; Lee, Ru-Ping; Chen, Ing-Ho; Yu, Tzai-Chiu; Peng, Cheng-Huan; Liu, Kuan-Lin; Wang, Jen-Hung; Wu, Wen-Tien

2018-05-01

Sagittal spinopelvic balance and proper sagittal alignment are important when planning corrective or reconstructive spinal surgery. Prior research suggests that people from different races and countries have moderate divergence; to the best of our knowledge, the population of Taiwan has not been studied with respect to this parameter. To investigate normal age- and sex-related differences in whole-spine sagittal alignment and balance of asymptomatic adults without spinal disorders. In this prospective study, we used convenience sampling to recruit asymptomatic volunteers who accompanied patients in the outpatient orthopaedic department. One hundred forty males with a mean age of 48 ± 19 years and 252 females with a mean age of 53 ± 17 years underwent standing lateral radiographs of the whole spine. For analysis, participants were divided in three groups by age (20 to 40 years, 41 to 60 years, and 61 to 80 years) and analyzed by sex (male and female). The following eight radiologic parameters were measured: sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis, cervical lordosis, C2-C7 sagittal vertical axis, and C7-S1 sagittal vertical axis. Three observers performed estimations of the sagittal parameters twice, and the intraclass correlation coefficients for inter- and intraobserver variability were 0.81 and 0.83. The mean pelvic incidence was 49° ± 12°; lumbar lordosis was smaller in the group that was 61 to 80 years old than in the groups that were 20 to 40 years and 41 to 60 years (95% CI of the difference, 4.50-13.64 and 1.00- 9.60; p < 0.001), while cervical lordosis was greater in the 61 to 80 years age group than the other two groups (95% CI of the difference, -14.64 to -6.57 and -11.57 to -3.45; p < 0.001). The mean C7-S1 sagittal vertical axis was 30 ± 29 mm, and there was no difference among the three groups and between males and females. Pelvic tilt was greater in the group 61 to 80 years old than the 20 to 40 years and 41 to 60 years age groups (95% CI of the difference, -10.81 to -5.42 and -7.15 to -2.08; p < 0.001), while sacral slope was larger in 61 to 80 years age group than in the 41 to 60 years group (95% CI of the difference, 0.79-6.25; p = 0.006). C7 slope was greater in 61 to 80 years age group than in the 20 to 40 years group (95% CI of the difference, -7.49 to -1.26; p = 0.002) and larger in 41 to 60 years age group than in 20 to 40 years group (95% CI of the difference, -6.31 to -0.05; p = 0.045). C2-C7 sagittal vertical axis was greater in males than in females (95% CI of the difference, 2.84-7.74; p < 0.001). C7 slope was negatively correlated with thoracic kyphosis (95% CI of the difference, -0.619 to 0.468; p < 0.001) and lumbar lordosis (95% CI of the difference, -0.356 to -0.223; p < 0.001), and positively correlated with pelvic incidence (95% CI of the difference, 0.058- 0.215; p < 0.001) and cervical lordosis (95% CI of the difference, 0.228 - 0.334; p < 0.001). Normal values of the spinopelvic sagittal parameters vary by age and sex in Taiwanese individuals. Pelvic incidence and sacral slope observed in this population seemed smaller than those reported in other studies of white populations; this seems important when considering spine surgery in Taiwanese patients. Future studies should include collection of whole body sagittal parameters of larger and more-diverse populations, and assessments of patients with symptomatic spinal disorders.

Sagittal Balance in Adolescent Idiopathic Scoliosis

PubMed Central

Xu, Xi-Ming; Wang, Fei; Zhou, Xiao-Yi; Liu, Zi-Xuan; Wei, Xian-Zhao; Bai, Yu-Shu; Li, Ming

2015-01-01

Abstract The relationship between spinal sagittal alignment and pelvic parameters is well known in adolescent idiopathic scoliosis. However, few studies have reported the sagittal spinopelvic relationship after selective posterior fusion of thoracolumbar/lumbar (TL/L) curves. We evaluated the relationship between spinal sagittal alignment and the pelvis, and analyzed how the pelvic sagittal state is adjusted in Lenke type 5C patients. We conducted a retrospective study of 36 patients with Lenke type 5C curves who received selective posterior TL/L curve fusion. Coronal and spinopelvic sagittal parameters were pre and postoperatively compared. Pearson coefficients were used to analyze the correlation between all spinopelvic sagittal parameters before and after surgery. We also evaluated 3 pelvic morphologies (anteverted, normal, and retroverted) before and after surgery. Preoperatively, the mean pelvic incidence was 46.0°, with a pelvic tilt and sacral slope (SS) of 8.2° and 37.8°, respectively, and 25% (9/36) of patients had an anteverted pelvis, whereas the other 75% had a normal pelvis. Postoperatively, 42% (15/36) of patients had a retroverted pelvis, 53% (19/36) had a normal pelvis, and 2 patients had an anteverted pelvis. Logistic regression analyses yielded 2 factors that were significantly associated with the risk for a postoperative unrecovered anteverted pelvis, including increased lumbar lordosis (LL) (odds ratio [OR] 4.8, P = 0.029) and increased SS (OR 5.6, P = 0.018). Four factors were significantly associated with the risk of a postoperative newly anteverted pelvis, including LL at the final follow-up (OR 6.9, P = 0.009), increased LL (OR 8.9, P = 0.003), LL below fusion (OR 9.4, P = 0.002), and increased SS (OR 11.5, P = 0.001). The pelvic state may be adjusted after selective posterior TL/L curve fusion in Lenke 5C adolescent idiopathic scoliosis patients. It is difficult to improve an anteverted pelvis in patients who have an LL that is increased by more than 11.6° or an SS that is increased by more than 4.7° after surgery. The anteverted pelvic state will generally occur with posterior correction surgery for patients with an LL that is greater than 63.7°, or an LL or SS that is respectively increased by more than 17.6° or 9.0° postoperatively. PMID:26559289

Sagittal Distal Tibial Articular Angle and the Relationship to Talar Subluxation in Total Ankle Arthroplasty.

PubMed

Veljkovic, Andrea; Norton, Adam; Salat, Peter; Abbas, Kaniza Zahra; Saltzman, Charles; Femino, John E; Phisitkul, Phinit; Amendola, Annunziato

2016-09-01

Longevity of total ankle replacement (TAR) depends heavily on anatomic alignment. The lateral talar station (LTS) classifies the sagittal position of the talus relative to the tibia. We hypothesized that correcting the sagittal distal tibial articular angle (sDTAA) during TAR would anatomically realign the tibiotalar joint and potentially reduce the risk of prosthesis subluxation. The LTS (millimeters) and sDTAA (degrees) were measured twice by 2 blinded observers using weight-bearing lateral ankle radiographs obtained before (n = 96) and after (n = 94) TAR, with excellent interobserver and intraobserver reliability (correlation coefficient >0.9). Preoperative LTS was as follows: anterior (60.4%), posterior (27.1%), and neutral (12.5%). A strong preoperative correlation was found between LTS and sDTAA (r = 0.81; P < .0001). In ankles that were initially anterior and became less anterior postoperatively (n = 41), LTS decreased from an average 8.1 mm to 6.5 mm and the LTS changed 1.1 mm per degree of sDTAA change. In ankles that were initially posterior (n = 25), LTS increased from an average of -5.1 mm to -2.8 mm and the LTS changed 0.6 mm per degree of sDTAA change. The correlation between LTS and sDTAA was reduced postoperatively (r = 0.62; P < .0001). Our results suggest that rather than following generic recommendations, the surgeon should customize the sagittal distal tibial cut to the individual patient based on the preoperative LTS in order to achieve neutral TAR alignment. Level III, retrospective comparative series. © The Author(s) 2016.

Evaluation of anterior cervical reconstruction with titanium mesh cages versus nano-hydroxyapatite/polyamide66 cages after 1- or 2-level corpectomy for multilevel cervical spondylotic myelopathy: a retrospective study of 117 patients.

PubMed

Zhang, Yuan; Quan, Zhengxue; Zhao, Zenghui; Luo, Xiaoji; Tang, Ke; Li, Jie; Zhou, Xu; Jiang, Dianming

2014-01-01

To retrospectively compare the efficacy of the titanium mesh cage (TMC) and the nano-hydroxyapatite/polyamide66 cage (n-HA/PA66 cage) for 1- or 2-level anterior cervical corpectomy and fusion (ACCF) to treat multilevel cervical spondylotic myelopathy (MCSM). A total of 117 consecutive patients with MCSM who underwent 1- or 2-level ACCF using a TMC or an n-HA/PA66 cage were studied retrospectively at a mean follow-up of 45.28 ± 12.83 months. The patients were divided into four groups according to the level of corpectomy (1- or 2-level corpectomy) and cage type used (TMC or n-HA/PA66 cage). Clinical and radiological parameters were used to evaluate outcomes. At the one-year follow-up, the fusion rate in the n-HA/PA66 group was higher, albeit non-significantly, than that in the TMC group for both 1- and 2-level ACCF, but the fusion rates of the procedures were almost equal at the final follow-up. The incidence of cage subsidence at the final follow-up was significantly higher in the TMC group than in the n-HA/PA66 group for the 1-level ACCF (24% vs. 4%, p = 0.01), and the difference was greater for the 2-level ACCF between the TMC group and the n-HA/PA66 group (38% vs. 5%, p = 0.01). Meanwhile, a much greater loss of fused height was observed in the TMC group compared with the n-HA/PA66 group for both the 1- and 2-level ACCF. All four groups demonstrated increases in C2-C7 Cobb angle and JOA scores and decreases in VAS at the final follow-up compared with preoperative values. The lower incidence of cage subsidence, better maintenance of the height of the fused segment and similar excellent bony fusion indicate that the n-HA/PA66 cage may be a superior alternative to the TMC for cervical reconstruction after cervical corpectomy, in particular for 2-level ACCF.

Evaluation of the rate of decompression in anterior cervical corpectomy using an intra-operative computerized tomography scan (O-Arm system).

PubMed

Costa, Francesco; Tomei, Massimo; Sassi, Marco; Cardia, Andrea; Ortolina, Alessandro; Servello, Domenico; Fornari, Maurizio

2012-02-01

The purpose of this study was to evaluate the efficacy of intra-operative computerized tomography (CT) scanning in the analysis of bone removal accuracy during anterior cervical corpectomy, in order to allow any necessary immediate correction in the event of inadequate bone removal. From September 2009 to December 2010 we performed an intra-operative (CT) scan using the O-Arm(™) Image system to assess the rate of central and lateral decompression in all patients treated for cervical spondylotic myelopathy by anterior cervical corpectomy and fusion. Out of a population of 187 patients admitted to our department, with a diagnosis of myelopathy due to spondylotic degenerative cervical stenosis, 15 patients underwent a surgical treatment with anterior cervical corpectomy and fusion. There were nine males (60%) and six females (40%); the mean age was 52.4 years, ranging from 41 to 57 years. The pre-operative radiologic investigations (MRI and CT scans) revealed in the nine patients (60%) the extent of the compression to one vertebral body (C4 one case, C5 four cases, C6 four cases), while in the six cases (40%) the compression regarded two vertebral body (C3 and C4 one case, C4 and C5 two cases, C5 and C6 three cases). During surgery, when the decompression was judged completely, a CT scan was performed: in 11 cases (73.3%) the decompression was considered adequate, while in four cases (26.7%) it was deemed insufficient and the surgical strategy was changed in order to optimize the bone removal. In these cases an additional scan was taken to prove the efficacy of decompression, achieved in all patients. Intra-operative CT scan performed during cervical corpectomy is a really useful tool in helping to ensure complete bone removal and the adequacy of surgery. The O-arm(™) Image system grants optimal image quality, allowing correctly assessing the rate of decompression and, in any case of doubt, allows an intra-operative evaluation of the final correct positioning of the graft.

Biomechanical analysis of anterior versus posterior instrumentation following a thoracolumbar corpectomy: Laboratory investigation.

PubMed

Viljoen, Stephanus V; DeVries Watson, Nicole A; Grosland, Nicole M; Torner, James; Dalm, Brian; Hitchon, Patrick W

2014-10-01

The objective of this study was to evaluate the biomechanical properties of lateral instrumentation compared with short- and long-segment pedicle screw constructs following an L-1 corpectomy and reconstruction with an expandable cage. Eight human cadaveric T10-L4 spines underwent an L-1 corpectomy followed by placement of an expandable cage. The spines then underwent placement of lateral instrumentation consisting of 4 monoaxial screws and 2 rods with 2 cross-connectors, short-segment pedicle screw fixation involving 1 level above and below the corpectomy, and long-segment pedicle screw fixation (2 levels above and below). The order of instrumentation was randomized in the 8 specimens. Testing was conducted for each fixation technique. The spines were tested with a pure moment of 6 Nm in all 6 degrees of freedom (flexion, extension, right and left lateral bending, and right and left axial rotation). In flexion, extension, and left/right lateral bending, posterior long-segment instrumentation had significantly less motion compared with the intact state. Additionally, posterior long-segment instrumentation was significantly more rigid than short-segment and lateral instrumentation in flexion, extension, and left/right lateral bending. In axial rotation, the posterior long-segment construct as well as lateral instrumentation were not significantly more rigid than the intact state. The posterior long-segment construct was the most rigid in all 6 degrees of freedom. In the setting of highly unstable fractures requiring anterior reconstruction, and involving all 3 columns, long-segment posterior pedicle screw constructs are the most rigid.

Patient-specific positioning guides for total knee arthroplasty: no significant difference between final component alignment and pre-operative digital plan except for tibial rotation.

PubMed

Boonen, Bert; Schotanus, Martijn G M; Kerens, Bart; Hulsmans, Frans-Jan; Tuinebreijer, Wim E; Kort, Nanne P

2017-09-01

To assess whether there is a significant difference between the alignment of the individual femoral and tibial components (in the frontal, sagittal and horizontal planes) as calculated pre-operatively (digital plan) and the actually achieved alignment in vivo obtained with the use of patient-specific positioning guides (PSPGs) for TKA. It was hypothesised that there would be no difference between post-op implant position and pre-op digital plan. Twenty-six patients were included in this non-inferiority trial. Software permitted matching of the pre-operative MRI scan (and therefore calculated prosthesis position) to a pre-operative CT scan and then to a post-operative full-leg CT scan to determine deviations from pre-op planning in all three anatomical planes. For the femoral component, mean absolute deviations from planning were 1.8° (SD 1.3), 2.5° (SD 1.6) and 1.6° (SD 1.4) in the frontal, sagittal and transverse planes, respectively. For the tibial component, mean absolute deviations from planning were 1.7° (SD 1.2), 1.7° (SD 1.5) and 3.2° (SD 3.6) in the frontal, sagittal and transverse planes, respectively. Absolute mean deviation from planned mechanical axis was 1.9°. The a priori specified null hypothesis for equivalence testing: the difference from planning is >3 or <-3 was rejected for all comparisons except for the tibial transverse plane. PSPG was able to adequately reproduce the pre-op plan in all planes, except for the tibial rotation in the transverse plane. Possible explanations for outliers are discussed and highlight the importance for adequate training surgeons before they start using PSPG in their day-by-day practise. Prospective cohort study, Level II.

Posterior tibial slope in medial opening-wedge high tibial osteotomy: 2-D versus 3-D navigation.

PubMed

Yim, Ji Hyeon; Seon, Jong Keun; Song, Eun Kyoo

2012-10-01

Although opening-wedge high tibial osteotomy (HTO) is used to correct deformities, it can simultaneously alter tibial slope in the sagittal plane because of the triangular configuration of the proximal tibia, and this undesired change in tibial slope can influence knee kinematics, stability, and joint contact pressure. Therefore, medial opening-wedge HTO is a technically demanding procedure despite the use of 2-dimensional (2-D) navigation. The authors evaluated the posterior tibial slope pre- and postoperatively in patients who underwent navigation-assisted opening-wedge HTO and compared posterior slope changes for 2-D and 3-dimensional (3-D) navigation versions. Patients were randomly divided into 2 groups based on the navigation system used: group A (2-D guidance for coronal alignment; 17 patients) and group B (3-D guidance for coronal and sagittal alignments; 17 patients). Postoperatively, the mechanical axis was corrected to a mean valgus of 2.81° (range, 1°-5.4°) in group A and 3.15° (range, 1.5°-5.6°) in group B. A significant intergroup difference existed for the amount of posterior tibial slope change (Δ slope) pre- and postoperatively (P=.04).Opening-wedge HTO using navigation offers accurate alignment of the lower limb. In particular, the use of 3-D navigation results in significantly less change in the posterior tibial slope postoperatively than does the use of 2-D navigation. Accordingly, the authors recommend the use of 3-D navigation systems because they provide real-time intraoperative information about coronal, sagittal, and transverse axes and guide the maintenance of the native posterior tibial slope. Copyright 2012, SLACK Incorporated.

Effect of mat pilates exercise on postural alignment and body composition of middle-aged women.

PubMed

Lee, Hyo Taek; Oh, Hyun Ok; Han, Hui Seung; Jin, Kwang Youn; Roh, Hyo Lyun

2016-06-01

[Purpose] This study attempted to examine whether Pilates is an effective exercise for improving the postural alignment and health of middle-aged women. [Subjects and Methods] The participants in this study were 36 middle-aged women (20 in the experimental group, 16 in the control group). The experimental group participated in Pilates exercise sessions three times a week for 12 weeks. Body alignment and composition measurements before and after applying the Pilates exercise program were performed with a body composition analyzer and a three-dimensional scanner. [Results] Postural alignment in the sagittal and horizontal planes was enhanced in the Pilates exercise group. Trunk alignment showed correlations with body fat and muscle mass. [Conclusion] The Pilates exercises are performed symmetrically and strengthen the deep muscles. Moreover, the results showed that muscle mass was correlated with trunk postural alignment and that the proper amount of muscle is critical in maintaining trunk postural alignment.

Patient-specific instrumentation for total knee arthroplasty.

PubMed

Nabavi, Arash; Olwill, Caroline M; Do, Mike; Wanasawage, Tanya; Harris, Ian A

2017-01-01

To assess the accuracy of total knee replacements (TKRs) performed using CT-based patient-specific instrumentation by postoperative CT scan. Approval from the Ethics Committee was granted prior to commencement of this study. Fifty prospective and consecutive patients who had undergone TKR (Evolis, Medacta International) using CT-based patient-specific instrumentation (MY KNEE, Medacta International) were assessed postoperatively using a CT scan and the validated Perth protocol measurement technique. The hip-knee-ankle (HKA) angle of the lower limb in the coronal plane; the coronal, sagittal, and rotational orientation of the femoral component; and the coronal and sagittal orientation of the tibial component were measured. These results were then compared to each patient's preoperative planning. The percentage of patients found to be less than or equal to 3° of planned alignment was calculated. One patient was excluded as the femoral cutting block did not fit the femur as predicted by planning and therefore underwent a conventional TKR. Ninety-eight percent of patients were within 3° of planned alignment in the coronal plane reproducing the predicted HKA angle. Predicted coronal plane orientation of the tibial and femoral component was achieved in 100% and 96% of patients, respectively. The sagittal orientation of the femoral component was within 3° in 98% of patients. The planned sagittal positioning of the tibial component was achieved in 92% of patients. Furthermore, 90% of patients were found to have a femoral rotation within 3° of planning. Eighty-six percent of patients achieved good-to-excellent outcome at 12 months (Oxford Knee Score > 34). We have found that TKR using this patient-specific instrumentation accurately reproduces preoperative planning in all six of the parameters measured in this study.

Analysis of cervical kyphosis and spinal balance in young idiopathic scoliosis patients classified by the apex of thoracic kyphosis.

PubMed

Ito, Kenyu; Imagama, Shiro; Ito, Zenya; Ando, Kei; Kobayashi, Kazuyoshi; Hida, Tetsuro; Tsushima, Mikito; Ishikawa, Yoshimoto; Matsumoto, Akiyuki; Nishida, Yoshihiro; Ishiguro, Naoki

2016-10-01

Sagittal balance has recently been the focus of studies aimed at understanding the correction force required for both coronal and sagittal malalignment. However, the correlation between cervical kyphosis and sagittal balance in AIS patients has yet to be thoroughly investigated. This study aimed to clarify the correlation between cervical alignment and spinal balance in patients with adolescent idiopathic scoliosis (AIS). Here, we hypothesized that cervical kyphosis patients can be classified into groups by the apex of thoracic kyphosis. This study included 92 AIS patients (84 females, 8 males; mean age, 15.1 years). Patients were divided into the cervical lordosis (CL), cervical sigmoid (CS), or cervical kyphosis (CK) groups and further classified according to the apex of thoracic kyphosis into High (above T3), Middle (T4-T9), and Low (below T10) groups. There were 17 (18.5 %), 22 (23.9 %), and 53 (57.6 %) patients with CL, CS, and CK, respectively. In the CK group, 13 had CK-High, 35 had CK-Middle, and 5 had CK-Low. The C7 sagittal vertical axis (C7SVA) measurements were most backward in CK-High and most forward in CK-Low. The T5-12 kyphosis (TK) measurement was significantly lower in CK-High. Most AIS patients had kyphotic cervical alignment. Patients with CK can be classified as having CK-High, CK-Middle, or CK-Low according to the apex of thoracic kyphosis. CK-High is due to thoracic hypokyphosis with a backward balanced C7SVA. CK-Middle is well-balanced cervical kyphosis. CK-Low has forward-bent global kyphosis of the cervicothoracic spine that positioned the C7SVA forward.

[Results to 4-year follow-up of the treatment of the cervical stenosis by corpectomy, titanium mesh cage and anterior plate fixation].

PubMed

Reyes Sánchez, Alejandro Antonio; Gameros Castañeda, Luis Alberto; Obil Chavarría, Claudia; Alpizar Aguirre, Armando; Zárate Kalfópulos, Barón; Rosales-Olivares, Luis Miguel

Cervical spondylotic myelopathy is caused by cervical stenosis. Several techniques have been described for the treatment of multilevel disease, such as the anterior corpectomy with titanium mesh cage and anterior cervical plate placement, which has the advantage of performing a wider decompression and using the same bone as graft. However, it has caused controversy since the collapse of the mesh cage continues being a major limitation of this procedure. A prospective 4-year follow-up study was conducted in 7 patients diagnosed with cervical stenosis, who were treated surgically by one level corpectomy with titanium mesh cage and anterior cervical plate placement, evaluating them by radiographs and clinical scales. 7 patients, 5 women and 2 males were studied. The most common level was C5 corpectomy (n=4). The Neck Disability Index (NDI) preoperative average was 30.01±24.32 and 4-year postoperative 16.90±32.05, with p=0.801. The preoperative and 4-year postoperative Nürick was 3.28± 48 and 3.14±1.21 respectively, with p=0.766. Preoperative lordosis was 14.42±8.03 and 4-year postoperative 17±11.67 degrees, with p=0.660. The immediate postoperative and 4-year postoperative subsidence was 2.69±2.8 and 6.11±1.61 millimeters respectively, with p=0.0001. Despite the small sample, the subsidence of the mesh cage is common in this procedure. No statistically significant changes were observed in the lordosis or Nürick scale and NDI. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Surgical management of metastatic tumors of the cervical spine.

PubMed

Davarski, Atanas N; Kitov, Borislav D; Zhelyazkov, Christo B; Raykov, Stefan D; Kehayov, Ivo I; Koev, Ilyan G; Kalnev, Borislav M

2013-01-01

To present the results from the clinical presentation, the imaging diagnostics, surgery and postoperative status of 17 patients with cervical spine metastases, to analyse all data and make the respective conclusions and compare them with the available data in the literature. The study analysed data obtained by patients with metastatic cervical tumours treated in St George University Hospital over a period of seven years. All patients underwent diagnostic imaging tests which included, separately or in combination, cervical x-rays, computed tomography scan and magnetic-resonance imaging. Severity of neurological damage and its pre- and postoperative state was graded according to the Frankel Scale. For staging and operating performance we used the Tomita scale and Harrington classification. Seven patients had only one affected vertebra, 4 patients--two vertebrae, one patient--three vertebrae, 2 patients--four vertebrae, and in the other 3 patients more than one segment was affected. Surgery was performed in 12 patients. One level anterior corpectomy was performed in 6 patients, three patients had two-level surgery, and one patient--three-level corpectomy; in the remaining 2 cases we used posterior approach in surgery. Complete corpectomy was performed in 4 patients, subtotal corpectomy was used in 6 patients and partial--in 2 patients. Anterior stabilization system ADD plus (Ulrich GmbH & Co. KG, Ulm, Germany) was implanted in 2 patients; in 8 patients anterior titanium plate and bone graft were used, and in 1 patient--posterior cervical stabilization system. Because of the pronounced pain syndrome and frequent neurological lesions as a result of the cervical spine metastases use of surgery is justified. The main purpose is to maximize tumor resection, achieve optimal spinal cord and nerve root decompression and stabilize the affected segment.

Clinical Efficacy of Anterior Partial Corpectomy and Titanium Mesh Fusion and Internal Fixation for Treatment of Old Fracture Dislocation of the Lower Cervical Spine

PubMed Central

Miao, De-chao; Zhang, Bao-yang; Lei, Tao; Shen, Yong

2017-01-01

Background The aim of this study was to analyze the clinical features and to evaluate the efficacy of anterior partial corpectomy and titanium mesh fusion and internal fixation of old fracture dislocation of the lower cervical spine. Material/Methods We retrospectively analyzed the clinical data of 52 patients with old lower cervical fracture and dislocation treated with anterior partial corpectomy and titanium mesh fusion fixation between January 2008 and December 2013, with a mean follow-up period of 4.1 years. There were 35 males and 17 females. Patient radiological data and clinical parameters were recorded and compared before and after the operations. Results The average follow-up was 4.1 years. Intervertebral height and physiological curvature were well-reconstructed for all cases. No loosening or rupturing of titanium plate or screw occurred. The neurological function of the patients with incomplete spinal cord injury was significantly improved, and the function of the nerve roots at the injury level was also improved in patients with complete spinal cord injury. Bone fusion was completed within 6 months to 1 year after surgery. Conclusions Completed decompression, sequence and physiological curvature of the cervical vertebra, immediate and long-term anterior cervical column support, and nerve function restoration can be achieved by using anterior partial corpectomy and titanium mesh fusion and internal fixation to treat old fracture dislocation of the lower cervical spine. For cases with locked facet joints or posterior structures invading the vertebral canal, the combined anterior and posterior approaches should be performed, when necessary, to achieve better results. PMID:29184051

In vitro evaluation of stiffness and load sharing in a two-level corpectomy: comparison of static and dynamic cervical plates.

PubMed

Fogel, Guy R; Li, Zhenyu; Liu, Weiqiang; Liao, Zhenhua; Wu, Jia; Zhou, Wenyu

2010-05-01

Anterior cervical plating has been accepted in corpectomy and fusion of the cervical spine. Constrained plates were criticized for stress shielding that may lead to subsidence and pseudarthrosis. A dynamic plate allows load sharing as the graft subsides. Ideally, the dynamic plate design should maintain adequate stiffness of the construct while providing a reasonable load sharing with the strut graft. The purpose of the study was to compare dynamic and static plate kinematics with graft subsidence. The study designed was an in vitro biomechanical study in a porcine cervical spine model. Twelve spines were initially tested in intact condition with 20-N axial load in 15 degrees of flexion and extension range of motion (ROM). Then, a two-level corpectomy was created in all specimens with spines randomized to receive either a static or dynamic plate. The spines were retested under identical conditions with optimal length and undersized graft. Range of motion and graft loading were analyzed with a one-way analysis of variance (p<.05). Both plates significantly limited ROM compared with the intact spine in both graft length conditions. In extension graft, load was significantly higher (p=.001) in the static plate with optimal length, and in flexion, there was a significant loss of graft load (p=.0004). In flexion, the dynamic plate with undersized graft demonstrated significantly more load sustained (p=.0004). Both plates reasonably limited the ROM of the corpectomy. The static plate had significantly higher graft loads in extension and significant loss of graft load in flexion, whereas the dynamic plate maintained a reasonable graft load in ROM even when graft contact was imperfect. Copyright 2010 Elsevier Inc. All rights reserved.

Global analysis of sagittal spinal alignment in major deformities: correlation between lack of lumbar lordosis and flexion of the knee.

PubMed

Obeid, Ibrahim; Hauger, Olivier; Aunoble, Stéphane; Bourghli, Anouar; Pellet, Nicolas; Vital, Jean-Marc

2011-09-01

It has become well recognised that sagittal balance of the spine is the result of an interaction between the spine and the pelvis. Knee flexion is considered to be the last compensatory mechanism in case of sagittal imbalance, but only few studies have insisted on the relationship between spino-pelvic parameters and lower extremity parameters. Correlation between the lack of lumbar lordosis and knee flexion has not yet been established. A retrospective study was carried out on 28 patients with major spinal deformities. The EOS system was used to measure spinal and pelvic parameters and the knee flexion angle; the lack of lumbar lordosis was calculated after prediction of lumbar lordosis with two different formulas. Correlation analysis between the different measured parameters was performed. Lumbar lordosis correlated with sacral slope (r = -0.71) and moderately with knee flexion angle (r = 0.42). Pelvic tilt correlated moderately with knee flexion angle (r = 0.55). Lack of lumbar lordosis correlated best with knee flexion angle (r = 0.72 and r = 0.63 using the two formulas, respectively). Knee flexion as a compensatory mechanism to sagittal imbalance was well correlated to the lack of lordosis and, depending on the importance of the former parameter, the best procedure to correct sagittal imbalance could be chosen.

Differences in erect sitting and natural sitting spinal alignment-insights into a new paradigm and implications in deformity correction.

PubMed

Hey, Hwee Weng Dennis; Wong, Chengyuan Gordon; Lau, Eugene Tze-Chun; Tan, Kimberly-Anne; Lau, Leok-Lim; Liu, Ka-Po Gabriel; Wong, Hee-Kit

2017-02-01

Sitting spinal alignment is increasingly recognized as a factor influencing strategy for deformity correction. Considering that most individuals sit for longer hours in a "slumped" rather than in an erect posture, greater understanding of the natural sitting posture is warranted. This study aimed to investigate the differences in sagittal spinal alignment between two common sitting postures: a natural, patient-preferred posture; and an erect, investigator-controlled posture that is commonly used in alignment studies. This is a randomized, prospective study of 28 young, healthy patients seen in a tertiary hospital over a 6-month period. Twenty-eight patients (24 men, 4 women), with a mean age of 24 years (range 19-38), were recruited for this study. All patients with first episode of lower back pain of less than 3 months' duration were included. The exclusion criteria consisted of previous spinal surgery, radicular symptoms, red flag symptoms, previous spinal trauma, obvious spinal deformity on forward bending test, significant personal or family history of malignancy, and current pregnancy. Radiographic measurements included sagittal vertical axis (SVA), lumbar lordosis (LL), thoracolumbar angle (TL), thoracic kyphosis (TK), and cervical lordosis (CL). Standard spinopelvic parameters (pelvic incidence, pelvic tilt [PT], and sacral slope) and sagittal apex and end vertebrae were also measured. Basic patient demographics (age, gender, ethnicity) were recorded. Lateral sitting whole spine radiographs were obtained using a slot scanner in the imposed erect and the natural sitting posture. Statistical analyses of the radiographical parameters were performed comparing the two sitting postures using chi-squared tests for categorical variables and paired t tests for continuous variables. There was forward SVA shift between the two sitting postures by a mean of 2.9 cm (p<.001). There was a significant increase in CL by a mean of 11.62° (p<.001), and TL kyphosis by a mean of 11.48° (p<.001), as well as a loss of LL by a mean of 21.26° (p<.001). The mean PT increased by 17.68° (p<.001). The entire thoracic and lumbar spine has the tendency to form a single C-shaped curve with the apex moving to L1 (p=.002) vertebra in the majority of patients. In a natural sitting posture, the lumbar spine becomes kyphotic and contributes to a single C-shaped sagittal profile comprising the thoracic and the lumbar spine. This is associated with an increase in CL and PT, as well as a constant SVA. These findings lend insight into the body's natural way of energy conservation using the posterior ligamentous tension band while achieving sitting spinal sagittal balance. It also provides information on one of the possible causes of proximal junctional kyphosis or proximal junctional failure. Copyright © 2016 Elsevier Inc. All rights reserved.

Postural orientation and standing postural alignment in ambulant children with bilateral cerebral palsy.

PubMed

Domagalska-Szopa, Małgorzata; Szopa, Andrzej

2017-11-01

Standing postural alignment in children with cerebral palsy is usually altered by central postural control disorders. The primary aim of this study is to describe body alignment in a quiet standing position in ambulatory children with bilateral cerebral palsy compared with children with typical development. Fifty-eight children with bilateral cerebral palsy (aged 7-13years) and 45 age-matched children with typical development underwent a surface topography examination based on Moiré topography and were classified according to their sagittal postural profiles. The following eight grouping variables were extracted using a data reduction technique: angle of trunk inclination, pelvic tilt, and lordosis, the difference between kyphosis and lordosis, angle of vertebral lateral curvature, shoulder inclination, and shoulder and pelvic rotation. According to the cluster analysis results, 25% of the participants were classified into Cluster 1, 9% into Cluster 2, 49% in Cluster 3, and 17% in Cluster 4. Three different postural patterns emerged in accordance with the sagittal postural profiles in children with bilateral cerebral palsy and were defined as follows: 1) a lordotic postural pattern corresponding to forward-leaning posture; 2) a swayback postural pattern corresponding to backward-leaning posture; and 3) a balanced postural pattern corresponding to balanced posture. Copyright © 2017 Elsevier Ltd. All rights reserved.

Correction of hypokyphosis in thoracic adolescent idiopathic scoliosis using sublaminar bands: a 3D multicenter study.

PubMed

Ilharreborde, Brice; Pesenti, Sébastien; Ferrero, Emmanuelle; Accadbled, Franck; Jouve, Jean-Luc; De Gauzy, Jérôme Sales; Mazda, Keyvan

2018-02-01

The comparison of implants and correction methods remain controversial in AIS. Excellent frontal and axial correction rates have been reported with all-screw constructs, but at the expense of sagittal alignment, which has a tendency to flatten postoperatively. Posteromedial translation using hybrid constructs seems to preserve and improve thoracic kyphosis (TK), but no series exist to date with a significant number of hypokyphotic patients. In addition, the measures of TK in 2D are often wrong in severe AIS due to axial rotation. The goals of this study were therefore to analyze the 3D radiological outcomes of a group of hypokyphotic AIS patients operated with sublaminar bands. 35 consecutive AIS hypokyphotic patients (T4T12 <15°) operated in three centers were included, with a minimum 2-year follow-up. The surgical technique was similar in all centers, associating lumbar pedicle screws and thoracic sublaminar bands. Posteromedial translation was the main correction technique, and no patient underwent prior anterior release. 3D spinal reconstructions were performed preoperatively, postoperatively and at the latest follow-up by an independent observer using SterEOS (EOS imaging, Paris, France), and 2D and 3D measurements were compared. In addition, a new 3D parameter [sagittal shift of the apical vertebra (SSAV)], reflecting the translation of the apical vertebra of the main curve in the patient sagittal plane, was described and reported. The age of the cohort was 16 years and the number of sublaminar bands used for correction averaged 6 (±1.5). T1T12 and T4T12 sagittal Cobb angles appeared to be overestimated on 2D postoperatively (3°, p = 0.002 and 4°, p < 0.001, respectively). Hence, only 3D measurements were kept for the quantitative analysis of the postoperative correction. T4T12 TK significantly increased after surgery (average 8° ± 7°, p < 0.001), but 11 patients (31.4%) remained hypokyphotic. Seven out of the eight patients (87.5%) who presented a thoracic lordosis (i.e., T4T12 <0°) preoperatively were corrected after surgery (mean gain 16° ± 4°). A posterior shift (positive SSAV) of the apical vertebra was reported in 24 patients (68.6%). In this subgroup, the mean SSAV was +2 cm (±1). Good correlation was found between the SSAV and the postoperative change in 3D T4T12 kyphosis (r = 0.62). Measures in 2D tend to overestimate sagittal alignment and are not sufficient to evaluate postoperative correction. SSAV is a new 3D parameter reflecting the TK change that needs to be further investigated and used in the future. This series confirms that sublaminar bands should be considered in hypokyphotic patients, since thoracic sagittal alignment was restored in 68.6% of the cases.

Postural Consequences of Cervical Sagittal Imbalance: A Novel Laboratory Model.

PubMed

Patwardhan, Avinash G; Havey, Robert M; Khayatzadeh, Saeed; Muriuki, Muturi G; Voronov, Leonard I; Carandang, Gerard; Nguyen, Ngoc-Lam; Ghanayem, Alexander J; Schuit, Dale; Patel, Alpesh A; Smith, Zachary A; Sears, William

2015-06-01

A biomechanical study using human spine specimens. To study postural compensations in lordosis angles that are necessary to maintain horizontal gaze in the presence of forward head posture and increasing T1 sagittal tilt. Forward head posture relative to the shoulders, assessed radiographically using the horizontal offset distance between the C2 and C7 vertebral bodies (C2-C7 [sagittal vertical alignment] SVA), is a measure of global cervical imbalance. This may result from kyphotic alignment of cervical segments, muscle imbalance, as well as malalignment of thoracolumbar spine. Ten cadaveric cervical spines (occiput-T1) were tested. The T1 vertebra was anchored to a tilting and translating base. The occiput was free to move vertically but its angular orientation was constrained to ensure horizontal gaze regardless of sagittal imbalance. A 5-kg mass was attached to the occiput to mimic head weight. Forward head posture magnitude and T1 tilt were varied and motions of individual vertebrae were measured to calculate C2-C7 SVA and lordosis across C0-C2 and C2-C7. Increasing C2-C7 SVA caused flexion of lower cervical (C2-C7) segments and hyperextension of suboccipital (C0-C1-C2) segments to maintain horizontal gaze. Increasing kyphotic T1 tilt primarily increased lordosis across the C2-C7 segments. Regression models were developed to predict the compensatory C0-C2 and C2-C7 angulation needed to maintain horizontal gaze given values of C2-C7 SVA and T1 tilt. This study established predictive relationships between radiographical measures of forward head posture, T1 tilt, and postural compensations in the cervical lordosis angles needed to maintain horizontal gaze. The laboratory model predicted that normalization of C2-C7 SVA will reduce suboccipital (C0-C2) hyperextension, whereas T1 tilt reduction will reduce the hyperextension in the C2-C7 segments. The predictive relationships may help in planning corrective strategy in patients experiencing neck pain, which may be attributed to sagittal malalignment. N/A.

Relationship Between T1 Slope and Cervical Alignment Following Multilevel Posterior Cervical Fusion Surgery: Impact of T1 Slope Minus Cervical Lordosis.

PubMed

Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

2016-04-01

Retrospective study. To assess the relationship between sagittal alignment of the cervical spine and patient-reported health-related quality-of-life scores following multilevel posterior cervical fusion, and to explore whether an analogous relationship exists in the cervical spine using T1 slope minus C2-C7 lordosis (T1S-CL). A recent study demonstrated that, similar to the thoracolumbar spine, the severity of disability increases with sagittal malalignment following cervical reconstruction surgery. From 2007 to 2013, 38 consecutive patients underwent multilevel posterior cervical fusion for cervical stenosis, myelopathy, and deformities. Radiographic measurements included C0-C2 lordosis, C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), T1 slope, and T1S-CL. Pearson correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life. C2-C7 SVA positively correlated with neck disability index (NDI) scores (r = 0.495). C2-C7 lordosis (P = 0.001) and T1S-CL (P = 0.002) changes correlated with NDI score changes after surgery. For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of 50 mm, beyond which correlations were most significant. The T1S-CL also correlated positively with C2-C7 SVA and NDI scores (r = 0.871 and r = 0.470, respectively). Results of the regression analysis indicated that a C2-C7 SVA value of 50 mm corresponded to a T1S-CL value of 26.1°. This study showed that disability of the neck increased with cervical sagittal malalignment following surgical reconstruction and a greater T1S-CL mismatch was associated with a greater degree of cervical malalignment. Specifically, a mismatch greater than 26.1° corresponded to positive cervical sagittal malalignment, defined as C2-C7 SVA greater than 50 mm. 3.

Effect of mat pilates exercise on postural alignment and body composition of middle-aged women

PubMed Central

Lee, Hyo Taek; Oh, Hyun Ok; Han, Hui Seung; Jin, Kwang Youn; Roh, Hyo Lyun

2016-01-01

[Purpose] This study attempted to examine whether Pilates is an effective exercise for improving the postural alignment and health of middle-aged women. [Subjects and Methods] The participants in this study were 36 middle-aged women (20 in the experimental group, 16 in the control group). The experimental group participated in Pilates exercise sessions three times a week for 12 weeks. Body alignment and composition measurements before and after applying the Pilates exercise program were performed with a body composition analyzer and a three-dimensional scanner. [Results] Postural alignment in the sagittal and horizontal planes was enhanced in the Pilates exercise group. Trunk alignment showed correlations with body fat and muscle mass. [Conclusion] The Pilates exercises are performed symmetrically and strengthen the deep muscles. Moreover, the results showed that muscle mass was correlated with trunk postural alignment and that the proper amount of muscle is critical in maintaining trunk postural alignment. PMID:27390396

Association of low back pain with muscle stiffness and muscle mass of the lumbar back muscles, and sagittal spinal alignment in young and middle-aged medical workers.

PubMed

Masaki, Mitsuhiro; Aoyama, Tomoki; Murakami, Takashi; Yanase, Ko; Ji, Xiang; Tateuchi, Hiroshige; Ichihashi, Noriaki

2017-11-01

Muscle stiffness of the lumbar back muscles in low back pain (LBP) patients has not been clearly elucidated because quantitative assessment of the stiffness of individual muscles was conventionally difficult. This study aimed to examine the association of LBP with muscle stiffness assessed using ultrasonic shear wave elastography (SWE) and muscle mass of the lumbar back muscle, and spinal alignment in young and middle-aged medical workers. The study comprised 23 asymptomatic medical workers [control (CTR) group] and 9 medical workers with LBP (LBP group). Muscle stiffness and mass of the lumbar back muscles (lumbar erector spinae, multifidus, and quadratus lumborum) in the prone position were measured using ultrasonic SWE. Sagittal spinal alignment in the standing and prone positions was measured using a Spinal Mouse. The association with LBP was investigated by multiple logistic regression analysis with a forward selection method. The analysis was conducted using the shear elastic modulus and muscle thickness of the lumbar back muscles, and spinal alignment, age, body height, body weight, and sex as independent variables. Multiple logistic regression analysis showed that muscle stiffness of the lumbar multifidus muscle and body height were significant and independent determinants of LBP, but that muscle mass and spinal alignment were not. Muscle stiffness of the lumbar multifidus muscle in the LBP group was significantly higher than that in the CTR group. The results of this study suggest that LBP is associated with muscle stiffness of the lumbar multifidus muscle in young and middle-aged medical workers. Copyright © 2017 Elsevier Ltd. All rights reserved.

Acute proximal junctional failure in patients with preoperative sagittal imbalance.

PubMed

Smith, Micah W; Annis, Prokopis; Lawrence, Brandon D; Daubs, Michael D; Brodke, Darrel S

2015-10-01

Proximal junctional failure (PJF) is a recognized complication of spinal deformity surgery. Acute PJF (APJF) has recently been demonstrated to be 5.6% in the adult spinal deformity (ASD) population. The incidence and rate of return to the operating room for APJF have not been specifically investigated in individuals with sagittal imbalance. The purpose of this study was to report the incidence of APJF in patients with preoperative sagittal imbalance and the rate of return to the operating room for APJF. This study is based on a retrospective review of prospectively collected database of ASD patients. One hundred seventy-three consecutive patients were included with preoperative sagittal imbalance according to one of the following common parameters: sagittal vertical axis (SVA) greater than 50 mm, global sagittal alignment greater than 45°, or pelvic incidence minus lumbar lordosis greater than 10°. Outcome measure was presence and/or absence of APJF defined as fracture at the upper instrumented vertebra (UIV) or UIV+1, failure of UIV fixation, 15° or more proximal junctional kyphosis, or need for extension of instrumentation within 6 months of surgery. We performed radiographic measurements on X-rays at preoperative, immediate postoperative, and 6-month follow-up visits. The APJF rate was reported for the entire patient population with preoperative sagittal imbalance. Acute PJF incidence was calculated postoperatively for each of the accepted sagittal balance parameters and/or formulas. Patients with persistent postoperative sagittal imbalance were compared with the sagittally balanced group. We also assessed for threshold values. Acute PJF was observed in 60 of 173 patients (35%) and was least common in fusions with the UIV in the upper thoracic (UT) spine (p=.035). Of those who developed APJF, 21.7% required surgery. Proximal junctional kyphosis 15° or more was the most common form of APJF in fusions to the UT spine but least likely to need revision (p=.014). The most common mode of failure in lower thoracic (LT) or lumbar (L) fusions was UIV fracture. Postoperative SVA less than 50 mm was a significant risk factor for APJF (p=.009). Acute PJF is more common in patients with preoperative sagittal imbalance (35%) than the general adult deformity patient population, and 37% of those with APJF require revision. It is least common when the UIV is in the UT spine, compared with the LT or L spine. Sagittal balance correction to an SVA 50 mm or less was a significant risk factor in patients with preoperative sagittal imbalance. Copyright © 2015 Elsevier Inc. All rights reserved.

Sagittal plane analysis of the spine and pelvis in degenerative lumbar scoliosis.

PubMed

Han, Fei; Weishi, Li; Zhuoran, Sun; Qingwei, Ma; Zhongqiang, Chen

2017-01-01

Previous studies have reported the normative values of pelvic sagittal parameters, but no study has analyzed the sagittal spino-pelvic alignment in degenerative lumbar scoliosis (DLS) and its role in the pathogenesis. Retrospective analysis was applied to 104 patients with DLS, together with 100 cases of asymptomatic young adults as a control group and another control group consisting of 145 cases with cervical spondylosis. The coronal and sagittal parameters were measured on the anteroposterior and lateral radiograph of the whole spine in the DLS group as well as in the two control groups. Statistical analysis showed that the DLS group had a higher pelvic incidence (PI) value (50.5° ± 10.2°), than the normal control group (with PI 47.2° ± 8.8°) and the cervical spondylosis group (46.9° ± 9.1°). In DLS group, there were 38 cases (36.5%) complicated with degenerative lumbar spondylolisthesis, who had higher PI values than patients without it. Besides, the lumbar lordosis (LL) and sacral slope (SS) of DLS group were lower; the scoliosis Cobb's angle was correlated with pelvic tilt (PT); thoracic kyphosis was correlated with LL, SS, and PT; and LL was correlated with other sagittal parameters. Patients with DLS may have a higher PI, which may impact the pathogenesis of DLS. A high PI value is probably associated with the high prevalence of degenerative lumbar spondylolisthesis among DLS patients. In DLS patients, the lumbar spine maintains the ability of regulating the sagittal balance, and the regulation depends more on thoracic curve.

A self-aligning knee joint for walking assistance devices.

PubMed

Byungjune Choi; Younbaek Lee; Jeonghun Kim; Minhyung Lee; Jongwon Lee; Se-Gon Roh; Hyundo Choi; Yong-Jae Kim; Jung-Yun Choi

2016-08-01

This paper presents a novel self-aligning knee mechanism for walking assistance devices for the elderly to provide physical gait assistance. Self-aligning knee joints can assist in flexion/extension motions of the knee joint and compensate the knee's transitional movements in the sagittal plane. In order to compensate the center of rotation, which moves with the flexion/extension motion of the human knee joint, a self-aligning knee joint is proposed that adds redundant degrees of freedom (i.e., 2-DoF) to the 1-DoF revolute joint. The key idea of the proposed mechanism is to decouple joint rotations and translations for use in lower-extremity wearable devices. This paper describes the mechanical design of this self-aligning knee mechanism and its implementation on a wearable robot and in preliminary experiments. The performance of the proposed mechanism is verified by simulations and experiments.

Does a minimally invasive approach affect positioning of components in unicompartmental knee arthroplasty? Early results with survivorship analysis.

PubMed

Cool, Steve; Victor, Jan; De Baets, Thierry

2006-12-01

Fifty unicompartmental knee arthroplasties (UKAs) were performed through a minimally invasive approach and were reviewed with an average follow-up of 3.7 years. This technique leads to reduced access to surgical landmarks. The purpose of this study was to evaluate whether correct component positioning is possible through this less invasive approach. Component positioning, femorotibial alignment and early outcomes were evaluated. We observed perfect tibial component position, but femoral component position was less consistent, especially in the sagittal plane. Femorotibial alignment in the coronal plane was within 2.5 degrees of the desired axis for 80% of the cases. Femoral component position in the sagittal plane was within a 10 degrees range of the ideal for 70% of the cases. The mean IKS Knee Function Score and Knee Score were 89/100 and 91/100 respectively. We observed two polyethylene dislocations, and one revision was performed for progressive patellofemoral arthrosis. According to our data, minimally invasive UKA does not conflict with component positioning although a learning curve needs to be respected, with femoral component positioning as the major obstacle.

Outcomes of Corpectomy in Patients with Metastatic Cancer.

PubMed

Guzik, Grzegorz

2017-01-26

The objective of surgical management of spinal metastases is to reduce pain and improve the patient's quality of life. The operation should restore spinal stability and decompress neural structures. One surgical technique is corpectomy followed by vertebral body reconstruction and stabilisation of the spine. The procedure may be performed in patients in overall good health and a good survival prognosis. The aim of this paper is to present the outcomes of surgical management of spinal metastases in patients who underwent corpectomy followed by vertebral body reconstruction and stabilisation of the spine. The aim of the study was achieved by analysing medical histories of 124 patients with spinal metastases treated in the Oncological Orthopaedics Department in Brzozów in the period 2010-2015. The majority of patients in the group were women, who represented 64% of all the subjects. The average age was 63 years for women and 67 for men. The metastases were most frequently produced by breast cancer (36%) and myeloma (22%). A total of 87% of the group were diagnosed with pathologic fractures and 92% had spinal instability. Stenosis of the spinal canal was found in 78% of the patients. The surgeries were performed in 18 persons with metastases to the cervical spine, 69 patients with metastases to the thoracic spine and 37 participants with metastases to the lumbar spine. Single-level corpectomies were performed in 83 patients and multilevel corpectomies in 41 persons. Parameters analysed comprised overall health condition, neurological function (the Frankel Grade) and performance status (the Karnofsky score) of the patients. A VAS was used to assess the intensity of pain. The course of the operation and complications were also analysed. Following the surgeries, the average VAS pain score decreased from 7.2 to 3.8. Performance improved from a Karnofsky score of 50.26 to 68.65. Neurological function improved in 21 out of 34 patients with pareses. The average duration of the surgery was 67 minutes for the cervical spine, 123 minutes for the thoracic spine and 112 minutes for the lumbar spine. The loss of blood was strongest for lumbar spine surgeries, amounting on average to 580 ml. 62% of patients required transfusion ofblood substitutes after the operation. The average hospitalisation time was 14 days, with a minimum and maximum duration of 7 and 24 days, respectively. The most common complication was damage to the endplate of the vertebra adjacent to the prosthesis (11%). Two patients developed complete and irreversible paralysis of lower limbs. 1. Corpectomy followed by vertebral body reconstruction should be used in patients with a good prognosis. 2. Therapeutic outcomes are good. The surgery produced a considerable reduction in pain and improvement in performance in the majority of patients. 3. Complications are not frequent. The most common complication is intrusion of the implant into the endplate of the adjacent vertebrae. 4. A high survival rate at one year after the surgery, exceeding 90% of the patients, is evidence of effectiveness of the treatment and appropriate qualification of patients for the operation.

Correction of antebrachial angulation-rotation deformities in dogs with oblique plane inclined osteotomies.

PubMed

Franklin, Samuel P; Dover, Ryan K; Andrade, Natalia; Rosselli, Desiree; M Clarke, Kevin

2017-11-01

To describe oblique plane inclined osteotomies and report preliminary data on outcomes in dogs treated for antebrachial angulation-rotation deformities. Retrospective clinical study. Six antebrachii from 5 dogs. Records of dogs with antebrachial angulation-rotation deformities treated with oblique plane inclined osteotomies were reviewed. Postoperative frontal, sagittal, and transverse plane alignments were assessed subjectively, and alignment in the frontal and sagittal planes was quantified on radiographs. Outcomes were classified based on owner's and veterinarian's evaluation as full, acceptable, and unacceptable function. Complications were classified as minor, major, or catastrophic. Limb alignment was subjectively considered excellent in 1 case, good in 3 cases, and fair in 2 cases. Osseous union was achieved in all cases (mean 10.5 weeks; range, 6-13 weeks). Outcomes were assessed by the veterinarian as return to full function in 5 cases and acceptable function in 1 case at the final in-hospital follow-up (mean 44 weeks; range, 6-124 weeks). All owners classified their dogs as returning to full function at the final phone/email interview (mean 107 weeks; range, 72-153 weeks). Implants were removed due to infection or irritation in 3/6 limbs, while the other 3 limbs had minor dermatitis secondary to postoperative external coaptation. No catastrophic complications occurred. Oblique plane inclined osteotomies led to a successful outcome in all 6 limbs, but the technique can be challenging and does not always lead to optimal alignment. Future refinement of this technique could focus on the development of patient-specific osteotomy guides to improve accuracy and precision. © 2017 The American College of Veterinary Surgeons.

Radiological and functional outcomes of high-grade spondylolisthesis treated by intrasacral fixation, dome resection and circumferential fusion: a retrospective series of 20 consecutive cases with a minimum of 2 years follow-up.

PubMed

Ferrero, E; Ilharreborde, B; Mas, V; Vidal, C; Simon, A-L; Mazda, K

2018-01-20

Major concern during surgery for high-grade spondylolisthesis (HGS) is to reduce lumbosacral kyphosis and restore sagittal alignment. Despite the numerous methods described, lumbosacral fixation in HGS is a challenging technique associated with high complication rate. Few series have described outcomes and most of the results are limited to lumbosacral correction without global sagittal alignment analysis. This study aims at analyzing clinical and radiological outcomes of HGS patients treated with intrasacral rods on full spine radiographs. HGS patients (Meyerding III or higher) operated between 2004 and 2014 were reviewed. All patients underwent full spine stereoradiographic images. After L5 and S1 decompression, reduction and circumferential fusion with intrasacral rod fixation and fusion up to L4 were performed under fluoroscopy. The entry points for S1 screws were located 3-5 mm above and 5 mm lateral to the first sacral hole, toward the promontory. The two short distal fusion rods were then positioned into the sacrum guided by anteroposterior fluoroscopy using Jackson's technique. Then, sacral dome resection was performed and a PEEK cage was impacted in L5S1 after reduction. Postoperatively, the hip and knee were kept flexed at 45° for 1 week and extended progressively. Preoperative, 3 months postoperative and last follow-up (> 2 years minimum) clinical and radiographic data were collected. Sagittal parameters included lumbosacral angle (LSA), olisthesis, T1 spinopelvic inclination (T1SPi) and spinopelvic parameters. 20 HGS patients were included (8 ptosis, 5 Meyerding IV). The mean age was 14 years. At final FU (7.2 years ± 3), LSA kyphosis and olisthesis were reduced (65° ± 14 vs 99° ± 11, p < 0.001 and 81% ± 19 vs 45% ± 18, p < 0.001, respectively). While L1L5 lordosis decreased, T1T12 kyphosis increased. At FU, global alignment with T1SPi was - 6° ± 3. No significant loss of correction was observed. Regarding complications, ten patients presented transient L5 motor deficit that occurred when patients were put in standing position. However, all recovered before 3 months postoperatively. Intrasacral rod fixation appears to be an effective technique to correct LSA kyphosis, compensatory hyperlordosis and restore global sagittal alignment with a postoperative T1SPi corresponding to the value of the asymptomatic subject and achieve fusion. However, it remains a demanding technique with high risk of transient neurologic complications.

Sagittal Vertical Axias, Spinosacral Angle, Spinopelvic Angle, and T1 Pelvic Angle: Which Parameters May Effectively Predict the Quality of Life in Ankylosing Spondylitis Patients With Thoracolumbar Kyphosis?

PubMed

Zhang, Yun-Peng; Qian, Bang-Ping; Qiu, Yong; Qu, Zhe; Mao, Sai-Hu; Jiang, Jun; Zhu, Ze-Zhang

2017-08-01

This is a retrospective study. To identify the relationship between global sagittal alignment and health-related quality of life (HRQoL) in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis. Little data are available on correlation between global sagittal alignment and HRQoL in AS. A total of 107 AS patients were included in this study. The radiographic parameters were measured on lateral radiographs of the whole spine, including sagittal vertical axias (SVA), spinosacral angle (SSA), spinopelvic angle (SPA), and T1 pelvic angle (TPA). HRQoL was assessed using the oswestry disability index questionnaire, the bath ankylosing spondylitis disease activity index, the bath ankylosing spondylitis functional index, and short form-36 questionnaire. The patients were divided into 2 groups: group A (n=76, global kyphosis≤70 degrees), group B (n=31, global kyphosis>70 degrees). Statistical analysis was performed to identify significant differences between these 2 groups. In addition, correlation analysis and multiple regression analysis between radiologic parameters and clinical questionnaires were conducted. With respect to SVA, SSA, SPA, TPA, and HRQoL scores, significant differences were observed between 2 groups (P<0.05). Also, SVA, SSA, SPA, and TPA were significantly related to HRQoL. Multiple regression analysis revealed that SVA, SSA, SPA, and TPA were significant parameters in the prediction of HRQoL in AS patients with thoracolumbar kyphosis. Of note, HRQoL related much more to SSA and SPA than SVA and TPA. AS patients with moderate and severe deformity were demonstrated to be significantly different in terms of SVA, SSA, SPA, TPA, and HRQoL. Moreover, SVA, SSA, SPA, and TPA correlated with HRQoL significantly. In particular, SSA and SPA could better predict HRQoL than SVA and TPA in AS patients with thoracolumbar kyphosis.

Sagittal imbalance treated with L5 pedicle subtraction osteotomy with short lumbar fusion from L4 to sacrum using four screws into L4 for enhanced fixation two additional vertebral screws: a technical note.

PubMed

Wangdi, Kuenzang; Otsuki, Bungo; Fujibayashi, Shunsuke; Tanida, Shimei; Masamoto, Kazutaka; Matsuda, Shuichi

2018-02-07

To report on suggested technique with four screws in a single vertebra (two pedicle screws and two direct vertebral body screws) for enhanced fixation with just one level cranially to a pedicle subtraction osteotomy (PSO). A 60-year-old woman underwent L4/5 fusion surgery for degenerative spondylolisthesis. Two years later, she was unable to stand upright even for a short time because of lumbar kyphosis caused by subsidence of the fusion cage and of Baastrup syndrome in the upper lumbar spine [sagittal vertical axis (SVA) of 114 mm, pelvic incidence of 75°, and lumbar lordosis (LL) of 41°]. She underwent short-segment fusion from L4 to the sacrum with L5 pedicle subtraction osteotomy. We reinforced the construct with two vertebral screws at L4 in addition to the conventional L4 pedicle screws. After the surgery, her sagittal parameters were improved (SVA, 36 mm; LL, 54°). Two years after the corrective surgery, she maintained a low sagittal vertical axis though high residual pelvic tilt indicated that the patient was still compensating for residual sagittal misalignment. PSO surgery for sagittal imbalance usually requires a long fusion at least two levels above and below the osteotomy site to achieve adequate stability and better global alignment. However, longer fixation may decrease the patients' quality of life and cause a proximal junctional failure. Our novel technique may shorten the fixation area after osteotomy surgery. These slides can be retrieved under Electronic Supplementary Material.

Normal variation in sagittal spinal alignment parameters in adult patients: an EOS study using serial imaging.

PubMed

Hey, Hwee Weng Dennis; Tan, Kian Loong Melvin; Moorthy, Vikaesh; Lau, Eugene Tze-Chun; Lau, Leok-Lim; Liu, Gabriel; Wong, Hee-Kit

2018-03-01

To describe normal variations in sagittal spinal radiographic parameters over an interval period and establish physiological norms and guidelines for which these images should be interpreted. Data were prospectively collected from a continuous series of adult patients with first-episode mild low back pain presenting to a single institution. The sagittal parameters of two serial radiographic images taken 6-months apart were obtained with the EOS ® slot scanner. Measured parameters include CL, TK, TL, LL, PI, PT, SS, and end and apical vertebrae. Chi-squared test and Wilcoxon Signed Rank test were used to compare categorical and continuous variables, respectively. Sixty patients with a total of 120 whole-body sagittal X-rays were analysed. Mean age was 52.1 years (SD 21.2). Mean interval between the first and second X-rays was 126.2 days (SD 47.2). Small variations (< 1°) occur for all except PT (1.2°), CL (1.2°), and SVA (2.9 cm). Pelvic tilt showed significant difference between two images (p = 0.035). Subgroup analysis based on the time interval between X-rays, and between the first and second X-rays, did not show significant differences. Consistent findings were found for end and apical vertebrae of the thoracic and lumbar spine between the first and second X-rays for sagittal curve shapes. Radiographic sagittal parameters vary between serial images and reflect dynamism in spinal balancing. SVA and PT are predisposed to the widest variation. SVA has the largest variation between individuals of low pelvic tilt. Therefore, interpretation of these parameters should be patient specific and relies on trends rather than a one-time assessment.

Global Alignment and Proportion (GAP) Score: Development and Validation of a New Method of Analyzing Spinopelvic Alignment to Predict Mechanical Complications After Adult Spinal Deformity Surgery.

PubMed

Yilgor, Caglar; Sogunmez, Nuray; Boissiere, Louis; Yavuz, Yasemin; Obeid, Ibrahim; Kleinstück, Frank; Pérez-Grueso, Francisco Javier Sánchez; Acaroglu, Emre; Haddad, Sleiman; Mannion, Anne F; Pellise, Ferran; Alanay, Ahmet

2017-10-04

The restoration of normal sagittal alignment is a critical goal in adult spinal deformity surgery to achieve favorable outcomes and prevent mechanical complications. Schwab sagittal modifiers have been accepted as targets for appropriate alignment, but addressing these targets does not always prevent high mechanical complication or revision rates. This may be because the linear absolute numerical parameters do not cover the whole pelvic incidence spectrum and the distribution of lordosis, pelvic anteversion, and negative malalignment are not considered as potential causes of failure. The aim of the present study was to develop and validate a score based on pelvic-incidence-based proportional parameters to better predict mechanical complications. Two hundred and twenty-two patients (168 women and 54 men) followed for ≥2 years after posterior fusion at ≥4 levels were included in the study. The mean age (and standard deviation) was 52.2 ± 19.3 years (range, 18 to 84 years), and the mean duration of follow-up was 28.8 ± 8.2 months (range, 24 to 62 months). The global alignment and proportion (GAP) score was developed and validated in groups of patients randomly assigned to derivation (n = 148, 66.7%) and validation (n = 74, 33.3%) cohorts. GAP score parameters were relative pelvic version (the measured minus the ideal sacral slope), relative lumbar lordosis (the measured minus the ideal lumbar lordosis), lordosis distribution index (the L4-S1 lordosis divided by the L1-S1 lordosis multiplied by 100), relative spinopelvic alignment (the measured minus the ideal global tilt), and an age factor. Proximal and distal junctional kyphosis and/or failure, rod breakage, and other implant-related complications were considered mechanical complications. The predictive accuracy of the GAP score was analyzed using receiver operating characteristic (ROC) analyses. Associations between GAP categories and mechanical complications and revisions were analyzed using Cochran-Armitage tests. In the validation cohort, 32 patients (43%) experienced mechanical complications and 17 (23%) underwent mechanical revision. The area under curve for the GAP score predicting mechanical complications was 0.92 (standard error [SE] = 0.034, p < 0.001, 95% [confidence interval [CI] = 0.85 to 0.98). Postoperatively, patients with a proportioned spinopelvic state according to the GAP score had a mechanical complication rate of 6% while those with a moderately or severely disproportioned spinopelvic state had rates of 47% and 95%, respectively. The GAP score is a new pelvic-incidence-based proportional method of analyzing the sagittal plane that predicts mechanical complications in patients undergoing surgery for adult spinal deformity. Setting surgical goals according to the GAP score may decrease the prevalence of mechanical complications.

Radiographic Findings in Revision Anterior Cruciate Ligament Reconstructions from the MARS Cohort

PubMed Central

2013-01-01

The Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) group was developed to investigate revision ACL reconstruction outcomes. An important part of this is obtaining and reviewing radiographic studies. The goal for this radiographic analysis is to establish radiographic findings for a large revision ACL cohort to allow comparison with future studies. The study was designed as a cohort study. Various established radiographic parameters were measured by three readers. These included sagittal and coronal femoral and tibial tunnel position, joint space narrowing, and leg alignment. Inter- and intraobserver comparisons were performed. Femoral sagittal position demonstrated 42% were more than 40% anterior to the posterior cortex. On the sagittal tibia tunnel position, 49% demonstrated some impingement on full-extension lateral radiographs. Limb alignment averaged 43% medial to the medial edge of the tibial plateau. On the Rosenberg view (45-degree flexion view), the minimum joint space in the medial compartment averaged 106% of the opposite knee, but it ranged down to a minimum of 4.6%. Lateral compartment narrowing at its minimum on the Rosenberg view averaged 91.2% of the opposite knee, but it ranged down to a minimum of 0.0%. On the coronal view, verticality as measured by the angle from the center of the tibial tunnel aperture to the center of the femoral tunnel aperture measured 15.8 degree ± 6.9% from vertical. This study represents the radiographic findings in the largest revision ACL reconstruction series ever assembled. Findings were generally consistent with those previously demonstrated in the literature. PMID:23404491

Cervical and shoulder postural assessment of adolescents between 15 and 17 years old and association with upper quadrant pain

PubMed Central

Ruivo, Rodrigo M.; Pezarat-Correia, Pedro; Carita, Ana I.

2014-01-01

Background: There is sparse literature that provides evidence of cervical and shoulder postural alignment of 15 to 17-year-old adolescents and that analyzes sex differences. Objectives: To characterize the postural alignment of the head and shoulder in the sagittal plane of 15 to 17-year-old Portuguese adolescents in natural erect standing and explore the relationships between three postural angles and presence of neck and shoulder pain. Method: This cross-sectional study was conducted in two secondary schools in Portugal. 275 adolescent students (153 females and 122 males) aged 15 to 17 were evaluated. Sagittal head, cervical, and shoulder angles were measured with photogrammetry and PAS software. The American Shoulder and Elbow Surgeons Shoulder Assessment (ASES) was used to assess shoulder pain, whereas neck pain was self-reported with a single question. Results: Mean values of sagittal head, cervical, and shoulder angles were 17.2±5.7, 47.4±5.2, and 51.4±8.5º, respectively. 68% of the participants revealed protraction of the head, whereas 58% of them had protraction of the shoulder. The boys showed a significantly higher mean cervical angle, and adolescents with neck pain revealed lower mean cervical angle than adolescents without neck pain. 53% of the girls self-reported regular neck pain, contrasting with 19% of the boys. Conclusions: This data shows that forward head and protracted shoulder are common postural disorders in adolescents, especially in girls. Neck pain is prevalent in adolescents, especially girls, and it is associated with forward head posture. PMID:25054381

Cervical and shoulder postural assessment of adolescents between 15 and 17 years old and association with upper quadrant pain.

PubMed

Ruivo, Rodrigo M; Pezarat-Correia, Pedro; Carita, Ana I

2014-01-01

There is sparse literature that provides evidence of cervical and shoulder postural alignment of 15 to 17-year-old adolescents and that analyzes sex differences. To characterize the postural alignment of the head and shoulder in the sagittal plane of 15 to 17-year-old Portuguese adolescents in natural erect standing and explore the relationships between three postural angles and presence of neck and shoulder pain. This cross-sectional study was conducted in two secondary schools in Portugal. 275 adolescent students (153 females and 122 males) aged 15 to 17 were evaluated. Sagittal head, cervical, and shoulder angles were measured with photogrammetry and PAS software. The American Shoulder and Elbow Surgeons Shoulder Assessment (ASES) was used to assess shoulder pain, whereas neck pain was self-reported with a single question. Mean values of sagittal head, cervical, and shoulder angles were 17.2±5.7, 47.4±5.2, and 51.4±8.5º, respectively. 68% of the participants revealed protraction of the head, whereas 58% of them had protraction of the shoulder. The boys showed a significantly higher mean cervical angle, and adolescents with neck pain revealed lower mean cervical angle than adolescents without neck pain. 53% of the girls self-reported regular neck pain, contrasting with 19% of the boys. This data shows that forward head and protracted shoulder are common postural disorders in adolescents, especially in girls. Neck pain is prevalent in adolescents, especially girls, and it is associated with forward head posture.

Early Recurrence of a Solid Variant of Aneurysmal Bone Cyst in a Young Child After Resection: Technique and Literature Review and Two-year Follow-up After Corpectomy.

PubMed

Samir Barakat, Ahmed; Alsingaby, Hisham; Shousha, Mootaz; El Saghir, Hesham; Boehm, Heinrich

2018-05-15

Aneurysmal bone cysts (ABCs) are considered to be rare benign tumors that may affect long bones or the vertebral column. Their incidence varies and is reported to be 1.4% of all benign skeletal tumors. The solid-variant aneurysmal bone cyst (S-ABC) is even rarer and constitutes 3.5% to 7% of all vertebral ABCs. We report the case of an Enneking stage 3 S-ABC in a 5-year-old boy at C7 that showed rapid local recurrence after primary excision from posterior and dorsal stabilization requiring ventral corpectomy and posterior excision of the right lateral mass and right posterolateral fusion. Histologic examination disclosed an S-ABC. To our knowledge, this is the first case of S-ABC described in the literature that used both anterior and posterior approaches and complete corpectomy. Over a 2-year period, the patient showed no radiologic or clinical signs of local recurrence with excellent neurologic function. Solid-variant aneurysmal bone cysts are difficult to diagnose and treat, and careful clinical and radiologic assessment should be done to tailor an appropriate surgical plan to prevent recurrence and neurologic sequelae. To the best of our knowledge, there are to date no publications that studied the behavior of this subtype.

The Thoracic Lordosis Correction Improves Sacral Slope and Walking Ability in Neuromuscular Scoliosis.

PubMed

Kim, Do Yeon; Moon, Eun Su; Park, Jin Oh; Chong, Hyon Su; Lee, Hwan Mo; Moon, Seong Hwan; Kim, Sung Hoon; Kim, Hak Sun

2016-10-01

Retrospective study. To report on neuromuscular patients with preserved walking ability, but forward bending of the body due to thoracic lordosis, and to suggest thoracic lordosis correction as the surgical treatment. It is an established fact that lumbar lordosis or pelvic parameter is directly related to thoracic sagittal balance. However, the reverse relationship has not been fully defined yet. Loss of thoracic kyphosis results in positive sagittal balance, which causes walking difficulty. Neuromuscular patients with thoracic lordosis have not been reported yet, and there have been no reports on their surgical treatments. This study analyzed 8 patients treated with thoracic lordosis correction surgery. Every patient was diagnosed with muscular dystrophy. In thoracic lordosis correction surgery, anterior release was performed in the first stage and posterior segmental instrumentation was performed in the second stage. Radiographic parameters were compared and walking ability was evaluated with gait analysis. All patients were classified according to the modified Rancho Los Amigos Hospital system preoperatively and 2 years postoperatively to evaluate functional ability. The average follow-up period was 2.9 years. Before surgery, the mean thoracic sagittal alignment was -2.1-degree lordosis, the mean Cobb angle and sacral slope increased to 36.3 and 56.6 degrees, respectively. The anterior pelvic tilt in gait analysis was 29.3 degrees. At last follow-up after surgery, the mean thoracic sagittal alignment changed to 12.6-degree kyphosis, and the Cobb angle and sacral slope decreased to 18.9 and 39.5 degrees, respectively. Lumbar lordosis and the sacral slope showed significant positive correlation (P<0.001). The improvement in thoracic lordosis showed a significant correlation to the preoperative flexibility of the major curve (P=0.028). The anterior pelvic tilt in gait analysis improved to 15.4 degrees. The functional ability improved in 2 (50%) of 4 patients in class 2 and maintained in remaining 6 patients 2 years after surgery. Thoracic lordosis correction surgery in neuromuscular scoliosis patients with thoracic lordosis improved the sacral slope in the standing position and the anterior pelvic tilt in gait. Sagittal imbalance was compensated by the spinopelvic mechanism, and back and hip extensor muscles seem to play a major role in this compensation.

Reciprocal Changes in Sagittal Alignment in Adolescent Idiopathic Scoliosis Patients Following Strategic Pedicle Screw Fixation.

PubMed

Dumpa, Srikanth Reddy; Shetty, Ajoy Prasad; Aiyer, Siddharth N; Kanna, Rishi Mugesh; Rajasekaran, S

2018-04-01

Retrospective observational study. To analyze the effect of low-density (LD) strategic pedicle screw fixation on the correction of coronal and sagittal parameters in adolescent idiopathic scoliosis (AIS) patients. LD screw fixation achieves favorable coronal correction, but its effect on sagittal parameters is not well established. AIS is often associated with decreased thoracic kyphosis (TK), and the use of multi-level pedicle screws may result in further flattening of the sagittal profile. A retrospective analysis was performed on 92 patients with AIS to compare coronal and sagittal parameters preoperatively and at 2-year follow-up. All patients underwent posterior correction via LD strategic pedicle screw fixation. Radiographs were analyzed for primary Cobb angle (PCA), coronal imbalance, cervical sagittal angle (CSA), TK, lumbar lordosis (LL), pelvic incidence, pelvic tilt (PT), sacral slope (SS), C7 plumb line, spino-sacral angle, curve flexibility, and screw density. PCA changed significantly from 57.6°±13.9° to 19°±8.4° ( p <0.0001) with 67% correction, where the mean curve flexibility was 41% and screw density was 68%. Regional sagittal parameters did not change significantly, including CSA (from 10.76° to 10.56°, p =0.893), TK (from 24.4° to 22.8°, p =0.145), and LL (from 50.3° to 51.1°, p =0.415). However, subgroup analysis of the hypokyphosis group (<10°) and the hyperkyphosis group (>40°) showed significant correction of TK ( p <0.0001 in both). Sacro-pelvic parameters showed a significant decrease of PT and increase of SS, suggesting a reduction in pelvic retroversion SS (from 37° to 40°, p =0.0001) and PT (from 15° to 14°, p =0.025). LD strategic pedicle screw fixation provides favorable coronal correction and improves overall sagittal sacro-pelvic parameters. This technique does not cause significant flattening of TK and results in a favorable restoration of TK in patients with hypokyphosis or hyperkyphosis.

Reciprocal Changes in Sagittal Alignment in Adolescent Idiopathic Scoliosis Patients Following Strategic Pedicle Screw Fixation

PubMed Central

Dumpa, Srikanth Reddy; Aiyer, Siddharth N.; Kanna, Rishi Mugesh; Rajasekaran, S

2018-01-01

Study Design Retrospective observational study. Purpose To analyze the effect of low-density (LD) strategic pedicle screw fixation on the correction of coronal and sagittal parameters in adolescent idiopathic scoliosis (AIS) patients. Overview of Literature LD screw fixation achieves favorable coronal correction, but its effect on sagittal parameters is not well established. AIS is often associated with decreased thoracic kyphosis (TK), and the use of multi-level pedicle screws may result in further flattening of the sagittal profile. Methods A retrospective analysis was performed on 92 patients with AIS to compare coronal and sagittal parameters preoperatively and at 2-year follow-up. All patients underwent posterior correction via LD strategic pedicle screw fixation. Radiographs were analyzed for primary Cobb angle (PCA), coronal imbalance, cervical sagittal angle (CSA), TK, lumbar lordosis (LL), pelvic incidence, pelvic tilt (PT), sacral slope (SS), C7 plumb line, spino-sacral angle, curve flexibility, and screw density. Results PCA changed significantly from 57.6°±13.9° to 19°±8.4° (p <0.0001) with 67% correction, where the mean curve flexibility was 41% and screw density was 68%. Regional sagittal parameters did not change significantly, including CSA (from 10.76° to 10.56°, p =0.893), TK (from 24.4° to 22.8°, p =0.145), and LL (from 50.3° to 51.1°, p =0.415). However, subgroup analysis of the hypokyphosis group (<10°) and the hyperkyphosis group (>40°) showed significant correction of TK (p <0.0001 in both). Sacro-pelvic parameters showed a significant decrease of PT and increase of SS, suggesting a reduction in pelvic retroversion SS (from 37° to 40°, p =0.0001) and PT (from 15° to 14°, p =0.025). Conclusions LD strategic pedicle screw fixation provides favorable coronal correction and improves overall sagittal sacro-pelvic parameters. This technique does not cause significant flattening of TK and results in a favorable restoration of TK in patients with hypokyphosis or hyperkyphosis. PMID:29713412

Sagittal plane analysis of selective posterior thoracic spinal fusion in adolescent idiopathic scoliosis: a comparison study of all pedicle screw and hybrid instrumentation.

PubMed

Liu, Tie; Hai, Yong

2014-07-01

To compare sagittal profiles of selective posterior thoracic instrumentation with segmental pedicle screws instrumentation and hybrid (hook and pedicle screw). Nowadays, thoracic screws are considered more effective than other constructs in spinal deformity correction and have become the treatment in adolescent idiopathic scoliosis surgery. However, recent research found that this enhanced correction ability may sacrifice sagittal balance. As lumbar lordosis is dependent upon thoracic kyphosis (TK), it has been important to maintain TK magnitude in selective thoracic fusions to keep balance. There is no sagittal measurement analysis between the hybrid and all-screw constructs type in cases of selective thoracic fusion. All adolescent idiopathic scoliosis (Lenke1) patients surgically treated in our department between 2003 and 2008 were reviewed. Radiographs of these patients, whose preoperative, immediately postoperative, and minimum 2-year follow-up after selective thoracic fusion (lower instrumented vertebrae not lower than L1, hybrid group the pedicle screw instrumentation not higher than T10) were evaluated, 21 patients underwent posterior hybrid instrumentation and 21 underwent pedicle screw instrumentation. No significant difference in sagittal profiles was observed between the 2 groups. At final follow-up, the proximal junctional measurement has a minor increase in both the groups. TK (T5-T12) also increased (+2.0 degrees of increase in hybrid group vs. +3.9 degrees of increase in the pedicle screw group). The effect of different instrumentation in changing TK at various time points between 2 groups was statistic different (P=0.004). Lumbar lordosis (L1-L5) was increased in both the groups. No significant changes in distal junctional measurement and thoracolumbar junction were noted. The C7 sagittal plumbline remained negative in both the groups at the final follow-up. There was no statistically significant difference comparing the sagittal alignment parameter of pedicle screw and hybrid constructs except for selective TK correction have differences. If used properly, both kinds of instrumentation could result in acceptable sagittal profiles when selective thoracic fusions were performed.

The association between whole body sagittal balance and risk of falls among elderly patients seeking treatment for back pain.

PubMed

Kim, J; Hwang, J Y; Oh, J K; Park, M S; Kim, S W; Chang, H; Kim, T-H

2017-05-01

The objective of this study was to assess the association between whole body sagittal balance and risk of falls in elderly patients who have sought treatment for back pain. Balanced spinal sagittal alignment is known to be important for the prevention of falls. However, spinal sagittal imbalance can be markedly compensated by the lower extremities, and whole body sagittal balance including the lower extremities should be assessed to evaluate actual imbalances related to falls. Patients over 70 years old who visited an outpatient clinic for back pain treatment and underwent a standing whole-body radiograph were enrolled. Falls were prospectively assessed for 12 months using a monthly fall diary, and patients were divided into fallers and non-fallers according to the history of falls. Radiological parameters from whole-body radiographs and clinical data were compared between the two groups. A total of 144 patients (120 female patients and 24 male patients) completed a 12-month follow-up for assessing falls. A total of 31 patients (21.5%) reported at least one fall within the 12-month follow-up. In univariate logistic regression analysis, the risk of falls was significantly increased in older patients and those with more medical comorbidities, decreased lumbar lordosis, increased sagittal vertical axis, and increased horizontal distance between the C7 plumb line and the centre of the ankle (C7A). Increased C7A was significantly associated with increased risk of falls even after multivariate adjustment. Whole body sagittal balance, measured by the horizontal distance between the C7 plumb line and the centre of the ankle, was significantly associated with risk of falls among elderly patients with back pain. Cite this article : J. Kim, J. Y. Hwang, J. K. Oh, M. S. Park, S. W. Kim, H. Chang, T-H. Kim. The association between whole body sagittal balance and risk of falls among elderly patients seeking treatment for back pain. Bone Joint Res 2017;6:-344. DOI: 10.1302/2046-3758.65.BJR-2016-0271.R2. © 2017 Kim et al.

Outcomes of long retrograde intramedullary nailing for periprosthetic supracondylar femoral fractures following total knee arthroplasty.

PubMed

Lee, Sung-San; Lim, Seung-Jae; Moon, Young-Wan; Seo, Jai-Gon

2014-01-01

The treatment of periprosthetic supracondylar femoral fractures following total knee arthroplasty (TKA) is challenging because of osteopenia and the limited bone available for distal fixation. The purpose of this study was to report the outcomes of periprosthetic supracondylar femoral fractures treated with long retrograde intramedullary nailing. We conducted a retrospective review of 25 patients who were treated with a long retrograde intramedullary nail for periprosthetic supracondylar femoral fractures following TKA. Clinical evaluation included range of motion of knee, Knee Society Score (KSS), Western Ontario and McMaster Universities Arthritis (WOMAC) score, and radiologic evaluation including time to union, coronal and sagittal alignment of femoral component, lower limb alignment, and implant loosening. The mean duration of follow-up after the fracture repair was 39 months (range 12-47). All 25 fractures were united with a mean time of 12 weeks (range 8-20). At the last follow-up, the mean knee flexion was 111° (range 60°-130°), the mean KSS was 81.5 (range 50-100), and the mean WOMAC score was 30.2 (range 5-55). Four (16%) of the 25 patients developed malalignment according to Rorabeck and Taylor criteria, but all patients had a knee flexion of more than 90°. Coronal and sagittal alignments of femoral component and lower limb alignment did not differ significantly between before and after the fracture repair. Complications included the loosening or breakage of distal interlocking screws in three patients. No deep infection or prosthesis loosening was detected at the last follow-up. Surgical treatment of periprosthetic supracondylar femoral fractures following TKA with long retrograde intramedullary nailing resulted in high union rates and encouraging functional outcomes.

Computer-assisted oblique single-cut rotation osteotomy to reduce a multidirectional tibia deformity: case report.

PubMed

Dobbe, J G G; du Pré, K J; Blankevoort, L; Streekstra, G J; Kloen, P

2017-08-01

The correction of multiplanar deformity is challenging. We describe preoperative 3-D planning and treatment of a complex tibia malunion using an oblique single-cut rotation osteotomy to correct deformity parameters in the sagittal, coronal and transverse plane. At 5 years postoperatively, the patient ambulates without pain with a well-aligned leg.

Exploring the effects of kinesiological awareness and mental imagery on movement intention in the performance of demi-plié.

PubMed

Couillandre, Annabelle; Lewton-Brain, Peter; Portero, Pierre

2008-01-01

This study was designed to assess the ability of a practitioner intervention using kinesiological explanations and mental imagery techniques to optimize the performance of demi-plié in dancers. Seven professional female ballet dancers were involved in the study. Biomechanical and electromyographical parameters (maximum knee flexion, jump height, maximal vertical acceleration and its duration, ratio of sagittal acceleration variation, and ratio of muscle activity in four muscles of the lower limb) were analyzed before and after the practitioner intervention. Results demonstrated no significant difference in the depth of the demi-plié, nor in the height of the jump that followed, nor in the maximal vertical acceleration and its duration, leading to the suggestion that the technical potential of the dancers was preserved. Significant differences were found in the SEMG of the hamstrings during the demi-plié and the jump, implying that an improvement in the dynamic alignment of the dancers was present. A correlation was also found between the ratio of sagittal acceleration variation and the hamstring activity, suggesting that increased hamstring engagement produces decreased disruption of dynamic alignment. However, the intervention was not assimilated equally by all of the dancers.

Construct stability of an instrumented 2-level cervical corpectomy model following fatigue testing: biomechanical comparison of circumferential antero-posterior instrumentation versus a novel anterior-only transpedicular screw-plate fixation technique.

PubMed

Koller, Heiko; Schmoelz, Werner; Zenner, Juliane; Auffarth, Alexander; Resch, Herbert; Hitzl, Wolfgang; Malekzadeh, Davud; Ernstbrunner, Lukas; Blocher, Martina; Mayer, Michael

2015-12-01

A high rate of complications in multilevel cervical surgery with corpectomies and anterior-only screw-and-plate stabilization is reported. A 360°-instrumentation improves construct stiffness and fusion rates, but adds the morbidity of a second approach. A novel ATS-technique (technique that used anterior transpedicular screw placement) was recently described, yet no study to date has analyzed its performance after fatigue loading. Accordingly, the authors performed an analysis of construct stiffness after fatigue testing of a cervical 2-level corpectomy model reconstructed using a novel anterior transpedicular screw-and-plate technique (ATS-group) in comparison to standard antero-posterior instrumentation (360°-group). Twelve fresh-frozen human cervical spines were mounted on a spine motion tester to analyze restriction of ROM under loading (1.5 Nm) in flexion-extension (FE), axial rotation (AR), and lateral bending (LB). Testing was performed in the intact state, and after instrumentation of a 2-level corpectomy C4 + C5 using a cage and the constructs of ATS- and 360°-group, after 1,000 cycles, and after 2,000 cycles of fatigue testing. In the ATS-group (n = 6), instrumentation was achieved using a customized C3-C6 ATS-plate system. In the 360°-group (n = 6), instrumentation consisted of a standard anterior screw-and-plate system with a posterior instrumentation using C3-C6 lateral mass screws. Motion data were assessed as degrees and further processed as normalized values after standardization to the intact ROM state. Specimen age and BMD were not significantly different between the ATS- and 360°-groups. After instrumentation and 2,000 cycles of testing, no specimen exhibited a ROM greater than in the intact state. No specimen exhibited catastrophic construct failure after 2,000 cycles. Construct stiffness in the 360°-group was significantly increased compared to the ATS-group for all loading conditions, except for FE-testing after instrumentation. After 2,000 cycles, restriction of ROM under loading in FE was 39.8 ± 30% in the ATS-group vs. 2.8 ± 2.3% in the 360°-group, in AR 60.4 ± 25.8 vs 15 ± 11%, and in LB 40 ± 23.4 vs 3.9 ± 1.2%. Differences were significant (p < 0.05). 360°-instrumentation resembles the biomechanical standard of reference for stabilization of 2-level corpectomies. An ATS-construct was also shown to confer high construct stiffness, significantly reducing the percentage ROM beyond that of an intact specimen after 2,000 cycles. This type of instrumentation might be a clinical valuable and biomechanically sound adjunct to multilevel anterior surgical procedures.

The stabilizing potential of anterior, posterior and combined techniques for the reconstruction of a 2-level cervical corpectomy model: biomechanical study and first results of ATPS prototyping.

PubMed

Koller, Heiko; Schmidt, Rene; Mayer, Michael; Hitzl, Wolfgang; Zenner, Juliane; Midderhoff, Stefan; Middendorf, Stefan; Graf, Nicolaus; Gräf, Nicolaus; Resch, H; Wilke, Hans-Joachim; Willke, Hans-Joachim

2010-12-01

Clinical studies reported frequent failure with anterior instrumented multilevel cervical corpectomies. Hence, posterior augmentation was recommended but necessitates a second approach. Thus, an author group evaluated the feasibility, pull-out characteristics, and accuracy of anterior transpedicular screw (ATPS) fixation. Although first success with clinical application of ATPS has already been reported, no data exist on biomechanical characteristics of an ATPS-plate system enabling transpedicular end-level fixation in advanced instabilities. Therefore, we evaluated biomechanical qualities of an ATPS prototype C4-C7 for reduction of range of motion (ROM) and primary stability in a non-destructive setup among five constructs: anterior plate, posterior all-lateral mass screw construct, posterior construct with lateral mass screws C5 + C6 and end-level fixation using pedicle screws unilaterally or bilaterally, and a 360° construct. 12 human spines C3-T1 were divided into two groups. Four constructs were tested in group 1 and three in group 2; the ATPS prototypes were tested in both groups. Specimens were subjected to flexibility test in a spine motion tester at intact state and after 2-level corpectomy C5-C6 with subsequent reconstruction using a distractable cage and one of the osteosynthesis mentioned above. ROM in flexion-extension, axial rotation, and lateral bending was reported as normalized values. All instrumentations but the anterior plate showed significant reduction of ROM for all directions compared to the intact state. The 360° construct outperformed all others in terms of reducing ROM. While there were no significant differences between the 360° and posterior constructs in flexion-extension and lateral bending, the 360° constructs were significantly more stable in axial rotation. Concerning primary stability of ATPS prototypes, there were no significant differences compared to posterior-only constructs in flexion-extension and axial rotation. The 360° construct showed significant differences to the ATPS prototypes in flexion-extension, while no significant differences existed in axial rotation. But in lateral bending, the ATPS prototype and the anterior plate performed significantly worse than the posterior constructs. ATPS was shown to confer increased primary stability compared to the anterior plate in flexion-extension and axial rotation with the latter yielding significance. We showed that primary stability after 2-level corpectomy reconstruction using ATPS prototypes compared favorably to posterior systems and superior to anterior plates. From the biomechanical point, the 360° instrumentation was shown the most efficient for reconstruction of 2-level corpectomies. Further studies will elucidate whether fatigue testing will enhance the benefit of transpedicular anchorage with posterior constructs and ATPS.

Self-learning computers for surgical planning and prediction of postoperative alignment.

PubMed

Lafage, Renaud; Pesenti, Sébastien; Lafage, Virginie; Schwab, Frank J

2018-02-01

In past decades, the role of sagittal alignment has been widely demonstrated in the setting of spinal conditions. As several parameters can be affected, identifying the driver of the deformity is the cornerstone of a successful treatment approach. Despite the importance of restoring sagittal alignment for optimizing outcome, this task remains challenging. Self-learning computers and optimized algorithms are of great interest in spine surgery as in that they facilitate better planning and prediction of postoperative alignment. Nowadays, computer-assisted tools are part of surgeons' daily practice; however, the use of such tools remains to be time-consuming. NARRATIVE REVIEW AND RESULTS: Computer-assisted methods for the prediction of postoperative alignment consist of a three step analysis: identification of anatomical landmark, definition of alignment objectives, and simulation of surgery. Recently, complex rules for the prediction of alignment have been proposed. Even though this kind of work leads to more personalized objectives, the number of parameters involved renders it difficult for clinical use, stressing the importance of developing computer-assisted tools. The evolution of our current technology, including machine learning and other types of advanced algorithms, will provide powerful tools that could be useful in improving surgical outcomes and alignment prediction. These tools can combine different types of advanced technologies, such as image recognition and shape modeling, and using this technique, computer-assisted methods are able to predict spinal shape. The development of powerful computer-assisted methods involves the integration of several sources of information such as radiographic parameters (X-rays, MRI, CT scan, etc.), demographic information, and unusual non-osseous parameters (muscle quality, proprioception, gait analysis data). In using a larger set of data, these methods will aim to mimic what is actually done by spine surgeons, leading to real tailor-made solutions. Integrating newer technology can change the current way of planning/simulating surgery. The use of powerful computer-assisted tools that are able to integrate several parameters and learn from experience can change the traditional way of selecting treatment pathways and counseling patients. However, there is still much work to be done to reach a desired level as noted in other orthopedic fields, such as hip surgery. Many of these tools already exist in non-medical fields and their adaptation to spine surgery is of considerable interest.

Are we simplifying balance evaluation in adolescent idiopathic scoliosis?

PubMed

Pasha, Saba; Baldwin, Keith

2018-01-01

Clinical evaluation of the postural balance in adolescent idiopathic scoliosis has been measured by sagittal vertical axis and frontal balance. The impact of the scoliotic deformity in three planes on balance has not been fully investigated. 47 right thoracic and left lumbar curves adolescent idiopathic scoliosis and 10 non-scoliotic controls were registered prospectively. 13 spinopelvic postural parameters were calculated from the 3-dimantional reconstructions of X-rays. 7 balance variables describing the position and sway of the center of pressure were recorded using a pressure mat. A regression analysis was used to predict sagittal vertical axis and frontal balance from the 7 balance variables. A canonical correlation analysis was performed between all the postural parameters and balance variables and the significant associations between the postural and balance variables were determined. sagittal vertical axis and frontal balance were not significantly associated with the position or sway of the center of pressure (p>0.05). Canonical correlation analysis showed significant associations between the postural variables in the 3 planes and center of pressure position (R 2 =0.81) and sway (R 2 =0.62), p<0.05. Frontal Cobbs, apical rotations, distal kyphosis, pelvic incidence, sacral slope, sagittal vertical axis, and frontal balance contributed to the postural balance in the cohort. The compensatory role of the pelvis and distal kyphosis in sagittal plane was underlined. Multidimensional analyses between the postural and balance variables showed the alignment of the thoracic, lumbar, and pelvis in the 3 planes, in addition to the global head-pelvic position impact on adolescent idiopathic scoliosis balance. Copyright © 2017 Elsevier Ltd. All rights reserved.

Application of Piezosurgery in Anterior Cervical Corpectomy and Fusion.

PubMed

Pan, Sheng-Fa; Sun, Yu

2016-05-01

Anterior cervical corpectomy and fusion (ACCF) is frequently used to decompress the cervical spine; however, this procedure is risky when dealing with a hard disc or ossification of the posterior longitudinal ligament (OPLL). Piezosurgery offers a useful tool for performing this procedure. In this article, we present a 50 years old man who had cervical spondylotic myelopathy with OPLL at the C 6 level and segmental stenosis of the cervical spinal canal. When removing the posterior wall of his C 6 vertebral body and OPLL, piezosurgery was used to selectively cut hard structures piece by piece without injuring delicate soft tissues like the nerve roots and spinal cord. Because there is no bleeding from the bone surface with piezosurgery, it provides a clean operative field. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

The distance from the extramedullary cutting guide rod to the skin surface as a reference guide for the tibial slope in total knee arthroplasty.

PubMed

Tsukeoka, Tadashi; Tsuneizumi, Yoshikazu

2016-03-01

Although sagittal tibial alignment in total knee arthroplasty (TKA) is important, no landmarks exist to achieve a reproducible slope. The purpose of this study was to evaluate the clinical usefulness of the distance from the guide rod to the skin surface for the tibial slope in TKA. Computer simulation studies were performed on 100 consecutive knees scheduled for TKA. The angle between the line connecting the most anterior point of the predicted tibial cut surface and the skin surface 20 cm distal to the predicted cut surface (Line S) and the mechanical axis (MA) of the tibia in the sagittal plane was measured. The mean (±SD) absolute angle difference between the Line S and the MA was 0.9°±0.7°. The Line S was almost parallel to the MA in the sagittal plane (95% and 99% within two degrees and three degrees of deviation from MA, respectively). The guide rod orientation is a surrogate for the tibial cut slope because the targeted posterior slope is usually built into the cutting block and ensuring the rod is parallel to the MA in the sagittal plane is recommended. Therefore the distance between the skin surface and the rod can be a useful guide for the tibial slope. II. Copyright © 2015 Elsevier B.V. All rights reserved.

Defining Spino-Pelvic Alignment Thresholds: Should Operative Goals in Adult Spinal Deformity Surgery Account for Age?

PubMed

Lafage, Renaud; Schwab, Frank; Challier, Vincent; Henry, Jensen K; Gum, Jeffrey; Smith, Justin; Hostin, Richard; Shaffrey, Christopher; Kim, Han J; Ames, Christopher; Scheer, Justin; Klineberg, Eric; Bess, Shay; Burton, Douglas; Lafage, Virginie

2016-01-01

Retrospective review of prospective, multicenter database. The aim of the study was to determine age-specific spino-pelvic parameters, to extrapolate age-specific Oswestry Disability Index (ODI) values from published Short Form (SF)-36 Physical Component Score (PCS) data, and to propose age-specific realignment thresholds for adult spinal deformity (ASD). The Scoliosis Research Society-Schwab classification offers a framework for defining alignment in patients with ASD. Although age-specific changes in spinal alignment and patient-reported outcomes have been established in the literature, their relationship in the setting of ASD operative realignment has not been reported. ASD patients who received operative or nonoperative treatment were consecutively enrolled. Patients were stratified by age, consistent with published US-normative values (Norms) of the SF-36 PCS (<35, 35-44, 45-54, 55-64, 65-74, >75  y old). At baseline, relationships between between radiographic spino-pelvic parameters (lumbar-pelvic mismatch [PI-LL], pelvic tilt [PT], sagittal vertical axis [SVA], and T1 pelvic angle [TPA]), age, and PCS were established using linear regression analysis; normative PCS values were then used to establish age-specific targets. Correlation analysis with ODI and PCS was used to determine age-specific ideal alignment. Baseline analysis included 773 patients (53.7 y old, 54% operative, 83% female). There was a strong correlation between ODI and PCS (r = 0.814, P < 0.001), allowing for the extrapolation of US-normative ODI by age group. Linear regression analysis (all with r > 0.510, P < 0.001) combined with US-normative PCS values demonstrated that ideal spino-pelvic values increased with age, ranging from PT = 10.9 degrees, PI-LL = -10.5 degrees, and SVA = 4.1 mm for patients under 35 years to PT = 28.5 degrees, PI-LL = 16.7 degrees, and SVA = 78.1 mm for patients over 75 years. Clinically, older patients had greater compensation, more degenerative loss of lordosis, and were more pitched forward. This study demonstrated that sagittal spino-pelvic alignment varies with age. Thus, operative realignment targets should account for age, with younger patients requiring more rigorous alignment objectives.

Bracing of the Reconstructed and Osteoarthritic Knee during High Dynamic Load Tasks.

PubMed

Hart, Harvi F; Crossley, Kay M; Collins, Natalie J; Ackland, David C

2017-06-01

Lateral compartment osteoarthritis accompanied by abnormal knee biomechanics is frequently reported in individuals with knee osteoarthritis after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to evaluate changes in knee biomechanics produced by an adjusted and unadjusted varus knee brace during high dynamic loading activities in individuals with lateral knee osteoarthritis after ACLR and valgus malalignment. Nineteen participants who had undergone ACLR 5 to 20 yr previously and had symptomatic and radiographic lateral knee osteoarthritis with valgus malalignment were assessed. Quantitative motion analysis experiments were conducted during hopping, stair ascent, and descent under three test conditions: (i) no brace, (ii) unadjusted brace with sagittal plane support and neutral frontal plane alignment, and (iii) adjusted brace with sagittal plane support and varus realignment (valgus to neutral). Sagittal, frontal, and transverse plane knee kinematics, external joint moment, and angular impulse data were calculated. Relative to an unbraced knee, braced conditions significantly increased knee flexion and adduction angles during hopping (P = 0.003 and P = 0.005; respectively), stair ascent (P = 0.003 and P < 0.001, respectively), and descent (P = 0.009 and P < 0.001, respectively). In addition, the brace conditions increased knee flexion (P < 0.001) and adduction (P = 0.001) angular impulses and knee stiffness (P < 0.001) during hopping, as well as increased knee adduction moments during stair ascent (P = 0.008) and flexion moments during stair descent (P = 0.006). There were no significant differences between the adjusted and the unadjusted brace conditions (P > 0.05). A knee brace, with or without varus alignment, can modulate knee kinematics and external joint moments during hopping, stairs ascent, and descent in individuals with predominant lateral knee osteoarthritis after ACLR. Longer-term use of a brace may have implications in slowing osteoarthritis progression.

Spino-pelvic sagittal balance of spondylolisthesis: a review and classification.

PubMed

Labelle, Hubert; Mac-Thiong, Jean-Marc; Roussouly, Pierre

2011-09-01

In L5-S1 spondylolisthesis, it has been clearly demonstrated over the past decade that sacro-pelvic morphology is abnormal and that it can be associated to an abnormal sacro-pelvic orientation as well as to a disturbed global sagittal balance of the spine. The purpose of this article is to review the work done within the Spinal Deformity Study Group (SDSG) over the past decade, which has led to a classification incorporating this recent knowledge. The evidence presented has been derived from the analysis of the SDSG database, a multi-center radiological database of patients with L5-S1 spondylolisthesis, collected from 43 spine surgeons in North America and Europe. The classification defines 6 types of spondylolisthesis based on features that can be assessed on sagittal radiographs of the spine and pelvis: (1) grade of slip, (2) pelvic incidence, and (3) spino-pelvic alignment. A reliability study has demonstrated substantial intra- and inter-observer reliability similar to other currently used classifications for spinal deformity. Furthermore, health-related quality of life measures were found to be significantly different between the 6 types, thus supporting the value of a classification based on spino-pelvic alignment. The clinical relevance is that clinicians need to keep in mind when planning treatment that subjects with L5-S1 spondylolisthesis are a heterogeneous group with various adaptations of their posture. In the current controversy on whether high-grade deformities should or should not be reduced, it is suggested that reduction techniques should preferably be used in subjects with evidence of abnormal posture, in order to restore global spino-pelvic balance and improve the biomechanical environment for fusion.

Lumbar Disc Replacement for Junctional Decompensation After Fusion Surgery: Clinical and Radiological Outcome at an Average Follow-Up of 33 Months

PubMed Central

Sliwa, Karen; Weinberg, Ian R.; Sweet, Barry MBE; de Villiers, Malan; Candy, Geoffrey P.

2007-01-01

Background Failed fusion surgery remains difficult to treat. Few published data on disc replacement surgery after failed fusion procedures exist. Our objective was to evaluate outcomes of junctional lumbar disc replacement after previous fusion surgery and to correlate outcome with radiological changes to parameters of sagittal balance. Methods Out of a single-center prospective registry of 290 patients with 404 lumbar disc replacements, 27 patients had had a previous lumbar fusion operation on 1 to 4 lumbar segments and had completed a mean follow- up of 33 months (range: 18–56). We correlated the clinical outcome measures (patient satisfaction, 10-point pain score, and Oswestry Disability Index [ODI] score) to parameters of spinal sagittal alignment (sacral tilt, pelvic tilt, pelvic incidence, and lumbar lordosis). Results Postoperative hospital stay averaged 3.3 days (range: 2–8). Previously-employed patients went back to their jobs with a mean of 32 days (range: 21–42) after the procedure. At the latest follow-up, 1 of the patients considered the outcome to be poor, 3 fair, 8 good, and 15 excellent. Twenty-four patients “would undergo the operation again.” Average pain score decreased from 9.1 ± 1.0 (SD) to 3.2 ± 2.1 (P < .01). Average ODI decreased from 50.2 ± 9.9 preoperatively to 21.7 ± 14.2 (P ≤ .01). We found the change in pelvic tilt to be an independent predictor of better clinical outcome by multivariate analysis (P < .05). Conclusions In patients with junctional failure adjacent to a previous posterolateral fusion, disc replacement at the junctional level(s), compared with osteotomy and fusion surgery, offers the advantage of maintaining segmental mobility and correcting the flat-back deformity through a single approach with less operative time and blood loss. Early- to intermediate-term results are promising. The influence of changes in spinal sagittal alignment on clinical outcome needs to be addressed in future research. Clinical Relevance This is the first study on “junctional disc replacement patients” correlating clinical outcome to changes in spinal/pelvic alignment. PMID:25802584

A modified technique to reduce tibial keel cutting errors during an Oxford unicompartmental knee arthroplasty.

PubMed

Inui, Hiroshi; Taketomi, Shuji; Tahara, Keitarou; Yamagami, Ryota; Sanada, Takaki; Tanaka, Sakae

2017-03-01

Bone cutting errors can cause malalignment of unicompartmental knee arthroplasties (UKA). Although the extent of tibial malalignment due to horizontal cutting errors has been well reported, there is a lack of studies evaluating malalignment as a consequence of keel cutting errors, particularly in the Oxford UKA. The purpose of this study was to examine keel cutting errors during Oxford UKA placement using a navigation system and to clarify whether two different tibial keel cutting techniques would have different error rates. The alignment of the tibial cut surface after a horizontal osteotomy and the surface of the tibial trial component was measured with a navigation system. Cutting error was defined as the angular difference between these measurements. The following two techniques were used: the standard "pushing" technique in 83 patients (group P) and a modified "dolphin" technique in 41 patients (group D). In all 123 patients studied, the mean absolute keel cutting error was 1.7° and 1.4° in the coronal and sagittal planes, respectively. In group P, there were 22 outlier patients (27 %) in the coronal plane and 13 (16 %) in the sagittal plane. Group D had three outlier patients (8 %) in the coronal plane and none (0 %) in the sagittal plane. Significant differences were observed in the outlier ratio of these techniques in both the sagittal (P = 0.014) and coronal (P = 0.008) planes. Our study demonstrated overall keel cutting errors of 1.7° in the coronal plane and 1.4° in the sagittal plane. The "dolphin" technique was found to significantly reduce keel cutting errors on the tibial side. This technique will be useful for accurate component positioning and therefore improve the longevity of Oxford UKAs. Retrospective comparative study, Level III.

How the spine differs in standing and in sitting-important considerations for correction of spinal deformity.

PubMed

Hey, Hwee Weng Dennis; Teo, Alex Quok An; Tan, Kimberly-Anne; Ng, Li Wen Nathaniel; Lau, Leok-Lim; Liu, Ka-Po Gabriel; Wong, Hee-Kit

2017-06-01

The current prevailing school of thought in spinal deformity surgery is to restore sagittal balance with reference to the alignment of the spine when the patient is standing. This strategy, however, likely accounts for increased rates of proximal junctional failure. The purpose of this study was to investigate the differences between the spine in standing and sitting positions as these may elucidate reasons for deformity correction failure. A prospective, comparative study of 58 healthy patients presenting to a tertiary hospital over a 6-month period was carried out. All patients presenting with a less than 3-month history of first episode lower back pain were included. Patients who had radicular symptoms, red flag symptoms, previous spine surgery, or visible spinal deformity during forward bending test were excluded. Pregnant patients were also excluded. Radiographic measurements including sagittal vertical axis (SVA), lumbar lordosis (LL), thoracolumbar angle (TL), thoracic kyphosis (TK), cervical lordosis (CL), pelvic incidence (PI), and pelvic tilt (PT) were collected. The sagittal apex and end vertebrae of all radiographs were also recorded. Basic demographic data (age, gender, and ethnicity) was recorded. Lateral standing and sitting radiographs were obtained using EOS technology. Statistical analysis was performed to compare standing and sitting parameters using chi-square tests for categorical variables and paired t tests for continuous variables. Taking the standing position as the reference point, forward displacement of the SVA occurred during sitting by a mean of 6.39±3.87 cm (p<.001). This was accompanied by a reduction of LL and TK by a mean of 24.63±12.70° (p<.001) and 8.56±7.21°(p<.001), respectively. The TL became more lordotic by a mean of 3.25±7.30° (p<.001). The CL only reached borderline significance (p=.047) for increased lordosis by a mean of 3.45±12.92°. The PT also increased by 50% (p<.001). Despite relatively constant end vertebrae, the apex vertebra moved inferiorly for the thoracic curve (p<.006) and superiorly for the lumbar curve (p<.001) by approximately one vertebral level each. Sagittal spinal alignment changes significantly between standing and sitting positions. Understanding these differences is crucial to avoid overcorrection of LL, which may occur if deformity correction is based solely on the spine's standing sagittal profile. Copyright © 2016 Elsevier Inc. All rights reserved.

Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation.

PubMed

Saunders, R L; Bernini, P M; Shirreffs, T G; Reeves, A G

1991-02-01

Since 1984, a consecutive series of patients with cervical spondylotic myelopathy has been treated by central corpectomy and strut grafting. This report focuses on 40 cases operated on between 1984 and 1987 and followed from 2 to 5 years. The perioperative complication rate was 47.5%, with a 7.5% incidence of persistent sequelae: severe C-5 radiculopathy in one patient, swallowing dysfunction in one, and hypoglossal nerve palsy in one. No single factor (age, duration of symptoms, or severity of myelopathy) was absolutely predictive of outcome; however, syndromes of short duration had the best likelihood of cure. Similar outcomes were associated, individually, with long duration of symptoms, age over 70 years, and severe myelopathy. After factoring a 5% regression of improvement, the long-term cure rate was 57.5% and the failure rate was 15%. Myelopathy worsening was not documented.

Graft position in arthroscopic anterior cruciate ligament reconstruction: anteromedial versus transtibial technique.

PubMed

Guler, Olcay; Mahırogulları, Mahir; Mutlu, Serhat; Cercı, Mehmet H; Seker, Ali; Cakmak, Selami

2016-11-01

When treating anterior cruciate ligament (ACL) injuries, the position of the ACL graft plays a key role in regaining postoperative knee function and physiologic kinematics. In this study, we aimed to compare graft angle, graft position in tibial tunnel, and tibial and femoral tunnel positions in patients operated with anteromedial (AM) and transtibial (TT) methods to those of contralateral healthy knees. Forty-eight patients who underwent arthroscopic ACL reconstruction with ipsilateral hamstring tendon autograft were included. Of these, 23 and 25 were treated by AM and TT techniques, respectively. MRI was performed at 18.4 and 19.7 months postoperatively in AM and TT groups. Graft angles, graft positions in the tibial tunnel and alignment of tibial and femoral tunnels were noted and compared in these two groups. The sagittal graft insertion tibia midpoint distance (SGON) has been used for evaluation of graft position in tunnel. Sagittal ACL graft angles in operated and healthy knees of AM patients were 57.78° and 46.80° (p < 0.01). With respect to TT patients, ACL graft angle was 58.87° and 70.04° on sagittal and frontal planes in operated knees versus 47.38° and 61.82° in healthy knees (p < 0.001). ACL graft angle was significantly different between the groups on both sagittal and frontal planes (p < 0.001). Sagittal graft insertion tibia midpoint distance ratio was 0.51 and 0.48 % in the operated and healthy knees of AM group (p < 0.001) and 0.51 and 0.48 % in TT group (p < 0.001). Sagittal tibial tunnel midpoint distance ratio did not differ from sagittal graft insertion tibia midpoint distance of healthy knees in either group. Femoral tunnel clock position was better in AM [right knee 10:19 o'clock-face position (310° ± 4°); left knee 1:40 (50° ± 3°)] compared with TT group [right knee 10:48 (324° ± 5°); left knee 1:04 (32° ± 4°)]. With respect to the sagittal plane, the anterior-posterior position of femoral tunnel was better in AM patients. Lysholm scores and range of motion of operated knees in the AM and TT groups showed no significant difference (p > 0.05). Precise reconstruction on sagittal plane cannot be obtained with either AM or TT technique. However, AM technique is superior to TT technique in terms of anatomical graft positioning. Posterior-placed grafts in tibial tunnel prevent ACL reconstruction, although tibial tunnel is drilled on sagittal plane.

Instrumentation Failure after Partial Corpectomy with Instrumentation of a Metastatic Spine

PubMed Central

Park, Sung Bae; Kim, Ki Jeong; Han, Sanghyun; Oh, Sohee; Kim, Chi Heon; Chung, Chun Kee

2018-01-01

Objective To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis. Methods We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest. Results There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure (p=0.049 and 0.050, respectively). Conclusion When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion. PMID:29631384

Instrumentation Failure after Partial Corpectomy with Instrumentation of a Metastatic Spine.

PubMed

Park, Sung Bae; Kim, Ki Jeong; Han, Sanghyun; Oh, Sohee; Kim, Chi Heon; Chung, Chun Kee

2018-05-01

To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis. We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest. There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure ( p =0.049 and 0.050, respectively). When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion.

Modic changes of the cervical spine: T1 slope and its impact on axial neck pain.

PubMed

Li, Jia; Qin, Shuhui; Li, Yongqian; Shen, Yong

2017-01-01

The purpose of the research was to evaluate cervical sagittal parameters on magnetic resonance imaging (MRI) in patients with Modic changes and its impact on axial neck pain. This study consisted of 266 consecutive asymptomatic or symptomatic patients with Modic changes, whose average age was 50.9±12.6 years from January 2015 to December 2016. Cervical sagittal parameters included sagittal alignment of the cervical spine (SACS), T1 slope, thoracic inlet angle (TIA), and neck tilt (NT). The Modic changes group was compared with an asymptomatic control group of 338 age- and gender-matched adults. In the Modic changes group, T1 slope was significantly higher (25.8°±6.3°) compared with that in the control group (22.5°±6.8°) ( P =0.000). However, there was no significant difference of the NT, TIA, and SACS between the two groups. Patients in the Modic changes group were more likely to have experienced historical axial neck pain compared with the control group ( P =0.000). With regard to the disc degeneration, it indicated that the disc in the Modic changes group had more severe disc degeneration ( P =0.032). T1 slope in the Modic changes group was significantly higher compared to that of the control group. The findings suggested that a higher T1 slope with broken compensation of cervical sagittal mechanism may be associated with the development of Modic changes in the cervical spine.

Comparison of Lumbosacral Alignment in Geriatric and Non-Geriatric patients suffering low back pain.

PubMed

Kocyigit, Burhan Fatih; Berk, Ejder

2018-01-01

Lumbosacral alignment is a crucial factor for an appropriate spinal function. Changes in spinal alignment lead to diminished body biomechanics. Additionally, lumbosacral alignment may affect quality of life, sagittal balance and fall risk in elderly. In this study, we aimed to compare lumbosacral alignment in geriatric and non-geriatric patients suffering from low back pain. A total of 202 (120 male and 82 female) patients who visited to physical medicine and rehabilitation clinic with low back pain between January 2017 and August 2017 were enrolled in this study. Standing lateral lumbar radiographs were obtained from the electronic hospital database. Lumbar lordosis angle, sacral tilt, lumbosacral angle and lumbosacral disc angle were calculated on lateral standing lumbar radiographs. The mean age of the non-geriatric group was 43.02 ± 13.20 years, the geriatric group was 71.61 ± 6.42 years. In geriatric patients, lumbar lordosis angle, sacral tilt and lumbosacral disc angle were significantly smaller (p = 0.042, p = 0.017 and p = 0.017). No significant differences were observed in lumbosacral angle between the groups (p = 0.508). Our study indicates the specific changes in lumbosacral alignment with aging. Identifying these changes in lumbosacral alignment in the geriatric population will enable to create proper rehabilitation strategies.

The use of the T1 sagittal angle in predicting overall sagittal balance of the spine.

PubMed

Knott, Patrick T; Mardjetko, Steven M; Techy, Fernando

2010-11-01

A balanced sagittal alignment of the spine has been shown to strongly correlate with less pain, less disability, and greater health status scores. To restore proper sagittal balance, one must assess the position of the occiput relative to the sacrum. The assessment of spinal balance preoperatively can be challenging, whereas predicting postoperative balance is even more difficult. This study was designed to evaluate and quantify multiple factors that influence sagittal balance. Retrospective analysis of existing spinal radiographs. A retrospective review of 52 adult spine patient records was performed. All patients had full-column digital radiographs that showed all the important skeletal landmarks necessary for accurate measurement. The average age of the patient was 53 years. Both genders were equally represented. The radiographs were measured using standard techniques to obtain the following parameters: scoliosis in the coronal plane; lordosis or kyphosis of the cervical, thoracic, and lumbar spine; the T1 sagittal angle (angle between a horizontal line and the superior end plate of T1); the angle of the dens in the sagittal plane; the angle of the dens in relation to the occiput; the sacral slope; the pelvic incidence; the femoral-sacral angle; and finally, the sagittal vertical axis (SVA) measured from both the dens of C2 and from C7. It was found that the SVA when measured from the dens was on average 16 mm farther forward than the SVA measured from C7 (p<.0001). The dens plumb line (SVA(dens)) was then used in the study. An analysis was done to examine the relationship between SVA(dens) and each of the other measurements. The T1 sagittal angle was found to have a moderate positive correlation (r=0.65) with SVA(dens), p<.0001, indicating that the amount of sagittal T1 tilt can be used as a good predictor of overall sagittal balance. When examining the other variables, it was found that cervical lordosis had a weak correlation (r=0.37) with SVA(dens) that was unexpected, given that cervical lordosis determines head position. Thoracic kyphosis also had a weak correlation (r=0.26) with SVA(C1), which was equally surprising. Lumbar lordosis had a slightly higher correlation (r=0.38), p=.006, than the cervical or thoracic spine. A multiple regression was run on the data to examine the relationship that all these independent variables have on SVA(dens). SPSS (SPSS, Inc., Chicago, IL, USA) was used to create a regression equation using the independent variables of T1 sagittal angle, cervical lordosis, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic incidence, and femoral-sacral angle and the dependent variable of SVA(dens). The model had a strong correlation (r=0.80, r(2)=0.64) and was statistically significant (p<.0001). The T1 sagittal angle was the variable that had the strongest correlation with the SVA(dens) Spearman r=0.65, p<.0001, followed by pelvic incidence, p=.002, and lumbar lordosis, p=.006. We also observed that when the T1 tilt was higher than 25°, all patients had at least 10 cm of positive sagittal imbalance. In addition, patients with negative sagittal balance had mostly low T1 tilt values, usually lower than 13°. The other variables were not shown to have a statically significant influence on SVA. This analysis shows that many factors influence the overall sagittal balance of the patient, but it may be the position of the pelvis and lower spine that have a stronger influence than the position of the upper back and neck. Unfortunately, to our knowledge, there are no studies to date that have established a normal sagittal T1 tilt angle. However, our analysis has shown that when the T1 tilt was higher than 25°, all patients had at least 10 cm of positive sagittal imbalance. It also showed that patients with negative sagittal balance had mostly low T1 tilt values, usually below 13° of angulation. The T1 sagittal angle is a measurement that may be very useful in evaluating sagittal balance, as it was the measure that most strongly correlated with SVA(dens). It has its great utility where long films cannot be obtained. Patients whose T1 tilt falls outside the range 13° to 25° should be sent for full-column radiographs for a complete evaluation of their sagittal balance. On the other hand, a T1 tilt within the above range does not guarantee a normal sagittal balance, and further investigation should be performed at the surgeon's discretion. Copyright © 2010 Elsevier Inc. All rights reserved.

Imageless navigation system does not improve component rotational alignment in total knee arthroplasty.

PubMed

Cheng, Tao; Zhang, Guoyou; Zhang, Xianlong

2011-12-01

The aim of computer-assisted surgery is to improve accuracy and limit the range of surgical variability. However, a worldwide debate exists regarding the importance and usefulness of computer-assisted navigation for total knee arthroplasty (TKA). The main purpose of this study is to summarize and compare the radiographic outcomes of TKA performed using imageless computer-assisted navigation compared with conventional techniques. An electronic search of PubMed, EMBASE, Web of Science, and Cochrane library databases was made, in addition to manual search of major orthopedic journals. A meta-analysis of 29 quasi-randomized/randomized controlled trials (quasi-RCTs/RCTs) and 11 prospective comparative studies was conducted through a random effects model. Additional a priori sources of clinical heterogeneity were evaluated by subgroup analysis with regard to radiographic methods. When the outlier cut-off value of lower limb axis was defined as ±2° or ±3° from the neutral, the postoperative full-length radiographs demonstrated that the risk ratio was 0.54 or 0.39, respectively, which were in favor of the navigated group. When the cut-off value used for the alignment in the coronal and sagittal plane was 2° or 3°, imageless navigation significantly reduced the outlier rate of the femoral and tibial components compared with the conventional group. Notably, computed tomography scans demonstrated no statistically significant differences between the two groups regarding the outliers in the rotational alignment of the femoral and tibial components; however, there was strong statistical heterogeneity. Our results indicated that imageless computer-assisted navigation systems improve lower limb axis and component orientation in the coronal and sagittal planes, but not the rotational alignment in TKA. Further multiple-center clinical trials with long-term follow-up are needed to determine differences in the clinical and functional outcomes of knee arthroplasties performed using computer-assisted techniques. Copyright © 2011 Elsevier Inc. All rights reserved.

Biomedical Analyses, Tolerance, and Mitigation of Acute and Chronic Trauma

DTIC Science & Technology

2012-07-01

aligned such that in one group the heads were constrained to rotate in the mid-sagittal line and in the other group head was angulated about all three...the restrained than in the unrestrained groups indicating the role of posture on trauma. Uniaxial force gages introduced into the C5-C6...directions for future experimental design. Tests conducted on the Hybrid-III ATD with both curved and straightened lumbar spines demonstrated that

Radiographic-directed local coordinate systems critical in kinematic analysis of walking in diabetes-related medial column foot deformity.

PubMed

Hastings, Mary K; Woodburn, James; Mueller, Michael J; Strube, Michael J; Johnson, Jeffrey E; Beckert, Krista S; Stein, Michelle L; Sinacore, David R

2014-01-01

Diabetic foot deformity onset and progression maybe associated with abnormal foot and ankle motion. The modified Oxford multi-segmental foot model allows kinematic assessment of inter-segmental foot motion. However, there are insufficient anatomical landmarks to accurately representation the alignment of the hindfoot and forefoot segments during model construction. This is most notable for the sagittal plane which is referenced parallel to the floor, allowing comparison of inter-segmental excursion but not capturing important sagittal hind-to-forefoot deformity associated with diabetic foot disease and can potentially underestimate true kinematic differences. The purpose of the study was to compare walking kinematics using local coordinate systems derived from the modified Oxford model and the radiographic directed model which incorporated individual calcaneal and 1st metatarsal declination pitch angles for the hindfoot and forefoot. We studied twelve participants in each of the following groups: (1) diabetes mellitus, peripheral neuropathy and medial column foot deformity (DMPN+), (2) DMPN without medial column deformity (DMPN-) and (3) age- and weight-match controls. The modified Oxford model coordinate system did not identify differences between groups in the initial, peak, final, or excursion hindfoot relative to shank or forefoot relative to hindfoot dorsiflexion/plantarflexion during walking. The radiographic coordinate system identified the DMPN+ group to have an initial, peak and final position of the forefoot relative to hindfoot that was more dorsiflexed (lower arch phenotype) than the DMPN- group (p<.05). Use of radiographic alignment in kinematic modeling of those with foot deformity reveals segmental motion occurring upon alignment indicative of a lower arch. Copyright © 2014 Elsevier B.V. All rights reserved.

Comparison of hybrid constructs with 2-level artificial disc replacement and 2-level anterior cervical discectomy and fusion for surgical reconstruction of the cervical spine: a kinematic study in whole cadavers.

PubMed

Liu, Baoge; Zeng, Zheng; Hoof, Tom Van; Kalala, Jean Pierre; Liu, Zhenyu; Wu, Bingxuan

2015-04-08

Multi-level cervical degeneration of the spine is a common clinical pathology that is often repaired by anterior cervical discectomy and fusion (ACDF). The aim of this study was to investigate the kinematics of the cervical spine after hybrid surgery compared with 2-level ACDF. Five freshly frozen, unembalmed whole human cadavers were used including 3 males and 2 females with a mean age of 51 ± 8 years. After evaluating the intact spine for range of motion (ROM), sagittal alignment and instantaneous center of rotation (ICR), each cadaver underwent 4 consecutive surgeries: 2-level artificial disc replacement (ADR) from C4 to C6 (ADR surgery); 2-level ACDF from C4 to C6 (ACDF surgery); hybrid C4-5 ACDF and C5-6 ADR (ACDF+ADR surgery); and hybrid C4-5 ADR and C5-6 ACDF (ADR+ACDF surgery). The ROM and ICR of adjacent intact segments (C3-4; C6-7), and whole sagittal alignment were revaluated. Two-level ACDF resulted in increased ROM at C3-4 and C6-7 compared with intact spine. ROM was significantly different to intact spine using ACDF surgery at C3-C4 and C6-C7 and ROM was increased with ACDF+ADR surgery at C6-C7 (all P<0.05). No improvement in sagittal alignment was observed with any approach. The localization of the ICR shifted upwards and anteriorly at C3-C4 after reconstruction. ICR changes at C3-C4 were greatest for ADR+ACDF surgery and were significantly different to ACDF surgery (P<0.05), but not between ADR surgery and ACDF+ADR surgery. At C6-C7, the ICR was more posterior and superior than in the intact condition. The greatest change in ICR was observed in ACDF surgery at the C6-C7 level, significantly different from the other groups (P<0.05). For 2-level reconstruction, hybrid surgery and ADR did not alter ROM and minimally changed ICR at the adjacent-level. The type of surgery had a significant impact on the ICR location. This suggests that hybrid surgery may be a viable option for 2-level cervical surgery.

Structural and Anatomic Restoration of the Anterior Cruciate Ligament Is Associated With Less Cartilage Damage 1 Year After Surgery: Healing Ligament Properties Affect Cartilage Damage

PubMed Central

Kiapour, Ata M.; Fleming, Braden C.; Murray, Martha M.

2017-01-01

Background: Abnormal joint motion has been linked to joint arthrosis after anterior cruciate ligament (ACL) reconstruction. However, the relationships between the graft properties (ie, structural and anatomic) and extent of posttraumatic osteoarthritis are not well defined. Hypotheses: (1) The structural (tensile) and anatomic (area and alignment) properties of the reconstructed graft or repaired ACL correlate with the total cartilage lesion area 1 year after ACL surgery, and (2) side-to-side differences in anterior-posterior (AP) knee laxity correlate with the total cartilage lesion area 1 year postoperatively. Study Design: Controlled laboratory study. Methods: Sixteen minipigs underwent unilateral ACL transection and were randomly treated with ACL reconstruction or bridge-enhanced ACL repair. The tensile properties, cross-sectional area, and multiplanar alignment of the healing ACL or graft, AP knee laxity, and cartilage lesion areas were assessed 1 year after surgery. Results: In the reconstructed group, the normalized graft yield and maximum failure loads, cross-sectional area, sagittal and coronal elevation angles, and side-to-side differences in AP knee laxity at 60° of flexion were associated with the total cartilage lesion area 1 year after surgery (R 2 > 0.5, P < .04). In the repaired group, normalized ACL yield load, linear stiffness, cross-sectional area, and the sagittal and coronal elevation angles were associated with the total cartilage lesion area (R 2 > 0.5, P < .05). Smaller cartilage lesion areas were observed in the surgically treated knees when the structural and anatomic properties of the ligament or graft and AP laxity values were closer to those of the contralateral ACL-intact knee. Reconstructed grafts had a significantly larger normalized cross-sectional area and sagittal elevation angle (more vertical) when compared with repaired ACLs (P < .02). Conclusion: The tensile properties, cross-sectional area, and multiplanar alignment of the healing ACLs or grafts and AP knee laxity in reconstructed knees were associated with the extent of tibiofemoral cartilage damage after ACL surgery. Clinical Relevance: These data highlight the need for novel ACL injury treatments that can restore the structural and anatomic properties of the torn ACL to those of the native ACL in an effort to minimize the risk of early-onset posttraumatic osteoarthritis. PMID:28875154

Implications of the center of rotation concept for the reconstruction of anterior column lordosis and axial preloads in spinal deformity surgery.

PubMed

Koller, Heiko; Mayer, Michael; Zenner, Juliane; Resch, Herbert; Niederberger, Alfred; Fierlbeck, Johann; Hitzl, Wolfgang; Acosta, Frank L

2012-07-01

In thoracolumbar deformity surgery, anterior-only approaches are used for reconstruction of anterior column failures. It is generally advised that vertebral body replacements (VBRs) should be preloaded by compression. However, little is known regarding the impact of different techniques for generation of preloads and which surgical principle is best for restoration of lordosis. Therefore, the authors analyzed the effect of different surgical techniques to restore spinal alignment and lordosis as well as the ability to generate axial preloads on VBRs in anterior column reconstructions. The authors performed a laboratory study using 7 fresh-frozen specimens (from T-3 to S-1) to assess the ability for lordosis reconstruction of 5 techniques and their potential for increasing preloads on a modified distractable VBR in a 1-level thoracolumbar corpectomy. The testing protocol was as follows: 1) Radiographs of specimens were obtained. 2) A 1-level corpectomy was performed. 3) In alternating order, lordosis was applied using 1 of the 5 techniques. Then, preloads during insertion and after relaxation using the modified distractable VBR were assessed using a miniature load-cell incorporated in the modified distractable VBR. The modified distractable VBR was inserted into the corpectomy defect after lordosis was applied using 1) a lamina spreader; 2) the modified distractable VBR only; 3) the ArcoFix System (an angular stable plate system enabling in situ reduction); 4) a lordosizer (a customized instrument enabling reduction while replicating the intervertebral center of rotation [COR] according to the COR method); and 5) a lordosizer and top-loading screws ([LZ+TLS], distraction with the lordosizer applied on a 5.5-mm rod linked to 2 top-loading pedicle screws inserted laterally into the vertebra). Changes in the regional kyphosis angle were assessed radiographically using the Cobb method. The bone mineral density of specimens was 0.72 ± 22.6 g/cm(2). The maximum regional kyphosis angle reconstructed among the 5 techniques averaged 9.7°-16.1°, and maximum axial preloads averaged 123.7-179.7 N. Concerning correction, in decreasing order the LZ+TLS, lordosizer, and ArcoFix System outperformed the lamina spreader and modified distractable VBR. The order of median values for insertion peak load, from highest to lowest, were lordosizer, LZ+TLS, and ArcoFix, which outperformed the lamina spreader and modified distractable VBR. In decreasing order, the axial preload was highest with the lordosizer and LZ+TLS, which both outperformed the lamina spreader and the modified distractable VBR. The technique enabling the greatest lordosis achieved the highest preloads. With the ArcoFix System and LZ+TLS, compression loads could be applied and were 247.8 and 190.6 N, respectively, which is significantly higher than the insertion peak load and axial preload (p < 0.05). Including the ability for replication of the COR in instruments designed for anterior column reconstructions, the ability for lordosis restoration of the anterior column and axial preloads can increase, which in turn might foster fusion.

Biomechanical testing of circumferential instrumentation after cervical multilevel corpectomy.

PubMed

Hartmann, Sebastian; Thomé, Claudius; Keiler, Alexander; Fritsch, Helga; Hegewald, Aldemar Andres; Schmölz, Werner

2015-12-01

Biomechanical investigation. This study describes ex vivo evaluation of the range of motion (ROM) to characterize the stability and need for additional dorsal fixation after cervical single-level, two-level or multilevel corpectomy (CE) to elucidate biomechanical differences between anterior-only and supplemental dorsal instrumentation. Twelve human cervical cadaveric spines were loaded in a spine tester with pure moments of 1.5 Nm in lateral bending (LB), flexion/extension (FE), and axial rotation (AR), followed by two cyclic loading periods for three-level corpectomies. After each cyclic loading session, flexibility tests were performed for anterior-only instrumentation (group_1, six specimens) and circumferential instrumentation (group_2, six specimens). The flexibility tests for all circumferential instrumentations showed a significant decrease in ROM in comparison with the intact state and anterior-only instrumentations. In comparison with the intact state, supplemental dorsal instrumentation after three-level CE reduced the ROM to 12% (±10%), 9% (±12%), and 22% (±18%) in LB, FE, and AR, respectively. The anterior-only construct outperformed the intact state only in FE, with a significant ROM reduction to 57% (±35 %), 60% (±27%), and 62% (±35%) for one-, two- and three-level CE, respectively. The supplemental dorsal instrumentation provided significantly more stability than the anterior-only instrumentation regardless of the number of levels resected and the direction of motion. After cyclic loading, the absolute differences in stability between the two instrumentations remained significant while both instrumentations showed a comparable increase of ROM after cyclic loading. The large difference in the absolute ROM of anterior-only compared to circumferential instrumentations supports a dorsal support in case of three-level approaches.

Anterior Z-plate and titanic mesh fixation for acute burst thoracolumbar fracture.

PubMed

Xu, Jian-Guang; Zeng, Bing-Fang; Zhou, Wei; Kong, Wei-Qing; Fu, Yi-Shan; Zhao, Bi-Zeng; Zhang, Tao; Lian, Xiao-Feng

2011-04-01

A retrospective study. To evaluate the clinical outcome, effectiveness, and security of the surgical management of acute thoracolumbar burst fracture with corpectomy, titanic mesh autograft, and Z-plate fixation by anterior approach. Many surgical methods were adopted to treat acute burst thoracolumbar fracture. But the optimal surgical management remains controversial. A retrospective review of a consecutive series of 48 patients with thoracolumbar burst fracture treated with anterior corpectomy, titanic mesh autograft, and Z-plate internal fixation was carried out. Preoperative clinical and radiographic data of all cases were originally collected. Surgical indications were motor neurologic deficit and thoracolumbar column instability. Twenty-two patients (45.8%) with acute thoracolumbar burst fractures presented with a neurologic deficit. The postoperative recovery of neural function, restoration of anterior cortex collapse, kyphotic angle, and spinal canal compromise were observed. The preoperative kyphotic angle was improved to a mean of 5.6°, radiographic height restored to 95.8% of the adjacent normal levels, and canal compromise was 0%. None of the patients had neurologic deterioration. Mean follow-up time was 32.4 months (range, 24-47 months). All 22 patients with neurologic deficit demonstrated at least one Frankel grade improvement on final observation, with 16 (73%) patients had accomplished complete neurologic recovery. Forty-six (96%) patients reported minimal or no pain at final follow-up observation, and 40 (83%) patients who had been working before injury returned to original work. The authors considered spinal cord decompression with anterior corpectomy and stability reconstruction with titanic mesh autograft and Z-plate fixation at same time in one incision as an effective technique for unstable thoracolumbar burst fracture with and without neurologic deficit.

Dynamic Knee Alignment and Collateral Knee Laxity and Its Variations in Normal Humans

PubMed Central

Deep, Kamal; Picard, Frederic; Clarke, Jon V.

2015-01-01

Alignment of normal, arthritic, and replaced human knees is a much debated subject as is the collateral ligamentous laxity. Traditional quantitative values have been challenged. Methods used to measure these are also not without flaws. Authors review the recent literature and a novel method of measurement of these values has been included. This method includes use of computer navigation technique in clinic setting for assessment of the normal or affected knee before the surgery. Computer navigation has been known for achievement of alignment accuracy during knee surgery. Now its use in clinic setting has added to the inventory of measurement methods. Authors dispel the common myth of straight mechanical axis in normal knees and also look at quantification of amount of collateral knee laxity. Based on the scientific studies, it has been shown that the mean alignment is in varus in normal knees. It changes from lying non-weight-bearing position to standing weight-bearing position in both coronal and the sagittal planes. It also varies with gender and race. The collateral laxity is also different for males and females. Further studies are needed to define the ideal alignment and collateral laxity which the surgeon should aim for individual knees. PMID:26636090

Role of high tibial osteotomy in chronic injuries of posterior cruciate ligament and posterolateral corner.

PubMed

Savarese, Eugenio; Bisicchia, Salvatore; Romeo, Rocco; Amendola, Annunziato

2011-03-01

High tibial osteotomy (HTO) is a surgical procedure used to change the mechanical weight-bearing axis and alter the loads carried through the knee. Conventional indications for HTO are medial compartment osteoarthritis and varus malalignment of the knee causing pain and dysfunction. Traditionally, knee instability associated with varus thrust has been considered a contraindication. However, today the indications include patients with chronic ligament deficiencies and malalignment, because an HTO procedure can change not only the coronal but also the sagittal plane of the knee. The sagittal plane has generally been ignored in HTO literature, but its modification has a significant impact on biomechanics and joint stability. Indeed, decreased posterior tibial slope causes posterior tibia translation and helps the anterior cruciate ligament (ACL)-deficient knee. Vice versa, increased tibial slope causes anterior tibia translation and helps the posterior cruciate ligament (PCL)-deficient knee. A review of literature shows that soft tissue procedures alone are often unsatisfactory for chronic posterior instability if alignment is not corrected. Since limb alignment is the most important factor to consider in lower limb reconstructive surgery, diagnosis and treatment of limb malalignment should not be ignored in management of chronic ligamentous instabilities. This paper reviews the effects of chronic posterior instability and tibial slope alteration on knee and soft tissues, in addition to planning and surgical technique for chronic posterior and posterolateral instability with HTO.

The Effect of Sagittal Plane Deformities after Tibial Plateau Fractures to Functions and Instability of Knee Joint.

PubMed

Erdil, M; Yildiz, F; Kuyucu, E; Sayar, Ş; Polat, G; Ceylan, H H; Koçyiğit, F

2016-01-01

The objective of this study is to evaluate the effect of posterior tibial slope after fracture healing on antero-posterior knee laxity, functional outcome and patient satisfaction. 126 patients who were treated for tibial plateau fractures between 2008-2013 in the orthopedics and traumatology department of our institution were evaluated for the study. Patients were treated with open reduction and internal fixation, arthroscopy assisted minimally invasive osteosynthesis or conservative treatment. Mean posterior tibial slope after the treatment was 6.91 ± 5.11 and there was no significant difference when compared to the uninvolved side 6.42 ± 4,21 (p = 0.794). Knee laxity in anterior-posterior plane was 6.14 ± 2.11 and 5.95 ± 2.25 respectively on healthy and injured side. The difference of mean laxity in anterior-posterior plane between two sides was statistically significant. In this study we found no difference in laxity between the injured and healthy knees. However Tegner score decreased significantly in patients who had greater laxity difference between the knees. We did not find significant difference between fracture type and laxity, IKDC functional scores independent of the ligamentous injury. In conclusion despite coronal alignment is taken into consideration in treatment of tibial plateau fractures, sagittal alignment is reasonably important for stability and should not be ignored.

Effects of Lordotic Angle of a Cage on Sagittal Alignment and Clinical Outcome in One Level Posterior Lumbar Interbody Fusion with Pedicle Screw Fixation

PubMed Central

Lee, Ji-Ho; Lee, Dong-Oh; Lee, Jae Hyup; Shim, Hee Jong

2015-01-01

This study aims to assess the differences in the radiological and clinical results depending on the lordotic angles of the cage in posterior lumbar interbody fusion (PLIF). We reviewed 185 segments which underwent PLIF using two different lordotic angles of 4° and 8° of a polyetheretherketone (PEEK) cage. The segmental lordosis and total lumbar lordosis of the 4° and 8° cage groups were compared preoperatively, as well as on the first postoperative day, 6th and 12th months postoperatively. Clinical assessment was performed using the ODI and the VAS of low back pain. The pre- and immediate postoperative segmental lordosis angles were 12.9° and 12.6° in the 4° group and 12° and 12.0° in the 8° group. Both groups exhibited no significant different segmental lordosis angle and total lumbar lordosis over period and time. However, the total lumbar lordosis significantly increased from six months postoperatively compared with the immediate postoperative day in the 8° group. The ODI and the VAS in both groups had no differences. Cages with different lordotic angles of 4° and 8° showed insignificant results clinically and radiologically in short-level PLIF surgery. Clinical improvements and sagittal alignment recovery were significantly observed in both groups. PMID:25685795

Age-related changes in osseous anatomy, alignment, and range of motion of the cervical spine. Part I: Radiographic data from over 1,200 asymptomatic subjects.

PubMed

Yukawa, Yasutsugu; Kato, Fumihiko; Suda, Kota; Yamagata, Masatsune; Ueta, Takayoshi

2012-08-01

This study aimed to establish radiographic standard values for cervical spine morphometry, alignment, and range of motion (ROM) in both male and female in each decade of life between the 3rd and 8th and to elucidate these age-related changes. A total of 1,230 asymptomatic volunteers underwent anteroposterior (AP), lateral, flexion, and extension radiography of the cervical spine. There were at least 100 men and 100 women in each decade of life between the 3rd and 8th. AP diameter of the spinal canal, vertebral body, and disc were measured at each level from the 2nd to 7th cervical vertebra (C2-C7). C2-C7 sagittal alignment and ROM during flexion and extension were calculated using a computer digitizer. The AP diameter of the spinal canal was 15.8 ± 1.5 [mean ± standard deviation (SD)] mm at the mid-C5 level, and 15.5 ± 2.0 mm at the C5/6 disc level. The disc height was 5.8 ± 1.3 mm at the C5/6 level, which was the minimum height, and the maximum height was at the C6/7 level. Both the AP diameter of the spinal canal and disc height decreased gradually with increasing age. The C2-C7 sagittal alignment and total ROM were 13.9 ± 12.3° in lordosis and 55.3 ± 16.0°, respectively. The C2-C7 lordotic angle was 8.0 ± 11.8° in the 3rd decade and increased to 19.7 ± 11.3 in the 8th decade, whereas the C2-C7 ROM was 67.7 ± 17.0° in the 3rd decade and decreased to 45.0 ± 12.5 in the 8th decade. The extension ROM decreased more than the flexion ROM, and lordotic alignment progressed with increasing age. There was a significant difference in C2-C7 alignment and ROM between men and women. The standard values and age-related changes in cervical anatomy, alignment, and ROM for males and females in each decade between the 3rd and 8th were established. Cervical lordosis in the neutral position develops with aging, while extension ROM decreases gradually. These data will be useful as normal values for the sake of comparison in clinical practice.

Overcorrection of lumbar lordosis for adult spinal deformity with sagittal imbalance: comparison of radiographic outcomes between overcorrection and undercorrection.

PubMed

Lee, Jung-Hee; Kim, Ki-Tack; Lee, Sang-Hun; Kang, Kyung-Chung; Oh, Hyun-Seok; Kim, Young-Jun; Jung, Hyuk

2016-08-01

To determine the correlation of the difference between postoperative lumbar lordosis (LL) and ideal LL with the sagittal vertical axis (SVA) at the final follow-up in patients with adult spinal deformity (ASD). Fifty-one patients with degenerative lumbar kyphosis (DLK) (mean age 66.5 years) who underwent surgical correction with a minimum 2-year follow-up were evaluated. Based on the difference between postoperative LL and ideal LL using the Korean version of Legaye's formula, we divided the 51 patients into two groups: overcorrection (degree of postoperative LL > ideal LL) and undercorrection (degree of postoperative LL < ideal LL). Our clinical series of patients comprised 24 in the overcorrection and 27 in the undercorrection group. No significant differences were found in preoperative pelvic incidence (PI 52.6° vs. 57.3°), sacral slope (SS 23.3° vs. 18.3°), LL (-6.9° vs. -2.3°), thoracic kyphosis (TK 4.7° vs. 4.9°) and SVA (140 vs. 139 mm) except pelvic tilt (PT 29.4° vs. 39.0°), between the two groups. All the patients in the overcorrection group and 16 in the undercorrection group achieved postoperative optimal sagittal balance based on SVA ≤ 50 mm. In addition, significant differences in PT (10.5° vs. 26.7°), SS (42.1° vs. 30.6°), LL (-64.3° vs. -37.1°), TK (22.6° vs. 15.8°), and SVA (-1 vs. 41 mm) between the two groups were observed postoperatively. Furthermore, four patients (16.7 %) in the overcorrection group and eight (50 %) in the undercorrection group had sagittal decompensation at the final follow-up. Our results showed that the difference between postoperative LL and ideal LL had a significant correlation with postoperative and final follow-up SVA in our clinical series. Overcorrection of LL is an effective treatment modality to maintain optimal sagittal alignment in patients with DLK; this suggests that it should be considered in preoperative planning for patients with ASD with sagittal imbalance.

The influence of knee alignment on lower extremity kinetics during squats.

PubMed

Slater, Lindsay V; Hart, Joseph M

2016-12-01

The squat is an assessment of lower extremity alignment during movement, however there is little information regarding altered joint kinetics during poorly performed squats. The purpose of this study was to examine changes in joint kinetics and power from altered knee alignment during a squat. Thirty participants completed squats while displacing the knee medially, anteriorly, and with neutral alignment (control). Sagittal and frontal plane torques at the ankle, knee, and hip were altered in the descending and ascending phase of the squat in both the medial and anterior malaligned squat compared to the control squat. Ankle and trunk power increased and hip power decreased in the medial malaligned squat compared to the control squat. Ankle, knee, and trunk power increased and hip power decreased in the anterior malaligned squat compared to the control squat. Changes in joint torques and power during malaligned squats suggest that altered knee alignment increases ankle and trunk involvement to execute the movement. Increased anterior knee excursion during squatting may also lead to persistent altered loading of the ankle and knee. Sports medicine professionals using the squat for quadriceps strengthening must consider knee alignment to reduce ankle and trunk involvement during the movement. Copyright © 2016 Elsevier Ltd. All rights reserved.

A technical case report on use of tubular retractors for anterior cervical spine surgery.

PubMed

Kulkarni, Arvind G; Patel, Ankit; Ankith, N V

2017-12-19

The authors put-forth this technical report to establish the feasibility of performing an anterior cervical corpectomy and fusion (ACCF) and a two-level anterior cervical discectomy and fusion (ACDF) using a minimally invasive approach with tubular retractors. First case: cervical spondylotic myelopathy secondary to a large postero-inferiorly migrated disc treated with corpectomy and reconstruction with a mesh cage and locking plate. Second case: cervical disc herniation with radiculopathy treated with a two-level ACDF. Both cases were operated with minimally invasive approach with tubular retractor using a single incision. Technical aspects and clinical outcomes have been reported. No intra or post-operative complications were encountered. Intra-operative blood loss was negligible. The patients had a cosmetic scar on healing. Standard procedure of placement of tubular retractors is sufficient for adequate surgical exposure with minimal invasiveness. Minimally invasive approach to anterior cervical spine with tubular retractors is feasible. This is the first report on use of minimally invasive approach for ACCF and two-level ACDF.

Reproducibility of sagittal radiographic parameters in adolescent idiopathic scoliosis-a guide to reference values using serial imaging.

PubMed

Hey, Hwee Weng Dennis; Wong, Gordon Chengyuan; Chan, Chloe Xiaoyun; Lau, Leok-Lim; Kumar, Naresh; Thambiah, Joseph Shantakumar; Ruiz, John Nathaniel; Liu, Ka-Po Gabriel; Wong, Hee-Kit

2017-06-01

Knowledge of sagittal radiographic parameters in adolescent idiopathic scoliosis (AIS) patients has not yet caught up with our understanding of their roles in patients with adult spinal deformity. It is likely that more emphasis will be placed in restoring sagittal parameters for AIS patients in the future. Therefore, we need to understand how these parameters may vary in AIS to facilitate management plans. This study aimed to determine the reproducibility of sagittal spinal parameters on lateral film radiographs in patients with AIS. This was a retrospective, comparative study conducted in a tertiary health-care institution from January 2013 to February 2016 (3-year period). All AIS patients who underwent deformity correction surgery from January 2013 to February 2016 and had two preoperative serial lateral radiographs taken within the time period of a month were included in the study. Radiographic sagittal spinal parameters including sagittal vertical axis (SVA), cervical lordosis (CL), thoracic kyphosis (TK), thoracolumbar alignment (TL), lumbar lordosis (LL); standard spinopelvic measurements such as pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS); as well as end and apical vertebrae of cervical, thoracic, and lumbar curves were the outcome measures. All patient data were pooled from electronic medical records, and X-ray images were retrieved from Centricity Enterprise Web. Averaged X-ray measurements by two independent assessors were analyzed by comparing two radiographs of the same patients performed within a 1-month time period. Chi-squared and Wilcoxon signed-rank tests were used for categorical and continuous variables. The study cohort comprised 138 patients, 28 men and 110 women, with a mean age of 15 years (range 11-20). Between the two lateral X-rays, there was a mean difference of 0.79 cm in SVA (p<.001), 0.70° in LL (p=.033), and 0.73° in PT (p=.010). In the combined Lenke 1 and 2 subgroup, there was a similar 0.77 cm (p=.002), 0.79° (p=.009), and 1.49° (p=.001) mean difference in SVA, LL, and PT, respectively. Additionally, there was also a 1.85° (p=.009) and 1.76° (p=.006) mean difference seen in TL and SS, respectively. The overall profile of the sagittal curves remained largely similar, with only the lumbar apex shifting from L3 to L4 during the first and the second X-rays, respectively (p<.001). This occurred for the combined Lenke 1 and 2 subgroup as well (p<.001). Most radiographic sagittal spinal parameters in AIS patients are generally reproducible with some variations up to a maximum of 4°. This natural variation should be taken into account when interpreting these radiographic sagittal parameters so as to achieve the most accurate results in surgical planning. Copyright © 2017 Elsevier Inc. All rights reserved.

Vertebral reconstruction using the telescopic plate spacer-thoracolumbar (TPS-TL) device.

PubMed

Atalay, Basar; Riesenburger, Ron I; Schirmer, Clemens M; Bhadelia, Rafeeque A; Weller, Simcha J

2010-07-01

Retrospective study of surgical technique and outcome. The authors conducted a study to evaluate the ability of the TPS-TL (telescopic plate spacer-thoracolumbar) implant to correct kyphotic deformity and restore vertebral body height after vertebrectomy in the thoracolumbar spine. TPS-TL is a novel vertebral body replacement device that consists of an expandable cage with an integrated plate component for transvertebral screw fixation. This is a retrospective study of 20 patients who underwent anterior column reconstruction with TPS-TL after a 1 or 2 level thoracolumbar vertebrectomy. Preoperative and postoperative sagittal alignment and vertebral body heights were radiologically analyzed in all patients. The mean follow-up was 14 months. Preoperative and postoperative Cobb angles were measured to assess sagittal alignment. The average preoperative Cobb angle was 16.0 + or - 7 degrees. This was reduced to 9.8 + or - 10 degrees at the final follow-up (P<0.001). Percent of ideal vertebral body height was used to assess postoperative restoration of vertebral body height. This value was obtained by creating a ratio of the height of the effected vertebral levels to the height of the adjacent normal vertebral bodies. The mean percent of ideal vertebral body height improved from a preoperative value from 86.2 + or - 2% to 93.1 + or - 6% at the final follow-up (P<0.001). The TPS-TL implant is effective in restoring vertebral body height and correcting kyphotic deformity after thoracolumbar vertebrectomy.

Alteration of the end-plane angle in press-fit cylindrical stem radial head prosthesis: an in vitro study.

PubMed

Luenam, Suriya; Chalongviriyalert, Piti; Kosiyatrakul, Arkaphat; Thanawattano, Chusak

2012-01-01

Many studies comparing the morphology of native radial head with the prosthesis have been published. However, there is limited information regarding the postoperative alignment of the articular surface following the radial head replacement. The purpose of this study is to evaluate the alteration of the end-plane angle in the modular radial head prosthesis with a press-fit cementless cylindrical stem. The study used 36 cadaveric radii. The press-fit size prosthesis with cylindrical stem was inserted into each specimen. The end-plane angles of the radial head before and after prosthetic replacement, were measured in coronal and sagittal planes with a digital inclinometer. The data were analyzed by paired t-test. From paired t-test, there were statistically symmetrical end-plane angles before and after radial head replacement in both coronal and sagittal planes (p-value < 0.01). The mean of radial head end-plane angle alteration in the coronal plane was 3.62° (SD, 2.76°) (range, 0.3°-8.9°). In the sagittal plane, the mean of alteration was 5.85° (SD, 3.56°) degrees (range, 0.3° - 14.2°). The modular radial head prosthesis with cylindrical stem is in vitro able to restore the native end-plane angles of radial heads statistically when used in a press-fit fashion.

Conflicting calculations of pelvic incidence and pelvic tilt secondary to transitional lumbosacral anatomy (lumbarization of S-1): case report.

PubMed

Crawford, Charles H; Glassman, Steven D; Gum, Jeffrey L; Carreon, Leah Y

2017-01-01

Advancements in the understanding of adult spinal deformity have led to a greater awareness of the role of the pelvis in maintaining sagittal balance and alignment. Pelvic incidence has emerged as a key radiographic measure and should closely match lumbar lordosis. As proper measurement of the pelvic incidence requires accurate identification of the S-1 endplate, lumbosacral transitional anatomy may lead to errors. The purpose of this study is to demonstrate how lumbosacral transitional anatomy may lead to errors in the measurement of pelvic parameters. The current case highlights one of the potential complications that can be avoided with awareness. The authors report the case of a 61-year-old man who had undergone prior lumbar surgeries and then presented with symptomatic lumbar stenosis and sagittal malalignment. Radiographs showed a lumbarized S-1. Prior numbering of the segments in previous surgical and radiology reports led to a pelvic incidence calculation of 61°. Corrected numbering of the segments using the lumbarized S-1 endplate led to a pelvic incidence calculation of 48°. Without recognition of the lumbosacral anatomy, overcorrection of the lumbar lordosis might have led to negative sagittal balance and the propensity to develop proximal junction failure. This case illustrates that improper identification of lumbosacral transitional anatomy may lead to errors that could affect clinical outcome. Awareness of this potential error may help improve patient outcomes.

What you need to know about ossification of the posterior longitudinal ligament to optimize cervical spine surgery: A review

PubMed Central

Epstein, Nancy E.

2014-01-01

What are the risks, benefits, alternatives, and pitfalls for operating on cervical ossification of the posterior longitudinal ligament (OPLL)? To successfully diagnose OPLL, it is important to obtain Magnetic Resonance Images (MR). These studies, particularly the T2 weighted images, provide the best soft-tissue documentation of cord/root compression and intrinsic cord abnormalities (e.g. edema vs. myelomalacia) on sagittal, axial, and coronal views. Obtaining Computed Tomographic (CT) scans is also critical as they best demonstrate early OPLL, or hypertrophied posterior longitudinal ligament (HPLL: hypo-isodense with punctate ossification) or classic (frankly ossified) OPLL (hyperdense). Furthermore, CT scans reveal the “single layer” and “double layer” signs indicative of OPLL penetrating the dura. Documenting the full extent of OPLL with both MR and CT dictates whether anterior, posterior, or circumferential surgery is warranted. An adequate cervical lordosis allows for posterior cervical approaches (e.g. lamionplasty, laminectomy/fusion), which may facilitate addressing multiple levels while avoiding the risks of anterior procedures. However, without lordosis and with significant kyphosis, anterior surgery may be indicated. Rarely, this requires single/multilevel anterior cervical diskectomy/fusion (ACDF), as this approach typically fails to address retrovertebral OPLL; single or multilevel corpectomies are usually warranted. In short, successful OPLL surgery relies on careful patient selection (e.g. assess comorbidities), accurate MR/CT documentation of OPLL, and limiting the pros, cons, and complications of these complex procedures by choosing the optimal surgical approach. Performing OPLL surgery requires stringent anesthetic (awake intubation/positioning) and also the following intraoperative monitoring protocols: Somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), and electromyography (EMG). PMID:24843819

Treatment of thoracolumbar burst fractures with variable screw placement or Isola instrumentation and arthrodesis: case series and literature review.

PubMed

Alvine, Gregory F; Swain, James M; Asher, Marc A; Burton, Douglas C

2004-08-01

The controversy of burst fracture surgical management is addressed in this retrospective case study and literature review. The series consisted of 40 consecutive patients, index included, with 41 fractures treated with stiff, limited segment transpedicular bone-anchored instrumentation and arthrodesis from 1987 through 1994. No major acute complications such as death, paralysis, or infection occurred. For the 30 fractures with pre- and postoperative computed tomography studies, spinal canal compromise was 61% and 32%, respectively. Neurologic function improved in 7 of 14 patients (50%) and did not worsen in any. The principal problem encountered was screw breakage, which occurred in 16 of the 41 (39%) instrumented fractures. As we have previously reported, transpedicular anterior bone graft augmentation significantly decreased variable screw placement (VSP) implant breakage. However, it did not prevent Isola implant breakage in two-motion segment constructs. Compared with VSP, Isola provided better sagittal plane realignment and constructs that have been found to be significantly stiffer. Unplanned reoperation was necessary in 9 of the 40 patients (23%). At 1- and 2-year follow-up, 95% and 79% of patients were available for study, and a satisfactory outcome was achieved in 84% and 79%, respectively. These satisfaction and reoperation rates are consistent with the literature of the time. Based on these observations and the loads to which implant constructs are exposed following posterior realignment and stabilization of burst fractures, we recommend that three- or four-motion segment constructs, rather than two motion, be used. To save valuable motion segments, planned construct shortening can be used. An alternative is sequential or staged anterior corpectomy and structural grafting.

Sagittal Alignment Two Years After Selective and Nonselective Thoracic Fusion for Lenke 1C Adolescent Idiopathic Scoliosis.

PubMed

Celestre, Paul C; Carreon, Leah Y; Lenke, Lawrence G; Sucato, Daniel J; Glassman, Steven D

2015-11-01

Matched cohort. To evaluate thoracic and thoracolumbar sagittal Cobb angles in patients undergoing either selective thoracic fusion (STF) or nonselective thoracic fusion (NSTF) for Lenke 1C adolescent idiopathic scoliosis (AIS). The Lenke classification is used to guide fusion levels in AIS. For some curve types, including 1C, there is a disparity in practice regarding whether the thoracolumbar/lumbar curve should be included in the arthrodesis. The impact of performing an NSTF on sagittal parameters has not been adequately evaluated. A multicenter database of AIS was queried for patients with right-sided 1C curves treated with posterior correction and fusion. A matched cohort for each group was created based on age, gender, preoperative Cobb angles, and Scoliosis Research Society-22R domain scores. Independent t tests for continuous variables and Fisher exact test for categorical variables were used to compare the STF and NSTF groups. Thirty-eight patients who underwent NSTF were matched to 38 patients in the STF. An average of 8.0 levels were fused in the STF group and 11.6 in the NSTF group (p < .001). Preoperative and radiographic variables were similar between the two groups. Postoperatively, there was a statistically significant difference between the STF and NSTF sagittal Cobb in the thoracic spine, 26.9° and 21.7° (p = .013). The greatest difference was in the thoracolumbar sagittal Cobb, which increased to 4.3° kyphosis in the STF group and decreased to 9° of lordosis in the NSTF group (p < .001). Residual thoracolumbar/lumbar scoliosis was 25.5° in the STF group and 14.5° in the NSTF group (p < .001). STF in 1C curves preserves lumbar motion segments but may be associated with an increase in thoracic and thoracolumbar kyphosis compared to NSTF. As expected, residual thoracolumbar/lumbar scoliosis was less in the NSTF group compared to the STF group. Although the long-term implications of these changes are unknown, consideration of sagittal balance is critical. Following these patients in the medium and long term will provide important information to guide fusion levels. II. Copyright © 2015 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Walking sagittal balance correction by pedicle subtraction osteotomy in adults with fixed sagittal imbalance.

PubMed

Yagi, Mitsuru; Kaneko, Shinjiro; Yato, Yoshiyuki; Asazuma, Takashi; Machida, Masafumi

2016-08-01

Pedicle subtraction osteotomy (PSO) is widely used to treat severe fixed sagittal imbalance. However, the effect of PSO on balance has not been fully documented. The aim of this study was to assess dynamic walking balance after PSO to treat fixed sagittal imbalance. Gait and balance were assessed in 15 consecutive adult female patients who had been treated by PSO for a fixed sagittal imbalance and compare patients' preop and postop dynamic walking balance with that of 15 age- and gender-matched healthy volunteers (HV). Each patient's chart, X-rays, pre and postop SRS22 outcome scores, and ODI were reviewed. Means were compared by Mann-Whitney U test and Chi-square test. The mean age was 66.3 years (51-74 years). The mean follow-up was 2.7 years (2-3.5 years). The C7PL and GL, measured on the force platform, were both improved from 24.2 ± 7.3 cm and 27.6 ± 9.4 to 5.4 ± 2.6 cm and 7.2 ± 3.4 cm, respectively. The baseline hip ROM was significantly smaller in patients compared to HV, whereas no significant difference was observed in the knee or ankle ROM. The pelvic tilt (preop -0.4° ± 1.4°, postop 8.9° ± 1.0°), and maximum hip-extension angle (preop -1.2° ± 14.2°, postop -11.2° ± 7.2°) were also improved after surgery. Cadence (116 s/min), stance-swing ratio (stance 63.2 % vs. swing 36.8 %), and stride (98.0 cm) were all increased after surgery. On the other hand, gait velocity was significantly slower in the PSO group at both pre and postop than in HV (PSO 53.3 m/min at preop and 58.8 m/min at postop vs. HV 71.1 m/min, p = 0.04). Despite a mild residual spinal-pelvic malalignment, PSO restored sagittal alignment and balance satisfactorily and has improved the gait pattern.

Effect of alignment changes on socket reaction moments during gait in transfemoral and knee-disarticulation prostheses: case series.

PubMed

Kobayashi, Toshiki; Orendurff, Michael S; Boone, David A

2013-09-27

The alignment of a lower-limb prosthesis is critical to the successful prosthetic fitting and utilization by the wearer. Loads generated by the socket applied to the residual limb while walking are thought to be different in transfemoral and knee-disarticulation prostheses. The aim of this case series was to compare the socket reaction moments between transfemoral and knee-disarticulation prostheses and to investigate the effect of alignment changes on them. Two amputees, one with a transfemoral prosthesis and another with a knee-disarticulation prosthesis, participated in this study. A Smart Pyramid™ was used to measure socket reaction moments while walking under 9 selected alignment conditions; including nominally aligned, angle malalignments of 6° (flexion, extension, abduction and adduction) and translation malalignments of 15 mm (anterior, posterior, medial and lateral) of the socket relative to the foot. This study found that the pattern of the socket reaction moments was similar between transfemoral and knee-disarticulation prostheses. An extension moment in the sagittal plane and a varus moment in the coronal plane were dominant during stance under the nominally aligned condition. This study also demonstrated that alignment changes might have consistent effects on the socket reaction moments in transfemoral and knee-disarticulation prostheses. Extension and posterior translation of the socket resulted in increases in an extension moment, while abduction and lateral translation of the socket resulted in increases in a varus moment. The socket reaction moments may potentially serve as useful biomechanical parameters to evaluate alignment in transfemoral and knee-disarticulation prostheses. Copyright © 2013 Elsevier Ltd. All rights reserved.

Short Segment Spinal Instrumentation With Index Vertebra Pedicle Screw Placement for Pathologies Involving the Anterior and Middle Vertebral Column Is as Effective as Long Segment Stabilization With Cage Reconstruction: A Biomechanical Study.

PubMed

Bartanusz, Viktor; Harris, Jonathan; Moldavsky, Mark; Cai, Yiwei; Bucklen, Brandon

2015-11-01

An in vitro, cadaveric biomechanical study. The aim of the present study was to compare single-segment posterior instrumentation and fracture-level screws with single/multilevel posterior fixation and corpectomy in a simulated, unstable burst fracture model. The optimal extent of instrumentation for surgical cases of non-neoplastic vertebral body pathologies remains uncertain. Although several clinical studies demonstrate advantages of short segment instrumentation with index-level screws over more extensive corpectomy and anterior-posterior techniques, a comprehensive biomechanical comparison of these techniques is currently lacking. Six bovine spines (T11-L5) were tested in flexion, extension, lateral bending (LB), and axial rotation (AR) following simulated burst fracture at L2. Posterior instrumentation included 1 level above/below (1LF) and 2 levels above/below fracture level (2LF), intermediate or index screws at fracture level (FF), and cross-connectors above/below fracture level (CC). Anterior corpectomy devices included expandable corpectomy spacers with/without integrated screws, ACDi and ACD, respectively FORTIFY-Integrated/FORTIFY; Globus Medical, Inc., PA. Constructs were tested in the following order: (1) Intact; (2) 1LF; (3) 1LF and CC; (4) 1LF and FF; (5) 1LF, CC, and FF; (6) 2LF; (7) 2LF and CC; (8) 2LF and FF; (9) 2LF, CC, and FF; (10) 2LF and ACD; (11) 2LF, ACD, and CC; (12) 1LF and ACDi; (13) 1LF, ACDi, and CC. During flexion, all constructs except 1LF reduced motion relative to intact (P ≤ 0.05). Anterior support was most stable, but no differences were found between constructs (P ≥ 0.05). Every construct reduced motion in extension, though no differences were found between constructs and intact (P ≥ 0.05). During LB, all constructs reduced motion relative to intact (P ≤ 0.05); 2LF constructs further reduced motion (P ≤ 0.05). No construct returned AR motion to intact, with significant increases in 1LF and ACDi, 2LF and ACD, and 2LF, ACD, and CC (P ≤ 0.05). Cross-connectors and fracture screws reinforced each other in posterior-only constructs, providing maximum stability (P ≥ 0.05). This biomechanical comparison study found no significant superiority of combined anterior-posterior constructs over short segment fracture screw fixation, only multilevel posterior instrumentation with and without anterior support, providing increased stability in LB. Biomechanical equivalency suggests that short segment fracture screw intervention may provide appropriate stabilization for non-neoplastic pathologies involving the anterior and middle vertebral columns. 2.

European Board of Orthodontics case report: severe skeletal discrepancy.

PubMed

Paduano, Sergio

2009-01-01

The 10.3 year-old patient presented a sagittal skeletal and dental Class II division I malocclusion with a severe overjet in the mixed dentition. The convex profile aesthetically improved with the mandibular advancement (positive Frankel manoeuvre). No signs or symptoms of TMJ disorders were present. Oral mucosa and gingiva conditions were good notwithstanding a scanty oral hygiene. The treatment plan included: a) Bass appliance to improve the retruded profile and, partially, OVJ; b) upper and lower arch fixed appliance for alignment, levelling and correction of the malocclusion c) posttreatment retention.

Extrinsic Factors as Component Positions to Bone and Intrinsic Factors Affecting Postoperative Rotational Limb Alignment in Total Knee Arthroplasty.

PubMed

Mochizuki, Tomoharu; Sato, Takashi; Tanifuji, Osamu; Watanabe, Satoshi; Kobayashi, Koichi; Endo, Naoto

2018-02-13

This study aimed to identify the factors affecting postoperative rotational limb alignment of the tibia relative to the femur. We hypothesized that not only component positions but also several intrinsic factors were associated with postoperative rotational limb alignment. This study included 99 knees (90 women and 9 men) with a mean age of 77 ± 6 years. A three-dimensional (3D) assessment system was applied under weight-bearing conditions to biplanar long-leg radiographs using 3D-to-2D image registration technique. The evaluation parameters were (1) component position; (2) preoperative and postoperative coronal, sagittal, and rotational limb alignment; (3) preoperative bony deformity, including femoral torsion, condylar twist angle, and tibial torsion; and (4) preoperative and postoperative range of motion (ROM). In multiple linear regression analysis using a stepwise procedure, postoperative rotational limb alignment was associated with the following: (1) rotation of the component position (tibia: β = 0.371, P < .0001; femur: β = -0.327, P < .0001), (2) preoperative rotational limb alignment (β = 0.253, P = .001), (3) postoperative flexion angle (β = 0.195, P = .007), and (4) tibial torsion (β = 0.193, P = .010). In addition to component positions, the intrinsic factors, such as preoperative rotational limb alignment, ROM, and tibial torsion, affected postoperative rotational limb alignment. On a premise of correct component positions, the intrinsic factors that can be controlled by surgeons should be taken care. In particular, ROM is necessary to be improved within the possible range to acquire better postoperative rotational limb alignment. Copyright © 2018 Elsevier Inc. All rights reserved.

Total knee arthroplasty with a computer-navigated saw: a pilot study.

PubMed

Garvin, Kevin L; Barrera, Andres; Mahoney, Craig R; Hartman, Curtis W; Haider, Hani

2013-01-01

Computer-aided surgery aims to improve implant alignment in TKA but has only been adopted by a minority for routine use. A novel approach, navigated freehand bone cutting (NFC), is intended to achieve wider acceptance by eliminating the need for cumbersome, implant-specific mechanical jigs and avoiding the expense of navigation. We determined cutting time, surface quality, implant fit, and implant alignment after NFC of synthetic femoral specimens and the feasibility and alignment of a complete TKA performed with NFC technology in cadaveric specimens. Seven surgeons prepared six synthetic femoral specimens each, using our custom NFC system. Cutting times, quality of bone cuts, and implant fit and alignment were assessed quantitatively by CT surface scanning and computational measurements. Additionally, a single surgeon performed a complete TKA on two cadaveric specimens using the NFC system, with cutting time and implant alignment analyzed through plain radiographs and CT. For the synthetic specimens, femoral coronal alignment was within ± 2° of neutral in 94% of the specimens. Sagittal alignment was within 0° to 5° of flexion in all specimens. Rotation was within ± 1° of the epicondylar axis in 97% of the specimens. The mean time to make cuts improved from 13 minutes for the first specimen to 9 minutes for the fourth specimen. TKA was performed in two cadaveric specimens without complications and implants were well aligned. TKA is feasible with NFC, which eliminates the need for implant-specific instruments. We observed a fast learning curve. NFC has the potential to improve TKA alignment, reduce operative time, and reduce the number of instruments in surgery. Fewer instruments and less sterilization could reduce costs associated with TKA.

Temporary Percutaneous Instrumentation and Selective Anterior Fusion for Thoracolumbar Fractures.

PubMed

Charles, Yann Philippe; Walter, Axel; Schuller, Sébastien; Steib, Jean-Paul

2017-05-01

Prospective clinical trial in thoracolumbar trauma with 5-year follow-up. To analyze clinical and radiographic outcomes of minimal invasive surgery, and the rational of circumferential fracture treatment with regard to age, degenerative changes, bone mineral density, and global sagittal balance. Non-neurologic fractures with anterior column defect can be treated by posterior percutaneous instrumentation and selective anterior fusion. After consolidation, instrumentation can be removed at 1 year to provide mobility in non-fused segments. Fifty-one patients, 47 (18-75) years, were operated for A2, A3, or B-type fractures. Visual analog scale (VAS) for back pain and Oswestry Disability Index (ODI) were assessed. Radiographic measurements were: sagittal index, regional kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, and T9 tilt. Anterior fusion and facet joints were analyzed on computed tomography (CT) at 1 year. The ODI was 8.8 before accident, 35.4 at 3 months, 17.8 at 2 years, 14.4 at 5 years. The VAS was 2.0 at 3 months and 1.0 at 5 years. The sagittal index was 18.0° preoperatively and 1.0° at 3 months (P < 0.0001). A loss of reduction of 1.1° occurred after implant removal (P = 0.009). Global sagittal balance remained unchanged. Ten patients with osteopenia or osteoporosis had a worse ODI: 24.7 versus 11.9 (P = 0.016), and a greater loss of correction: 4.9° versus 1.3° (P = 0.007). Cages filled with cancellous bone from the fractured vertebra fused regularly. Spontaneous facet joint fusions were observed in two patients at the fracture level in B-type injuries. Percutaneous instrumentation and selective anterior fusion using autologous bone and mesh cages lead to high fusion rates, which provided good long-term clinical results in younger patients with thoracolumbar fractures. Sagittal alignment was maintained after instrumentation removal without damaging paravertebral muscles. Outcomes were worse in elderly patients presenting osteopenia or osteoporosis. 3.

Eccentric Capitellar Ossification Limits the Utility of the Radiocapitellar Line in Young Children.

PubMed

Fader, Lauren M; Laor, Tal; Eismann, Emily A; Cornwall, Roger; Little, Kevin J

2016-03-01

The radiocapitellar line (RCL) has long been used for the radiographic evaluation of elbow alignment. In children, the capitellar ossific nucleus serves as a proxy for the entire capitellum, but this substitution has not been verified. Using magnetic resonance imaging (MRI), we sought to understand how maturation of the ossific nucleus of the capitellum affects the utility of RCL throughout skeletal maturation of the elbow. The RCL was drawn on coronal and sagittal MRIs in 82 children (43 boys, 39 girls; age range, 1 to 13 y) with at least 3 patients in each 1-year interval age group. The perpendicular distance of the RCL from the center of both the cartilaginous capitellum and the capitellar ossific nucleus was measured relative to its total width, and a percent offset for each measurement was calculated. Logarithmic regression analysis was performed to analyze the effect of age and sex on percent offset. The RCL reliably intersected with the central third of the cartilaginous capitellum at all ages in both planes. Although the RCL intersected with the ossified capitellum in all but 3 measurements, it intersected with the central third of the ossified capitellum less often in younger children in both sagittal (B=0.47, P<0.001) and coronal (B=0.31, P=0.002) planes. Percent offset decreased significantly with age in a logarithmic manner in both sagittal (r=0.57, P<0.001) and coronal (r=-0.47, P<0.001) planes. 95% confidence intervals predict that the sagittal plane RCL will accurately intersect the central third of the ossified capitellum by age 10 years in girls and age 11 years in boys but not in the coronal plane. Eccentric ossification of the capitellum explains RCL variability in young children. The RCL does not reliably intersect the central third of the ossified capitellum until ages 10 years in girls and 11 years in boys in the sagittal plane. The RCL should be used within its limitations in skeletally immature children and should be combined with advanced imaging if necessary.

Reliability of digital photography for assessing lower extremity alignment in individuals with flatfeet and normal feet types.

PubMed

Ashnagar, Zinat; Hadian, Mohammad Reza; Olyaei, Gholamreza; Talebian Moghadam, Saeed; Rezasoltani, Asghar; Saeedi, Hassan; Yekaninejad, Mir Saeed; Mahmoodi, Rahimeh

2017-07-01

The aim of this study was to investigate the intratester reliability of digital photographic method for quantifying static lower extremity alignment in individuals with flatfeet and normal feet types. Thirteen females with flexible flatfeet and nine females with normal feet types were recruited from university communities. Reflective markers were attached over the participant's body landmarks. Frontal and sagittal plane photographs were taken while the participants were in a standardized standing position. The markers were removed and after 30 min the same procedure was repeated. Pelvic angle, quadriceps angle, tibiofemoral angle, genu recurvatum, femur length and tibia length were measured from photographs using the Image j software. All measured variables demonstrated good to excellent intratester reliability using digital photography in both flatfeet (ICC: 0.79-0.93) and normal feet type (ICC: 0.84-0.97) groups. The findings of the current study indicate that digital photography is a highly reliable method of measurement for assessing lower extremity alignment in both flatfeet and normal feet type groups. Copyright © 2016. Published by Elsevier Ltd.

Effects of toe-in and toe-in with wider step width on level walking knee biomechanics in varus, valgus, and neutral knee alignments.

PubMed

Bennett, Hunter J; Shen, Guangping; Cates, Harold E; Zhang, Songning

2017-12-01

Increased peak external knee adduction moments exist for individuals with knee osteoarthritis and varus knee alignments, compared to healthy and neutrally aligned counterparts. Walking with increased toe-in or increased step width have been individually utilized to successfully reduce 1st and 2nd peak knee adduction moments, respectfully, but have not previously been combined or tested among all alignment groups. The purpose of this study was to compare toe-in only and toe-in with wider step width gait modifications in individuals with neutral, valgus, and varus alignments. Thirty-eight healthy participants with confirmed varus, neutral, or valgus frontal-plane knee alignment through anteroposterior radiographs, performed level walking in normal, toe-in, and toe-in with wider step width gaits. A 3×3 (group×intervention) mixed model repeated measures ANOVA compared alignment groups and gait interventions (p<0.05). The 1st peak knee adduction moment was reduced in both toe-in and toe-in with wider step width compared to normal gait. The 2nd peak adduction moment was increased in toe-in compared to normal and toe-in with wider step width. The adduction impulse was also reduced in toe-in and toe-in with wider step width compared to normal gait. Peak knee flexion and external rotation moments were increased in toe-in and toe-in with wider step width compared to normal gait. Although the toe-in with wider step width gait seems to be a viable option to reduce peak adduction moments for varus alignments, sagittal, and transverse knee loadings should be monitored when implementing this gait modification strategy. Copyright © 2017 Elsevier B.V. All rights reserved.

Shaft-Condylar Angle for surgical correction in neglected and displaced lateral humeral condyle fracture in children.

PubMed

Mulpruek, Pornchai; Angsanuntsukh, Chanika; Woratanarat, Patarawan; Sa-Ngasoongsong, Paphon; Tawonsawatruk, Tulyapruek; Chanplakorn, Pongsthorn

2015-09-01

To assess the outcome after using the Shaft-Condylar angle (SCA) as intraoperative reference for sagittal plane correction in displaced lateral humeral condyle fractures in children presented 3-weeks after injury. Ten children, with delayed presentation of a displaced lateral humeral condyle fracture and undergoing surgery during 1999-2011, were reviewed. The goal was to obtain a smooth articular surface with an intraoperative SCA of nearly 40° and nearest-anatomical carrying angle. They were allocated into two groups according to the postoperative SCA [Good-reduction group (SCA=30-50°), and Bad-reduction group (SCA<30°, >50°)] and the final outcomes were then compared. All fractures united without avascular necrosis. The Good-reduction group (n=7) showed a significant improvement in final range of motion and functional outcome compared to the Bad-reduction group (n=3) (p=0.02). However, there was no significant difference in pain, carrying angle and overall outcome between both groups. SCA is a possible intraoperative reference for sagittal alignment correction in late presented displaced lateral humeral condyle fractures.

Anterior Cervical Corpectomy with free vascularized fibular graft versus multilevel discectomy and grafting for Cervical Spondylotic Myelopathy

PubMed Central

Addosooki, Ahmad I; El-deen, Mohamed Alam

2015-01-01

Purpose A retrospective study to compare the radiologic and clinical outcomes of 2 different anterior approaches, multilevel anterior cervical discectomy with fusion (ACDF) using autologus ticortical bone graft versus anterior cervical corpectomy with fusion (ACCF) using free vascularized fibular graft (FVFG) for the management of cervical spondylotic myelopathy(CSM). Methods A total of 15 patients who underwent ACDF or ACCF using FVFG for multilevel CSM were divided into two groups. Group A (n = 7) underwent ACDF and group B (n = 8) ACCF. Clinical outcomes using Japanese Orthopaedic Association (JOA) score, perioperative parameters including operation time and hospital stay, radiological parameters including fusion rate and cervical lordosis, and complications were compared. Results Both group A and group B demonstrated significant increases in JOA scores. Patients who underwent ACDF experienced significantly shorter operation times and hospital stay. Both groups showed significant increases in postoperative cervical lordosis and achieved the same fusion rate (100 %). No major complications were encountered in both groups. Conclusion Both ACDF and ACCF using FVFG provide satisfactory clinical outcomes and fusion rates for multilevel CSM. However, multilevel ACDF is associated with better radiologic parameters, shorter hospital stay and shorter operative times. PMID:26767152

PROXIMAL JUNCTIONAL KYPHOSIS IN ADULT RECONSTRUCTIVE SPINE SURGERY RESULTS FROM INCOMPLETE RESTORATION OF THE LUMBAR LORDOSIS RELATIVE TO THE MAGNITUDE OF THE THORACIC KYPHOSIS

PubMed Central

Mendoza-Lattes, Sergio; Ries, Zachary; Gao, Yubo; Weinstein, Stuart L

2011-01-01

Background Proximal junctional kyphosis (PJK) is defined as: 1) Proximal junction sagittal Cobb angle >≥10°, and 2) Proximal junction sagittal Cobb angle of at least 10° greater than the pre-operative measurement PJK is a common complication which develops in 39% of adults following surgery for spinal deformity. The pathogenesis, risk factors and prevention of this complication are unclear. Methods Of 54 consecutive adults treated with spinal deformity surgery (age≥59.3±10.1 years), 19 of 54 (35%) developed PJK. The average follow-up was 26.8months (range 12 - 42). Radiographic parameters were measured at the pre-operative, early postoperative (4-6 weeks), and final follow-up visits. Sagittal alignment was measured by the ratio between the C7-plumbline and the sacral-femoral distance. Binary logistic regression model with predictor variables included: Age, BMI, C7-plumbline, and whether lumbar lordosis, thoracic kyphosis and sacral slope were present Results Patients who developed PJK and those without PJK presented with comparable age, BMI, pelvic incidence and sagittal imbalance before surgery. They also presented with comparable sacral slope and lumbar lordosis. The average magnitude of thoracic kyphosis was significantly larger than the lumbar lordosis in the proximal junctional kyphosis group, both at baseline and in the early postoperative period, as represented by [(-lumbar )lordosis - (thoracic kyphosis)]; no- PJK versus PJK; 6.6°±23.2° versus -6.6°±14.2°; p≥0.012. This was not effectively addressed with surgery in the PJK group [(-LL-TK): 6.2°±13.1° vs. -5.2°±9.6°; p≥0.004]. This group also presented with signs of pelvic retroversion with a sacral slope of 29.3°±8.2° pre-operatively that was unchanged after surgery (30.4°±8.5° postoperatively). Logistic regression determined that the magnitude of thoracic kyphosis and sagittal balance (C7-plumbline) was the most important predictor of proximal junctional kyphosis. Conclusions Proximal junctional kyphosis developed in those patients where the thoracic kyphosis remained greater in magnitude relative to the lumbar lordosis, and where the sagittal balance seemed corrected, but part of thise correction was secondary to pelvic retroversion. Level of Evidence Prognostic case-control study – Level III. PMID:22096442

Maintaining neutral sagittal cervical alignment after football helmet removal during emergency spine injury management.

PubMed

Decoster, Laura C; Burns, Matthew F; Swartz, Erik E; Murthi, Dinakar S; Hernandez, Adam E; Vailas, James C; Isham, Linda L

2012-04-15

Descriptive laboratory study. To determine whether the placement of padding beneath the occiput after helmet removal is an effective intervention to maintain neutral sagittal cervical spine alignment in a position comparable with the helmeted condition. Current on-field recommendations for managing football athletes with suspected cervical spine injuries call for face mask removal, rather than helmet removal, because the combination of helmet and shoulder pads has been shown to maintain neutral cervical alignment. Therefore, in cases when helmet removal is required, recommendations also call for shoulder pad removal. Because removal of equipment causes motion, any technique that postpones the need to remove the shoulder pads would reduce prehospital motion. Four lateral radiographs of 20 male participants were obtained (age = 23.6 ± 2.7 years). Radiographs of participants wearing shoulder pads and helmet were first obtained. The helmet was removed and radiographs of participants with occipital padding were obtained immediately and 20 minutes later and finally without occipital padding. Cobb angle measurements for C2-C6 vertebral segments were determined by an orthopedic spine surgeon blinded to the study's purpose. Intraobserver reliability was determined using intraclass coefficient analysis. Measurements were analyzed using a 1×4 repeated-measures analysis of variance and post hoc pairwise comparisons with Bonferroni correction. Intraobserver analysis showed excellent reliability (intraclass correlation = 1.0; 95% confidence interval [CI], 0.999-1.0). Repeated-measures analysis of variance detected significant differences (F(3,17) = 13.34; P < 0.001). Pairwise comparisons revealed no differences in cervical alignment (all measurements reported reflect lordosis) when comparing the baseline helmeted condition (10.1° ± 8.7°; 95% CI, 6.0-14.1) with the padded conditions. Measurements taken after removal of occipital padding (14.4° ± 8.1°; 95% CI, 10.6-18.2) demonstrated a significant increase in cervical lordosis compared with the immediate padded measurement (9.5° ± 6.9°; 95% CI, 6.3-12.7; P = 0.011) and the 20-minute padded measurement (6.5° ± 6.8°; 95% CI, 3.4-9.7; P < 0.001). Although face mask removal remains the standard, if it becomes necessary to remove the football helmet in the field, occipital padding (along with full body/head immobilization techniques) may be used to limit cervical lordosis, allowing safe delay of shoulder pad removal.

Redefining Optimal Nail to Medullary Canal Diameter Ratio in Stainless Steel Flexible Intramedullary Nailing of Pediatric Femur Fractures.

PubMed

Shaha, James S; Cage, Jason M; Black, Sheena R; Wimberly, Robert L; Shaha, Steven H; Riccio, Anthony I

The ideal canal fill for flexible intramedullary fixation of pediatric femoral shaft fractures is considered to be 80% based upon relatively few clinical studies. The purpose of this study is to assess the relationship between the summed nail to intramedullary canal diameter (ND/MCD) ratio and alignment at radiographic union following flexible intramedullary nailing (FIMN) of pediatric femoral shaft fractures. An Internal Review Board approved, retrospective review of a consecutive series of patients who sustained a femoral shaft fracture treated by retrograde, stainless steel FIMN was performed at a single level 1 pediatric trauma center from 2005 to 2012. Preoperative radiographs were analyzed to determine fracture pattern, location, and isthmic canal diameter. ND/MCD ratio was calculated using the sum of the known nail diameters and the measured isthmic diameter. Radiographs at bony union were reviewed to measure shortening, coronal angulation, and sagittal angulation. ND/MCD ratio was analyzed to determine correlative factors with final radiographic outcomes. In total, 261 children underwent retrograde FIMN at an average age of 8.2 years (range, 2.2 to 17.0 y). ND/MCD ratio of ≥80% was seen in 108 (41.4%) patients. When compared with those with <80% ND/MCD ratio, there were no significant differences in age (8.8 vs. 8.0 y), sex (76.9% vs. 71.0% males), or body mass index (18.5 vs. 17.2 kg/m). There were significantly more length unstable fractures in the <80% ND/MCD ratio group (49.4% vs. 29.7%; P<0.01). Radiographic outcome was no different with respect to coronal angulation (2.7 vs. 3.0 degrees), sagittal angulation (3.0 vs. 3.2 degrees), or shortening (2.5 vs. 4.1 mm). ND/MCD ratio of ≥70% was seen in 176 (67.4%) patients and, when compared with the <70% ND/MCD ratio group, there were no differences in shortening (3.3 vs. 3.9 mm), coronal angulation (2.8 vs. 3.0 degrees), or sagittal angulation (3.0 vs. 3.4 degrees). Finally, 6.9% of the population (18 patients) had ND/MCD ratios <60% and did not demonstrate a significant increase in shortening, coronal, or sagittal angulation compared with groups with higher ND/MCD ratios. No group had an increased rate of infection, implant removal, nonunion, or need for reoperation. In a large series of consecutive patients treated with retrograde stainless steel FIMN there does not appear to be any correlation between the ND/MCD ratio and radiographic outcome. Stainless steel flexible IM nails seem to maintain fracture alignment without an increase in complications at lower ND/MCD ratios than previously reported as "optimal." Level III.

The aim of this retrospective study is to evaluate the efficacy and safety of posterior-only vertebral column resection (PVCR) for the treatment of angular and isolated congenital kyphosis.

PubMed

Wang, Shengru; Aikenmu, Kahaer; Zhang, Jianguo; Qiu, Guixing; Guo, Jianwei; Zhang, Yanbin; Weng, Xisheng

2017-07-01

The aim of this retrospective study is to evaluate the efficacy and safety of posterior-only vertebral column resection (PVCR) for the treatment of angular and isolated congenital kyphosis. 24 patients with isolated angular congenital kyphosis treated by PVCR in our hospital were retrospectively studied. The patients' radiographs and hospital records were reviewed. Deformity in sagittal planes and global sagittal alignment were analyzed for correction and maintenance of the correction in preoperative, postoperative, and follow-up radiographs. The complications and related risk factors were analyzed. The average age was 13.9 (4-40) years. Three of them were revision surgeries. Two patients have intraspinal anomalies. The mean follow-up is 56.9 (26-129) months. The mean operation time was 293.1 (170-480) min. The averaged blood loss was 993.8 (250-3000) ml. The segmental kyphosis was 87.3° before surgery, 17.6° post surgery and 20.4° at the latest the follow-up. And the sagittal vertical axis was improved from 43.1 mm to 9.2 mm. Mean total score of SRS-22 was 89.3. Complications occurred in 4 patients, including 1 screw pullout due to pseudarthrosis, 1 proximal junctional kyphosis, 1 incomplete spinal cord injury and 1 root injuries. Posterior-only vertebral column resection is an ideal procedure for severe rigid congenital kyphosis. However, it is still a highly technical demanding procedure. Neurological compromises still remain the biggest challenges. Sufficient height of anterior reconstruction, avoidance sacrifice of bilateral roots in the same level in the thoracic spine, avoidance of the sagittal translation of the upper and lower vertebras, intra-operative neuromonitoring, and preoperative surgical release of diastematomyelia and tethered cord may help to improve the safety.

Progressive restoration of spinal sagittal balance after surgical correction of lumbosacral spondylolisthesis before skeletal maturity.

PubMed

Thomas, Diala; Bachy, Manon; Courvoisier, Aurélien; Dubory, Arnaud; Bouloussa, Houssam; Vialle, Raphaël

2015-03-01

Spinopelvic alignment is crucial in assessing an energy-efficient posture in both normal and disease states, such as high-displacement developmental spondylolisthesis (HDDS). The overall effect in patients with HDDS who have undergone local surgical correction of lumbosacral imbalance for the global correction of spinal balance remains unclear. This paper reports the progressive spontaneous improvement of global sagittal balance following surgical correction of lumbosacral imbalance in patients with HDDS. The records of 15 patients with HDDS who underwent surgery between 2005 and 2010 were reviewed. The treatment consisted of L4-sacrum reduction and fusion via a posterior approach, resulting in complete correction of lumbosacral kyphosis. Preoperative, 6-month postoperative, and final follow-up postoperative angular measurements were taken from full-spine lateral radiographs obtained with the patient in a standard standing position. Radiographic measurements included pelvic incidence, sacral slope, lumbar lordosis, and thoracic kyphosis. The degree of lumbosacral kyphosis was evaluated by the lumbosacral angle. Because of the small number of patients, nonparametric tests were considered for data analysis. Preoperative lumbosacral kyphosis and L-5 anterior slip were corrected by instrumentation. Transient neurological complications were noted in 5 patients. Statistical analysis showed a significant increase of thoracic kyphosis on 6-month postoperative and final follow-up radiographs (p < 0.001). A statistically significant decrease of lumbar lordosis was noted between preoperative and 6-month control radiographs (p < 0.001) and between preoperative and final follow-up radiographs (p < 0.001). Based on the authors' observations, this technique resulted in an effective reduction of L-5 anterior slip and significant reduction of lumbosacral kyphosis (from 69.8° to 105.13°). Due to complete reduction of lumbosacral kyphosis and anterior trunk displacement associated with L-5 anterior slipping, lumbar lordosis progressively decreased and thoracic kyphosis progressively increased postoperatively. Adjusting the sagittal trunk balance produced not only pelvic anteversion, but also reciprocal adjustment of lumbar lordosis and thoracic kyphosis, creating a satisfactory level of compensated global sagittal balance.

Management of Osseous and Soft-Tissue Ankle Equinus During Total Ankle Replacement.

PubMed

Roukis, Thomas S; Simonson, Devin C

2015-10-01

Obtaining functional alignment of a total ankle replacement, including physiologic sagittal plane range of motion, is paramount for a successful outcome. This article reviews the literature on techniques available for correction of osseous and soft-tissue equinus at the time of index total ankle replacement. These techniques include anterior tibiotalar joint cheilectomy, posterior superficial muscle compartment lengthening, posterior ankle capsule release, and release of the posterior portions of the medial and lateral collateral ligament complexes. The rationale for these procedures and the operative sequence of events for these procedures are presented. Copyright © 2015 Elsevier Inc. All rights reserved.

Anterior cement augmentation of adjacent levels after vertebral body replacement leads to superior stability of the corpectomy cage under cyclic loading-a biomechanical investigation.

PubMed

Oberkircher, Ludwig; Krüger, Antonio; Hörth, Dominik; Hack, Juliana; Ruchholtz, Steffen; Fleege, Christoph; Rauschmann, Michael; Arabmotlagh, Mohammad

2018-03-01

In the operative treatment of osteoporotic vertebral body fractures, a dorsal stabilization in combination with a corpectomy of the fractured vertebral body might be necessary with respect to the fracture morphology, whereby the osteoporotic bone quality may possibly increase the risk of implant failure. To achieve better stability, it is recommended to use cement-augmented screws for dorsal instrumentation. Besides careful end plate preparation, cement augmentation of the adjacent end plates has also been reported to lead to less reduction loss. The aim of the study was to evaluate biomechanically under cyclic loading whether an additional cement augmentation of the adjacent end plates leads to improved stability of the inserted cage. Methodical cadaver study. Fourteen fresh frozen human thoracic spines with proven osteoporosis were used (T2-T7). After removal of the soft tissues, the spine was embedded in Technovit (Kulzer, Germany). Subsequently, a corpectomy of T5 was performed, leaving the dorsal ligamentary structures intact. After randomization with respect to bone quality, two groups were generated: Dorsal instrumentation (cemented pedicle screws, Medtronic, Minneapolis, MN, USA)+cage implantation (CAPRI Corpectomy Cage, K2M, Leesburg, VA, USA) without additional cementation of the adjacent endplates (Group A) and dorsal instrumentation+cage implantation with additional cement augmentation of the adjacent end plates (Group B). The subsequent axial and cyclic loading was performed at a frequency of 1 Hz, starting at 400 N and increasing the load within 200 N after every 500 cycles up to a maximum of 2,200 N. Load failure was determined when the cages sintered macroscopically into the end plates (implant failure) or when the maximum load was reached. One specimen in Group B could not be clamped appropriately into the test bench for axial loading because of a pronounced scoliotic misalignment and had to be excluded. The mean strength for implant failure was 1,000 N±258.2 N in Group A (no cement augmentation of the adjacent end plates, n=7); on average, 1,622.1±637.6 cycles were achieved. In Group B (cement augmentation of the adjacent end plates, n=6), the mean force at the end of loading was 1,766.7 N±320.4 N; an average of 3,572±920.6 cycles was achieved. Three specimens reached a load of 2,000 N. The differences between the two groups were significant (p=.006 and p=.0047) regarding load failure and number of cycles. Additional cement augmentation of the adjacent end plates during implantation of a vertebral body replacement in osteoporotic bone resulted in a significant increased stability of the cage in the axial cyclic loading test. Copyright © 2017 Elsevier Inc. All rights reserved.

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: a Retrospective Matched Cohort Study.

PubMed

Steinhaus, Michael E; McLawhorn, Alexander S; Richardson, Shawn S; Maher, Patrick; Mayman, David J

2016-10-01

Proper alignment of total knee arthroplasty (TKA) is essential for TKA function and may reduce the risk of aseptic failure. Technologies that prevent malalignment may reduce the risk of revision surgery. The purpose of this study was to compare two competing TKA systems that purport improved alignment: patient-specific instrumentation (PSI), and a handheld portable navigation device (NAV). After IRB approval, 49 consecutive PSI TKAs (40 patients) were matched based on preoperative characteristics to 49 NAV TKAs (40 patients) performed by a single surgeon. A blinded observer measured alignment on digital radiographs. Operating room records were reviewed for procedure times. Two-tailed paired sample t tests and McNemar's test were used as appropriate. Alpha level was 0.05 for all tests. Preoperative cohort characteristics were not different. Mean postoperative long-leg mechanical alignment was within ±1° of neutral for both groups, although statistically different ( p  = 0.026). There were no other significant differences in coronal alignment. PSI exhibited significantly greater posterior tibial slope (4.4°) compared to NAV (2.7°) ( p  = 0.004); PSI resulted in significantly more outliers (>6°; p  = 0.004). Procedure time for unilateral TKAs was lower for PSI (74.4 min) compared to that for NAV (80.6 min; p  = 0.023). NAV and PSI technologies provided excellent coronal plane alignment. NAV was better for sagittal tibial slope, while PSI procedure times were shorter for unilateral TKA. The impact of these technologies on patient-reported outcomes and TKA survivorship is controversial and should be the focus of future research.

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

PubMed Central

Koller, Heiko; Ferraris, Luis; Maier, Oliver; Hitzl, Wolfgang; Metz-Stavenhagen, Peter

2007-01-01

In the future, there will be an increased number of cervical revision surgeries, including 4- and more-levels. But, there is a paucity of literature concerning the geometrical and clinical outcome in these challenging reconstructions. To contribute to current knowledge, we want to share our experience with 4- and 5-level anterior cervical fusions in 26 cases in sight of a critical review of literature. At index procedure, almost 50% of our patients had previous cervical surgeries performed. Besides failed prior surgeries, indications included degenerative multilevel instability and spondylotic myelopathy with cervical kyphosis. An average of 4.1 levels was instrumented and fused using constrained (26.9%) and non-constrained (73.1%) screw-plate systems. At all, four patients had 3-level corpectomies, and three had additional posterior stabilization and fusion. Mean age of patients at index procedure was 54 years with a mean follow-up intervall of 30.9 months. Preoperative lordosis C2-7 was 6.5° in average, which measured a mean of 15.6° at last follow-up. Postoperative lordosis at fusion block was 14.4° in average, and 13.6° at last follow-up. In 34.6% of patients some kind of postoperative change in construct geometry was observed, but without any catastrophic construct failure. There were two delayed unions, but finally union rate was 100% without any need for the Halo device. Eleven patients (42.3%) showed an excellent outcome, twelve good (46.2%), one fair (3.8%), and two poor (7.7%). The study demonstrated that anterior-only instrumentations following segmental decompressions or use of the hybrid technique with discontinuous corpectomies can avoid the need for posterior supplemental surgery in 4- and 5-level surgeries. However, also the review of literature shows that decreased construct rigidity following more than 2-level corpectomies can demand 360° instrumentation and fusion. Concerning construct rigidity and radiolographic course, constrained plates did better than non-constrained ones. The discussion of our results are accompanied by a detailed review of literature, shedding light on the biomechanical challenges in multilevel cervical procedures and suggests conclusions. PMID:17605052

Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study.

PubMed

Shilton, Michael; Branney, Jonathan; de Vries, Bas Penning; Breen, Alan C

2015-01-01

The association between cervical lordosis (sagittal alignment) and neck pain is controversial. Further, it is unclear whether spinal manipulative therapy can change cervical lordosis. This study aimed to determine whether cervical lordosis changes after a course of spinal manipulation for non-specific neck pain. Posterior tangents of C2 and C6 were drawn on the lateral cervical fluoroscopic images of 29 patients with subacute/chronic non-specific neck pain and 30 healthy volunteers matched for age and gender, recruited August 2011 to April 2013. The resultant angle was measured using 'Image J' digital geometric software. The intra-observer repeatability (measurement error and reliability) and intra-subject repeatability (minimum detectable change (MDC) over 4 weeks) were determined in healthy volunteers. A comparison of cervical lordosis was made between patients and healthy volunteers at baseline. Change in lordosis between baseline and 4-week follow-up was determined in patients receiving spinal manipulation. Intra-observer measurement error for cervical lordosis was acceptable (SEM 3.6°) and reliability was substantial ICC 0.98, 95 % CI 0.962-0991). The intra-subject MDC however, was large (13.5°). There was no significant difference between lordotic angles in patients and healthy volunteers (p = 0.16). The mean cervical lordotic increase over 4 weeks in patients was 2.1° (9.2) which was not significant (p = 0.12). This study found no difference in cervical lordosis (sagittal alignment) between patients with mild non-specific neck pain and matched healthy volunteers. Furthermore, there was no significant change in cervical lordosis in patients after 4 weeks of cervical spinal manipulation.

Fusion Rate and Clinical Outcomes in Two-Level Posterior Lumbar Interbody Fusion.

PubMed

Aono, Hiroyuki; Takenaka, Shota; Nagamoto, Yukitaka; Tobimatsu, Hidekazu; Yamashita, Tomoya; Furuya, Masayuki; Iwasaki, Motoki

2018-04-01

Posterior lumbar interbody fusion (PLIF) has become a general surgical method for degenerative lumbar diseases. Although many reports have focused on single-level PLIF, few have focused on 2-level PLIF, and no report has covered the fusion status of 2-level PLIF. The purpose of this study is to investigate clinical outcomes and fusion for 2-level PLIF by using a combination of dynamic radiographs and multiplanar-reconstruction computed tomography scans. This study consisted of 48 consecutive patients who underwent 2-level PLIF for degenerative lumbar diseases. We assessed surgery duration, estimated blood loss, complications, clinical outcomes as measured by the Japanese Orthopaedic Association score, lumbar sagittal alignment as measured on standing lateral radiographs, and fusion status as measured by dynamic radiographs and multiplanar-reconstruction computed tomography. Patients were examined at a follow-up point of 4.8 ± 2.2 years after surgery. Thirty-eight patients who did not undergo lumbosacral fusion comprised the lumbolumbar group, and 10 patients who underwent lumbosacral fusion comprised the lumbosacral group. The mean Japanese Orthopaedic Association score improved from 12.1 to 22.4 points by the final follow-up examination. Sagittal alignment also was improved. All patients had fusion in the cranial level. Seven patients had nonunion in the caudal level, and the lumbosacral group (40%) had a significantly poorer fusion rate than the lumbolumbar group (97%) did. Surgical outcomes of 2-level PLIF were satisfactory. The fusion rate at both levels was 85%. All nonunion was observed at the caudal level and concentrated at L5-S level in L4-5-S PLIF. Copyright © 2018 Elsevier Inc. All rights reserved.

Relationships among spinal mobility and sagittal alignment of spine and lower extremity to quality of life and risk of falls.

PubMed

Ishikawa, Yoshinori; Miyakoshi, Naohisa; Hongo, Michio; Kasukawa, Yuji; Kudo, Daisuke; Shimada, Yoichi

2017-03-01

Spinal deformities can affect quality of life (QOL) and risk of falling, but no studies have explored the relationships of spinal mobility and sagittal alignment of spine and the lower extremities simultaneously. Purpose of this study is to clarify the relationship of those postural parameters to QOL and risk of falling. The study evaluated 110 subjects (41 men, 69 women; mean age, 73 years). Upright and flexion and extension angles for thoracic kyphosis, lumbar lordosis, and spinal inclination were evaluated with SpinalMouse ® . Total-body inclination and hip and knee flexion angles in upright position were measured from lateral photographs. Subjects were divided into Fallers (n=23, 21%) and Non-fallers (n=87, 79%) based on past history of falls. QOL was assessed using the Short Form 36 Health Survey (SF-36 ® ). Age, total-body inclination, spinal inclination upright and in extension, thoracic kyphosis in flexion, lumbar lordosis upright and in extension, and knee flexion correlated significantly with the SF-36. Multiple regression analysis revealed total-body inclination and knee flexion to have the most significant relationships with the SF-36. SF-36, total-body inclination, spinal inclination in extension, thoracic kyphosis in flexion, lumbar lordosis upright and in extension, and hip and knee flexion angles differed significantly between Fallers and Non-fallers (P<0.05 for all). Multivariate logistic regression analyses revealed lumbar lordosis in extension to be a significant predictor of falling (P=0.038). Forward-stooped posture and knee-flexion deformity could be important indicator of lower QOL. Moreover, limited extension in the lumbar spine could be a useful screening examination for fall prevention in the elderly. Copyright © 2017 Elsevier B.V. All rights reserved.

Adjacent segment disease after instrumented fusion for adult lumbar spondylolisthesis: Incidence and risk factors.

PubMed

Zhong, Zhao-Ming; Deviren, Vedat; Tay, Bobby; Burch, Shane; Berven, Sigurd H

2017-05-01

A potential long-term complication of lumbar fusion is the development of adjacent segment disease (ASD), which may necessitate second surgery and adversely affect outcomes. The objective of this is to determine the incidence of ASD following instrumented fusion in adult patients with lumbar spondylolisthesis and to identify the risk factors for this complication. We retrospectively assessed adult patients who had undergone decompression and instrumented fusion for lumbar spondylolisthesis between January 2006 and December 2012. The incidence of ASD was analyzed. Potential risk factors included the patient-related factors, surgery-related factors, and radiographic variables such as sagittal alignment, preexisting disc degeneration and spinal stenosis at the adjacent segment. A total of 154 patients (mean age, 58.4 years) were included. Mean duration of follow-up was 28.6 months. Eighteen patients (11.7%) underwent a reoperation for ASD; 15 patients had reoperation at cranial ASD and 3 at caudal ASD. The simultaneous decompression at adjacent segment (p=0.002) and preexisting spinal stenosis at cranial adjacent segment (p=0.01) were identified as risk factors for ASD. The occurrence of ASD was not affected by patient-related factors, the types, grades and levels of spondylolisthesis, surgical approach, fusion procedures, levels of fusion, number of levels fused, types of bone graft, use of bone morphogenetic proteins, sagittal alignment, preexisting adjacent disc degeneration and preexisting spinal stenosis at caudal adjacent segments. Our findings suggest the overall incidence of ASD is 11.7% in adult patients with lumbar spondylolisthesis after decompression and instrumented fusion at a mean follow-up of 28.6 months, the simultaneous decompression at the adjacent segment and preexisting spinal stenosis at cranial adjacent segment are risk factors for ASD. Copyright © 2017. Published by Elsevier B.V.

Multilevel extreme lateral interbody fusion (XLIF) and osteotomies for 3-dimensional severe deformity: 25 consecutive cases

PubMed Central

McAfee, Paul C.; Shucosky, Erin; Chotikul, Liana; Salari, Ben; Chen, Lun; Jerrems, Dan

2013-01-01

Background This is a retrospective review of 25 patients with severe lumbar nerve root compression undergoing multilevel anterior retroperitoneal lumbar interbody fusion and posterior instrumentation for deformity. The objective is to analyze the outcomes and clinical results from anterior interbody fusions performed through a lateral approach and compare these with traditional surgical procedures. Methods A consecutive series of 25 patients (78 extreme lateral interbody fusion [XLIF] levels) was identified to illustrate the primary advantages of XLIF in correcting the most extreme of the 3-dimensional deformities that fulfilled the following criteria: (1) a minimum of 40° of scoliosis; (2) 2 or more levels of translation, anterior spondylolisthesis, and lateral subluxation (subluxation in 2 planes), causing symptomatic neurogenic claudication and severe spinal stenosis; and (3) lumbar hypokyphosis or flat-back syndrome. In addition, the majority had trunks that were out of balance (central sacral vertical line ≥2 cm from vertical plumb line) or had sagittal imbalance, defined by a distance between the sagittal vertical line and S1 of greater than 3 cm. There were 25 patients who had severe enough deformities fulfilling these criteria that required supplementation of the lateral XLIF with posterior osteotomies and pedicle screw instrumentation. Results In our database, with a mean follow-up of 24 months, 85% of patients showed evidence of solid arthrodesis and no subsidence on computed tomography and flexion/extension radiographs. The complication rate remained low, with a perioperative rate of 2.4% and postoperative rate of 12.2%. The lateral listhesis and anterior spondylolisthetic subluxation were anatomically reduced with minimally invasive XLIF. The main finding in these 25 cases was our isolation of the major indication for supplemental posterior surgery: truncal decompensation in patients who are out of balance by 2 cm or more, in whom posterior spinal osteotomies and segmental pedicle screw instrumentation were required at follow up. No patients were out of sagittal balance (sagittal vertical line <3 cm from S1) postoperatively. Segmental instrumentation with osteotomies was also more effective for restoration of physiologic lumbar lordosis compared with anterior stand-alone procedures. Conclusions This retrospective study supports the finding that clinical outcomes (coronal/sagittal alignment) improve postoperatively after minimally invasive surgery with multilevel XLIF procedures and are improved compared with larger extensile thoracoabdominal anterior scoliosis procedures. PMID:25694908

Restoration of Lumbar Lordosis in Flat Back Deformity: Optimal Degree of Correction

PubMed Central

Kim, Ki-Tack; Lee, Sang-Hun; Kim, Hyo-Jong; Kim, Jung-Youn; Lee, Jung-Hee

2015-01-01

Study Design A retrospective comparative study. Purpose To provide an ideal correction angle of lumbar lordosis (LL) in degenerative flat back deformity. Overview of Literature The degree of correction in degenerative flat back in relation to pelvic incidence (PI) remains controversial. Methods Forty-nine patients with flat back deformity who underwent corrective surgery were enrolled. Posterior-anterior-posterior sequential operation was performed. Mean age and mean follow-up period was 65.6 years and 24.2 months, respectively. We divided the patients into two groups based on immediate postoperative radiographs-optimal correction (OC) group (PI-9°≤LL

Initial experience with custom-fit total knee replacement: intra-operative events and long-leg coronal alignment.

PubMed

Spencer, Brian A; Mont, Michael A; McGrath, Mike S; Boyd, Bradley; Mitrick, Michael F

2009-12-01

New technology using magnetic resonance imaging (MRI) allows the surgeon to place total knee replacement components into each patient's pre-arthritic natural alignment. This study evaluated the initial intra-operative experience using this technique. Twenty-one patients had a sagittal MRI of their arthritic knee to determine component placement for a total knee replacement. Cutting guides were machined to control all intra-operative cuts. Intra-operative events were recorded and these knees were compared to a matching cohort of the senior surgeon's previous 30 conventional total knee replacements. Post-operative scanograms were obtained from each patient and coronal alignment was compared to previous studies using conventional and computer-assisted techniques. There were no intra-operative or acute post-operative complications. There were no differences in blood loss and there was a mean decrease in operative time of 14% compared to a cohort of patients with conventional knee replacements. The average deviation from the mechanical axis was 1.2 degrees of varus, which was comparable to previously reported conventional and computer-assisted techniques. Custom-fit total knee replacement appeared to be a safe procedure for uncomplicated cases of osteoarthritis.

Uncovertebral joint injury in cervical facet dislocation: the headphones sign.

PubMed

Palmieri, Francesco; Cassar-Pullicino, Victor N; Dell'Atti, Claudia; Lalam, Radhesh K; Tins, Bernhard J; Tyrrell, Prudencia N M; McCall, Iain W

2006-06-01

The purpose of our study is to demonstrate the uncovertebral mal-alignment as a reliable indirect sign of cervical facet joint dislocation. We examined the uncovertebral axial plane alignment of 12 patients with unilateral and bilateral cervical facet joint dislocation (UCFJD and BCFJD, respectively), comparing its frequency to the reverse hamburger bun sign on CT and MR axial images. Of the seven cases with BCFJD, five clearly demonstrated the diagnostic reverse facet joint hamburger bun sign on CT and MR images, but in two cases this sign was not detectable. In the five cases with UCFJD, four demonstrated the reverse hamburger bun sign on both CT and MRI. In one case the reverse hamburger bun sign was not seen adequately with either image modality, but the facet dislocation was identified on sagittal imaging. The uncovertebral mal-alignment was detected in all 12 cases. Normally, the two components of the uncovertebral joint enjoy a concentric relationship that in the axial plane is reminiscent of the relationship of headphones with the wearer's head. We name this appearance the 'headphones' sign. Radiologists should be aware of the headphones sign as a reliable indicator of facet joint dislocation on axial imaging used in the assessment of cervical spine injuries.

Patient-specific instruments in total knee arthroplasty.

PubMed

Conteduca, Fabio; Iorio, Raffaele; Mazza, Daniele; Ferretti, Andrea

2014-02-01

In recent years, patient-specific instruments (PSI) has been introduced with the aim of reducing the overall costs of the implants, minimising the size and number of instruments required, and also reducing surgery time. The purpose of this study was to perform a review of the current literature, as well as to report about our personal experience, to assess reliability of patient specific instrument system in total knee arthroplasty (TKA). A literature review was conducted of PSI system reviewing articles related to coronal alignment, clinical knee and function scores, cost, patient satisfaction and complications. Studies have reported incidences of coronal alignment ≥3° from neutral in TKAs performed with patient-specific cutting guides ranging from 6% to 31%. PSI seem not to be able to result in the same degree of accuracy as the CAS system, while comparing well with standard manual technique with respect to component positioning and overall lower axis, in particular in the sagittal plane. In cases in which custom-made cutting jigs were used, we recommend performing an accurate control of the alignment before and after any cuts and in any further step of the procedure, in order to avoid possible outliers.

Adjustable selective maxillary expansion combined with maxillomandibular surgery: A case report.

PubMed

Leyder, Patrick; Altounian, Gérard; Chardain, Jacques; Quilichini, Julien

2015-09-01

Surgically assisted rapid maxillary expansion (SARME) is usually considered the gold standard for maxillary transverse expansion in adults. However, a second surgical procedure is needed in cases of associated sagittal or vertical discrepancies. We describe the use of two new innovative devices for the correction of discrepancies in all dimensions during a single surgical procedure, thus reducing treatment duration. We report the case of a 21-year-old female patient, referred to our department for skeletal Class III malocclusion associated with right-side laterognathism and transverse maxillary deficiency. The patient underwent one-stage surgery, using sliding osteosynthesis plates and an adjustable bone-borne distractor. Pre-surgical orthodontics consisted in leveling and aligning the mandibular arch; maxillary leveling was initiated 3 months before surgery. Postoperative palatal distraction combined with orthodontic finishing enabled complete correction of dental and bony discrepancies after 3 months. In our experience, treatment of transverse, sagittal and vertical discrepancies has been possible in a single surgical procedure, using two innovative techniques: sliding osteosynthesis and an adjustable bone distractor. Two years post-surgery, the correction is stable in all dimensions. Copyright © 2015. Published by Elsevier Masson SAS.

The Surgical Management of Skeletal Disproportion with Lingual Orthodontics and Three-dimensional Planning

PubMed Central

Patel, Krutiben; Kau, Chung How; Waite, Peter D; Celebi, Ahmet Arif

2017-01-01

This case report describes the successful treatment of a 26-year-old Caucasian male with skeletal and dental Class III malocclusion associated with mild maxillary and mandibular crowding. The patient had anteroposterior and transverse discrepancies with a reverse overjet and bilateral posterior crossbites. The nonextraction treatment plan included aligning and leveling of the teeth in both arches, Le Fort I and bilateral sagittal split osteotomies, and postsurgical correction of the malocclusion. Orthodontic treatment was initiated with custom lingual appliances followed by orthognathic surgery planned with virtual surgical planning. Treatment was concluded with detailed orthodontic finishing, achieving optimum esthetics and function. PMID:28713747

Spinal sagittal balance substantially influences locomotive syndrome and physical performance in community-living middle-aged and elderly women.

PubMed

Muramoto, Akio; Imagama, Shiro; Ito, Zenya; Hirano, Kenichi; Ishiguro, Naoki; Hasegawa, Yukiharu

2016-03-01

Spinal sagittal imbalance has been well known risk factor of decreased quality of life in the field of adult spinal deformity. However, the impact of spinal sagittal balance on locomotive syndrome and physical performance in community-living elderly has not yet been clarified. The present study investigated the influence of spinal sagittal alignment on locomotive syndrome (LS) and physical performance in community-living middle-aged and elderly women. A total of 125 women between the age of 40-88 years (mean 66.2 ± 9.7 years) who completed the questionnaires, spinal mouse test, physical examination and physical performance tests in Yakumo study were enrolled in this study. Participants answered the 25-Question Geriatric Locomotive Function Scale (GLFS-25), the visual analog scale (VAS) for low back pain (LBP), knee pain. LS was defined as having a score of >16 points on the GLFS-25. Using spinal mouse, spinal inclination angle (SIA), thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), sacral slope angle (SSA), thoracic spinal range of motion (TSROM), lumbar spinal range of motion (LSROM) were measured. Timed-up-and-go test (TUG), one-leg standing time with eyes open (OLS), and maximum stride, back muscle strength were also measured. The relationship between spinal sagittal parameters and GLFS-25, VAS and physical performance tests were analyzed. 26 people were diagnosed as LS and 99 were diagnosed as non-LS. LBP and knee pain were greater, physical performance tests were poorer, SIA were greater, LLA were smaller in LS group compared to non-LS group even after adjustment by age. SIA significantly correlated with GLFS-25, TUG, OLS and maximum stride even after adjustment by age. The cutoff value of SIA for locomotive syndrome was 6°. People with a SIA of 6° or greater were grouped as "Inclined" and people with a SIA of less than 6° were grouped as "Non-inclined". 21 people were "Inclined" and 104 were "Non-inclined". Odds ratio to fall in LS of Inclined group compared to Non-inclined group is 5.0. GLFS-25 were significantly higher, VAS for LBP were greater, TUG, OLS and maximum stride were poorer in Inclined group compared to Non-inclined group even after adjustment by age. The present study demonstrated that spinal sagittal balance influences the LS and physical performance in community-living middle-aged and elderly women. SIA is a useful spinal parameter to evaluate the risk of LS, and its cutoff value is 6°. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction.

PubMed

Macri, Erin M; Culvenor, Adam G; Morris, Hayden G; Whitehead, Timothy S; Russell, Trevor G; Khan, Karim M; Crossley, Kay M

2017-05-09

Patellofemoral osteoarthritis (PFOA) occurs in approximately half of anterior cruciate ligament (ACL)-injured knees within 10-15 years of trauma. Risk factors for post-traumatic PFOA are poorly understood. Patellofemoral alignment and trochlear morphology may be associated with PFOA following ACL reconstruction (ACLR), and understanding these relationships, particularly early in the post-surgical time period, may guide effective early intervention strategies. In this study, patellofemoral alignment and trochlear morphology were investigated in relation to radiographic features of early PFOA 1-year post-ACLR. Participants (aged 18-50 years) had undergone ACLR approximately 1 year prior to being assessed. Early PFOA was defined as presence of a definite patellofemoral osteophyte on lateral or skyline radiograph. Sagittal and axial plane alignment and trochlear morphology were estimated using MRI. Using logistic regression, the relationship between alignment or morphology and presence of osteophytes was evaluated. Of 111 participants [age 30 ± 8.5; 41 (37%) women], 19 (17%) had definite osteophytes, only two of whom had had patellofemoral chondral lesions noted intra-operatively. One measure of patellar alignment (bisect offset OR 1.1 [95% confidence interval 1.0, 1.2]) and two measures of trochlear morphology (sulcus angle OR 1.1 [1.0, 1.2], trochlear angle OR 1.2 [1.0, 1.5]) were associated with patellofemoral osteophytes. Patellofemoral malalignment and/or altered trochlear morphology were associated with PFOA 1 year following ACLR compared to individuals post-ACLR without these features. Clarifying the role of alignment and morphology in post-traumatic PFOA may contribute to improving early intervention strategies aimed at secondary prevention. IV.

Patient-specific guides do not improve accuracy in total knee arthroplasty: a prospective randomized controlled trial.

PubMed

Victor, Jan; Dujardin, Jan; Vandenneucker, Hilde; Arnout, Nele; Bellemans, Johan

2014-01-01

Recently, patient-specific guides (PSGs) have been introduced, claiming a significant improvement in accuracy and reproducibility of component positioning in TKA. Despite intensive marketing by the manufacturers, this claim has not yet been confirmed in a controlled prospective trial. We (1) compared three-planar component alignment and overall coronal mechanical alignment between PSG and conventional instrumentation and (2) logged the need for applying changes in the suggested position of the PSG. In this randomized controlled trial, we enrolled 128 patients. In the PSG cohort, surgical navigation was used as an intraoperative control. When the suggested cut deviated more than 3° from target, the use of PSG was abandoned and marked as an outlier. When cranial-caudal position or size was adapted, the PSG was marked as modified. All patients underwent long-leg standing radiography and CT scan. Deviation of more than 3° from the target in any plane was defined as an outlier. The PSG and conventional cohorts showed similar numbers of outliers in overall coronal alignment (25% versus 28%; p = 0.69), femoral coronal alignment (7% versus 14%) (p = 0.24), and femoral axial alignment (23% versus 17%; p = 0.50). There were more outliers in tibial coronal (15% versus 3%; p = 0.03) and sagittal 21% versus 3%; p = 0.002) alignment in the PSG group than in the conventional group. PSGs were abandoned in 14 patients (22%) and modified in 18 (28%). PSGs do not improve accuracy in TKA and, in our experience, were somewhat impractical in that the procedure needed to be either modified or abandoned with some frequency.

Correlation between preoperative spinopelvic alignment and risk of proximal junctional kyphosis after posterior-only surgical correction of Scheuermann kyphosis.

PubMed

Nasto, Luigi A; Perez-Romera, Ana Belen; Shalabi, Saggah Tarek; Quraishi, Nasir A; Mehdian, Hossein

2016-04-01

Surgical correction of Scheuermann kyphosis (SK) is challenging and plagued by relatively high rates of proximal junctional kyphosis and failure (PJK and PJF). Normal sagittal alignment of the spine is determined by pelvic geometric parameters. How these parameters correlate with the risk of developing PJK in SK is not known. The study aimed to investigate the relationship between preoperative and postoperative spinopelvic alignment and occurrence of PJK and PJF. This is a retrospective observational cohort study. The sample included 37 patients who underwent posterior correction of SK from January 2006 to December 2012. The outcome measure was correlation analysis between preoperative and postoperative spinopelvic alignment parameters and the development of PJK over the course of the study period. Whole spine x-rays obtained before surgery, 3 months after surgery, and at the latest follow-up were analyzed. The following parameters were measured: thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). The development of PJK was considered the primary end point of the study. Patient population was split into a control and a PJK group; repeated-measures analysis of variance was used to assess group and time differences. Seven patients developed PJK over the study period. Although the severity of the preoperative deformity (TK) did not differ significantly between the two groups, preoperative PI was significantly higher in the PJK group (51.9°C±8.6°C vs. 42.7°C±8.8°C, p=.018). Postoperative correction of TK was similar between the two groups (39.3% and 41.2%, p=.678) and final LL did not differ as well (53.6°C±9.2°C vs. 51.3°C±11.5°C). However, because PJK patients had larger preoperative PI values, a significant deficit of LL was observed at final follow-up in this group compared with the control group (ΔLL -10.5°C±9.8°C vs. 0.6°C±10.5°C, p=.013). Scheuermann kyphosis patients who developed PJK appeared to have a significant postoperative deficit of LL (lumbopelvic mismatch). Lumbar lordosis decreases after surgery following correction of TK; therefore, TK correction should be planned according to preoperative PI values to avoid excessive reduction of LL in patients with higher PI values. Copyright © 2016 Elsevier Inc. All rights reserved.

The influence of different sets of surgical instrumentation in Oxford UKA on bearing size and component position.

PubMed

Walker, Tilman; Heinemann, Pascal; Bruckner, Thomas; Streit, Marcus R; Kinkel, Stefan; Gotterbarm, Tobias

2017-07-01

The Oxford unicompartmental knee arthroplasty (OUKA) has been proven to be an effective treatment for anteromedial osteoarthritis of the knee joint. New instrumentation has been introduced to improve the reproducibility of implant positioning and to minimize bone loss during tibial resection (Oxford Microplasty; Zimmer Biomet, Warsaw, Indiana, USA). To assess the effect of the new instrumentation, we retrospectively evaluated the postoperative radiographs and surgical records of 300 OUKAs in three consecutive cohorts of patients. The first cohort consists of the first 100 minimal invasive implantations of the OUKA using the conventional phase III instrumentation, the second cohort consists of the 100 most recent minimal invasive OUKA with the conventional phase III instrumentation and the third cohort consists of the first 100 minimal invasive OUKA using the new Oxford Microplasty instrumentation. Mean bearing thickness was statistically significant and lower in OUKA with use of the updated instrumentation than with the conventional instrumentation (p = 0.01 and p = 0.04). Additionally, statistically significant and more femoral components were aligned within the accepted range of tolerance in both the coronal and the sagittal plane with use of the updated instrumentation compared to the conventional phase III instrumentation in group A (p = 0.029 and p = 0.038) and in the sagittal plane with use of the updated instrumentation compared to the conventional phase III instrumentation in group B (p = 0.002). The new modified instrumentation seems to be an effective tool to reduce the risk of malalignment of the femoral component in the coronal and in the sagittal plane compared to the conventional phase III instrumentation. Furthermore, the instrumentation is also effective in determining an adequate level of tibial resection and thus avoiding unnecessary bone loss.

The influence of foot hyperpronation on pelvic biomechanics during stance phase of the gait: A biomechanical simulation study.

PubMed

Yazdani, Farzaneh; Razeghi, Mohsen; Karimi, Mohammad Taghi; Raeisi Shahraki, Hadi; Salimi Bani, Milad

2018-05-01

Despite the theoretical link between foot hyperpronation and biomechanical dysfunction of the pelvis, the literature lacks evidence that confirms this assumption in truly hyperpronated feet subjects during gait. Changes in the kinematic pattern of the pelvic segment were assessed in 15 persons with hyperpronated feet and compared to a control group of 15 persons with normally aligned feet during the stance phase of gait based on biomechanical musculoskeletal simulation. Kinematic and kinetic data were collected while participants walked at a comfortable self-selected speed. A generic OpenSim musculoskeletal model with 23 degrees of freedom and 92 muscles was scaled for each participant. OpenSim inverse kinematic analysis was applied to calculate segment angles in the sagittal, frontal and horizontal planes. Principal component analysis was employed as a data reduction technique, as well as a computational tool to obtain principal component scores. Independent-sample t-test was used to detect group differences. The difference between groups in scores for the first principal component in the sagittal plane was statistically significant (p = 0.01; effect size = 1.06), but differences between principal component scores in the frontal and horizontal planes were not significant. The hyperpronation group had greater anterior pelvic tilt during 20%-80% of the stance phase. In conclusion, in persons with hyperpronation we studied the role of the pelvic segment was mainly to maintain postural balance in the sagittal plane by increasing anterior pelvic inclination. Since anterior pelvic tilt may be associated with low back symptoms, the evaluation of foot posture should be considered in assessing the patients with low back and pelvic dysfunction.

Directional constraint of endpoint force emerges from hindlimb anatomy.

PubMed

Bunderson, Nathan E; McKay, J Lucas; Ting, Lena H; Burkholder, Thomas J

2010-06-15

Postural control requires the coordination of force production at the limb endpoints to apply an appropriate force to the body. Subjected to horizontal plane perturbations, quadruped limbs stereotypically produce force constrained along a line that passes near the center of mass. This phenomenon, referred to as the force constraint strategy, may reflect mechanical constraints on the limb or body, a specific neural control strategy or an interaction among neural controls and mechanical constraints. We used a neuromuscular model of the cat hindlimb to test the hypothesis that the anatomical constraints restrict the mechanical action of individual muscles during stance and constrain the response to perturbations to a line independent of perturbation direction. In a linearized neuromuscular model of the cat hindlimb, muscle lengthening directions were highly conserved across 10,000 different muscle activation patterns, each of which produced an identical, stance-like endpoint force. These lengthening directions were closely aligned with the sagittal plane and reveal an anatomical structure for directionally constrained force responses. Each of the 10,000 activation patterns was predicted to produce stable stance based on Lyapunov stability analysis. In forward simulations of the nonlinear, seven degree of freedom model under the action of 200 random muscle activation patterns, displacement of the endpoint from its equilibrium position produced restoring forces, which were also biased toward the sagittal plane. The single exception was an activation pattern based on minimum muscle stress optimization, which produced destabilizing force responses in some perturbation directions. The sagittal force constraint increased during simulations as the system shifted from an inertial response during the acceleration phase to a viscoelastic response as peak velocity was obtained. These results qualitatively match similar experimental observations and suggest that the force constraint phenomenon may result from the anatomical arrangement of the limb.

Pelvic Rotation in Femoroacetabular Impingement Is Decreased Compared to Other Symptomatic Hip Conditions.

PubMed

Azevedo, Daniel Camara; Paiva, Edson Barreto; Lopes, Alexia Moura Abuhid; Santos, Henrique de Oliveira; Carneiro, Ricardo Luiz; Rodrigues, André Soares; de Andrade, Marco Antonio Percope; Novais, Eduardo N; Van Dillen, Linda R

2016-11-01

Study Design Cross-sectional, case-control design. Background Pelvic movement has been considered a possible discriminating parameter associated with femoroacetabular impingement (FAI) symptom onset. Decreased pelvic rotation has been found during squatting in people with FAI when compared to people with healthy hips. However, it is possible that changes in pelvic movement may occur in other hip conditions because of pain and may not be specific to FAI. Objectives To compare sagittal pelvic rotation during hip flexion and in sitting between people with FAI and people with other symptomatic hip conditions. Methods Thirty people with symptomatic FAI, 30 people with other symptomatic hip conditions, and 20 people with healthy hips participated in the study. Sagittal pelvic rotation was calculated based on measures of pelvic alignment in standing, hip flexion to 45° and 90°, and sitting. Results There were significant differences in sagittal pelvic rotation among the 3 groups in all conditions (P<.05). Post hoc analyses revealed that participants in the symptomatic FAI group had less pelvic rotation during hip flexion to 45° and 90° compared to participants in the other symptomatic hip conditions group and the hip-healthy group (mean difference, 1.2°-1.9°). In sitting, participants in the other symptomatic hip conditions group had less posterior pelvic rotation compared to those in the hip-healthy group (mean difference, 3.9°). Conclusion People with symptomatic FAI have less posterior pelvic rotation during hip flexion when compared to people with other symptomatic hip conditions and those with healthy hips. Level of Evidence Diagnosis, level 4. J Orthop Sports Phys Ther 2016;46(11):957-964. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6713.

Directional constraint of endpoint force emerges from hindlimb anatomy

PubMed Central

Bunderson, Nathan E.; McKay, J. Lucas; Ting, Lena H.; Burkholder, Thomas J.

2010-01-01

Postural control requires the coordination of force production at the limb endpoints to apply an appropriate force to the body. Subjected to horizontal plane perturbations, quadruped limbs stereotypically produce force constrained along a line that passes near the center of mass. This phenomenon, referred to as the force constraint strategy, may reflect mechanical constraints on the limb or body, a specific neural control strategy or an interaction among neural controls and mechanical constraints. We used a neuromuscular model of the cat hindlimb to test the hypothesis that the anatomical constraints restrict the mechanical action of individual muscles during stance and constrain the response to perturbations to a line independent of perturbation direction. In a linearized neuromuscular model of the cat hindlimb, muscle lengthening directions were highly conserved across 10,000 different muscle activation patterns, each of which produced an identical, stance-like endpoint force. These lengthening directions were closely aligned with the sagittal plane and reveal an anatomical structure for directionally constrained force responses. Each of the 10,000 activation patterns was predicted to produce stable stance based on Lyapunov stability analysis. In forward simulations of the nonlinear, seven degree of freedom model under the action of 200 random muscle activation patterns, displacement of the endpoint from its equilibrium position produced restoring forces, which were also biased toward the sagittal plane. The single exception was an activation pattern based on minimum muscle stress optimization, which produced destabilizing force responses in some perturbation directions. The sagittal force constraint increased during simulations as the system shifted from an inertial response during the acceleration phase to a viscoelastic response as peak velocity was obtained. These results qualitatively match similar experimental observations and suggest that the force constraint phenomenon may result from the anatomical arrangement of the limb. PMID:20511528

Extended Asymmetrical Pedicle Subtraction Osteotomy for Adult Spinal Deformity: 2-Dimensional Operative Video.

PubMed

Buell, Thomas J; Buchholz, Avery L; Quinn, John C; Mullin, Jeffrey P; Garces, Juanita; Mazur, Marcus D; Shaffrey, Mark E; Yen, Chun-Po; Shaffrey, Christopher I; Smith, Justin S

2018-06-16

Pedicle subtraction osteotomy (PSO) is an effective technique to correct fixed sagittal malalignment. A variation of this technique, the "trans-discal" or "extended" PSO (Schwab grade IV osteotomy), involves extending the posterior wedge resection of the index vertebra to include the superior adjacent disc for radical discectomy. The posterior wedge may be resected in asymmetric fashion to correct concurrent global coronal malalignment.This video illustrates the technical nuances of an extended asymmetrical lumbar PSO for adult spinal deformity. A 62-yr-old female with multiple prior lumbar fusions presented with worsening back pain and posture. Preoperative scoliosis X-rays demonstrated severe global sagittal and coronal malalignment (sagittal vertical axis [SVA, C7-plumbline] of 13.5 cm, pelvic incidence [PI] of 60°, lumbar lordosis [LL] of 14° [in kyphosis], pelvic tilt [PT] of 61°, thoracic kyphosis [TK] of 18°, and rightward coronal shift of 9.3 cm). The patient gave informed consent to surgery and for use of her imaging for medical publication. Briefly, surgery first involved transpedicular instrumentation from T10 to S1 with bilateral iliac screw fixation, and then T11-12 and T12-L1 Smith-Petersen osteotomies were performed. Next, an extended asymmetrical L4 PSO was performed and a 12° lordotic cage (9 × 14 × 40 mm) was placed at the PSO defect. Rods were placed from T10 to iliac bilaterally, and accessory supplemental rods spanning the PSO were attached. Postoperative scoliosis X-rays demonstrated improved alignment: SVA 5.5 cm, PI 60°, LL 55°, PT 36°, TK 37°, and 3.7 cm of rightward coronal shift. The patient had uneventful recovery.

Will immediate postoperative imbalance improve in patients with thoracolumbar/lumbar degenerative kyphoscoliosis? A comparison between Smith-Petersen osteotomy and pedicle subtraction osteotomy with an average 4 years of follow-up.

PubMed

Bao, Hongda; He, Shouyu; Liu, Zhen; Zhu, Zezhang; Qiu, Yong; Zhu, Feng

2015-03-01

A retrospective radiographical study. To compare compensatory behavior of coronal and sagittal alignment after pedicle subtraction osteotomy (PSO) and Smith-Petersen osteotomy (SPO) for degenerative kyphoscoliosis. There was a paucity of literature paying attention to the postoperative imbalance after PSO or SPO and natural evolution of the imbalance. A retrospective study was performed on 68 consecutive patients with degenerative kyphoscoliosis treated by lumbar PSO (25 patients) or SPO (43 patients) procedures at a single institution. Long-cassette standing radiographs were taken preoperatively, postoperatively, and at the last follow-up and radiographical parameters were measured. The lower instrumented vertebral level and level of osteotomy were compared between the patients with and without improvement. Negative sagittal vertical axis (SVA) was observed in the PSO group postoperatively, implying an overcorrection of SVA. This negative SVA improved spontaneously during follow-up (P < 0.05). Coronal balance was found to worsen immediately postoperatively in the SPO group (P < 0.05). At the last follow-up, spontaneous improvement was observed in 15 patients and the average coronal balance decreased to 16.35 mm. For the 15 patients with improved coronal balance, fusion at L5 or above was more common compared with the 11 patients with persisted postoperative imbalance (P = 0.027), whereas no difference in term of levels of osteotomy was found (P > 0.05). The overcorrection of SVA is more often seen in the PSO group. The coronal imbalance is more likely to occur in the SPO group. The postoperative sagittal imbalance often spontaneously improves with time. Lower instrumented vertebra at S1 or with pelvic fixation should be regarded as potential risk factors for persistent coronal imbalance in patients with SPO. 3.

No difference in mechanical alignment and femoral component placement between patient-specific instrumentation and conventional instrumentation in TKA.

PubMed

Fu, Huichao; Wang, Jiaxing; Zhou, Shenyuan; Cheng, Tao; Zhang, Wen; Wang, Qi; Zhang, Xianlong

2015-11-01

There is a rising interest in the use of patient-specific instrumentation (PSI) during total knee arthroplasty (TKA). The goal of this meta-analysis was to compare PSI with conventional instrumentation (CI) in patients undergoing TKA. A literature search was performed in PubMed, Embase, Springer, Ovid, China National Knowledge Infrastructure, and the Cochrane Library. A total of 10 randomized controlled studies involving 837 knees comparing outcomes of PSI TKAs with CI TKAs were included in the present analysis. Outcomes of interest included component alignment, surgical time, blood loss, and hospital stay. The results presented no significant differences between the two instrumentations in terms of restoring a neutral mechanical axis and femoral component placement. However, their differences have been noted regarding the alignment of the tibial component in coronal and sagittal planes. Also, 3 min less surgical time was used in PSI patients. Based on these findings, PSI appeared not to be superior to CI in terms of the post-operative mechanical axis of the limb or femoral component placement. Despite a statistical difference for operative duration, the benefit of a small reduction in surgical time with PSI is clinically irrelevant. Therapeutic study (systematic review and meta-analysis), Level I.

Postimplant left ventricular assist device fit analysis using three-dimensional reconstruction.

PubMed

Truong, Thang V; Stanfield, J Ryan; Chaffin, John S; Elkins, C Craig; Kanaly, Paul J; Horstmanshof, Douglas A; Long, James W; Snyder, Trevor A

2013-01-01

Left ventricular assist devices (LVADs) are blood pumps that augment the function of the failing heart to improve perfusion, resulting in improved survival. For LVADs to effectively unload the left ventricle, the inflow cannula (IC) should be unobstructed and ideally aligned with the heart's mitral valve (MV). We examined IC orientation deviation from a hypothesized conventional angle (45° right-posterior) and the approximate angle for direct IC-MV alignment in many patients. Three-dimensional anatomic models were created from computed tomography scans for 24 LVAD-implanted patients, and angles were measured between the IC and the apical z-axis in both the coronal and the sagittal planes. Common surgical IC angulation was found to be 22 ± 15° rightward and 21 ± 12° posterior from the apical z-axis; 38% (n = 9) of patients fell in this range. Direct IC-MV angulation was found to be 34 ± 8° rightward and 15 ± 7° posterior; only 8% (n = 2) of patients fell in this range. Rightward deviation toward ventricular septal wall and anterior deviation toward LV anterior freewall are associated with mortalities more so than leftward and posterior deviation. In conclusion, anatomic reconstruction may be a useful preoperative tool to obtain general population and patient-specific alignment for optimal LVAD implantation.

Spinal Instrumentation in Growing Children Retards the Natural Development of Pelvic Incidence.

PubMed

Bekmez, Senol; Demirkiran, Halil Gokhan; Dede, Ozgur; Atici, Yunus; Balioglu, Mehmet Bulent; Kruyt, Moyo; Ward, Timothy; Yazici, Muharrem

2016-09-22

Pelvic incidence increases gradually throughout growth until skeletal maturity. Growing rod instrumentation has been suggested to have a stabilizing effect on the development of the normal sagittal spinal alignment. The purpose of this study is to determine the effect of fixed sagittal plane caused by dual growing rod instrumentation on the natural progression of sagittal spinopelvic parameters in children with idiopathic or idiopathic-like early onset scoliosis. Hospital records of children with growing rod instrumentation from 4 separate institutions were reviewed retrospectively. Inclusion criteria were idiopathic or idiopathic-like early onset scoliosis, treatment with dual growing rods with lower instrumented vertebra L4 or upper and more than 2 years of follow-up. Instrumentation levels, magnitudes of major curve, thoracic kyphosis (T2-T12), lumbar lordosis (L1-S1) and pelvic incidence were recorded from preoperative and postoperative standing whole-spine radiographs. Estimated pelvic incidence was also calculated for each patient as if their spines had not been instrumented using the previous normative data. A total of 37 patients satisfied the inclusion criteria. Average age at initial surgery was 7.4±1.8 years (range, 4 to 12 y). Mean follow-up time was 71±26 months (range, 27 to 120 mo). Mean preoperative Cobb angle of 59±13.5 (range, 30 to 86) degrees was reduced to 35.1±17.5 (range, 11 to 78) degrees at the last follow-up. Mean preoperative T2-T12 kyphosis angle was 46.2±14.9 degrees (range, 22 to 84 degrees). At the latest follow-up, it was 44.8±16.2 degrees (range, 11 to 84 degrees) (P=0.93). Mean L1-S1 lordosis angle was 50.5±10.7 degrees (range, 30 to 72 degrees) preoperatively. At the latest follow-up, mean L1-S1 lordosis angle was 48.8±12.7 degrees (range, 26 to 74 degrees) (P=0.29). Mean preoperative pelvic incidence was 45.7±7.9 degrees (range, 30 to 68 degrees). At the latest follow-up, it was 46.7±8.4 degrees (range, 34 to 72 degrees) (P=0.303). The estimated average pelvic incidence was 49.5 degrees (P=0.012). Previously reported developmental changes of the sagittal spinal parameters were not observed in children who underwent posterior spinal instrumentation. Our findings suggest that spinal instrumentation impedes the natural development of the sagittal spinal profile. Level IV-this is a retrospective case-series.

Cervical spine metastases: techniques for anterior reconstruction and stabilization.

PubMed

Sayama, Christina M; Schmidt, Meic H; Bisson, Erica F

2012-10-01

The surgical management of cervical spine metastases continues to evolve and improve. The authors provide an overview of the various techniques for anterior reconstruction and stabilization of the subaxial cervical spine after corpectomy for spinal metastases. Vertebral body reconstruction can be accomplished using a variety of materials such as bone autograft/allograft, polymethylmethacrylate, interbody spacers, and/or cages with or without supplemental anterior cervical plating. In some instances, posterior instrumentation is needed for additional stabilization.

Orthodontically induced external apical root resorption in patients treated with fixed appliances vs removable aligners.

PubMed

Iglesias-Linares, Alejandro; Sonnenberg, Boris; Solano, Beatriz; Yañez-Vico, Rosa-Maria; Solano, Enrique; Lindauer, Steven J; Flores-Mir, Carlos

2017-01-01

To determine whether orthodontic treatment with removable aligners vs fixed orthodontic appliances is associated with a different frequency of orthodontically induced external apical root resorption (OIEARR) when genetic, radiographic, and clinical factors are accounted for. Three hundred seventy-two orthodontic patients treated with removable aligners (Invisalign) or fixed appliances were genetically screened for interleukin 1B gene (IL1B) (rs1143634), interleukin 1 receptor antagonist gene (IL1RN) (rs419598), and osteopontin gene (SPP1) (rs9138/rs11730582). Twelve clinical variables, potentially associated with OIEARR, were also considered. Subjects were divided according to the presence of radiographically determined OIEARR (>2 mm). The association between OIEARR and appliance type, and radiographic, clinical and genetic factors, was assessed using backward stepwise conditional logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Reliability of the methods was adequate. Clinical case complexity (American Board of Orthodontics [ABO] Discrepancy Index) (OR: 1.032; 95% CI: 1.005-1.061; P = .021) and extent of incisor apical displacement in the sagittal plane (OR: 1.478; 95% CI: 1.285-1.699; P = .001) were associated with an increased OIEARR risk. After adjusting for associations between clinical/radiographic/genetic factors, there were no statistically significant differences with respect to OIEARR or type of orthodontic appliance used, whether removable aligners or fixed appliances (OR: 1.662; 95% CI: 0.945-2.924; P = .078). Only subjects homozygous for the T allele of IL1RN (rs419598) were more prone to OIEARR during orthodontic treatment (OR: 3.121; CI: 1.93-5.03; P < .001). A similar OIEARR predisposition was identified using either removable aligners (Invisalign) or fixed appliances.

[Clinical studies of pedicle screw-rod fixation of thoracolumbar burst fractures through posterior unilateral approach after vertebrae corpectomy fusion].

PubMed

Hua, Yong-jun; Wang, Ren-yan; Guo, Zhi-hui; Shu, Cun-hong; Li, Chao-hua

2016-01-01

To compare the clinical curative effect of thoracolumbar burst fracture treated by the posterior unilateral approach corpectomy fusion screw-rod fixation and anterior corpectomy bone fusion screw plate fixation. From January 2008 to May 2014,36 cases of thoracolumbar burst fracture underwent operation of decompression, fusion, and internal fixation was retrospective analyzed. Among them, 16 patients were treated through posterior approach as posterior group, including 13 males and 3 females aged from 37 to 62 years old; 9 cases caused by falling injury, 3 cases by traffic accident injury,4 cases by heavy aboved;the injury segment was on T₁₂ in 2 cases, L₁ in 5 cases, L₂ in 7 cases, L₃ in 2 cases; according ASIA grade, 3 cases were grade A, 2 cases were grade B, 2 cases were grade C, 5 cases were grade D, 4 cases were grade E; the time between injury and operation ranged from 5 to 15 days. Other 20 patients were treated through anterior-lateral approach as anterior-lateral group, including 15 males and 5 females with age from 27 to 62 years old; 12 cases caused by falling injury, 4 cases by traffic accident injury, 4 cases by heavy aboved; the injury segment was on T₁₂ in 2 cases, L₁, in 7 cases, L₂ in 9 cases, L₃ in 2 cases; for ASIA grade: 4 cases were grade A, 2 cases were grade B, 4 cases were grade C, 6 cases were grade D, 4 cases were grade E; the time between injury and operation ranged from 4 to 12 days. The operation time, bleeding during operation and postoperative drainage volume were observed in two groups,and the changes of nerve function of ASIA grade, clinical efficacy,improved degree of thoracic and lumbar lordosis,and bony fusion were compared between two groups. All patients were followed up from 12 to 24 months with an average of (15.8 ± 3.3) months. The operation time, bleeding during operation, and postoperative drainage volume had no significant different between two groups (P > 0.05). As compared with preoperative, ASIA grade of two groups at last follow-up had statistically significantly different (P < 0.01), the neural function of two groups after operation was recovered for different extent. The JOA score of two groups was compared between last follow-up and preoperative, the difference had statistically significant (P < 0.01), the two groups showed good clinical effect. The clinical results of ASIA grade, JOA score and RIS had no significant differences between two groups. All patients of two groups were obtained fusion. Thoracic and lumbar lordosis angle improvement degree had no significant difference between two groups ,it bad significant difference had statistical significance compared with preoperative, the two approaches could effectively restore the spinal sequence. For patients with thoracolumbar burst fracture just treated by anterior decompression and reconstruction of anterior column, according to the degree of operation performer' skill proficiency and the patient' condition to choose, but for patients must performed the spinal canal decompression anterior and posterior, the three column-reconstruction to required anterior-posterior approach, the posterior unilateral approach corpectomy fusion screw-rod fixation obviously shorten operation time, reduce the operation wound, it is worth the clinical promotion.

Prospective dynamic functional evaluation of gait and spinal balance following spinal fusion in adolescent idiopathic scoliosis.

PubMed

Lenke, L G; Engsberg, J R; Ross, S A; Reitenbach, A; Blanke, K; Bridwell, K H

2001-07-15

Prospective evaluation of gait and spinal-pelvic balance parameters in patients with adolescent idiopathic scoliosis undergoing a spinal fusion. To evaluate changes in gait and three-dimensional alignment and balance of the spine relative to the pelvis as a consequence of spinal fusion. Preoperative and postoperative spinal radiographs have been the major forms of outcome analysis of adolescent idiopathic scoliosis fusions. The use of optoelectronic analysis for posture and gait has gained acceptance recently. However, there is a paucity of data quantifying, comparing, and correlating structural and functional changes in patients undergoing scoliosis fusion surgery including upright posture and gait. Thirty patients with adolescent idiopathic scoliosis undergoing an instrumented spinal fusion were prospectively evaluated. Coronal and sagittal vertical alignment was evaluated on radiographs (CVA-R, SVA-R), during upright posture (CVA-P and SVA-P), and during gait (CVA-G, SVA-G). Transverse plane alignment was evaluated by the acromion-pelvis angle during gait. Gait speed was significantly decreased (P < 0.05) between preoperative (129 +/- 16 cm/sec) and 2-year postoperative (119 +/- 16 cm/sec) testing sessions. Decreasing gait speed was the result of significantly reduced cadence and decreased stride length. There were no significant differences for lower extremity kinematics over the entire gait cycle. Spinal-pelvic balance parameters showed significant improvement in mean CVA-R, CVA-G (P < 0.05), then unchanged CVA-P at 2 years postoperation. CVA-P was relatively unchanged while the mean CVA-G also showed significant improvement from preoperation (2.2 +/- 2.4 cm) to 2 years postoperation (1.3 +/- 1.3 cm)(P < 0.05). The mean SVA-R, SVA-P, and SVA-G were unchanged at 2 years postoperation (P > 0.05). The acromion-pelvis angle during gait at maximum shoulder rotation was statistically improved at 1 year (P = 0.002) and 2 years (P = 0.001) after surgery. Importantly, CVA-P correlated with CVA-G, and SVA-P correlated with SVA-G to the P < 0.05 level. Patients with adolescent idiopathic scoliosis undergoing spinal fusion show slightly decreased gait speed at 2 years postoperation without any change in lower extremity kinematics. Spinal-pelvic balance parameters are improved in the coronal plane and unchanged in the sagittal plane radiographically and during standing posture and gait. Transverse plane parameters also are improved at maximum shoulder rotation during gait.

Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis.

PubMed

Jo, Dae-Jean; Kim, Yong-Sang; Kim, Sung-Min; Kim, Ki-Tack; Seo, Eun-Min

2015-10-01

Most thoracolumbar fractures have a good healing outcome with adequate treatment. However, posttraumatic thoracolumbar kyphosis can occur in a proportion of thoracolumbar fractures after inappropriate treatment, osteoporosis, or osteonecrosis of the vertebral body. There are several surgical options to correct posttraumatic thoracolumbar kyphosis, including anterior, posterior, and combined approaches, which are associated with varying degrees of success. The aim of this study was to assess the use of a modified closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis and to evaluate the radiographic findings and clinical outcomes of patients treated using this technique. Thirteen consecutive patients with symptomatic posttraumatic thoracolumbar kyphosis were treated using a modified closing wedge osteotomy. The mean patient age was 62 years. The kyphosis apex ranged from T-10 to L-2. The sagittal alignment, kyphotic angle, neurological function, visual analog scale for back pain, and Oswestry Disability Index were evaluated before surgery and at follow-up. RESULTS The mean preoperative regional angle was 27.4°, and the mean correction angle was 29.6°. Sagittal alignment improved with a mean correction rate of 58.3%. The mean surgical time was 275 minutes, and the mean intraoperative blood loss was 1585 ml. The intraoperative complications included 2 dural tears, 1 nerve root injury, and 1 superficial wound infection. The mean visual analog scale score for back pain improved from 6. 6 to 2, and the Oswestry Disability Index score decreased from 55.4 to 22.6 at the last follow-up. All patients achieved bony anterior fusion based on the presence of trabecular bone bridging at the osteotomy site. The modified posterior closing wedge osteotomy technique achieves satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion with less blood loss and fewer complications. It is an alternative method for treating patients with posttraumatic thoracolumbar kyphosis.

Improved astigmatic focus error detection method

NASA Technical Reports Server (NTRS)

Bernacki, Bruce E.

1992-01-01

All easy-to-implement focus- and track-error detection methods presently used in magneto-optical (MO) disk drives using pre-grooved media suffer from a side effect known as feedthrough. Feedthrough is the unwanted focus error signal (FES) produced when the optical head is seeking a new track, and light refracted from the pre-grooved disk produces an erroneous FES. Some focus and track-error detection methods are more resistant to feedthrough, but tend to be complicated and/or difficult to keep in alignment as a result of environmental insults. The astigmatic focus/push-pull tracking method is an elegant, easy-to-align focus- and track-error detection method. Unfortunately, it is also highly susceptible to feedthrough when astigmatism is present, with the worst effects caused by astigmatism oriented such that the tangential and sagittal foci are at 45 deg to the track direction. This disclosure outlines a method to nearly completely eliminate the worst-case form of feedthrough due to astigmatism oriented 45 deg to the track direction. Feedthrough due to other primary aberrations is not improved, but performance is identical to the unimproved astigmatic method.

Comparison of custom to standard TKA instrumentation with computed tomography.

PubMed

Ng, Vincent Y; Arnott, Lindsay; Li, Jia; Hopkins, Ronald; Lewis, Jamie; Sutphen, Sean; Nicholson, Lisa; Reader, Douglas; McShane, Michael A

2014-08-01

There is conflicting evidence whether custom instrumentation for total knee arthroplasty (TKA) improves component position compared to standard instrumentation. Studies have relied on long-limb radiographs limited to two-dimensional (2D) analysis and subjected to rotational inaccuracy. We used postoperative computed tomography (CT) to evaluate preoperative three-dimensional templating and CI to facilitate accurate and efficient implantation of TKA femoral and tibial components. We prospectively evaluated a single-surgeon cohort of 78 TKA patients (51 custom, 27 standard) with postoperative CT scans using 3D reconstruction and contour-matching technology to preoperative imaging. Component alignment was measured in coronal, sagittal and axial planes. Preoperative templating for custom instrumentation was 87 and 79 % accurate for femoral and tibial component size. All custom components were within 1 size except for the tibial component in one patient (2 sizes). Tourniquet time was 5 min longer for custom (30 min) than standard (25 min). In no case was custom instrumentation aborted in favour of standard instrumentation nor was original alignment of custom instrumentation required to be adjusted intraoperatively. There were more outliers greater than 2° from intended alignment with standard instrumentation than custom for both components in all three planes. Custom instrumentation was more accurate in component position for tibial coronal alignment (custom: 1.5° ± 1.2°; standard: 3° ± 1.9°; p = 0.0001) and both tibial (custom: 1.4° ± 1.1°; standard: 16.9° ± 6.8°; p < 0.0001) and femoral (custom: 1.2° ± 0.9°; standard: 3.1° ± 2.1°; p < 0.0001) rotational alignment, and was similar to standard instrumentation in other measurements. When evaluated with CT, custom instrumentation performs similar or better to standard instrumentation in component alignment and accurately templates component size. Tourniquet time was mildly increased for custom compared to standard.

A cadaveric investigation into the demographic and bony alignment properties associated with osteoarthritis of the patellofemoral joint.

PubMed

Weinberg, Douglas S; Tucker, Braden J; Drain, Joseph P; Wang, David M; Gilmore, Allison; Liu, Raymond W

2016-06-01

Patellofemoral joint osteoarthritis is common, although circumstances dictating its evolution and pathogenesis remain unclear. Advances in surgical technique have improved the ability to modify long-bone alignment in the coronal, sagittal, and axial planes. However, to our knowledge, there is no significant long-term data available in regard to the relationship between anatomic alignment parameters most amenable to surgical modification and patellofemoral joint osteoarthritis. Five-hundred and seventy-one cadaveric skeletons were obtained from the Hamann-Todd osteological collection. Mechanical lateral distal femoral angle, medial proximal tibial angle, tibial slope, femoral version, tibial torsion, the position of the tibial tubercle relative to the width of the tibial plateau, trochlear depth, and patellar size were measured using validated techniques. A previously published grading system for patellofemoral joint arthritis was used to quantify macroscopic signs of degenerative joint disease. Increasing age (standardized beta 0.532, p<0.001), female gender (standardized beta 0.201, p=0.002), and decreasing mechanical lateral distal femoral angle (standardized beta -0.128, p=0.025) were independent correlates of increased patellofemoral joint osteoarthritis. A relatively more laterally positioned tibial tubercle trended towards predicting patellofemoral joint osteoarthritis (standardized beta 0.080, p=0.089). These findings confirm that patellofemoral joint osteoarthritis is strongly associated with increasing age and female gender. Valgus alignment of the distal femur, a relatively more lateral location of the tibial tubercle, and a shallower trochlear grove appear to have modest effects on the development of patellofemoral joint osteoarthritis. Copyright © 2016 Elsevier B.V. All rights reserved.

Sagittal crest formation in great apes and gibbons.

PubMed

Balolia, Katharine L; Soligo, Christophe; Wood, Bernard

2017-06-01

The frequency of sagittal crest expression and patterns of sagittal crest growth and development have been documented in hominoids, including some extinct hominin taxa, and the more frequent expression of the sagittal crest in males has been traditionally linked with the need for larger-bodied individuals to have enough attachment area for the temporalis muscle. In the present study, we investigate sagittal cresting in a dentally mature sample of four hominoid taxa (Pan troglodytes schweinfurthii, Gorilla gorilla gorilla, Pongo pygmaeus pygmaeus and Hylobates lar). We investigate whether sagittal crest size increases with age beyond dental maturity in males and females of G. g. gorilla and Po. pyg. pygmaeus, and whether these taxa show sex differences in the timing of sagittal crest development. We evaluate the hypothesis that the larger sagittal crest of males may not be solely due to the requirement for a larger surface area than the un-crested cranial vault can provide for the attachment of the temporalis muscle, and present data on sex differences in temporalis muscle attachment area and sagittal crest size relative to cranial size. Gorilla g. gorilla and Po. pyg. pygmaeus males show significant relationships between tooth wear rank and sagittal crest size, and they show sagittal crest size differences between age groups that are not found in females. The sagittal crest emerges in early adulthood in the majority of G. g. gorilla males, whereas the percentage of G. g. gorilla females possessing a sagittal crest increases more gradually. Pongo pyg. pygmaeus males experience a three-fold increase in the number of specimens exhibiting a sagittal crest in mid-adulthood, consistent with a secondary growth spurt. Gorilla g. gorilla and Po. pyg. pygmaeus show significant sex differences in the size of the temporalis muscle attachment area, relative to cranial size, with males of both taxa showing positive allometry not shown in females. Gorilla g. gorilla males also show positive allometry for sagittal crest size relative to cranial size. Our results suggest that although patterns of sagittal crest expression have limited utility for taxonomy and phylogeny reconstruction, they could be useful for reconstructing aspects of social behaviour in some extinct hominin taxa. In particular, our results in G. g. gorilla and Po. pyg. pygmaeus, which suggest that the size of sagittal crests in males cannot be solely explained by the surface area required for attachment of the temporalis muscle, offer partial support for the hypothesis that large sagittal crests form in response to sexual selection and may play a role in social signalling. © 2017 Anatomical Society.

Comprehensive Analysis of Mandibular Residual Asymmetry after Bilateral Sagittal Split Ramus Osteotomy Correction of Menton Point Deviation

PubMed Central

Lin, Qiuping; Huang, Xiaoqiong; Xu, Yue; Yang, Xiaoping

2016-01-01

Purpose Facial asymmetry often persists even after mandibular deviation corrected by the bilateral sagittal split ramus osteotomy (BSSRO) operation, since the reference facial sagittal plane for the asymmetry analysis is usually set up before the mandibular menton (Me) point correction. Our aim is to develop a predictive and quantitative method to assess the true asymmetry of the mandible after a midline correction performed by a virtual BSSRO, and to verify its availability by evaluation of the post-surgical improvement. Patients and Methods A retrospective cohort study was conducted at the Hospital of Stomatology, Sun Yat-sen University (China) of patients with pure hemi-mandibular elongation (HE) from September 2010 through May 2014. Mandibular models were reconstructed from CBCT images of patients with pre-surgical orthodontic treatment. After mandibular de-rotation and midline alignment with virtual BSSRO, the elongation hemi-mandible was virtually mirrored along the facial sagittal plane. The residual asymmetry, defined as the superimposition and boolean operation of the mirrored elongation side on the normal side, was calculated, including the volumetric differences and the length of transversal and vertical asymmetry discrepancy. For more specific evaluation, both sides of the hemi-mandible were divided into the symphysis and parasymphysis (SP), mandibular body (MB), and mandibular angle (MA) regions. Other clinical variables include deviation of Me point, dental midline and molar relationship. The measurement of volumetric discrepancy between the two sides of post-surgical hemi-mandible were also calculated to verify the availability of virtual surgery. Paired t-tests were computed and the P value was set at .05. Results This study included 45 patients. The volume differences were 407.8±64.8 mm3, 2139.1±72.5 mm3, and 422.5±36.9 mm3; residual average transversal discrepancy, 1.9 mm, 1.0 mm, and 2.2 mm; average vertical discrepancy, 1.1 mm, 2.2 mm, and 2.2 mm (before virtual surgery). The post-surgical volumetric measurement showed no statistical differences between bilateral mandibular regions. Conclusions Mandibular asymmetry persists after Me point correction. A 3D quantification of mandibular residual asymmetry after Me point correction and mandible de-rotation with virtual BSSRO sets up a true reference mirror plane for comprehensive asymmetry assessment of bilateral mandibular structure, thereby providing an accurate guidance for orthognathic surgical planning. PMID:27571364

Comprehensive Analysis of Mandibular Residual Asymmetry after Bilateral Sagittal Split Ramus Osteotomy Correction of Menton Point Deviation.

PubMed

Lin, Han; Zhu, Ping; Lin, Qiuping; Huang, Xiaoqiong; Xu, Yue; Yang, Xiaoping

2016-01-01

Facial asymmetry often persists even after mandibular deviation corrected by the bilateral sagittal split ramus osteotomy (BSSRO) operation, since the reference facial sagittal plane for the asymmetry analysis is usually set up before the mandibular menton (Me) point correction. Our aim is to develop a predictive and quantitative method to assess the true asymmetry of the mandible after a midline correction performed by a virtual BSSRO, and to verify its availability by evaluation of the post-surgical improvement. A retrospective cohort study was conducted at the Hospital of Stomatology, Sun Yat-sen University (China) of patients with pure hemi-mandibular elongation (HE) from September 2010 through May 2014. Mandibular models were reconstructed from CBCT images of patients with pre-surgical orthodontic treatment. After mandibular de-rotation and midline alignment with virtual BSSRO, the elongation hemi-mandible was virtually mirrored along the facial sagittal plane. The residual asymmetry, defined as the superimposition and boolean operation of the mirrored elongation side on the normal side, was calculated, including the volumetric differences and the length of transversal and vertical asymmetry discrepancy. For more specific evaluation, both sides of the hemi-mandible were divided into the symphysis and parasymphysis (SP), mandibular body (MB), and mandibular angle (MA) regions. Other clinical variables include deviation of Me point, dental midline and molar relationship. The measurement of volumetric discrepancy between the two sides of post-surgical hemi-mandible were also calculated to verify the availability of virtual surgery. Paired t-tests were computed and the P value was set at .05. This study included 45 patients. The volume differences were 407.8±64.8 mm3, 2139.1±72.5 mm3, and 422.5±36.9 mm3; residual average transversal discrepancy, 1.9 mm, 1.0 mm, and 2.2 mm; average vertical discrepancy, 1.1 mm, 2.2 mm, and 2.2 mm (before virtual surgery). The post-surgical volumetric measurement showed no statistical differences between bilateral mandibular regions. Mandibular asymmetry persists after Me point correction. A 3D quantification of mandibular residual asymmetry after Me point correction and mandible de-rotation with virtual BSSRO sets up a true reference mirror plane for comprehensive asymmetry assessment of bilateral mandibular structure, thereby providing an accurate guidance for orthognathic surgical planning.

Clinical and radiological outcomes of lumbar posterior subtraction osteotomies are correlated to pelvic incidence and FBI index : Prospective series of 63 cases.

PubMed

Cogniet, A; Aunoble, S; Rigal, J; Demezon, H; Sadikki, R; Le Huec, J C

2016-08-01

Pedicle subtraction osteotomy (PSO) is one of the surgical options for treating alignment disorders of the fused spine (due to post-surgical fusion or related to arthritis). It enables satisfactory sagittal realignment and improved function due to economic sagittal balance. The aim of this study was to analyze clinical and radiological results of PSO after a minimum follow-up of 2 years and demonstrate the benefit of sub-group analysis as a function of pelvic incidence (PI). A descriptive prospective single center study of 63 patients presenting with spinal global malalignment who underwent correction by PSO. Function was assessed by the Oswestry disability index (ODI), a visual analog scale of lumbar pain (VAS) and a SF-36 questionnaire. Radiographic analyses of pre- and post-operative pelvic-spinal parameters were performed on X-rays obtained by EOS(®) imaging after 3D modeling. Global analysis and analysis of sub-groups as a function of pelvic incidence were performed and the full balance integrated index (FBI) was calculated. this series showed a marked clinical improvement and significant progress of functional scores. Global post-operative radiological analysis showed a significant improvement in all pelvic and spinal parameters. The mean correction obtained after PSO was 31.7° ± 8.4°, hence global improvement of lumbar lordosis of 22°. The sagittal vertical angle (SVA) decreased from +9 cm before surgery to +4.3 cm after surgery. Sub-group analysis demonstrated greater improvement in pelvic tilt, sacral slope and spinal parameters of patients with a small or moderate pelvic incidence; all had an FBI index <10°. Most of the pelvic and spinal parameters of patients with a large pelvic incidence were insufficiently corrected and they had an FBI index >10° PSO is a surgical procedure enabling correction of multiplane rigid spinal deformities that require major sagittal correction. It was seen to be highly effective in patients with a small or moderate pelvic incidence (PI <60°) but was sometimes less effective in patients with large pelvic incidence due to insufficient lordosis correction. Clinical results were highly correlated with the value of the FBI index.

Effect of posterior multilevel vertebral osteotomies on coronal and sagittal balance in fused scoliosis deformity caused by previous surgery: preliminary results.

PubMed

Yang, Jae Hyuk; Suh, Seung Woo; Cho, Won Tae; Hwang, Jin Ho; Hong, Jae Young; Modi, Hitesh N

2014-10-15

Prospective case series study. To study the effect of posterior multilevel vertebral osteotomy (posterior crack osteotomy) on coronal and sagittal balance in patients with the fusion mass over the spine caused by previous surgery. Few studies have investigated revisional scoliosis surgery with the fusion mass using osteotomy. Among patients who had a history of prior surgery for scoliosis correction and posterior fusion, those showing progression of the curve postoperatively due to nonunion, implant failure, or adding-on phenomenon were enrolled. All patients were treated using posterior crack osteotomy. For clinical evaluation, the pre- and postoperative Gross Motor Function Classification System score for walking status and the Berg balanced scale were used. For radiological evaluation, pre- and postoperative Cobb angle, and coronal and sagittal balance factors were used. Ten patients (5 males and 5 females) were enrolled. The preoperative diagnosis was neuromuscular scoliosis (3 cases), syndromic scoliosis (1 case), congenital scoliosis (5 cases), and neurofibromatosis (1 case). Osteotomies were performed at 3.3±1.3 levels on average. Pre- and postoperative Cobb angles were 70.8°±30.0° and 28.1°±20.0° (P=0.002 (0.97)), respectively. In pre- and postoperative evaluation of coronal balance, the coronal balance, clavicle angle, and T1-tilt angle were 36.8±27.1 mm and 10.4±8.5 mm, 6.7°±8.0° and 3.3°±1.5°, and 7.8°±19.0° and 4.7°±2.1°, respectively (P=0.002, 0.002, 0.002). In pre- and postoperative evaluation of sagittal balance, the spinal vertical axis, thoracic kyphosis, and lumbar alignments were 25.1±37.8 mm and 14.1±21.8 mm, 33.5°±51.1° and 29.7°±27.4°, and 45.7°±34.8° and 48.9°±23.1° (P=0.002, 0.169, 0.169). The walking and functional statuses did not change (P=0.317, 0.932). Although pulmonary and gastrointestinal complications were noted, the patients were discharged without complications. Posterior crack osteotomy can be used effectively in revisional scoliosis surgery and the clinical and radiological results seem to be acceptable. 4.

Oblique Sagittal Images Prevent Underestimation of the Neuroforaminal Stenosis Grade Caused by Disc Herniation in Cervical Spine MRI.

PubMed

Kintzelé, Laurent; Rehnitz, Christoph; Kauczor, Hans-Ulrich; Weber, Marc-André

2018-06-06

 To identify whether standard sagittal MRI images result in underestimation of the neuroforaminal stenosis grade compared to oblique sagittal MRI images in patients with cervical spine disc herniation.  74 patients with a total of 104 cervical disc herniations compromising the corresponding nerve root were evaluated. Neuroforaminal stenosis grades were evaluated in standard and oblique sagittal images by one senior and one resident radiologist experienced in musculoskeletal imaging. Oblique images were angled 30° towards the standard sagittal plane. Neuroforaminal stenosis grades were classified from 0 (no stenosis) to 3 (high grade stenosis).  Average neuroforaminal stenosis grades of both readers were significantly lower in standard compared to oblique sagittal images (p < 0.001). For 47.1 % of the cases, one or both readers reported a stenosis grade, which was at least 1 grade lower in standard compared to oblique sagittal images. There was also a significant difference when looking at patients who had neurological symptoms (p = 0.002) or underwent cervical spine surgery subsequently (p = 0.004). Interreader reliability, as measured by kappa value, and accordance rates were better for oblique sagittal images (0.94 vs. 0.88 and 99 % vs. 93 %).  Standard sagittal images tend to underestimate neuroforaminal stenosis grades compared to oblique sagittal images and are less reliable in the evaluation of disc herniations within the cervical spine MRI. In order to assess the potential therapeutic consequence, oblique images should therefore be considered as a valuable adjunct to the standard MRI protocol for patients with a radiculopathy.   · Neuroforaminal stenosis grades are underestimated in standard compared to oblique sagittal images. · Interreader reliability is higher for oblique sagittal images. · Oblique sagittal images should be performed in patients with a cervical radiculopathy. · Kintzele L, Rehnitz C, Kauczor H et al. Oblique Sagittal Images Prevent Underestimation of the Neuroforaminal Stenosis Grade Caused by Disc Herniation in Cervical Spine MRI. Fortschr Röntgenstr 2018; DOI: 10.1055/a-0612-8205. © Georg Thieme Verlag KG Stuttgart · New York.

The dosimetric impact of implants on the spinal cord dose during stereotactic body radiotherapy.

PubMed

Yazici, Gozde; Sari, Sezin Yuce; Yedekci, Fazli Yagiz; Yucekul, Altug; Birgi, Sumerya Duru; Demirkiran, Gokhan; Gultekin, Melis; Hurmuz, Pervin; Yazici, Muharrem; Ozyigit, Gokhan; Cengiz, Mustafa

2016-05-25

The effects of spinal implants on dose distribution have been studied for conformal treatment plans. However, the dosimetric impact of spinal implants in stereotactic body radiotherapy (SBRT) treatments has not been studied in spatial orientation. In this study we evaluated the effect of spinal implants placed in sawbone vertebra models implanted as in vivo instrumentations. Four different spinal implant reconstruction techniques were performed using the standard sawbone lumbar vertebrae model; 1. L2-L4 posterior instrumentation without anterior column reconstruction (PI); 2. L2-L4 anterior instrumentation, L3 corpectomy, and anterior column reconstruction with a titanium cage (AIAC); 3. L2-L4 posterior instrumentation, L3 corpectomy, and anterior column reconstruction with a titanium cage (PIAC); 4. L2-L4 anterior instrumentation, L3 corpectomy, and anterior column reconstruction with chest tubes filled with bone cement (AIABc). The target was defined as the spinous process and lamina of the lumbar (L) 3 vertebra. A thermoluminescent dosimeter (TLD, LiF:Mg,Ti) was located on the measurement point anterior to the spinal cord. The prescription dose was 8 Gy and the treatment was administered in a single fraction using a CyberKnife® (Accuray Inc., Sunnyvale, CA, USA). We performed two different treatment plans. In Plan A beam interaction with the rod was not limited. In plan B the rod was considered a structure of avoidance, and interaction between the rod and beam was prevented. TLD measurements were compared with the point dose calculated by the treatment planning system (TPS). In plan A, the difference between TLD measurement and the dose calculated by the TPS was 1.7 %, 2.8 %, and 2.7 % for the sawbone with no implant, PI, and PIAC models, respectively. For the AIAC model the TLD dose was 13.8 % higher than the TPS dose; the difference was 18.6 % for the AIABc model. In plan B for the AIAC and AIABc models, TLD measurement was 2.5 % and 0.9 % higher than the dose calculated by the TPS, respectively. Spinal implants may be present in the treatment field in patients scheduled to undergo SBRT. For the types of implants studied herein anterior rod instrumentation resulted in an increase in the spinal cord dose, whereas use of a titanium cage had a minimal effect on dose distribution. While planning SBRT in patients with spinal reconstructions, avoidance of the rod and preventing interaction between the rod and beam might be the optimal solution for preventing unexpectedly high spinal cord doses.

Hybrid Decompression Technique Versus Anterior Cervical Corpectomy and Fusion for Treating Multilevel Cervical Spondylotic Myelopathy: Which One Is Better?

PubMed

Liu, Jia-Ming; Peng, Hong-Wei; Liu, Zhi-Li; Long, Xin-Hua; Yu, Yan-Qing; Huang, Shan-Hu

2015-12-01

The hybrid decompression technique (corpectomy combined with discectomy) and anterior cervical corpectomy with fusion (ACCF) both provide good neurological recovery and disease stabilization for the treatment of multilevel cervical spondylotic myelopathy (CSM). However, no single study has been large enough to determine definitively which one is superior for this condition. A meta-analysis was conducted to compare the clinical efficacy and safety of the hybrid decompression technique versus ACCF for the treatment of multilevel CSM. Electronic databases such as PubMed, MEDLINE, EMBASE, Google Scholar, and the Cochrane Library were selected to search for potentially relevant trials up to April 2015 that compared the outcomes of the hybrid technique with ACCF for the treatment of multilevel CSM. Data extraction and quality assessment were performed according to Cochrane Collaboration guidelines. The outcome assessments were duration of surgery, blood loss, Cobb angle of C2-C7, segment angle, fusion rate, Japanese Orthopedics Association score, Neck Disability Index, and complications. The results were expressed as the odds ratio (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes with a 95% confidence interval (CI). Five controlled clinical trials published between 2009 and 2013, involving 356 patients (hybrid, 196; ACCF, 160) with 3- or 4-level CSM were retrieved in this study. Overall, there were significant differences between the 2 treatment groups for blood loss (MD = -38.69, 95% CI = -54.62 to -22.76, P < 0.01), fusion rate (OR = 2.56, 95% CI = 1.11 to 5.93, P = 0.03), and complications (OR = 0.25, 95% CI = 0.15 to 0.43, P < 0.01). However, no significant differences were found for duration of surgery (MD = -4.50, 95% CI = -22.902 to 13.91, P = 0.63), Cobb angle of C2-C7 after surgery (MD = 3.32, 95% CI = -3.72 to 10.37, P = 0.35), segment angle after surgery (MD = 2.87, 95% CI = -2.47 to 8.21, P = 0.29), Japanese Orthopedics Association score (MD = -0.07, 95% CI = -0.36 to 0.22, P = 0.62), or Neck Disability Index (MD = -0.86, 95% CI = -3.26 to 1.54, P = 0.48). Based on this meta-analysis, both the hybrid technique and ACCF can achieve good results for CSM. However, the hybrid technique is associated with significantly less blood loss, complications, and a higher fusion rate than ACCF. Copyright © 2015 Elsevier Inc. All rights reserved.

Does the application of kinesiotape change scapular kinematics in healthy female handball players?

PubMed

Van Herzeele, M; van Cingel, R; Maenhout, A; De Mey, K; Cools, A

2013-11-01

Elastic taping is widely used in sports medicine for correcting functional alignment and muscle recruitment. However, evidence regarding its influence on scapular dynamic positioning is scarce. This study aimed to investigate the effect of a specific kinesiotaping method on scapular kinematics in female elite handball players without shoulder complaints. 25 athletes (18.0±1.5 years) active in the highest national division were recruited. All subjects received an elastic adhesive tape (K-active tape©) with the purpose to correct scapular position. 3-dimensional scapular motion measurements were performed (Fastrak®) during humeral elevation in the sagittal, frontal and scapular plane. The results showed that taping has a moderate to large effect (Cohen's d>0.7) towards scapular posterior tilting, in all 3 planes of humeral movement and for all angles of elevation (mean posteriorizing effect of 4.23 °, 3.23 ° and 4.33 ° respectively for elevation in the sagittal, frontal and scapular plane, p<0.001). In addition, taping also moderately increased the scapular upward rotation at 30 °, 60 ° and 90 ° of humeral abduction (mean increase of 2.90 °, Cohen's d>0.7). Together these results suggest that kinesiotape application causes positive changes in scapular motion. This could support its use in sports medicine for preventing shoulder problems in overhead athletes. © Georg Thieme Verlag KG Stuttgart · New York.

Twice cutting method reduces tibial cutting error in unicompartmental knee arthroplasty.

PubMed

Inui, Hiroshi; Taketomi, Shuji; Yamagami, Ryota; Sanada, Takaki; Tanaka, Sakae

2016-01-01

Bone cutting error can be one of the causes of malalignment in unicompartmental knee arthroplasty (UKA). The amount of cutting error in total knee arthroplasty has been reported. However, none have investigated cutting error in UKA. The purpose of this study was to reveal the amount of cutting error in UKA when open cutting guide was used and clarify whether cutting the tibia horizontally twice using the same cutting guide reduced the cutting errors in UKA. We measured the alignment of the tibial cutting guides, the first-cut cutting surfaces and the second cut cutting surfaces using the navigation system in 50 UKAs. Cutting error was defined as the angular difference between the cutting guide and cutting surface. The mean absolute first-cut cutting error was 1.9° (1.1° varus) in the coronal plane and 1.1° (0.6° anterior slope) in the sagittal plane, whereas the mean absolute second-cut cutting error was 1.1° (0.6° varus) in the coronal plane and 1.1° (0.4° anterior slope) in the sagittal plane. Cutting the tibia horizontally twice reduced the cutting errors in the coronal plane significantly (P<0.05). Our study demonstrated that in UKA, cutting the tibia horizontally twice using the same cutting guide reduced cutting error in the coronal plane. Copyright © 2014 Elsevier B.V. All rights reserved.

Anterior Cervical Spine Surgery for Degenerative Disease: A Review

PubMed Central

SUGAWARA, Taku

Anterior cervical spine surgery is an established surgical intervention for cervical degenerative disease and high success rate with excellent long-term outcomes have been reported. However, indications of surgical procedures for certain conditions are still controversial and severe complications to cause neurological dysfunction or deaths may occur. This review is focused mainly on five widely performed procedures by anterior approach for cervical degenerative disease; anterior cervical discectomy, anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, anterior cervical foraminotomy, and arthroplasty. Indications, procedures, outcomes, and complications of these surgeries are discussed. PMID:26119899

MRI-based analysis of patellofemoral cartilage contact, thickness, and alignment in extension, and during moderate and deep flexion.

PubMed

Freedman, Benjamin R; Sheehan, Frances T; Lerner, Amy L

2015-10-01

Several factors are believed to contribute to patellofemoral joint function throughout knee flexion including patellofemoral (PF) kinematics, contact, and bone morphology. However, data evaluating the PF joint in this highly flexed state have been limited. Therefore, the purpose of this study was to evaluate patellofemoral contact and alignment in low (0°), moderate (60°), and deep (140°) knee flexion, and then correlate these parameters to each other, as well as to femoral morphology. Sagittal magnetic resonance images were acquired on 14 healthy female adult knees (RSRB approved) using a 1.5 T scanner with the knee in full extension, mid-flexion, and deep flexion. The patellofemoral cartilage contact area, lateral contact displacement (LCD), cartilage thickness, and lateral patellar displacement (LPD) throughout flexion were defined. Intra- and inter-rater repeatability measures were determined. Correlations between patellofemoral contact parameters, alignment, and sulcus morphology were calculated. Measurement repeatability ICCs ranged from 0.94 to 0.99. Patellofemoral cartilage contact area and thickness, LCD, and LPD were statistically different throughout all levels of flexion (p<0.001). The cartilage contact area was correlated to LPD, cartilage thickness, sulcus angle, and epicondylar width (r=0.47-0.72, p<0.05). This study provides a comprehensive analysis of the patellofemoral joint throughout its range of motion. This study agrees with past studies that investigated patellofemoral measures at a single flexion angle, and provides new insights into the relationship between patellofemoral contact and alignment at multiple flexion angles. The study provides a detailed analysis of the patellofemoral joint in vivo, and demonstrates the feasibility of using standard clinical magnetic resonance imaging scanners to image the knee joint in deep flexion. Copyright © 2015 Elsevier B.V. All rights reserved.

Postural alignment in children with Duchenne muscular dystrophy and its relationship with balance

PubMed Central

Baptista, Cyntia R. J. A.; Costa, Andreia A.; Pizzato, Tatiana M.; Souza, Francine B.; Mattiello-Sverzut, Ana C.

2014-01-01

Background In Duchenne muscular dystrophy, functional deficits seem to arise from body misalignment, deconditioning, and obesity secondary to weakness and immobility. The question remains about the effects of postural deviations on the functional balance of these children. Objectives To identify and quantify postural deviations in children with DMD in comparison to non-affected children (eutrophic and overweight/obese), exploring relationships between posture and function. Method This case-control study evaluated 29 participants aged 6 to 11 years: 10 DMD (DG), 10 eutrophic (EG), and 9 overweight/obese (OG). Digital photogrammetry and SAPo program were used to measure postural alignment and the Pediatric Balance Scale (PBS) was used to measure balance. The Kruskall-Wallis and Dunn post-hoc tests were used for inter-group comparison of posture and balance. Spearman's coefficient tested the correlation between postural and balance variables. Results The horizontal pelvic alignment data indicated that the anteversion of the DG was similar to that of the OG and twice that of the EG (p<0.05). Compared to the EG, the DG and OG showed an increased forward position of the center of mass (p<0.05). There was a moderate and weak correlation between the PBS score and horizontal pelvic alignment (0.58 and 0.47-left/right). The PBS showed a weak correlation with asymmetries in the sagittal plane (-0.39). The PBS scores for the OG and EG suggest that obesity did not have a deleterious effect on balance. Conclusions The balance deficit in children with DMD was accompanied by an increased forward position of the center of mass and significant pelvic anteversion that constitutes a compensatory strategy to guarantee similar performance to the children not affected by the disease. PMID:24838810

Characterization of cartilage defects detected by MRI in Kellgren-Lawrence grade 0 or 1 knees.

PubMed

Taguchi, Kenji; Chiba, Ko; Okazaki, Narihiro; Kido, Yasuo; Miyamoto, Takashi; Yonekura, Akihiko; Tomita, Masato; Uetani, Masataka; Osaki, Makoto

2017-09-01

Osteoarthritis of the knee is generally evaluated by plain X-rays, which are incapable of detecting small cartilage damage. There are some patients who have small cartilage defects on MRI with no abnormal findings on plain X-rays. In this study, the prevalence and regional characteristics of cartilage defects detected by MRI were studied in cases with normal X-ray findings (Kellgren-Lawrence grade 0 and 1). Relationships between the cartilage defects and OA risk factors such as obesity and leg alignment were also investigated. A total of 51 knees of Kellgren-Lawrence grade 0 or 1 without knee joint pain were included. Fat-suppressed spoiled-gradient recalled (SPGR) sagittal images were scanned by 3 T MRI, and the presence of cartilage damage was confirmed. Cartilage damage was visualized three-dimensionally, and its location and morphology were analyzed. On a full length standing radiograph of the lower extremities, leg alignment and other parameters were measured, and their associations with cartilage damage were analyzed. Cartilage defects were detected in 26% of women aged >50 years. Cartilage damage was located on the medial femoral condyle near the intercondylar notch, and was mostly elliptically shaped in the anteroposterior direction. Subjects with damaged cartilage were not obese and did not have abnormal leg alignment. It should be borne in mind that some elderly women may have damaged cartilage on the intercondylar notch side of the medial joint, even though plain X-rays appear normal, and this cannot be predicted by obesity or leg alignment. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Cervical Alignment Variations in Different Postures and Predictors of Normal Cervical Kyphosis: A New Understanding.

PubMed

Hey, Hwee Weng Dennis; Lau, Eugene Tze-Chun; Wong, Gordon Chengyuan; Tan, Kimberly-Anne; Liu, Gabriel Ka-Po; Wong, Hee-Kit

2017-11-01

Comparative study of prospectively collected radiographic data. To predict physiological alignment of the cervical spine and study its morphology in different postures. There is increasing evidence that normal cervical spinal alignment may vary from lordosis to neutral to kyphosis, or form S-shaped or reverse S-shaped curves. Standing, erect sitting, and natural sitting whole-spine radiographs were obtained from 26 consecutive patients without cervical spine pathology. Sagittal vertical axis (SVA), global cervical lordosis, lower cervical alignment C4-T1, C0-C2 angle, T1 slope, C0-C7 SVA and C2-7SVA, SVA, thoracic kyphosis, thoracolumbar junctional angle, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence were measured. Statistical analysis was performed to elucidate differences in cervical alignment for all postures. Predictive values of T1 slope and SVA for cervical kyphosis were evaluated. Most patients (73.0%) do not have lordotic cervical alignment (C2-C7) upon standing (mean -0.6, standard deviation 11.1°). Lordosis increases significantly when transitioning from standing to erect sitting, as well as from erect to natural sitting (mean -17.2, standard deviation 12.1°). Transition from standing to natural sitting also produces concomitant increases in SVA (-8.8-65.2 mm) and T1-slope (17.4°-30.2°). T1 slope and SVA measured during standing significantly predicts angular cervical spine alignment in the same position. SVA < 10 mm significantly predicts C4-C7 kyphosis (P < 0.001), and to a lesser extent, C2-C7 kyphosis (P = 0.02). T1 slope <20° is both predictive of C2-C7 and C4-7 kyphosis (P = 0.001 and P = 0.023, respectively). For global cervical Cobb angle, T1 slope seems to be a more significant predictor of kyphosis than SVA (odds ratio 17.33, P = 0.001 vs odds ratio 11.67, P = 0.02, respectively). The cervical spine has variable normal morphology. Key determinants of its alignment include SVA and T1 slope. Lordotic correction of the cervical spine is not always physiological and thus correction targets should be individualized. 3.

How does electromagnetic navigation stack up against infrared navigation in minimally invasive total knee arthroplasties?

PubMed

Lionberger, David R; Weise, Jennifer; Ho, David M; Haddad, John L

2008-06-01

Forty-six primary total knee arthroplasties were performed using either an electromagnetic (EM) or infrared (IR) navigation system. In this IRB-approved study, patients were evaluated clinically and for accuracy using spiral computed tomographic imaging and 36-in standing radiographs. Although EM navigation was subject to metal interference, it was not as drastic as line-of-sight interference with IR navigation. Mechanical alignment was ideal in 92.9% of EM and 90.0% of IR cases based on spiral computed tomographic imaging and 100% of EM and 95% of IR cases based on x-ray. Individual measurements of component varus/valgus and sagittal measurements showed EM to be equivalent to IR, with both systems producing subdegree accuracy in 95% of the readings.

The effects of transverse rotation angle on compression and effective lever arm of prosthetic feet during simulated stance.

PubMed

Major, Matthew J; Howard, David; Jones, Rebecca; Twiste, Martin

2012-06-01

Unlike sagittal plane prosthesis alignment, few studies have observed the effects of transverse plane alignment on gait and prosthesis behaviour. Changes in transverse plane rotation angle will rotate the points of loading on the prosthesis during stance and may alter its mechanical behaviour. This study observed the effects of increasing the external transverse plane rotation angle, or toe-out, on foot compression and effective lever arm of three commonly prescribed prosthetic feet. The roll-over shape of a SACH, Flex and single-axis foot was measured at four external rotation angle conditions (0°, 5°, 7° and 12° relative to neutral). Differences in foot compression between conditions were measured as average distance between roll-over shapes. Increasing the transverse plane rotation angle did not affect foot compression. However, it did affect the effective lever arm, which was maximized with the 5° condition, although differences between conditions were small. Increasing the transverse plane rotation angle of prosthetic feet by up to 12° beyond neutral has minimal effects on their mechanical behaviour in the plane of walking progression during weight-bearing.

Usefulness of the dynamic gadolinium-enhanced magnetic resonance imaging with simultaneous acquisition of coronal and sagittal planes for detection of pituitary microadenomas.

PubMed

Lee, Han Bee; Kim, Sung Tae; Kim, Hyung-Jin; Kim, Keon Ha; Jeon, Pyoung; Byun, Hong Sik; Choi, Jin Wook

2012-03-01

Does dynamic gadolinium-enhanced imaging with simultaneous acquisition of coronal and sagittal planes improve diagnostic accuracy of pituitary microadenomas compared with coronal images alone? Fifty-six patients underwent 3-T sella MRI including dynamic simultaneous acquisition of coronal and sagittal planes after gadolinium injection. According to conspicuity, lesions were divided into four scores (0, no; 1, possible; 2, probable; 3, definite delayed enhancing lesion). Additional information on supplementary sagittal images compared with coronal ones was evaluated with a 4-point score (0, no; 1, possible; 2, probable; 3, definite additional information). Accuracy of tumour detection was calculated. Average scores for lesion detection of a combination of two planes, coronal, and sagittal images were 2.59, 2.32, and 2.18. 6/10 lesions negative on coronal images were detected on sagittal ones. Accuracy of a combination of two planes, of coronal and of sagittal images was 92.86%, 82.14% and 75%. Six patients had probable or definite additional information on supplementary sagittal images compared with coronal ones alone (10.71%). Dynamic MRI with combined coronal and sagittal planes was more accurate for detection of pituitary microadenomas than routinely used coronal images. Simultaneous dynamic enhanced acquisition can make study time fast and costs low. We present a new dynamic MRI technique for evaluating pituitary microadenomas • This technique provides simultaneous acquisition of contrast enhanced coronal and sagittal images. • This technique makes the diagnosis more accurate and reduces the examination time. • Such MR imaging only requires one single bolus of contrast agent.

Small C7-T1 lordotic angle and muscle degeneration at C7 level were independent radiological characteristics of patients with cervical imbalance: a propensity score-matched analysis.

PubMed

Tamai, Koji; Romanu, Joshua; Grisdela, Phillip; Paholpak, Permsak; Zheng, Pengfei; Nakamura, Hiroaki; Buser, Zorica; Wang, Jeffrey C

2018-01-31

Cervical sagittal vertical axis (cSVA) of ≥40 mm is recognized as the key factor of poor health-related quality of life, poor surgical outcomes, and correction loss after surgery for cervical deformity. However, little is known about the radiological characteristics of patients with cSVA≥40 mm. The purpose of this study was to identify the radiological characteristics of patients with cervical imbalance. Retrospective analysis of weight-bearing cervical magnetic resonance (MR) images. Consecutive 1,500 MR images of symptomatic patients in weight-bearing position. Cervical sagittal vertical axis, cervical alignment, cervical balance parameters (T1 slope, Co-C2 angle, C2-C7 angle, C7-T1 angle, neck tilt, and thoracic inlet angle), disc degeneration (Pfirmann and Suzuki classification), end plate degeneration (Modic change), spondylolisthesis (antero- and retrolisthesis), anteroposterior (AP) diameter of dural sac, cross-sectional area (CSA), and fat infiltration ratio of the transversospinalis muscles at C4 and C7 levels. Patients were divided into two groups: cSVA≥40 mm and cSVA<40 mm. Gender, age, and cervical alignment were analyzed. Subsequently, matched imbalance (cSVA≥40 mm) and control (<40 mm) groups were created using the propensity score to adjust for age, gender, and cervical alignment. Cervicothoracic angular parameters, disc degeneration, Modic change, spondylolisthesis, and degeneration of the transversospinalis muscles at C4 and C7 were compared. Variables with p<.05 were included in the multinomial logistic regression model to identify factors that relate to the cervical balance grouping. The incidence of patients with cervical imbalance was 2.5% (37 patients). Those patients had a higher incidence of kyphosis, were older, and there were more male patients. In the matched imbalance group, the T1 slope was greater (p=.028), C7-T1 lordotic angle was smaller (p<.001), the number of anterolisthesis was greater (p=.012), and the fat infiltration ratio at C4 and C7 was higher (p=.023, 0.030) compared with the control. Logistic regression analysis showed that the C7-T1 angle (adjusted odds ratio [aOR]=0.592, p=.001) and fat infiltration ratio at C7 level (aOR=1.178, p=.030) were significant independent variables. Smaller C7-T1 lordotic angle and severe muscle degeneration at C7 level were independent characteristics of patients with cervical imbalance. Copyright © 2018 Elsevier Inc. All rights reserved.

Is more lordosis associated with improved outcomes in cervical laminectomy and fusion when baseline alignment is lordotic?

PubMed

Sielatycki, John A; Armaghani, Sheyan; Silverberg, Arnold; McGirt, Matthew J; Devin, Clinton J; O'Neill, Kevin

2016-08-01

In cervical spondylotic myelopathy (CSM), cervical sagittal alignment (CSA) is associated with disease severity. Increased kyphosis and C2-C7 sagittal vertical axis (SVA) correlate with worse myelopathy and poor outcomes. However, when alignment is lordotic, it is unknown whether these associations persist. The study aimed to investigate the associations between CSA parameters and patient-reported outcomes (PROs) following posterior decompression and fusion for CSM when baseline lordosis is maintained. This is an analysis of a prospective surgical cohort at a single academic institution. The sample includes adult patients undergoing primary cervical laminectomy and fusion for CSM over a 3-year period. The PROs included EuroQol-5D, Short-Form-12 (SF-12) physical composite (PCS) and mental composite scales (MCS), Neck Disability Index, and the modified Japanese Orthopaedic Association scores. Radiographic CSA parameters measured included C1-C2 Cobb, C2-C7 Cobb, C1-C7 Cobb, C2-C7 SVA, C1-C7 SVA, and T1 slope. The PROs were recorded at baseline and at 3 and 12 months postoperatively. The CSA parameters were measured on standing radiographs in the neutral position at baseline and 3 months. Wilcoxon rank test was used to test for changes in PROs and CSA parameters, and Pearson correlation coefficients were calculated for CSA parameters and PROs preoperatively and at 12 months. No external sources of funding were used for this work. There were 45 patients included with an average age of 63 years who underwent posterior decompression and fusion of 3.7±1.3 levels. Significant improvements were found in all PROs except SF-12 MCS (p=.06). Small but statistically significant changes were found in C2-C7 Cobb (mean change: +3.6°; p=.03) and C2-C7 SVA (mean change: +3 mm; p=.01). At baseline, only C2-C7 SVA associated with worse SF-12 PCS scores (r=-0.34, p=.02). Postoperatively, there were no associations found between PROs and any CSA parameters. Similarly, no CSA parameters were associated with changes in PROs. Although creating more lordosis and decreasing SVA are associated with improved myelopathy and outcomes in patients with kyphosis, our study did not find such associationsin patients with lordosis undergoing posterior laminectomy and fusion for CSM. This suggests that any amount of lordosis may be sufficient. Copyright © 2016 Elsevier Inc. All rights reserved.

Improvement of spinal alignment and quality of life after corrective surgery for spinal kyphosis in patients with osteoporosis: a comparative study with non-operated patients.

PubMed

Miyakoshi, N; Hongo, M; Kobayashi, T; Abe, T; Abe, E; Shimada, Y

2015-11-01

This study evaluated changes in spinal alignment and quality of life (QOL) after corrective spinal surgery for patients with postmenopausal osteoporosis and spinal kyphosis. Spinal global alignment and QOL were significantly improved after corrective spinal surgery but did not reach the level of non-operated controls. With the increased aging of society, the demand for corrective spinal instrumentation for spinal kyphosis in osteoporotic patients is increasing. However, previous studies have not focused on the improvement of quality of life (QOL) after corrective spinal surgery in patients with osteoporosis, compared to non-operated control patients. The purposes of this study were thus to evaluate changes in spinal alignment and QOL after corrective spinal instrumentation for patients with osteoporosis and spinal kyphosis and to compare these results with non-operated patients. Participants comprised 39 patients with postmenopausal osteoporosis ≥50 years old who underwent corrective spinal surgery using multilevel posterior lumbar interbody fusion (PLIF) for symptomatic thoracolumbar or lumbar kyphosis, and 82 age-matched patients with postmenopausal osteoporosis without prevalent vertebral fractures. Spinopelvic parameters were evaluated with standing lateral spine radiography, and QOL was evaluated with the Japanese Osteoporosis QOL Questionnaire (JOQOL), SF-36, and Roland-Morris Disability Questionnaire (RDQ). Lumbar kyphosis angle, sagittal vertical axis, and pelvic tilt were significantly improved postoperatively. QOL evaluated with all three questionnaires also significantly improved after 6 months postoperatively, particularly in domain and subscale scores for pain and general/mental health. However, these radiographic parameters, total JOQOL score, SF-36 physical component summary score, and RDQ score were significantly inferior compared with non-operated controls. The results indicate that spinal global alignment and QOL were significantly improved after corrective spinal surgery using multilevel PLIF for patients with osteoporosis and spinal kyphosis but did not reach the level of non-operated controls.

Apical root resorption during orthodontic treatment with aligners? A retrospective radiometric study.

PubMed

Krieger, Elena; Drechsler, Thomas; Schmidtmann, Irene; Jacobs, Collin; Haag, Simeon; Wehrbein, Heinrich

2013-08-14

Objective of this study was to investigate the incidence and severity of apical root resorptions (ARR) during orthodontic treatment with aligners. The sample comprised 100 patients (17-75 years of age) with a class I occlusion and anterior crowding before treatment, treated exclusively with aligners (Invisalign®, Align Technologies, Santa Clara, CA, USA). The following teeth were assessed: upper and lower anterior teeth and first molars. Root and crown lengths of a total of 1600 teeth were measured twice in pre- and post-treatment panoramic radiographs. Afterwards, relative changes of the root length during treatment were calculated by a root-crown-ratio taking pre- and post-treatment root and crown lengths into consideration. A reduction of this ratio was considered as a shortening of the initial root length. Additionally, tooth movements of the front teeth were assessed by lateral cephalograms and the 3-dimensonal set up of each patient. All patients had a reduction of the pre-treatment root length with a minimum of two teeth. On average 7.36 teeth per patient were affected. 54% of 1600 measured teeth showed no measurable root reduction. A reduction of >0%-10% of the pre-treatment root length was found in 27.75%, a distinct reduction of >10%-20% in 11.94%. 6.31% of all teeth were affected with a considerable reduction of >20%. We found no statistically significant correlation between relative root length changes and the individual tooth, gender, age or sagittal and vertical orthodontic tooth movement; except for extrusion of upper front teeth, which was considered as not clinical relevant due to the small amount of mean 4% ARR. The present study is the first analyzing ARR in patients with a fully implemented orthodontic treatment with aligners (i.e. resolving anterior crowding). The variety was high and no clinical relevant influence factor could be detected. A minimum of two teeth with a root length reduction was found in every patient. On average, 7.36 teeth per patient were affected.

Regional instability following cervicothoracic junction surgery.

PubMed

Steinmetz, Michael P; Miller, Jared; Warbel, Ann; Krishnaney, Ajit A; Bingaman, William; Benzel, Edward C

2006-04-01

The cervicothoracic junction (CTJ) is the transitional region between the cervical and thoracic sections of the spinal axis. Because it is a transitional zone between the mobile lordotic cervical and rigid kyphotic thoracic spines, the CTJ is a region of potential instability. This potential for instability may be exaggerated by surgical intervention. A retrospective review of all patients who underwent surgery involving the CTJ in the Department of Neurosurgery at the Cleveland Clinic Foundation during a 5-year period was performed. The CTJ was strictly defined as encompassing the C-7 vertebra and C7-T1 disc interspace. Patients were examined after surgery to determine if treatment had failed. Failure was defined as construct failure, deformity (progression or de novo), or instability. Variables possibly associated with treatment failure were analyzed. Statistical comparisons were performed using the Fisher exact test. Between January 1998 and November 2003, 593 CTJ operations were performed. Treatment failed in 14 patients. Of all variables studied, failure was statistically associated with laminectomy and multilevel ventral corpectomies with fusion across the CTJ. Other factors statistically associated with treatment failure included histories of cervical surgery, tobacco use, and surgery for the correction of deformity. The CTJ is a vulnerable region, and this vulnerability is exacerbated by surgery. Results of the present study indicate that laminectomy across the CTJ should be supplemented with instrumentation (and fusion). Multilevel ventral corpectomies across the CTJ should also be supplemented with dorsal instrumentation. Supplemental instrumentation should be considered for patients who have undergone prior cervical surgery, have a history of tobacco use, or are undergoing surgery for deformity correction.

Design and preliminary biomechanical analysis of artificial cervical joint complex.

PubMed

Jian, Yu; Lan-Tao, Liu; Zhao, Jian-ning; Jian-ning, Zhao

2013-06-01

To design an artificial cervical joint complex (ACJC) prosthesis for non-fusion reconstruction after cervical subtotal corpectomy, and to evaluate the biomechanical stability, preservation of segment movements and influence on adjacent inter-vertebral movements of this prosthesis. The prosthesis was composed of three parts: the upper/lower joint head and the middle artificial vertebrae made of Cobalt-Chromium-Molybdenum (Co-Cr-Mo) alloy and polyethylene with a ball-and-socket joint design resembling the multi-axial movement in normal inter-vertebral spaces. Biomechanical tests of intact spine (control), Orion locking plate system and ACJC prosthesis were performed on formalin-fixed cervical spine specimens from 21 healthy cadavers to compare stability, range of motion (ROM) of the surgical segment and ROM of adjacent inter-vertebral spaces. As for stability of the whole lower cervical spine, there was no significant difference of flexion, extension, lateral bending and torsion between intact spine group and ACJC prosthesis group. As for segment movements, difference in flexion, lateral bending or torsion between ACJC prosthesis group and control group was not statistically significant, while ACJC prosthesis group showed an increase in extension (P < 0.05) compared to that of the control group. In addition, ACJC prosthesis group demonstrated better flexion, extension and lateral bending compared to those of Orion plating system group (P < 0.05). Difference in adjacent inter-vertebral ROM of the ACJC prosthesis group was not statistically significant compared to that of the control group. After cervical subtotal corpectomy, reconstruction with ACJC prosthesis not only obtained instant stability, but also reserved segment motions effectively, without abnormal gain of mobility at adjacent inter-vertebral spaces.

Can standard anterior Smith-Robinson supramanubrial approach be utilized for approach down to T2 or T3?

PubMed

Singhatanadgige, Weerasak; Zebala, Lukas P; Luksanapruksa, Panya; Daniel Riew, K

2017-09-01

The aim of this study was to determine a plain radiographic criterion for determining the feasibility of using the standard anterior Smith-Robinson supramanubrial approach for anterior surgery down to T2 or T3. The surgical database (2002-2014) was searched to identify patients with anterior cervical surgery to T2 or T3. A method to determine whether a standard anterior Smith-Robinson approach can be used to operate on the upper thoracic levels was evaluated. The surgeon chose the surgical approach preoperatively using a lateral radiograph by determining if a line from the intended skin incision to the lower instrumented level (LIV) passed above the top of the manubrium. If so, a standard Smith-Robinson approach was selected. Another spine surgeon then analyzed all patients who had anterior thoracic fusion to T2 or below. The lateral radiographs were retrospectively reviewed. A total of 44 patients who underwent anterior surgery down to T2 or T3 vertebrae were identified. T2 was the LIV in 39 patients. T3 was the LIV in five patients. No surgery was abandoned or converted to a difference approach after making the standard Smith-Robinson approach. To increase visualization, T1 corpectomy was necessary in 4 of 39 patients when T2 was the LIV. T2 corpectomy was necessary in 2 of 5 patients when T3 was the LIV. If a line from the intended skin incision to the LIV passes over the top of the manubrium, a standard Smith-Robinson approach without sternotomy can be successfully used.

A Randomized Double-Blinded Trial on the Effects of Ultrasound Transducer Orientation on Teaching and Learning Ultrasound-Guided Regional Anesthesia.

PubMed

Lam, Nicholas C K; Baker, Elizabeth B; Fishburn, Steven J; Hammer, Angie R; Petersen, Timothy R; Mariano, Edward R

2016-07-01

Learning ultrasound-guided regional anesthesia skills, especially needle/ beam alignment, can be especially difficulty for trainees, who can often become frustrated. We hypothesized that teaching novices to orient the transducer and needle perpendicular to their shoulders will improve performance on a standardized task, compared to holding the transducer and needle parallel to the shoulders. This study compared the effects of transducer orientation on trainees' ability to complete a standardized ultrasound-guided nerve block simulation. The time to task completion and percentage of the attempt time without adequate needle visualization were measured. Participants were right-handed healthy adults with no previous ultrasound experience and were randomly assigned to training in either transducer and needle alignment in a coronal plane, parallel to the shoulders (parallel group) or transducer and needle alignment in a sagittal plane, perpendicular to the shoulders (perpendicular group). Participants used ultrasound to direct a needle to 3 targets in a standardized gelatin phantom and repeated this task 3 times. Their efforts were timed and evaluated by an assessor, who was blinded to group assignment. Data were analyzed on 28 participants. The perpendicular group was able to complete the task more quickly (P < .001) and with a smaller proportion of time lost to inadequate needle visualization (P < .001). Ultrasound-guided regional anesthesia trainees complete a standardized task more quickly and efficiently when instructed to hold the transducer and needle in an orientation perpendicular to their shoulders.

Comparative Study of the Difference of Perioperative Complication and Radiologic Results: MIS-DLIF (Minimally Invasive Direct Lateral Lumbar Interbody Fusion) Versus MIS-OLIF (Minimally Invasive Oblique Lateral Lumbar Interbody Fusion).

PubMed

Jin, Jie; Ryu, Kyeong-Sik; Hur, Jung-Woo; Seong, Ji-Hoon; Kim, Jin-Sung; Cho, Hyun-Jin

2018-02-01

Retrospective observatory analysis. The purpose of this study was to compare the incidence of perioperative complication, difference of cage location, and sagittal alignment between minimally invasive oblique lateral lumbar interbody fusion (MIS-OLIF) and MIS-direct lateral lumbar interbody fusion (DLIF) in the cases of single-level surgery at L4-L5. MIS-DLIF using tubular retractor has been used for the treatment of lumbar degenerative diseases; however, blunt transpsoas dissection poses a risk of injury to the lumbar plexus. As an alternative, MIS-OLIF uses a window between the prevertebral venous structures and psoas muscle. A total of 43 consecutive patients who underwent MIS-DLIF or MIS-OLIF for various L4/L5 level pathologies between November 2011 and April 2014 by a single surgeon were retrospectively reviewed. A complication classification based on the relation to surgical procedure and effect duration was used. Perioperative complications until 3-month postoperatively were reviewed for the patients. Radiologic results including the cage location and sagittal alignment were also assessed with plain radiography. There were no significant statistical differences in perioperative parameters and early clinical outcome between 2 groups. Overall, there were 13 (59.1%) approach-related complications in the DLIF group and 3 (14.3%) in the OLIF group. In the DLIF group, 3 (45.6%) were classified as persistent, however, there was no persistent complication in the OLIF group. In the OLIF group, cage is located mostly in the middle 1/3 of vertebral body, significantly increasing posterior disk space height and foraminal height compared with the DLIF group. Global and segmental lumbar lordosis was greater in the DLIF group due to anterior cage position without statistical significance. In our report of L4/L5 level diseases, the OLIF technique may decrease approach-related perioperative morbidities by eliminating the risk of unwanted muscle and nerve manipulations. Using orthogonal maneuver, cage could be safely placed more posteriorly, resulting in better disk and foraminal height restoration.

Minimum 20 Years Long-term Clinical Outcome After Spinal Fusion and Instrumentation for Scoliosis: Comparison of the SRS-22 Patient Questionnaire With That in Nonscoliosis Group.

PubMed

Iida, Takahiro; Suzuki, Nobumasa; Kono, Katsuki; Ohyama, Yasumasa; Imura, Jyunya; Ato, Akihisa; Ozeki, Satoru; Nohara, Yutaka

2015-08-15

A retrospective minimum 20-year follow-up study using 4 standard self-administered questionnaires, one of which, the SRS-22 was also administered to control groups. To evaluate long-term postoperative pain and other clinical outcomes of scoliosis correction and fusion surgery with Harrington instrumentation using Moe square-ended rods for better preservation of sagittal alignment. Only a few long-term outcome studies have used standardized and validated self-administered tools, and no studies have established SRS-22 control data within their own population. There is no previous minimum 20-year follow-up evaluation after correction surgery preserving thoracic kyphosis and lumbar lordosis. Of 86 consecutive patients who underwent instrumentation surgery for scoliosis by a single surgeon, 61 patients participated using Japanese Orthopaedic Association, Roland-Morris Disability Questionnaire, Oswestry Disability Index, and Scoliosis Research Society (SRS-22) questionnaires and 51 patients were included in this study. Results were analyzed for pain and other clinical outcomes. A total of 771 hospital employees were sent SRS-22 questionnaires. A total of 763 responded, resulting in 2 control groups composed of nonscoliosis and untreated mild scoliosis controls of the same culture and language as the long-term follow-up group. The prevalence of continuous low back pain was about 15%. Average Japanese Orthopaedic Association, Oswestry Disability Index, and Roland-Morris Disability Questionnaire scores at follow-up were 25 points, 7.3%, and 1.6, respectively. The average SRS-22 scores were 4.2 (function), 4.3 (pain), 3.7 (self-image), and 3.9 (mental health) for the postoperative follow-up group compared with 4.5 (function), 4.3 (pain), 3.5 (self-image), and 3.5 (mental health) for the nonscoliosis controls. Improved preservation of normal sagittal alignment resulted in a prevalence of low back pain comparable with the age-matched general population. Moreover, SRS-22 results for self-image and mental health were positive compared with the controls, possibly reflecting the surgeon's emphases on mental health and management of patient expectations. 4.

Symptomatic vertebral hemangioma in pregnancy treated antepartum. A case report with review of literature.

PubMed

Vijay, Kamath; Shetty, Ajoy P; Rajasekaran, S

2008-09-01

Pregnancy related compressive myelopathy secondary to vertebral hemangioma is a rare occurrence and its treatment antepartum is rare. We report a 22-year-old lady in her 26th-week of pregnancy who was treated in two stages--antepartum with a laminectomy and posterior stabilization. This resulted in complete recovery of the neurological deficits. She delivered a normal baby after 3 months, following which a corpectomy and fusion was performed. This two-staged approach appears safe and effective in treating symptomatic vertebral haemangiomas causing neurological deficits during pregnancy. A review of relevant literature has been done.

Training intensity and sagittal curvature of the spine in male and female artistic gymnasts.

PubMed

Sanz-Mengibar, Jose M; Sainz-de-Baranda, Pilar; Santonja-Medina, Fernando

2018-04-01

Specific adaptations of the spine in the sagittal plane have been described according to different sports disciplines. The goal of this study was to describe the integrative diagnosis of the sagittal morphotype of the spine in male and female artistic gymnasts. Forty-eight gymnasts were measured with an inclinometer. Thoracic and lumbar curves were quantified in standing position, in Sit and Reach and Slump Sitting in order to assess the sagittal spine posture and analyze if adaptations were related to training intensity. Correlation values of the sagittal plane spine measurements showed significantly increased thoracic kyphosis in men (-0.445, P<0.001). No significant correlations have been found between training hours per year or training volume and any measurements of the spine on the sagittal plane. When data from the two sitting tests were integrated, 62.5% of gymnasts had a functional thoracic kyphosis and 39.6% had lumbar kyphotic attitude. Our hypothesis has only been partially confirmed, because training intensity did not influence the sagittal curvatures in artistic gymnastics; however, this sport seems to cause specific adaptations in postural hypolordosis, functional thoracic kyphosis and lumbar kyphotic attitude during sitting and trunk flexion. The implications of the functional adaptations observed in our results may require a preventive intervention in male and female artistic gymnasts can be assessed with the integrative diagnosis of the sagittal morphotype of the spine.

Sagittal imbalance in patients with lumbar spinal stenosis and outcomes after simple decompression surgery.

PubMed

Shin, E Kyung; Kim, Chi Heon; Chung, Chun Kee; Choi, Yunhee; Yim, Dahae; Jung, Whei; Park, Sung Bae; Moon, Jung Hyeon; Heo, Won; Kim, Sung-Mi

2017-02-01

Lumbar spinal stenosis (LSS) is the most common lumbar degenerative disease, and sagittal imbalance is uncommon. Forward-bending posture, which is primarily caused by buckling of the ligamentum flavum, may be improved via simple decompression surgery. The objectives of this study were to identify the risk factors for sagittal imbalance and to describe the outcomes of simple decompression surgery. This is a retrospective nested case-control study PATIENT SAMPLE: This was a retrospective study that included 83 consecutive patients (M:F=46:37; mean age, 68.5±7.7 years) who underwent decompression surgery and a minimum of 12 months of follow-up. The primary end point was normalization of sagittal imbalance after decompression surgery. Sagittal imbalance was defined as a C7 sagittal vertical axis (SVA) ≥40 mm on a 36-inch-long lateral whole spine radiograph. Logistic regression analysis was used to identify the risk factors for sagittal imbalance. Bilateral decompression was performed via a unilateral approach with a tubular retractor. The SVA was measured on serial radiographs performed 1, 3, 6, and 12 months postoperatively. The prognostic factors for sagittal balance recovery were determined based on various clinical and radiological parameters. Sagittal imbalance was observed in 54% (45/83) of patients, and its risk factors were old age and a large mismatch between pelvic incidence and lumbar lordosis. The 1-year normalization rate was 73% after decompression surgery, and the median time to normalization was 1 to 3 months. Patients who did not experience SVA normalization exhibited low thoracic kyphosis (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.02-1.10) (p<.01) and spondylolisthesis (HR, 0.33; 95% CI, 0.17-0.61) before surgery. Sagittal imbalance was observed in more than 50% of LSS patients, but this imbalance was correctable via simple decompression surgery in 70% of patients. Copyright © 2016 Elsevier Inc. All rights reserved.

'Lumbar Degenerative Kyphosis' Is Not Byword for Degenerative Sagittal Imbalance: Time to Replace a Misconception.

PubMed

Lee, Chang-Hyun; Chung, Chun Kee; Jang, Jee-Soo; Kim, Sung-Min; Chin, Dong-Kyu; Lee, Jung-Kil

2017-03-01

Lumbar degenerative kyphosis (LDK) is a subgroup of the flat-back syndrome and is most commonly caused by unique life styles, such as a prolonged crouched posture during agricultural work and performing activities of daily living on the floor. Unfortunately, LDK has been used as a byword for degenerative sagittal imbalance, and this sometimes causes confusion. The aim of this review was to evaluate the exact territory of LDK, and to introduce another appropriate term for degenerative sagittal deformity. Unlike what its name suggests, LDK does not only include sagittal balance disorder of the lumbar spine and kyphosis, but also sagittal balance disorder of the whole spine and little lordosis of the lumbar spine. Moreover, this disease is closely related to the occupation of female farmers and an outdated Asian life style. These reasons necessitate a change in the nomenclature of this disorder to prevent misunderstanding. We suggest the name "primary degenerative sagittal imbalance" (PDSI), which encompasses degenerative sagittal misalignments of unknown origin in the whole spine in older-age patients, and is associated with back muscle wasting. LDK may be regarded as a subgroup of PDSI related to an occupation in agriculture. Conservative treatments such as exercise and physiotherapy are recommended as first-line treatments for patients with PDSI, and surgical treatment is considered only if conservative treatments failed. The measurement of spinopelvic parameters for sagittal balance is important prior to deformity corrective surgery. LDK can be considered a subtype of PDSI that is more likely to occur in female farmers, and hence the use of LDK as a global term for all degenerative sagittal imbalance disorders is better avoided. To avoid confusion, we recommend PDSI as a newer, more accurate diagnostic term instead of LDK.

‘Lumbar Degenerative Kyphosis’ Is Not Byword for Degenerative Sagittal Imbalance: Time to Replace a Misconception

PubMed Central

Lee, Chang-Hyun; Chung, Chun Kee; Jang, Jee-Soo; Kim, Sung-Min; Chin, Dong-Kyu; Lee, Jung-Kil

2017-01-01

Lumbar degenerative kyphosis (LDK) is a subgroup of the flat-back syndrome and is most commonly caused by unique life styles, such as a prolonged crouched posture during agricultural work and performing activities of daily living on the floor. Unfortunately, LDK has been used as a byword for degenerative sagittal imbalance, and this sometimes causes confusion. The aim of this review was to evaluate the exact territory of LDK, and to introduce another appropriate term for degenerative sagittal deformity. Unlike what its name suggests, LDK does not only include sagittal balance disorder of the lumbar spine and kyphosis, but also sagittal balance disorder of the whole spine and little lordosis of the lumbar spine. Moreover, this disease is closely related to the occupation of female farmers and an outdated Asian life style. These reasons necessitate a change in the nomenclature of this disorder to prevent misunderstanding. We suggest the name “primary degenerative sagittal imbalance” (PDSI), which encompasses degenerative sagittal misalignments of unknown origin in the whole spine in older-age patients, and is associated with back muscle wasting. LDK may be regarded as a subgroup of PDSI related to an occupation in agriculture. Conservative treatments such as exercise and physiotherapy are recommended as first-line treatments for patients with PDSI, and surgical treatment is considered only if conservative treatments failed. The measurement of spinopelvic parameters for sagittal balance is important prior to deformity corrective surgery. LDK can be considered a subtype of PDSI that is more likely to occur in female farmers, and hence the use of LDK as a global term for all degenerative sagittal imbalance disorders is better avoided. To avoid confusion, we recommend PDSI as a newer, more accurate diagnostic term instead of LDK. PMID:28264231

[Analysis of normal pelvis morphometry of modern Chinese southern Han female and its correlation with age].

PubMed

Liu, Ping; Yu, Yan-Hong; Chen, Chun-Lin; Tang, Yi-Xin; Wang, Li; Mao, Dong-Rui; Xu, Yi-Kai; Chen, Lan

2013-07-01

To analyze the normal pelvis morphometry of Chinese southern Han female and its correlation with age. From August 2009 to September 2011, 289 Han nationality females who received pelvis CT scan at Nanfang Hospital of Southern Medical University were eligible for the study. Their mean age was 43.5 years, with normal body development and no pelvic abnormality. The patients were divided into 3 age groups: 25 to 40 (n = 109), 41 to 50 (n = 115), and >50 years (n = 65). After constructing a three-dimensional digital model of the pelvis, the following parameters were measured, including transverse inlet diameter, posterior sagittal diameter of pelvic inlet, sagittal inlet, diagonal conjugate, biischial diameter, posterior sagittal diameter of midpelvis, sagittal midpelvic diameter, intertuberous distance, posterior sagittal diameter of outlet, angle of pubic arch, sagittal outlet, penal height, sacrum length and sacrum curvature. The relationship between all parameters and age was analyzed. (1) The posterior sagittal diameters of pelvic inlet of the 25 to 40 age group, 41 to 50 age group, >50 years age group were (53 ± 8), (51 ± 7), (48 ± 6) mm. The sagittal inlet of the three groups were (122 ± 8), (120 ± 9), (114 ± 8) mm. And the diagonal conjugate of the three groups were (135 ± 10), (132 ± 9), (127 ± 9) mm. All had significant differences among the three groups (P < 0.01) . (2) The posterior sagittal diameter of midpelvis of the three groups were (43 ± 6), (44 ± 6), (43 ± 7) mm, and the sagittal midpelvic diameter of the three groups were (119 ± 8), (120 ± 8), (119 ± 7) mm, with no significant difference among the three groups (P > 0.05). (3) The intertuberous distance of the three groups were (122 ± 11), (121 ± 10), (117 ± 11) mm, and the posterior sagittal diameter of outlet of the three groups were (56 ± 9), (58 ± 8), (57 ± 9) mm. There was no significant difference among the three groups (P > 0.05) .(4) Penal height of three groups were (31 ± 3), (33 ± 3), (34 ± 3) mm, there was with significant differences (P < 0.01) .(5) Pearson correlation analysis showed that penal height was positively correlated with age (r = 0.331, P < 0.05), while sagittal inlet, posterior sagittal diameter of inlet, diagonal conjugate, intertuberous distance, angle of pubic arch, sacrum length and sacrum curvature were negatively correlated with age (r = -0.120 to -0.343, P < 0.05). The shape of the pelvic inlet of Chinese southern Han female changed from sagittal elliptic into transverse elliptic form, and the posterior part of pelvic inlet became larger.Sacral concavity was increased and the pelvis became deeper. Mid pelvis and the pelvic outlet was almost unchanged, and showed no correlation with age.

Position des lignes temporales sur le cranium de «Mrs » Ples (A.africanus) : une attribution sexuelle est-elle possible ?Possible position of the temporal lines on the cranium of 'Mrs' Ples (A. africanus): is sexual determination possible?

NASA Astrophysics Data System (ADS)

Prat, Sandrine; Thackeray, John Francis

2001-03-01

The cranium and associated matrix of Sts 5, a cranium of Australopithecus africanus is re-examined in the context of an unfused sagittal suture and the position of the temporal lines. These lines are not developed as a sagittal crest although they are close to the mid-sagittal line. A comparative study of the presence of sagittal crests in male, female, juvenile and adult specimens of extant great apes ( Gorilla, Pan, Pongo) suggests that the existence of a sagittal crest is influenced to a greater extent by anatomical age rather than by the sex of the individuals.

Spinal sagittal imbalance in patients with lumbar disc herniation: its spinopelvic characteristics, strength changes of the spinal musculature and natural history after lumbar discectomy.

PubMed

Liang, Chen; Sun, Jianmin; Cui, Xingang; Jiang, Zhensong; Zhang, Wen; Li, Tao

2016-07-22

Spinal sagittal imbalance is a widely acknowledged problem, but there is insufficient knowledge regarding its occurrence. In some patients with lumbar disc herniation (LDH), their symptom is similar to spinal sagittal imbalance. The aim of this study is to illustrate the spinopelvic sagittal characteristics and identity the role of spinal musculature in the mechanism of sagittal imbalance in patients with LDH. Twenty-five adults with spinal sagittal imbalance who initially came to our clinic for treatment of LDH, followed by posterior discectomy were reviewed. The horizontal distance between C7 plumb line-sagittal vertical axis (C7PL-SVA) greater than 5 cm anteriorly with forward bending posture is considered as spinal sagittal imbalance. Radiographic parameters including thoracic kyphotic angle (TK), lumbar lordotic angle (LL), pelvic tilting angle (PT), sacral slope angle (SS) and an electromyography(EMG) index 'the largest recruitment order' were recorded and compared. All patients restored coronal and sagittal balance immediately after lumbar discectomy. The mean C7PL-SVA and trunk shift value decreased from (11.6 ± 6.6 cm, and 2.9 ± 6.1 cm) preoperatively to (-0.5 ± 2.6 cm and 0.2 ± 0.5 cm) postoperatively, while preoperative LL and SS increased from (25.3° ± 14.0° and 25.6° ± 9.5°) to (42.4° ± 10.2° and 30.4° ± 8.7°) after surgery (P < 0.05). The preoperative mean TK and PT (24.7° ± 11.3° and 20.7° ± 7.8°) decreased to (22.0° ± 9.8° and 15.8 ± 5.5°) postoperatively (P < 0.05). The largest recruitment order on the level of T7-T8, T12-L1 and the herniated level all improved compared with before and after surgery (P < 0.05). All patients have been followed up for more than 2 years. The mean ODI was 77.8 % before surgery to 4.2 % at the final follow-up. Spinal sagittal imbalance caused by LDH is one type of compensatory sagittal imbalance. Compensatory mechanism of spinal sagittal imbalance mainly includes a loss of lumbar lordosis, an increase of thoracic kyphosis and pelvis tilt. Spinal musculature plays an important role in spinal sagittal imbalance in patients with LDH.

Neurologic outcome after thoracolumbar partial lateral corpectomy for intervertebral disc disease in 72 dogs.

PubMed

Salger, Florian; Ziegler, Luisa; Böttcher, Irene Christine; Oechtering, Gerhard; Böttcher, Peter; Flegel, Thomas

2014-07-01

To determine neurologic outcome and factors influencing outcome after thoracolumbar partial lateral corpectomy (PLC) in dogs with intervertebral disc disease (IVDD) causing ventral spinal cord compression. Retrospective case series. Dogs with IVDD (n = 72; 87 PLC). Dogs with IVDD between T9 and L5 were included if treated by at least 1 PLC. Exclusion criteria were: previous spinal surgery, combination of PLC with another surgical procedure. Neurologic outcome was assessed by: (1) modified Frankel score (MFS) based on neurologic examinations at 4 time points (before surgery, immediately after PLC, at discharge and 4 weeks after PLC); and (2) owner questionnaire. The association of the following factors with neurologic outcome was analyzed: age, body weight, duration of current neurologic dysfunction (acute, chronic), IVDD localization, breed (chondrodystrophic, nonchondrodystrophic), number of PLCs, degree of presurgical spinal cord compression and postsurgical decompression, slot depth, presurgical MFS. Presurgical spinal cord compression was determined by CT myelography (71 dogs) or MRI (1 dog), whereas postsurgical decompression and slot depth were determined on CT myelography (69 dogs). MFS was improved in 18.7%, 31.7%, and 64.2% of dogs at the 3 postsurgical assessments, whereas it was unchanged in 62.6%, 52.8%, and 32.0% at corresponding time points. Based on owner questionnaire, 91.4% of dogs were ambulatory 6 months postsurgically with 74.5% having a normal gait. Most improvement in neurologic function developed within 6 months after surgery. Presurgical MFS was the only variable significantly associated with several neurologic outcome measurements (P < .01). PLC is an option for decompression in ventrally compressing thoracolumbar IVDD. Prognosis is associated with presurgical neurologic condition. © Copyright 2014 by The American College of Veterinary Surgeons.

Cervical bracing practices after degenerative cervical surgery: a survey of cervical spine research society members.

PubMed

Lunardini, David J; Krag, Martin H; Mauser, Nathan S; Lee, Joon Y; Donaldson, William H; Kang, James D

2018-05-21

Context: Prior studies have shown common use of post-operative bracing, despite advances in modern day instrumentation rigidity and little evidence of brace effectiveness. To document current practice patterns of brace use after degenerative cervical spine surgeries among members of the Cervical Spine Research Society (CSRS), to evaluate trends, and to identify areas of further study. A questionnaire survey METHODS: A 10 question survey was sent to members of the Cervical Spine Research Society to document current routine bracing practices after various common degenerative cervical spine surgical scenarios, including fusion and non-fusion procedures. The overall bracing rate was 67%. This included 8.4% who used a hard collar in each scenario. Twenty-two percent of surgeons never used a hard collar, while 34% never used a soft collar, and 3.6% (3 respondents) did not use a brace in any surgical scenario. Bracing frequency for specific surgical scenarios varied from 39% after foraminotomy to 88% after multi-level corpectomy with anterior & posterior fixation. After one, two and three level anterior cervical discectomy & fusion (ACDF), bracing rates were 58%, 65% and 76% for an average of 3.3, 4.3 and 5.3 weeks, respectively. After single level corpectomy, 77% braced for an average of 6.2 weeks. After laminectomy and fusion, 72% braced for an average of 5.4 weeks. Significant variation persists among surgeons on the type and length of post-operative brace usage after cervical spine surgeries. Overall rates of bracing have not changed significantly with time. Given the lack evidence in the literature to support bracing, reconsidering use of a brace after certain surgeries may be warranted. Copyright © 2018. Published by Elsevier Inc.

Dynamic anterior cervical plates for multilevel anterior corpectomy and fusion with simultaneous posterior wiring and fusion: efficacy and outcomes.

PubMed

Epstein, N E

2006-07-01

To prospectively evaluate major complications associated with the application of dynamic ABC plates (Aesculap, Tuttlingen, Germany) to multilevel Anterior Corpectomy/Fusion (ACF) followed by posterior fusion (C2-C7 PF). To determine whether dynamic ABC (Aesculap, Tuttlingen, Germany) plates would minimize major complications (plate/graft extrusion, pseudarthrosis) while maximizing neurological outcomes in 40 consecutive patients undergoing simultaneous multilevel ACF/PF with halo application. USA. Patients averaged 53 years of age and preoperatively exhibited severe myeloradiculopathy (Nurick Grade 3.9). MR/CT studies documented marked ossification of the posterior longitudinal ligament/spondylostenosis. Surgery included two to four level ACF utilizing fibula strut allograft and ABC plates. Posterior spinous process wiring/fusions utilized braided titanium cables. The average operative time was 8.9 h. Fusion was confirmed on dynamic X-rays/CTs (3-12 months postoperatively). The average follow-up interval was 2.7 years. Outcomes (3 months-2 years postoperatively) were assessed utilizing Odom's Criteria, Nurick Grades, and SF-36 questionnaires. Major complications included one pseudarthrosis requiring secondary PWF. Minor complications in six patients included two pulmonary emboli (PE), two tracheostomies, and five superficial wound infections. At 1 year postoperatively, marked improvement was observed in all patients utilizing Odom's criteria (38 excellent/good), Nurick Grades (mild radiculopathy 0.4), and the SF-36 (3 Health Scales; Role Physical (12.5-38.6), Bodily Pain (39.9-65.5), and Role Emotional (53.8-75.8)]. The 2-year postoperative data showed minimal additional improvement. The average time to fusion was 6.3 months. Patients undergoing multilevel ACF/PF demonstrated marked neurological improvement (SF-36), and only one of 40 developed a delayed pseudarthrosis.

Hybrid Corpectomy and Disc Arthroplasty for Cervical Spondylotic Myelopathy Caused by Ossification of Posterior Longitudinal Ligament and Disc Herniation.

PubMed

Chang, Huang-Chou; Tu, Tsung-Hsi; Chang, Hsuan-Kan; Wu, Jau-Ching; Fay, Li-Yu; Chang, Peng-Yuan; Wu, Ching-Lan; Huang, Wen-Cheng; Cheng, Henrich

2016-11-01

The combination of anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) has been demonstrated to be effective for multilevel cervical spondylotic myelopathy (CSM); however, the combination of ACCF and cervical disc arthroplasty (CDA) for 3-level CSM has never been addressed. Consecutive patients (>18 years of age) with CSM caused by segmental ossification of posterior longitudinal ligament (OPLL) and degenerative disc disease (DDD) were reviewed. Inclusion criteria were patients who underwent hybrid ACCF and CDA surgery for symptomatic 3-level CSM with OPLL and DDD. Medical and radiologic records were reviewed retrospectively. A total of 15 patients were analyzed with a mean follow-up of 18.1 ± 7.42 months. Every patient had hybrid surgery composed of 1-level ACCF (for segmental-type OPLL causing spinal stenosis) and 1-level CDA at the adjacent level (for DDD causing stenosis). All clinical outcomes, including visual analogue scale of neck and arm pain, Neck Disability Index, Japanese Orthopedic Association scores, and Nurick scores of myelopathy, demonstrated significant improvement at 12 months after surgery. All patients (100%) achieved arthrodesis for the ACCF (instrumented) and preserved mobility for CDA (preoperation 6.2 ± 3.81° vs. postoperation 7.0 ± 4.18°; P = 0.579). For patients with multilevel CSM caused by segmental OPLL and DDD, the hybrid surgery of ACCF and CDA demonstrated satisfactory clinical and radiologic outcomes. Moreover, although located next to each other, the instrumented ACCF construct and CDA still achieved solid arthrodesis and preserved mobility, respectively. Therefore, hybrid surgery may be a reasonable option for the management of CSM with OPLL. Copyright © 2016 Elsevier Inc. All rights reserved.

The path of the superior sagittal sinus in unicoronal synostosis.

PubMed

Russell, Aaron J; Patel, Kamlesh B; Skolnick, Gary; Woo, Albert S; Smyth, Matthew D

2014-10-01

This study investigates the anatomic relationship between the superior sagittal sinus (SSS) and the sagittal suture in infants with uncorrected unicoronal synostosis. The morphology of the SSS is also evaluated postoperatively to assess whether normalization of intracranial structures occurs following reconstruction. The study sample consisted of 20 computed tomography scans (10 preoperative, 6 postoperative, and 4 unaffected controls) obtained between 2001 and 2013. The SSS and the sagittal suture were outlined using Analyze imaging software. These data were used to measure the maximum lateral discrepancy between the SSS and the sagittal suture preoperatively and to assess for postoperative changes in the morphology of the SSS. In children with uncorrected unicoronal synostosis, the SSS deviates to the side of the patent coronal suture posteriorly and tends to follow the path of the sagittal and metopic sutures. The lateral discrepancy between the SSS and the sagittal suture ranged from 5.0 to 11.8 mm, with a 99.9 % upper prediction bound of 14.4 mm. Postoperatively, the curvature of the SSS was statistically decreased following surgical intervention, though it remained significantly greater than in unaffected controls. The SSS follows a predictable course relative to surface landmarks in children with unicoronal synostosis. When creating burr holes for craniotomies, the SSS can be avoided in 99.9 % of cases by remaining at least 14.4 mm from the lateral edge of the sagittal suture. Postoperative changes in the path of the SSS provide indirect evidence for normalization of regional brain morphology following fronto-orbital advancement.

Measurement and Finite Element Model Validation of Immature Porcine Brain-Skull Displacement during Rapid Sagittal Head Rotations.

PubMed

Pasquesi, Stephanie A; Margulies, Susan S

2018-01-01

Computational models are valuable tools for studying tissue-level mechanisms of traumatic brain injury, but to produce more accurate estimates of tissue deformation, these models must be validated against experimental data. In this study, we present in situ measurements of brain-skull displacement in the neonatal piglet head ( n  = 3) at the sagittal midline during six rapid non-impact rotations (two rotations per specimen) with peak angular velocities averaging 51.7 ± 1.4 rad/s. Marks on the sagittally cut brain and skull/rigid potting surfaces were tracked, and peak values of relative brain-skull displacement were extracted and found to be significantly less than values extracted from a previous axial plane model. In a finite element model of the sagittally transected neonatal porcine head, the brain-skull boundary condition was matched to the measured physical experiment data. Despite smaller sagittal plane displacements at the brain-skull boundary, the corresponding finite element boundary condition optimized for sagittal plane rotations is far less stiff than its axial counterpart, likely due to the prominent role of the boundary geometry in restricting interface movement. Finally, bridging veins were included in the finite element model. Varying the bridging vein mechanical behavior over a previously reported range had no influence on the brain-skull boundary displacements. This direction-specific sagittal plane boundary condition can be employed in finite element models of rapid sagittal head rotations.

Measurement and Finite Element Model Validation of Immature Porcine Brain–Skull Displacement during Rapid Sagittal Head Rotations

PubMed Central

Pasquesi, Stephanie A.; Margulies, Susan S.

2018-01-01

Computational models are valuable tools for studying tissue-level mechanisms of traumatic brain injury, but to produce more accurate estimates of tissue deformation, these models must be validated against experimental data. In this study, we present in situ measurements of brain–skull displacement in the neonatal piglet head (n = 3) at the sagittal midline during six rapid non-impact rotations (two rotations per specimen) with peak angular velocities averaging 51.7 ± 1.4 rad/s. Marks on the sagittally cut brain and skull/rigid potting surfaces were tracked, and peak values of relative brain–skull displacement were extracted and found to be significantly less than values extracted from a previous axial plane model. In a finite element model of the sagittally transected neonatal porcine head, the brain–skull boundary condition was matched to the measured physical experiment data. Despite smaller sagittal plane displacements at the brain–skull boundary, the corresponding finite element boundary condition optimized for sagittal plane rotations is far less stiff than its axial counterpart, likely due to the prominent role of the boundary geometry in restricting interface movement. Finally, bridging veins were included in the finite element model. Varying the bridging vein mechanical behavior over a previously reported range had no influence on the brain–skull boundary displacements. This direction-specific sagittal plane boundary condition can be employed in finite element models of rapid sagittal head rotations. PMID:29515995

Determining the Cost-Savings Threshold and Alignment Accuracy of Patient-Specific Instrumentation in Total Ankle Replacements.

PubMed

Hamid, Kamran S; Matson, Andrew P; Nwachukwu, Benedict U; Scott, Daniel J; Mather, Richard C; DeOrio, James K

2017-01-01

Traditional intraoperative referencing for total ankle replacements (TARs) involves multiple steps and fluoroscopic guidance to determine mechanical alignment. Recent adoption of patient-specific instrumentation (PSI) allows for referencing to be determined preoperatively, resulting in less steps and potentially decreased operative time. We hypothesized that usage of PSI would result in decreased operating room time that would offset the additional cost of PSI compared with standard referencing (SR). In addition, we aimed to compare postoperative radiographic alignment between PSI and SR. Between August 2014 and September 2015, 87 patients undergoing TAR were enrolled in a prospectively collected TAR database. Patients were divided into cohorts based on PSI vs SR, and operative times were reviewed. Radiographic alignment parameters were retrospectively measured at 6 weeks postoperatively. Time-driven activity-based costing (TDABC) was used to derive direct costs. Cost vs operative time-savings were examined via 2-way sensitivity analysis to determine cost-saving thresholds for PSI applicable to a range of institution types. Cost-saving thresholds defined the price of PSI below which PSI would be cost-saving. A total of 35 PSI and 52 SR cases were evaluated with no significant differences identified in patient characteristics. Operative time from incision to completion of casting in cases without adjunct procedures was 127 minutes with PSI and 161 minutes with SR ( P < .05). PSI demonstrated similar postoperative accuracy to SR in coronal tibial-plafond alignment (1.1 vs 0.3 degrees varus, P = .06), tibial-plafond alignment (0.3 ± 2.1 vs 1.1 ± 2.1 degrees varus, P = .06), and tibial component sagittal alignment (0.7 vs 0.9 degrees plantarflexion, P = .14). The TDABC method estimated a PSI cost-savings threshold range at our institution of $863 below which PSI pricing would provide net cost-savings. Two-way sensitivity analysis generated a globally applicable cost-savings threshold model based on institution-specific costs and surgeon-specific time-savings. This study demonstrated equivalent postoperative TAR alignment with PSI and SR referencing systems but with a significant decrease in operative time with PSI. Based on TDABC and associated sensitivity analysis, a cost-savings threshold of $863 was identified for PSI pricing at our institution below which PSI was less costly than SR. Similar internal cost accounting may benefit health care systems for identifying cost drivers and obtaining leverage during price negotiations. Level III, therapeutic study.

Reliability and reproducibility analysis of the Cobb angle and assessing sagittal plane by computer-assisted and manual measurement tools.

PubMed

Wu, Weifei; Liang, Jie; Du, Yuanli; Tan, Xiaoyi; Xiang, Xuanping; Wang, Wanhong; Ru, Neng; Le, Jinbo

2014-02-06

Although many studies on reliability and reproducibility of measurement have been performed on coronal Cobb angle, few results about reliability and reproducibility are reported on sagittal alignment measurement including the pelvis. We usually use SurgimapSpine software to measure the Cobb angle in our studies; however, there are no reports till date on its reliability and reproducible measurements. Sixty-eight standard standing posteroanterior whole-spine radiographs were reviewed. Three examiners carried out the measurements independently under the settings of manual measurement on X-ray radiographies and SurgimapSpine software on the computer. Parameters measured included pelvic incidence, sacral slope, pelvic tilt, Lumbar lordosis (LL), thoracic kyphosis, and coronal Cobb angle. SPSS 16.0 software was used for statistical analyses. The means, standard deviations, intraclass and interclass correlation coefficient (ICC), and 95% confidence intervals (CI) were calculated. There was no notable difference between the two tools (P = 0.21) for the coronal Cobb angle. In the sagittal plane parameters, the ICC of intraobserver reliability for the manual measures varied from 0.65 (T2-T5 angle) to 0.95 (LL angle). Further, for SurgimapSpine tool, the ICC ranged from 0.75 to 0.98. No significant difference in intraobserver reliability was found between the two measurements (P > 0.05). As for the interobserver reliability, measurements with SurgimapSpine tool had better ICC (0.71 to 0.98 vs 0.59 to 0.96) and Pearson's coefficient (0.76 to 0.99 vs 0.60 to 0.97). The reliability of SurgimapSpine measures was significantly higher in all parameters except for the coronal Cobb angle where the difference was not significant (P > 0.05). Although the differences between the two methods are very small, the results of this study indicate that the SurgimapSpine measurement is an equivalent measuring tool to the traditional manual in coronal Cobb angle, but is advantageous in spino-pelvic measurement in T2-T5, PT, PI, SS, and LL.

Reliability and reproducibility analysis of the Cobb angle and assessing sagittal plane by computer-assisted and manual measurement tools

PubMed Central

2014-01-01

Background Although many studies on reliability and reproducibility of measurement have been performed on coronal Cobb angle, few results about reliability and reproducibility are reported on sagittal alignment measurement including the pelvis. We usually use SurgimapSpine software to measure the Cobb angle in our studies; however, there are no reports till date on its reliability and reproducible measurements. Methods Sixty-eight standard standing posteroanterior whole-spine radiographs were reviewed. Three examiners carried out the measurements independently under the settings of manual measurement on X-ray radiographies and SurgimapSpine software on the computer. Parameters measured included pelvic incidence, sacral slope, pelvic tilt, Lumbar lordosis (LL), thoracic kyphosis, and coronal Cobb angle. SPSS 16.0 software was used for statistical analyses. The means, standard deviations, intraclass and interclass correlation coefficient (ICC), and 95% confidence intervals (CI) were calculated. Results There was no notable difference between the two tools (P = 0.21) for the coronal Cobb angle. In the sagittal plane parameters, the ICC of intraobserver reliability for the manual measures varied from 0.65 (T2–T5 angle) to 0.95 (LL angle). Further, for SurgimapSpine tool, the ICC ranged from 0.75 to 0.98. No significant difference in intraobserver reliability was found between the two measurements (P > 0.05). As for the interobserver reliability, measurements with SurgimapSpine tool had better ICC (0.71 to 0.98 vs 0.59 to 0.96) and Pearson’s coefficient (0.76 to 0.99 vs 0.60 to 0.97). The reliability of SurgimapSpine measures was significantly higher in all parameters except for the coronal Cobb angle where the difference was not significant (P > 0.05). Conclusion Although the differences between the two methods are very small, the results of this study indicate that the SurgimapSpine measurement is an equivalent measuring tool to the traditional manual in coronal Cobb angle, but is advantageous in spino-pelvic measurement in T2-T5, PT, PI, SS, and LL. PMID:24502397

Knee Joint Loading during Gait in Healthy Controls and Individuals with Knee Osteoarthritis

PubMed Central

Kumar, Deepak; Manal, Kurt T.; Rudolph, Katherine S.

2013-01-01

Objective People with knee osteoarthritis (OA) are thought to walk with high loads at the knee which are yet to be quantfied using modeling techniques that account for subject specific EMG patterns, kinematics and kinetics. The objective was to estimate medial and lateral loading for people with knee OA and controls using an approach that is sensitive to subject specific muscle activation patterns. Methods 16 OA and 12 control (C) subjects walked while kinematic, kinetic and EMG data were collected. Muscle forces were calculated using an EMG-Driven model and loading was calculated by balancing the external moments with internal muscle and contact forces Results OA subjects walked slower and had greater laxity, static and dynamic varus alignment, less flexion and greater knee adduction moment (KAM). Loading (normalized to body weight) was no different between the groups but OA subjects had greater absolute medial load than controls and maintained a greater %total load on the medial compartment. These patterns were associated with body mass, sagittal and frontal plane moments, static alignment and close to signficance for dynamic alignment. Lateral compartment unloading during mid-late stance was observed in 50% of OA subjects. Conclusions Loading for control subjects was similar to data from instrumented prostheses. Knee OA subjects had high medial contact loads in early stance and half of the OA cohort demonstared lateral compartment lift-off. Results suggest that interventions aimed at reducing body weight and dynamic malalignment might be effective in reducing medial compartment loading and establishing normal medio-lateral load sharing patterns. PMID:23182814

Generalized design of a zero-geometric-loss, astigmatism-free, modified four-objective multipass matrix system.

PubMed

Guo, Yin; Sun, LiQun; Yang, Zheng; Liu, Zilong

2016-02-20

During this study we constructed a generalized parametric modified four-objective multipass matrix system (MMS). We used an optical system comprising four asymmetrical spherical mirrors to improve the alignment process. The use of a paraxial equation for the design of the front transfer optics yielded the initial condition for modeling our MMS. We performed a ray tracing simulation to calculate the significant aberration of the system (astigmatism). Based on the calculated meridional and sagittal focus positions, the complementary focusing mirror was easily designed to provide an output beam free of astigmatism. We have presented an example of a 108-transit multipass system (5×7 matrix arrangement) with a relatively larger numerical aperture source (xenon light source). The whole system exhibits zero theoretical geometrical loss when simulated with Zemax software. The MMS construction strategy described in this study provides an anastigmatic output beam and the generalized approach to design a controllable matrix spot pattern on the field mirrors. Asymmetrical reflective mirrors aid in aligning the whole system with high efficiency. With the generalized design strategy in terms of optics configuration and asymmetrical fabrication method in this paper, other kinds of multipass matrix system coupled with different sources and detector systems also can be achieved.

Quantitative Postural Analysis of Children With Congenital Visual Impairment.

PubMed

de Pádua, Michelle; Sauer, Juliana F; João, Silvia M A

2018-01-01

The aim of this study was to compare the postural alignment of children with visual impairment with that of children without visual impairment. The sample studied was 74 children of both sexes ages 5 to 12 years. Of these, 34 had visual impairment and 40 were control children. Digital photos from the standing position were used to analyze posture. Postural variables, such as tilt of the head, shoulder position, scapula position, lateral deviation of the spine, ankle position in the frontal plane and head posture, angle of thoracic kyphosis, angle of lumbar lordosis, pelvis position, and knee position in the frontal and sagittal planes, were measured with the Postural Assessment Software 0.63, version 36 (SAPO, São Paulo, Brazil), with markers placed in predetermined bony landmarks. The main results of this study showed that children with visual impairment have increased head tilt (P < .001), shoulder deviation in frontal plane (P = .004), lateral deviation of the spine (P < .001), changes in scapula position (P = .012), higher thoracic kyphosis (P = .004), and lower lumbar lordosis (P < .001). Visual impairment influences postural alignment. Children with visual impairment had increased head tilt, uneven shoulders, greater lateral deviation of the spine, thoracic kyphosis, lower lumbar lordosis, and more severe valgus deformities on knees. Copyright © 2017. Published by Elsevier Inc.

Self-Inflicted Drywall Screws in the Sagittal Sinus.

PubMed

Guppy, Kern H; Ochi, Calvin

2018-02-01

A 30-year-old right-handed man with a history of schizophrenia presented with 2 self-inflicted drywall screws in the skull. The patient was sleepy but easily arousable; blood tests showed he had taken methamphetamines. Computed tomography and computed tomography angiography of the head showed the frontal screw abutted left of the superior sagittal sinus, and the posterior screw went through the superior sagittal sinus with no extravasation of contrast material at either site. Both screws were removed with exposure of the sagittal sinus using U-shaped craniectomies. There was no bleeding on the removal of the screws. It appears the posterior screw entered between the leaflets of the sagittal sinus dura mater. The patient had returned to work without any sequelae 1 month after injury. Copyright © 2017 Elsevier Inc. All rights reserved.

Mid-sagittal plane and mid-sagittal surface optimization in brain MRI using a local symmetry measure

NASA Astrophysics Data System (ADS)

Stegmann, Mikkel B.; Skoglund, Karl; Ryberg, Charlotte

2005-04-01

This paper describes methods for automatic localization of the mid-sagittal plane (MSP) and mid-sagittal surface (MSS). The data used is a subset of the Leukoaraiosis And DISability (LADIS) study consisting of three-dimensional magnetic resonance brain data from 62 elderly subjects (age 66 to 84 years). Traditionally, the mid-sagittal plane is localized by global measures. However, this approach fails when the partitioning plane between the brain hemispheres does not coincide with the symmetry plane of the head. We instead propose to use a sparse set of profiles in the plane normal direction and maximize the local symmetry around these using a general-purpose optimizer. The plane is parameterized by azimuth and elevation angles along with the distance to the origin in the normal direction. This approach leads to solutions confirmed as the optimal MSP in 98 percent of the subjects. Despite the name, the mid-sagittal plane is not always planar, but a curved surface resulting in poor partitioning of the brain hemispheres. To account for this, this paper also investigates an optimization strategy which fits a thin-plate spline surface to the brain data using a robust least median of squares estimator. Albeit computationally more expensive, mid-sagittal surface fitting demonstrated convincingly better partitioning of curved brains into cerebral hemispheres.

Does correction of preoperative coronal imbalance make a difference in outcomes of adult patients with deformity?

PubMed

Daubs, Michael D; Lenke, Lawrence G; Bridwell, Keith H; Kim, Yongjung J; Hung, Man; Cheh, Gene; Koester, Linda A

2013-03-15

Retrospective study with prospectively collected outcomes data. Determine the significance of coronal balance on spinal deformity surgery outcomes. Sagittal balance has been confirmed as an important radiographic parameter correlating with adult deformity treatment outcomes. The significance of coronal balance on functional outcomes is less clear. Eighty-five patients with more than 4 cm of coronal imbalance who underwent reconstructive spinal surgery were evaluated to determine the significance of coronal balance on functional outcomes as measured with the Oswestry Disability Index (ODI) and Scoliosis Research Society outcomes questionnaires. Sixty-two patients had combined coronal (>4 cm) and sagittal imbalance (>5 cm), while 23 patients had coronal imbalance alone. Postoperatively, 85% of patients demonstrated improved coronal balance. The mean improvement in the coronal C7 plumb line was 26 mm for a mean correction of 42%. The mean preoperative sagittal C7 plumb line in patients with combined coronal and sagittal imbalance was 118 mm (range, 50-310 mm) and improved to a mean 49 mm. The mean preoperative and postoperative ODI scores were 42 (range, 0-90) and 27 (range, 0-78), for a mean improvement of 15 (36%) (P = 0.00001; 95% CI, 12-20). The mean Scoliosis Research Society scores improved by 17 points (29%) (P = 0.00). Younger age (P = 0.008) and improvement in sagittal balance (P = 0.014) were positive predictors for improved ODI scores. Improvement in sagittal balance (P = 0.010) was a positive predictor for improved Scoliosis Research Society scores. In patients with combined coronal and sagittal imbalance, improvement in sagittal balance was the most significant predictor for improved ODI scores (P = 0.009). In patients with preoperative coronal imbalance alone, improvement in coronal balance trended toward, but was not a significant predictor for improved ODI (P = 0.092). Sagittal balance improvement is the strongest predictor of improved outcomes in patients with combined coronal and sagittal imbalance. In patients with coronal imbalance alone, improvement in coronal balance was not a factor for predicting improved functional outcomes.

Cervical lordotic alignment following posterior spinal fusion for adolescent idiopathic scoliosis: reciprocal changes and risk factors for malalignment.

PubMed

Hayashi, Kazunori; Toyoda, Hiromitsu; Terai, Hidetomi; Suzuki, Akinobu; Hoshino, Masatoshi; Tamai, Koji; Ohyama, Shoichiro; Nakamura, Hiroaki

2017-04-01

OBJECTIVE Numerous reports have been published on the effectiveness and safety of correction of the coronal Cobb angle and thoracolumbar sagittal alignment in patients with adolescent idiopathic scoliosis (AIS). Suboptimal sagittal alignment, such as decreased thoracic kyphosis (TK), after corrective surgery, is a possible cause of lumbar or cervical spinal degeneration and junctional malalignment; however, few reports are available on reciprocal changes outside of the fused segments, such as the cervical lordotic angle (CLA). This study aimed to investigate the relationship between the perioperative CLA and other radiographic factors or clinical results in AIS, and to identify independent risk factors of postoperative cervical hyperkyphosis. METHODS A total of 51 AIS patients who underwent posterior spinal fusion with the placement of pedicle screw (PS) constructs at thoracic levels were included in the study. Clinical and radiographic follow-up of patients was conducted for a minimum of 2 years, and the postoperative course was evaluated. The authors measured and identified the changes in the CLA and other radiographic parameters using whole-spine radiography, with the patient in the standing position, performed immediately before surgery, 2 weeks after surgery, and 2 years after surgery. The postoperative cervical hyperkyphosis group included patients whose CLA at 2-year follow-up was smaller than -10°. The reciprocal changes of the CLA and other parameters were also investigated. Univariate and multivariate analyses were conducted to determine the associated risk factors for postoperative cervical hyperkyphosis. RESULTS This study comprised 48 females and 3 males (mean age 16.0 years). The mean follow-up period was 47 months (range 24-90 months). The main coronal thoracic curve was corrected from 54.6° to 16.4°, and the mean correction rate was 69.8% at 2 years. The CLA significantly increased from the mean preoperative measurement (-5.4° ± 14°) to the 2-year follow-up measurement (-1.7° ± 11°) (p = 0.019). Twelve of the 51 patients had postoperative cervical hyperkyphosis. This group exhibited significantly smaller preoperative CLA and TK measurements (p = 0.001 and 0.004, respectively) than the others. After adjusting for confounding factors, preoperative CLA less than -5° and preoperative TK less than 10° were significantly associated with postoperative cervical hyperkyphosis (p < 0.05; OR 12.5 and 8.59, respectively). However, no differences were found in the clinical results regardless of cervical hyperkyphosis. CONCLUSIONS The CLA increased significantly from preoperatively to 2 years after surgery. Preoperative small CLA and TK measurements were independent risk factors of postoperative cervical hyperkyphosis. However, there was no difference in the clinical outcomes regardless of cervical hyperkyphosis.

The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis.

PubMed

Chun, Se-Woong; Lim, Chai-Young; Kim, Keewon; Hwang, Jinseub; Chung, Sun G

2017-08-01

Clinicians regard lumbar lordotic curvature (LLC) with respect to low back pain (LBP) in a contradictory fashion. The time-honored point of view is that LLC itself, or its increment, causes LBP. On the other hand, recently, the biomechanical role of LLC has been emphasized, and loss of lordosis is considered a possible cause of LBP. The relationship between LLC and LBP has immense clinical significance, because it serves as the basis of therapeutic exercises for treating and preventing LBP. This study aimed to (1) determine the difference in LLC in those with and without LBP and (2) investigate confounding factors that might affect the association between LLC and LBP. Systematic review and meta-analysis. The inclusion criteria consisted of observational studies that included information on lumbar lordotic angle (LLA) assessed by radiological image, in both patients with LBP and healthy controls. Studies solely involving pediatric populations, or addressing spinal conditions of nondegenerative causes, were excluded. A systematic electronic search of Medline, Embase, Cochrane Library, CINAHL, Scopus, PEDro, and Web of Science using terms related to lumbar alignment and Boolean logic was performed: (lumbar lordo*) or (lumbar alignment) or (sagittal alignment) or (sagittal balance). Standardized mean differences (SMD) and 95% confidence intervals (CI) were estimated, and chi-square and I 2 statistics were used to assess within-group heterogeneity by random effects model. Additionally, the age and gender of participants, spinal disease entity, and the severity and duration of LBP were evaluated as possible confounding factors. A total of 13 studies consisting of 796 patients with LBP and 927 healthy controls were identified. Overall, patients with LBP tended to have smaller LLA than healthy controls. However, the studies were heterogeneous. In the meta-regression analysis, the factors of age, severity of LBP, and spinal disease entity were revealed to contribute significantly to variance between studies. In the subgroup analysis of the five studies that compared patients with disc herniation or degeneration with healthy controls, patients with LBP had smaller LLA (SMD: -0.94, 95% CI: -1.19 to -0.69), with sufficient homogeneity based on significance level of .1 (I 2 =45.7%, p=.118). In the six age-matched studies, patients with LBP had smaller LLA than healthy controls (SMD: -0.33, 95% CI: -0.46 to -0.21), without statistical heterogeneity (I 2 =0%, p=.916). This meta-analysis demonstrates a strong relationship between LBP and decreased LLC, especially when compared with age-matched healthy controls. Among specific diseases, LBP by disc herniation or degeneration was shown to be substantially associated with the loss of LLC. Copyright © 2017 Elsevier Inc. All rights reserved.

Cervical vertebrae maturation index estimates on cone beam CT: 3D reconstructions vs sagittal sections.

PubMed

Bonfim, Marco A E; Costa, André L F; Fuziy, Acácio; Ximenez, Michel E L; Cotrim-Ferreira, Flávio A; Ferreira-Santos, Rívea I

2016-01-01

The aim of this study was to evaluate the performance of CBCT three-dimensional (3D) reconstructions and sagittal sections for estimates of cervical vertebrae maturation index (CVMI). The sample consisted of 72 CBCT examinations from patients aged 8-16 years (45 females and 27 males) selected from the archives of two private clinics. Two calibrated observers (kappa scores: ≥0.901) interpreted the CBCT settings twice. Intra- and interobserver agreement for both imaging exhibition modes was analyzed by kappa statistics, which was also used to analyze the agreement between 3D reconstructions and sagittal sections. Correlations between cervical vertebrae maturation estimates and chronological age, as well as between the assessments by 3D reconstructions and sagittal sections, were analyzed using gamma Goodman-Kruskal coefficients (α = 0.05). The kappa scores evidenced almost perfect agreement between the first and second assessments of the cervical vertebrae by 3D reconstructions (0.933-0.983) and sagittal sections (0.983-1.000). Similarly, the agreement between 3D reconstructions and sagittal sections was almost perfect (kappa index: 0.983). In most divergent cases, the difference between 3D reconstructions and sagittal sections was one stage of CVMI. Strongly positive correlations (>0.8, p < 0.001) were found not only between chronological age and CVMI but also between the estimates by 3D reconstructions and sagittal sections (p < 0.001). Although CBCT imaging must not be used exclusively for this purpose, it may be suitable for skeletal maturity assessments.

Cervical vertebrae maturation index estimates on cone beam CT: 3D reconstructions vs sagittal sections

PubMed Central

Bonfim, Marco A E; Costa, André L F; Ximenez, Michel E L; Cotrim-Ferreira, Flávio A; Ferreira-Santos, Rívea I

2016-01-01

Objectives: The aim of this study was to evaluate the performance of CBCT three-dimensional (3D) reconstructions and sagittal sections for estimates of cervical vertebrae maturation index (CVMI). Methods: The sample consisted of 72 CBCT examinations from patients aged 8–16 years (45 females and 27 males) selected from the archives of two private clinics. Two calibrated observers (kappa scores: ≥0.901) interpreted the CBCT settings twice. Intra- and interobserver agreement for both imaging exhibition modes was analyzed by kappa statistics, which was also used to analyze the agreement between 3D reconstructions and sagittal sections. Correlations between cervical vertebrae maturation estimates and chronological age, as well as between the assessments by 3D reconstructions and sagittal sections, were analyzed using gamma Goodman–Kruskal coefficients (α = 0.05). Results: The kappa scores evidenced almost perfect agreement between the first and second assessments of the cervical vertebrae by 3D reconstructions (0.933–0.983) and sagittal sections (0.983–1.000). Similarly, the agreement between 3D reconstructions and sagittal sections was almost perfect (kappa index: 0.983). In most divergent cases, the difference between 3D reconstructions and sagittal sections was one stage of CVMI. Strongly positive correlations (>0.8, p < 0.001) were found not only between chronological age and CVMI but also between the estimates by 3D reconstructions and sagittal sections (p < 0.001). Conclusions: Although CBCT imaging must not be used exclusively for this purpose, it may be suitable for skeletal maturity assessments. PMID:26509559

Symptomatic vertebral hemangioma in pregnancy treated antepartum. A case report with review of literature

PubMed Central

Vijay, Kamath; Shetty, Ajoy P.

2008-01-01

Pregnancy related compressive myelopathy secondary to vertebral hemangioma is a rare occurrence and its treatment antepartum is rare. We report a 22-year-old lady in her 26th-week of pregnancy who was treated in two stages––antepartum with a laminectomy and posterior stabilization. This resulted in complete recovery of the neurological deficits. She delivered a normal baby after 3 months, following which a corpectomy and fusion was performed. This two-staged approach appears safe and effective in treating symptomatic vertebral haemangiomas causing neurological deficits during pregnancy. A review of relevant literature has been done. PMID:18224354

Is arch form influenced by sagittal molar relationship or Bolton tooth-size discrepancy?

PubMed

Aldrees, Abdullah M; Al-Shujaa, Abdulmajeed M; Alqahtani, Mohammad A; Aljhani, Ali S

2015-06-26

Orthodontic patients show high prevalence of tooth-size discrepancy. This study investigates the possible association between arch form, clinically significant tooth-size discrepancy, and sagittal molar relationship. Pretreatment orthodontic casts of 230 Saudi patients were classified into one of three arch form types (tapered, ovoid, and square) using digitally scanned images of the mandibular arches. Bolton ratio was calculated, sagittal molar relationship was defined according to Angle classification, and correlations were analyzed using ANOVA, chi-square, and t-tests. No single arch form was significantly more common than the others. Furthermore, no association was observed between the presence of significant Bolton discrepancy and the sagittal molar relationship or arch form. Overall Bolton discrepancy is significantly more prevalent in males. Arch form in a Saudi patient group is independent of gender, sagittal molar relationship, and Bolton discrepancy.

The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis.

PubMed

Yagi, Mitsuru; Hosogane, Naobumi; Watanabe, Kota; Asazuma, Takashi; Matsumoto, Morio

2016-04-01

Various factors are reported to affect the spinal alignment in degenerative lumbar scoliosis (DLS). Although trunk muscles also appear to affect spinal alignment, the role of the trunk muscles is not yet clear. The aim was to elucidate the role of the multifidus (MF) and psoas (PS) in maintaining global spinal alignment in patients with DLS. This was a multicenter retrospective matched cohort study. Surgically treated 60 paired DLS and lumbar spinal stenosis (LSS) female (120 patients), matched for age and body mass index (BMI; DLS age 68.0±6.8 vs. LSS 67.1±8.9 years; BMI 21.6±3.3 vs. 23.2±3.8 kg/m(2)), were included and were followed for at least 2 years. Spinal alignment, muscle area, and volume were measured from radiographs, magnetic resonance images (MRIs), and whole-body dual-energy X-ray absorptiometry (DXA) scans. Muscle strength was measured by grip power and peak expiratory flow (PEF). As a surrogate of muscle area, we obtained the cross-sectional area (CSA) at the L5-S level from preoperative MRIs. The MF and PS CSAs were significantly smaller in the DLS group than in the LSS group (MF 477.7±192.5 vs. 779.8±248.6 mm(2), p<.01; PS 692.3±201.2 vs. 943.4±272.4 mm(2), p=.002), whereas percentage of difference between the right and left sides was significantly larger in the DLS group (MF 18.4±30.6 vs. 2.4±3.3%, p<.01; PS 14.4±15.8 vs. 2.1±2.2%, p<.01). In the extremities, there were no significant differences in the left- or right-side lean composition and grip strength or PEF tests between the groups. Correlation coefficient tests showed moderate correlations between the MF average CSA (avCSA) and global spinal alignment and spinopelvic alignment (pelvic incidence-lumbar lordosis; R=-0.37, -0.38) in the DLS group. The MF avCSA was correlated with the postoperative progression of kyphosis at the unfused thoracic vertebrae in the DLS group (R=0.34). The CSAs of the MF and PS were significantly smaller in the DLS group. Whole-body DXA showed no significant difference in the lean composition between the groups. There were significant correlations in the DLS patients between the MF CSA and sagittal spinal alignment. These findings suggest the causal relationship between muscles and global spine alignment. Copyright © 2016 Elsevier Inc. All rights reserved.

Central obesity is an independent predictor of erectile dysfunction in older men.

PubMed

Riedner, Charles Edison; Rhoden, Ernani Luis; Ribeiro, Eduardo Porto; Fuchs, Sandra Costa

2006-10-01

There is a growing body of evidence in the literature correlating erectile dysfunction to obesity. We investigated the correlation of different anthropometric indexes of central obesity to erectile dysfunction. A cross-sectional study was performed including 256 consecutive men 40 years old or older. All men completed the International Index of Erectile Function, and were evaluated routinely with a clinical history, physical examination and blood analysis for fasting serum glucose, lipid profile and serum testosterone. Anthropometric measures included body mass index, waist circumference, sagittal abdominal diameter, maximal abdominal circumference, and waist-hip, waist-thigh, waist-height, sagittal abdominal diameter-thigh and sagittal abdominal diameter-height indexes. In men 40 to 60 years old the different anthropometric indexes of central obesity were not correlated with the presence of erectile dysfunction (p > 0.05). Men older than 60 years (41%, range 61 to 81) demonstrated an association among erectile dysfunction and waist-hip index (p = 0.04), waist-thigh index (p = 0.02), sagittal abdominal diameter (p = 0.03), sagittal abdominal diameter-height index (p = 0.02) and maximal abdominal circumference (p = 0.04). After logistic regression analysis an independent effect on the presence of erectile dysfunction was observed for waist-hip index (OR 8.56, 95% CI 1.44-50.73), sagittal abdominal diameter (OR 7.87, 95% CI 1.24-49.75), sagittal abdominal diameter-height index (OR 14.21, 95% CI 1.11-182.32), maximum abdominal circumference (OR 11.72, 95% CI 1.73-79.18) and waist circumference (OR 19.37, 95% CI 1.15-326.55). This study suggests that central obesity, assessed by several anthropometric indicators, is associated to the presence of erectile dysfunction in men older than 60 years. Sagittal abdominal diameter, sagittal abdominal diameter-height index, maximum abdominal circumference, waist circumference and waist-hip index were useful indicators to predict the presence of erectile dysfunction.

Combined Orthodontic-surgical Treatment for Skeletal Class III Malocclusion with Multiple Impacted Permanent and Supernumerary Teeth: Case Report.

PubMed

Xue, Dai Juan And Feng

2014-01-01

In this report we describe a combined orthodontic and surgical treatment for a 14-year-old boy with severe skeletal class III deformity and dental problem. His upper posterior primary teeth in the left side were over-retained and 6 maxillary teeth (bilateral central incisors and canines, left first and second premolars) were impacted, together with 5 supernumerary teeth in both arches. The treatment protocol involved extraction of all the supernumerary and deciduous teeth, surgical exposure and orthodontic traction of the impacted teeth, a bimaxillary orthognathic approach including Lefort I osteotomy. Bilateral sagittal split ramus osteotomy (BSSRO) and genioplasty was performed to correct skeletal problem. After treatment, all of the impacted teeth were brought to proper alignment in the maxillary arch. A satisfied profile and good posterior occlusion was achieved. Treatment mechanics and consideration during different stages are discussed.

The longitudinal sagittal growth changes of maxilla and mandible according to quantitative cervical vertebral maturation.

PubMed

Chen, Lili; Lin, Jiuxiang; Xu, Tianmin; Long, Xiaosi

2009-04-01

To investigate the longitudinal sagittal growth changes of maxilla and mandible according to the quantitative cervical vertebral maturation (QCVM) for adolescents with normal occlusion, mixed longitudinal data were used. The samples included 87 adolescents aged from 8 to 18 y old with normal occlusion (32 males, 55 females) selected from 901 candidates. Sequential lateral cephalograms and hand-wrist films were taken once a year, lasting for 6 y. The longitudinal sagittal growth changes of maxilla and mandible according to QCVM were measured. There were some significant differences between maxilla and mandible according to QCVM. The sagittal growth change of maxilla showed a trend towards high velocity-->decelerating velocity-->completing velocity from QCVM stage I to stage IV. The sagittal growth change of mandible showed a trend towards accelerating velocity-->high velocity-->decelerating velocity-->completing velocity from QCVM stage I to stage IV. With sagittal relationship, growth magnitude was almost the same between maxilla and mandible at QCVM stage I. At stage II the growth of mandible exceeded that of maxilla and growth in mandible continued at stages III and IV, while the maxilla ceased to grow. Growth magnitude was greater and the growth duration was longer with male mandible. It is concluded that the longitudinal sagittal growth changes of maxilla and mandible on the basis of QCVM is of value in the orthodontic practice.

Landing Biomechanics in Participants With Different Static Lower Extremity Alignment Profiles

PubMed Central

Nguyen, Anh-Dung; Shultz, Sandra J.; Schmitz, Randy J.

2015-01-01

Context: Whereas static lower extremity alignment (LEA) has been identified as a risk factor for anterior cruciate ligament injury, little is known about its influence on joint motion and moments commonly associated with anterior cruciate ligament injury. Objective: To cluster participants according to combinations of LEA variables and compare these clusters in hip- and knee-joint kinematics and kinetics during the landing phase of a drop-jump task. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: A total of 141 participants (50 men: age = 22.2 ± 2.8 years, height = 177.9 ± 9.3 cm, weight = 80.9 ± 13.3 kg; 91 women: age = 21.2 ± 2.6 years, height = 163.9 ± 6.6 cm, weight = 61.1 ± 8.7 kg). Main Outcome Measure(s): Static LEA included pelvic angle, femoral anteversion, quadriceps angle, tibiofemoral angle, genu recurvatum, tibial torsion, and navicular drop. Cluster analysis grouped participants according to their static LEA profiles, and these groups were compared on their hip- and knee-joint kinematics and external moments during the landing phase of a double-legged drop jump. Results: Three distinct clusters (C1–C3) were identified based on their static LEAs. Participants in clusters characterized with static internally rotated hip and valgus knee posture (C1) and externally rotated knee and valgus knee posture (C3) alignments demonstrated greater knee-valgus motion and smaller hip-flexion moments than the cluster with more neutral static alignment (C2). Participants in C1 also experienced greater hip internal-rotation and knee external-rotation moments than those in C2 and C3. Conclusions: Static LEA clusters that are positioned anatomically with a more rotated and valgus knee posture experienced greater dynamic valgus along with hip and knee moments during landing. Whereas static LEA contributes to differences in hip and knee rotational moments, sex may influence the differences in frontal-plane knee kinematics and sagittal-plane hip moments. PMID:25658815

Extensor Tendon Instability Due to Sagittal Band Injury in a Martial Arts Athlete: A Case Report.

PubMed

Kochevar, Andrew; Rayan, Ghazi

2017-03-01

A Taekwondo participant sustained a hand injury from punching an opponent that resulted in painful instability of the ring finger extensor digitorum communis tendon due to sagittal band damage. His symptoms resolved after reconstructive surgery on the sagittal band (SB) with stabilization of the extensor tendon over the metacarpophalangeal joint.

Metatarsal Shape and Foot Type: A Geometric Morphometric Analysis.

PubMed

Telfer, Scott; Kindig, Matthew W; Sangeorzan, Bruce J; Ledoux, William R

2017-03-01

Planus and cavus foot types have been associated with an increased risk of pain and disability. Improving our understanding of the geometric differences between bones in different foot types may provide insights into injury risk profiles and have implications for the design of musculoskeletal and finite-element models. In this study, we performed a geometric morphometric analysis on the geometry of metatarsal bones from 65 feet, segmented from computed tomography (CT) scans. These were categorized into four foot types: pes cavus, neutrally aligned, asymptomatic pes planus, and symptomatic pes planus. Generalized procrustes analysis (GPA) followed by permutation tests was used to determine significant shape differences associated with foot type and sex, and principal component analysis was used to find the modes of variation for each metatarsal. Significant shape differences were found between foot types for all the metatarsals (p < 0.01), most notably in the case of the second metatarsal which showed significant pairwise differences across all the foot types. Analysis of the principal components of variation showed pes cavus bones to have reduced cross-sectional areas in the sagittal and frontal planes. The first (p = 0.02) and fourth metatarsals (p = 0.003) were found to have significant sex-based differences, with first metatarsals from females shown to have reduced width, and fourth metatarsals from females shown to have reduced frontal and sagittal plane cross-sectional areas. Overall, these findings suggest that metatarsal bones have distinct morphological characteristics that are associated with foot type and sex, with implications for our understanding of anatomy and numerical modeling of the foot.

Six degree-of-freedom knee joint kinematics in obese individuals with knee pain during gait.

PubMed

Li, Jing-Sheng; Tsai, Tsung-Yuan; Felson, David T; Li, Guoan; Lewis, Cara L

2017-01-01

Knee joint pain is a common symptom in obese individuals and walking is often prescribed as part of management programs. Past studies in obese individuals have focused on standing alignment and kinematics in the sagittal and coronal planes. Investigation of 6 degree-of-freedom (6DOF) knee joint kinematics during standing and gait is important to thoroughly understand knee function in obese individuals with knee pain. This study aimed to investigate the 6DOF knee joint kinematics in standing and during gait in obese patients using a validated fluoroscopic imaging system. Ten individuals with obesity and knee pain were recruited. While standing, the knee was in 7.4±6.3°of hyperextension, 2.8±3.3° of abduction and 5.6±7.3° of external rotation. The femoral center was located 0.7±3.1mm anterior and 5.1±1.5mm medial to the tibial center. During treadmill gait, the sagittal plane motion, i.e., flexion/extension and anterior-posterior translation, showed a clear pattern. Specifically, obese individuals with knee pain maintained the knee in more flexion and more anterior tibial translation during most of the stance phase of the gait cycle and had a reduced total range of knee flexion when compared to a healthy non-obese group. In conclusion, obese individuals with knee pain used hyperextension knee posture while standing, but maintained the knee in more flexion during gait with reduced overall range of motion in the 6DOF analysis.

Six degree-of-freedom knee joint kinematics in obese individuals with knee pain during gait

PubMed Central

Li, Jing-Sheng; Tsai, Tsung-Yuan; Felson, David T.; Li, Guoan; Lewis, Cara L.

2017-01-01

Knee joint pain is a common symptom in obese individuals and walking is often prescribed as part of management programs. Past studies in obese individuals have focused on standing alignment and kinematics in the sagittal and coronal planes. Investigation of 6 degree-of-freedom (6DOF) knee joint kinematics during standing and gait is important to thoroughly understand knee function in obese individuals with knee pain. This study aimed to investigate the 6DOF knee joint kinematics in standing and during gait in obese patients using a validated fluoroscopic imaging system. Ten individuals with obesity and knee pain were recruited. While standing, the knee was in 7.4±6.3°of hyperextension, 2.8±3.3° of abduction and 5.6±7.3° of external rotation. The femoral center was located 0.7±3.1mm anterior and 5.1±1.5mm medial to the tibial center. During treadmill gait, the sagittal plane motion, i.e., flexion/extension and anterior-posterior translation, showed a clear pattern. Specifically, obese individuals with knee pain maintained the knee in more flexion and more anterior tibial translation during most of the stance phase of the gait cycle and had a reduced total range of knee flexion when compared to a healthy non-obese group. In conclusion, obese individuals with knee pain used hyperextension knee posture while standing, but maintained the knee in more flexion during gait with reduced overall range of motion in the 6DOF analysis. PMID:28339477

Comparison of patellofemoral outcomes after TKA using two prostheses with different patellofemoral design features.

PubMed

Bae, Dae Kyung; Baek, Jong Hun; Yoon, Kyung Tack; Son, Hyuck Sung; Song, Sang Jun

2017-12-01

The purpose of the present study was to compare the clinical and radiographic results after TKA using two prostheses with different sagittal patellofemoral design features, including outcomes related to compatibility of the patellofemoral joint. The clinical and radiographic results of 81 patients (100 knees) who underwent TKA using the specific prosthesis (group A) were compared with those in a control group who underwent TKA using the other prosthesis (group B). The presence of anterior knee joint pain, patellar crepitation, and patellar clunk syndrome was also checked. The function score and maximum flexion angle at the last follow-up were slightly better in group A than those in group B (92.0 ± 2.3 vs. 90.6 ± 4.2) (133.6° ± 8.4° vs. 129.6° ± 11.4°). Anterior knee pain was observed in 6 knees and patellar crepitation in four knees in group A. In group B, these symptoms were observed in 22 knees and 18 knees, respectively. There was no patellar clunk syndrome in either group. The alignment was corrected with satisfactory positioning of components. The patellar height remained unchanged after TKA in the two groups. The differences between preoperative and postoperative patellar tilt angle and patellar translation were small. When comparing the clinical and radiographic results after TKA using two prostheses with different sagittal patellofemoral design features, TKA using the specific prosthesis provided satisfactory results with less clinical symptoms related to the patellofemoral kinematics with TKA using the other prosthesis. III.

Carrying a rucksack on either shoulder or the back, does it matter? Load induced functional scoliosis in "normal" young subjects.

PubMed

Bettany-Saltikov, J; Warren, J; Stamp, M

2008-01-01

Approximately 40 million students in the United States and a similar number in Europe carry school rucksacks. The average student carries a rucksack weighing almost one fourth of his or her body weight. This has led to more than 7,000 A&E, referrals each year related to carrying school bags in the US. The purpose of this study was to investigate the effects of carrying a rucksack (on each shoulder or on both), on 3D spinal curvature in healthy young students. A convenience sample of 30 healthy young adults participated in this study. A Microscribe 3DX digitiser recorded the three dimensional coordinates of thirteen key anatomical landmarks along the spine in four different loading conditions; no rucksack (reference) carrying a rucksack (17% body weight) simultaneously on both shoulders and solely on the right or the left shoulder. The data obtained was analyzed using standard statistical methods. Carrying the load on both shoulders resulted in no difference in the frontal plane angle but significantly decreased the thoracic kyphosis in the sagittal plane. However, carrying the load on the right shoulder significantly increased the thoracic lateral curvature in the frontal plane and decreased the thoracic kyphosis in the sagittal plane. This study confirms that even carrying a 17% load causes significant changes in spinal alignment. It is essential that Health and Safety professionals promote the awareness and effects of diverse rucksack carriage modes and excessive rucksack weight to avoid the early onset of low back pain.

Effect of stretching program in an industrial workplace on hamstring flexibility and sagittal spinal posture of adult women workers: a randomized controlled trial.

PubMed

Muyor, José M; López-Miñarro, Pedro A; Casimiro, Antonio J

2012-01-01

To determine the effect of a stretching program performed in the workplace on the hamstring muscle extensibility and sagittal spinal posture of adult women. Fifty-eight adult women volunteers (mean age of 44.23 ± 8.87 years) from a private fruit and vegetable company were randomly assigned to experimental (n=27) or control (n=31) groups. The experimental group performed three exercises of hamstrings stretching of 20 seconds per exercise, three sessions a week for a period of 12 weeks. The control group did not participate in any hamstring stretching program. Hamstring flexibility was evaluated through the passive straight leg raise test and toe-touch test, performed both before and after the stretching program. Thoracic and lumbar curvatures and pelvic inclination were measured in relaxed standing and toe-touch test with a Spinal Mouse. Significant increases (p < 0.01) in toe-touch score and straight leg raise angle (in both legs) were found in the experimental group during post-test, while the control group showed a non-significant decrease for both toe-touch score and straight leg raise test. A significant decrease in thoracic curve and significant increase in pelvic inclination were found in the toe-touch test for the experimental group (p <0.05). However, no significant changes were found in standing posture for any group. Hamstring stretching exercises performed in the working place are effective for increasing hamstring muscle extensibility. This increase generates a more aligned thoracic curve and more anterior pelvic inclination when maximal trunk flexion is performed.

Influence of implant rod curvature on sagittal correction of scoliosis deformity.

PubMed

Salmingo, Remel Alingalan; Tadano, Shigeru; Abe, Yuichiro; Ito, Manabu

2014-08-01

Deformation of in vivo-implanted rods could alter the scoliosis sagittal correction. To our knowledge, no previous authors have investigated the influence of implanted-rod deformation on the sagittal deformity correction during scoliosis surgery. To analyze the changes of the implant rod's angle of curvature during surgery and establish its influence on sagittal correction of scoliosis deformity. A retrospective analysis of the preoperative and postoperative implant rod geometry and angle of curvature was conducted. Twenty adolescent idiopathic scoliosis patients underwent surgery. Average age at the time of operation was 14 years. The preoperative and postoperative implant rod angle of curvature expressed in degrees was obtained for each patient. Two implant rods were attached to the concave and convex side of the spinal deformity. The preoperative implant rod geometry was measured before surgical implantation. The postoperative implant rod geometry after surgery was measured by computed tomography. The implant rod angle of curvature at the sagittal plane was obtained from the implant rod geometry. The angle of curvature between the implant rod extreme ends was measured before implantation and after surgery. The sagittal curvature between the corresponding spinal levels of healthy adolescents obtained by previous studies was compared with the implant rod angle of curvature to evaluate the sagittal curve correction. The difference between the postoperative implant rod angle of curvature and normal spine sagittal curvature of the corresponding instrumented level was used to evaluate over or under correction of the sagittal deformity. The implant rods at the concave side of deformity of all patients were significantly deformed after surgery. The average degree of rod deformation Δθ at the concave and convex sides was 15.8° and 1.6°, respectively. The average preoperative and postoperative implant rod angle of curvature at the concave side was 33.6° and 17.8°, respectively. The average preoperative and postoperative implant rod angle of curvature at the convex side was 25.5° and 23.9°, respectively. A significant relationship was found between the degree of rod deformation and preoperative implant rod angle of curvature (r=0.60, p<.005). The implant rods at the convex side of all patients did not have significant deformation. The results indicate that the postoperative sagittal outcome could be predicted from the initial rod shape. Changes in implant rod angle of curvature may lead to over- or undercorrection of the sagittal curve. Rod deformation at the concave side suggests that corrective forces acting on that side are greater than the convex side. Copyright © 2014 Elsevier Inc. All rights reserved.

A clinico-radiographic analysis of sagittal condylar guidance determined by protrusive interocclusal registration and panoramic radiographic images in humans

PubMed Central

Prasad, Krishna D.; Shah, Namrata; Hegde, Chethan

2012-01-01

Purpose: To evaluate the correlation between sagittal condylar guidance obtained by protrusive interocclusal records and panoramic radiograph tracing methods in human dentulous subjects. Materials and Methods: The sagittal condylar guidance was determined in 75 dentulous subjects by protrusive interocclusal records using Aluwax through a face bow transfer (HANAU™ Spring Bow, Whip Mix Corporation, USA) to a semi-adjustable articulator (HANAU™ Wide-Vue Articulator, Whip Mix Corporation, USA). In the same subjects, the sagittal outline of the articular eminence and glenoid fossa was traced in panoramic radiographs. The sagittal condylar path inclination was constructed by joining the heights of curvature in the glenoid fossa and the corresponding articular eminence. This was then related to the constructed Frankfurt's horizontal plane to determine the radiographic angle of sagittal condylar guidance. Results: A strong positive correlation existed between right and left condylar guidance by the protrusive interocclusal method (P 0.000) and similarly by the radiographic method (P 0.013). The mean difference between the condylar guidance obtained using both methods were 1.97° for the right side and 3.18° for the left side. This difference between the values by the two methods was found to be highly significant for the right (P 0.003) and left side (P 0.000), respectively. The sagittal condylar guidance obtained from both methods showed a significant positive correlation on right (P 0.000) and left side (P 0.015), respectively. Conclusion: Panoramic radiographic tracings of the sagittal condylar path guidance may be made relative to the Frankfurt's horizontal reference plane and the resulting condylar guidance angles used to set the condylar guide settings of semi-adjustable articulators. PMID:23633793

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ball, J.B. Jr.

Direct oblique sagittal CT was used to evaluate trauma to 77 orbits. Sixty-seven orbital wall fractures with intact orbital rims (36 floor, 22 medial wall, nine roof) were identified in 47 orbits. Since persistent diplopia and/or enophthalmos may warrant surgical repair of orbital floor fractures, optimal imaging should include an evaluation of extraocular muscle status, the nature and amount of displaced orbital contents, and an accurate definition of fracture margins. For orbital floor fractures, a combination of the direct oblique sagittal and direct coronal projections optimally displayed all fracture margins, the fracture's relationship to the inferior orbital rim and medialmore » orbital wall, and the amount of displacement into the maxillary sinus. Inferior rectus muscle status with 36 floor fractures was best seen on the direct oblique sagittal projection in 30 fractures (83.3%) and was equally well seen on sagittal and coronal projections in two fractures (5.5%). Floor fractures were missed on 100% of axial, 5.5% of sagittal, and 0% of coronal projections. Since the direct oblique sagittal projection complements the direct coronal projection in evaluating orbital floor fractures, it should not be performed alone. A technical approach to the CT evaluation or orbital wall fractures is presented.« less

Stability and alignment do not improve by using patient-specific instrumentation in total knee arthroplasty: a randomized controlled trial.

PubMed

Kosse, Nienke M; Heesterbeek, Petra J C; Schimmel, Janneke J P; van Hellemondt, Gijs G; Wymenga, Ate B; Defoort, Koen C

2018-06-01

The primary aim of the study was to examine stability and alignment after total knee arthroplasty (TKA) using patient-specific instrumentation (PSI) and conventional instrumentation (CI). The hypothesis was that stability and alignment would be better using PSI than CI, 12 months postoperatively. The secondary aim included the evaluation of clinical outcomes after TKA. In this prospective randomized controlled trial, 42 patients with knee osteoarthritis received a Genesis II PS prosthesis with either PSI or CI. Patients visited the hospital preoperatively and postoperatively after 6 weeks and 3 and 12 months. To evaluate stability, varus-valgus laxity was determined in extension and flexion using stress radiographs 12 months postoperatively. Three months postoperatively, a long-leg radiograph and CT scan were obtained to measure hip-knee-ankle (HKA) alignment and component rotation. Furthermore, frontal and sagittal alignment of the components, the Knee Society Score, VAS Pain, VAS Satisfaction, Knee injury and Osteoarthritis Outcome score, Patella score (Kujala), University of California Los Angeles activity score, anterior-posterior laxity, (serious) adverse device-related events, and intraoperative complications were reported. The clinical outcomes were compared using independent t tests or non-parametric alternatives, and repeated measurements ANOVA with a significance level of p < 0.05. No significant differences were found between the two groups regarding stability, HKA angle, and rotational alignment. In four patients, the PSI did not fit correctly on the tibia and/or femur requiring intraoperative modifications. Both groups improved significantly over time on all clinical outcomes, with no significant differences between the groups 12 months postoperatively. The PSI group showed less tibial slope than the patients in the CI group [PSI 2.6° versus CI 4.8° (p = 0.02)]. Finally, the PSI group more frequently received a thinner insert size than the CI group (p = 0.03). Patients operated with PSI did not differ from CI in terms of stability and alignment. However, in the PSI group ligament releases were more often required intraoperatively. Furthermore, the two methods did not show different clinical results. It seems that the preoperative planning for the PSI facilitates more conservative bone cuts than CI, but whether this is clinically relevant should be investigated. Since PSI is more expensive and time consuming than CI, and does not outperform CI with regard to clinical results, we recommend to use CI. I.

Comparison of prostate contours between conventional stepping transverse imaging and Twister-based sagittal imaging in permanent interstitial prostate brachytherapy.

PubMed

Kawakami, Shogo; Ishiyama, Hiromichi; Satoh, Takefumi; Tsumura, Hideyasu; Sekiguchi, Akane; Takenaka, Kouji; Tabata, Ken-Ichi; Iwamura, Masatsugu; Hayakawa, Kazushige

2017-08-01

To compare prostate contours on conventional stepping transverse image acquisitions with those on twister-based sagittal image acquisitions. Twenty prostate cancer patients who were planned to have permanent interstitial prostate brachytherapy were prospectively accrued. A transrectal ultrasonography probe was inserted, with the patient in lithotomy position. Transverse images were obtained with stepping movement of the transverse transducer. In the same patient, sagittal images were also obtained through rotation of the sagittal transducer using the "Twister" mode. The differences of prostate size among the two types of image acquisitions were compared. The relationships among the difference of the two types of image acquisitions, dose-volume histogram (DVH) parameters on the post-implant computed tomography (CT) analysis, as well as other factors were analyzed. The sagittal image acquisitions showed a larger prostate size compared to the transverse image acquisitions especially in the anterior-posterior (AP) direction ( p < 0.05). Interestingly, relative size of prostate apex in AP direction in sagittal image acquisitions compared to that in transverse image acquisitions was correlated to DVH parameters such as D 90 ( R = 0.518, p = 0.019), and V 100 ( R = 0.598, p = 0.005). There were small but significant differences in the prostate contours between the transverse and the sagittal planning image acquisitions. Furthermore, our study suggested that the differences between the two types of image acquisitions might correlated to dosimetric results on CT analysis.

Reliability of the xipho-pubic angle in patients with sagittal imbalance of the spine.

PubMed

Langella, Francesco; Villafañe, Jorge H; Ismael, Maryem; Buric, Josip; Piazzola, Andrea; Lamartina, Claudio; Berjano, Pedro

2018-04-01

Proximal junctional kyphosis (PJK) is a frequent complication that compromises the outcomes of spinal surgery, especially for adult deformity. To the date no single risk factor or cause has been identified that explains its occurrence. The purpose of this study was to investigate the test-retest reliability of the radiologic measurements using xipho-pubic angle (XPA) for subjects undergoing surgery for sagittal misalignment of the spine. Retrospective observational cross-sectional study of prospectively collected data. Full-spine standing lateral radiographs of 50 patients who underwent surgery for fixed sagittal imbalance (preoperative and postoperative) were evaluated. Internal consistency, reproducibility, concurrent validity, and discriminative ability of the XPA. Two physicians measured XPA on the 100 randomly sorted and anonymized radiographs on two occasions, one week apart (test and retest conditions), were calculated for inter and intraobserver agreement. Test-retest reliability of XPA measurement was excellent for pre- (ICC=0.98; P=0.001) and post-surgical (ICC=0.86; P=0.001) radiographs of subjects with sagittal imbalance of the spine. XPA was able to discriminate between preoperative and postoperative radiographs F=17.924, P<0.001) in patients undergoing surgery for fixed sagittal imbalance for both raters. There were significant differences between pre- vs. postoperative XPA, pelvic tilt, lumbar lordosis and sagittal vertical axis values (all P<0.001). Xipho-pubic angle had fair to excellent test-retest reliability, and it did possess validity to discriminate between preoperative and postoperative radiographs in patients undergoing surgery for fixed sagittal imbalance.

Cephalometric Evaluation of the Hyoid Bone Position in Lebanese Healthy Young Adults.

PubMed

Daraze, Antoine

2018-05-01

The objectives of this study are to assess hyoid sagittal and vertical position, and potential correlations with gender, skeletal class, and anthropometrics. Twenty-seven cephalometric linear, angular, and ratio measurements for the hyoid were recorded on lateral cephalograms obtained from 117 healthy young Lebanese adults. Anthropometric parameters including height, weight, body mass index (BMI), and neck circumference (NC) were measured. Statistically significant gender differences were demonstrated for 21 out of 27 parameters considered. All linear and two out of three angular measurements defining the vertical hyoid position were larger in males compared with females. Five linear, one angular, and two ratio measurements showed differences in the sagittal dimension. Skeletal classes did not influence the sagittal and vertical hyoid position. Anthropometric variables as height were strongly correlated to the vertical hyoid position, while weight correlated more sagittally. Cephalometric norms for hyoid position were established, sexual dimorphism and ethnic differences were demonstrated. Skeletal patterns did not influence the sagittal and vertical hyoid bone position. Anthropometric parameters, such as BMI correlated the least to both vertical and sagittal hyoid position measurements, while the impact of height and weight as separate entities made a paradigm shift providing accurate and strong correlation of the vertical hyoid position to the height, and the sagittal hyoid position to the weight of individuals. The cephalometric norms for the hyoid bone position in the Lebanese population established in the present study are of paramount clinical importance and should be considered in planning combined orthodontic and breathing disorders treatments.

Posture Alignment of Adolescent Idiopathic Scoliosis: Photogrammetry in Scoliosis School Screening.

PubMed

Penha, Patrícia Jundi; Penha, Nárima Lívia Jundi; De Carvalho, Bárbarah Kelly Gonçalves; Andrade, Rodrigo Mantelatto; Schmitt, Ana Carolina Basso; João, Sílvia Maria Amado

The objective of this study was to describe the posture patterns of adolescents diagnosed with adolescent idiopathic scoliosis (AIS) in a scoliosis school screening (SSS). Two-dimensional photogrammetry was used to assess the posture of 37 adolescents diagnosed with scoliosis (scoliosis group, SG) (Cobb angle ≥10°) and 76 adolescents with a false positive diagnosis (false positive group, FPG) (Cobb angle <10°, angle of trunk rotation ≥7°). In total, 2562 10- to 14-year-old adolescents were enrolled in the SSS, which was performed in public schools in the cities of Amparo, Pedreira, and Mogi Mirim in the state of São Paulo, Brazil. Their posture was analyzed using Postural Analysis Software. Continuous variables were tested using Student t test, and categorical variables were tested using a χ2 test. The SG, FPG, simple curve group, and double curve group were all compared. Bivariate analysis was used to identify associations between postural deviations and scoliosis. The adopted significance level was α = .05. The SG (2.7 ± 1.9°) had greater shoulder obliquity than the FPG (1.9 ± 1.4°) (P = .010), and this deviation was associated with scoliosis (odds ratio [95% CI] P = 1.4 [1.1-1.8] 0.011). The SG had asymmetry between the right- and left-side lower limb frontal angle, shoulder sagittal alignment, and knee angle. The double curve group (3 ± 1.7°) presented a greater value of the vertical alignment of the torso than the simple curve group did (1.9 ± 1°; P = .032). Adolescents diagnosed with AIS in an SSS had greater shoulder obliquity and asymmetry between the right and left sides. Shoulder obliquity was the only postural deviation associated with AIS. Copyright © 2017. Published by Elsevier Inc.

Favourable outcome of posterior decompression and stabilization in lordosis for cervical spondylotic myelopathy: the spinal cord "back shift" concept.

PubMed

Denaro, Vincenzo; Longo, Umile Giuseppe; Berton, Alessandra; Salvatore, Giuseppe; Denaro, Luca

2015-11-01

Surgical management of patients with multilevel CSM aims to decompress the spinal cord and restore the normal sagittal alignment. The literature lacks of high level evidences about the best surgical approach. Posterior decompression and stabilization in lordosis allows spinal cord back shift, leading to indirect decompression of the anterior spinal cord. The purpose of this study was to investigate the efficacy of posterior decompression and stabilization in lordosis for multilevel CSM. 36 out of 40 patients were clinically assessed at a mean follow-up of 5, 7 years. Outcome measures included EMS, mJOA Score, NDI and SF-12. Patients were asked whether surgery met their expectations and if they would undergo the same surgery again. Bone graft fusion, instrumental failure and cervical curvature were evaluated. Spinal cord back shift was measured and correlation with EMS and mJOA score recovery rate was analyzed. All scores showed a significative improvement (p < 0.001), except the SF12-MCS (p > 0.05). Ninety percent of patients would undergo the same surgery again. There was no deterioration of the cervical alignment, posterior grafted bones had completely fused and there were no instrument failures. The mean spinal cord back shift was 3.9 mm (range 2.5-4.5 mm). EMS and mJOA recovery rates were significantly correlated with the postoperative posterior cord migration (P < 0.05). Posterior decompression and stabilization in lordosis is a valuable procedure for patients affected by multilevel CSM, leading to significant clinical improvement thanks to the spinal cord back shift. Postoperative lordotic alignment of the cervical spine is a key factor for successful treatment.

Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases

PubMed Central

Limson, Marc Anthony; Kim, Soo-Bum; Arbatin, Jose Joefrey F.; Chang, Kee-Young; Park, Moon-Soo; Shin, Jae-hyuk; Ju, Yeong-Su

2009-01-01

The object of this study is to compare radiographic outcomes of anterior cervical decompression and fusion (ACDF) versus cervical disc replacement using the Bryan Cervical Disc Prosthesis (Medtronic Sofamor Danek, Memphis, TN) in terms of range of motion (ROM), Functional spinal unit (FSU), overall sagittal alignment (C2–C7), anterior intervertebral height (AIH), posterior intervertebral height (PIH) and radiographic changes at the implanted and adjacent levels. The study consisted of 105 patients. A total of 63 Bryan disc were placed in 51 patients. A single level procedure was performed in 39 patients and a two-level procedure in the other 12. Fifty-four patients underwent ACDF, 26 single level cases and 28 double level cases. The Bryan group had a mean follow-up 19 months (12–38). Mean follow-up for the ACDF group was 20 months (12–40 months). All patients were evaluated using static and dynamic cervical spine radiographs as well as MR imaging. All patients underwent anterior cervical discectomy followed by autogenous bone graft with plate (or implantation of a cage) or the Bryan artificial disc prosthesis. Clinical evaluation included the visual analogue scale (VAS), and neck disability index (NDI). Radiographic evaluation included static and dynamic flexion-extension radiographs using the computer software (Infinitt PiviewSTAR 5051) program. ROM, disc space angle, intervertebral height were measured at the operative site and adjacent levels. FSU and overall sagittal alignment (C2–C7) were also measured pre-operatively, postoperatively and at final follow-up. Radiological change was analyzed using χ2 test (95% confidence interval). Other data were analyzed using the mixed model (SAS enterprises guide 4.1 versions). There was clinical improvement within each group in terms of VAS and NDI scores from pre-op to final follow-up but not significantly between the two groups for both single (VAS p = 0.8371, NDI p = 0.2872) and double (VAS p = 0.2938, NDI p = 0.6753) level surgeries. Overall, ROM and intervertebral height was relatively well maintained during the follow-up in the Bryan group compared to ACDF. Regardless of the number of levels operated on, significant differences were noted for overall ROM of the cervical spine (p < 0.0001) and all other levels except at the upper adjacent level for single level surgeries (p = 0.2872). Statistically significant (p < 0.0001 and p = 0.0172) differences in the trend of intervertebral height measurements between the two groups were noted at all levels except for the AIH of single level surgeries at the upper (p = 0.1264) and lower (p = 0.7598) adjacent levels as well as PIH for double level surgeries at the upper (p = 0.8363) adjacent level. Radiological change was 3.5 times more observed for the ACDF group. Clinical status of both groups, regardless of the number of levels, showed improvement. Although clinical outcomes between the two groups were not significantly different at final follow-up, radiographic parameters, namely ROM and intervertebral heights at the operated site, some adjacent levels as well as FSU and overall sagittal alignment of the cervical spine were relatively well maintained in Bryan group compared to ACDF group. We surmise that to a certain degree, the maintenance of these parameters could contribute to reduce development of adjacent level change. Noteworthy is that radiographic change was 3.5 times more observed for ACDF surgeries. A longer period of evaluation is needed, to see if all these radiographic changes will translate to symptomatic adjacent level disease. PMID:19127374

Cerebellar Purkinje Cells Generate Highly Correlated Spontaneous Slow-Rate Fluctuations.

PubMed

Cao, Ying; Liu, Yu; Jaeger, Dieter; Heck, Detlef H

2017-01-01

Cerebellar Purkinje cells (PC) fire action potentials at high, sustained rates. Changes in spike rate that last a few tens of milliseconds encode sensory and behavioral events. Here we investigated spontaneous fluctuations of PC simple spike rate at a slow time scale of the order of 1 s. Simultaneous recordings from pairs of PCs that were aligned either along the sagittal or transversal axis of the cerebellar cortex revealed that simple spike rate fluctuations at the 1 s time scale were highly correlated. Each pair of PCs had either a predominantly positive or negative slow-rate correlation, with negative correlations observed only in PC pairs aligned along the transversal axis. Slow-rate correlations were independent of faster rate changes that were correlated with fluid licking behavior. Simultaneous recordings from PCs and cerebellar nuclear (CN) neurons showed that slow-rate fluctuations in PC and CN activity were also highly correlated, but their correlations continually alternated between periods of positive and negative correlation. The functional significance of this new aspect of cerebellar spike activity remains to be determined. Correlated slow-rate fluctuations seem too slow to be involved in the real-time control of ongoing behavior. However, slow-rate fluctuations of PCs converging on the same CN neuron are likely to modulate the excitability of the CN neuron, thus introduce a possible slow modulation of cerebellar output activity.

Predictors of cervical lordosis loss after laminoplasty in patients with cervical spondylotic myelopathy.

PubMed

Zhang, Jing Tao; Li, Jia Qi; Niu, Rui Jie; Liu, Zhao; Tong, Tong; Shen, Yong

2017-04-01

To determine whether radiological, clinical, and demographic findings in patients with cervical spondylotic myelopathy (CSM) were independently associated with loss of cervical lordosis (LCL) after laminoplasty. The prospective study included 41 consecutive patients who underwent laminoplasty for CSM. The difference in C2-7 Cobb angle between the postoperative and preoperative films was used to evaluate change in cervical alignment. Age, sex, body mass index (BMI), smoking history, preoperative C2-7 Cobb angle, T1 slope, C2-7 range of motion (C2-7 ROM), C2-7 sagittal vertical axis (C2-7 SVA), and cephalad vertebral level undergoing laminoplasty (CVLL) were assessed. Data were analyzed using Pearson and Spearman correlation test, and univariate and stepwise multivariate linear regression. T1 slope, C2-7 SVA, and CVLL significantly correlated with LCL (P < 0.001), whereas age, BMI, and preoperative C2-7 Cobb angle did not. In multiple linear regression analysis, higher T1 slope (B = 0.351, P = 0.037), greater C2-7 SVA (B = 0.393, P < 0.001), and starting laminoplasty at C4 level (B = - 7.038, P < 0.001) were significantly associated with higher postoperative LCL. Cervical alignment was compromised after laminoplasty in patients with CSM, and the degree of LCL was associated with preoperative T1 slope, C2-7 SVA, and CVLL.

Combined experimental and Monte Carlo verification of brachytherapy plans for vaginal applicators

NASA Astrophysics Data System (ADS)

Sloboda, Ron S.; Wang, Ruqing

1998-12-01

Dose rates in a phantom around a shielded and an unshielded vaginal applicator containing Selectron low-dose-rate sources were determined by experiment and Monte Carlo simulation. Measurements were performed with thermoluminescent dosimeters in a white polystyrene phantom using an experimental protocol geared for precision. Calculations for the same set-up were done using a version of the EGS4 Monte Carlo code system modified for brachytherapy applications into which a new combinatorial geometry package developed by Bielajew was recently incorporated. Measured dose rates agree with Monte Carlo estimates to within 5% (1 SD) for the unshielded applicator, while highlighting some experimental uncertainties for the shielded applicator. Monte Carlo calculations were also done to determine a value for the effective transmission of the shield required for clinical treatment planning, and to estimate the dose rate in water at points in axial and sagittal planes transecting the shielded applicator. Comparison with dose rates generated by the planning system indicates that agreement is better than 5% (1 SD) at most positions. The precision thermoluminescent dosimetry protocol and modified Monte Carlo code are effective complementary tools for brachytherapy applicator dosimetry.

Effects of frontal and sagittal thorax attitudes in gait on trunk and pelvis three-dimensional kinematics.

PubMed

Begon, Mickaël; Leardini, Alberto; Belvedere, Claudio; Farahpour, Nader; Allard, Paul

2015-10-01

While sagittal trunk inclinations alter upper body biomechanics, little is known about the extent of frontal trunk bending on upper body and pelvis kinematics in adults during gait and its relation to sagittal trunk inclinations. The objective was to determine the effect of the mean lateral trunk attitude on upper body and pelvis three-dimensional kinematics during gait in asymptomatic subjects. Three gait cycles were collected in 30 subjects using a motion analysis system (Vicon 612) and an established protocol. Sub-groups were formed based on the mean thorax lateral bending angle, bending side, and also sagittal tilt. These were compared based on 38 peak angles identified on pelvis, thorax and shoulder kinematics using MANOVAs. A main effect for bending side (p = 0.038) was found, especially for thorax peak angles. Statistics revealed also a significant interaction (p = 0.04993) between bending side and tilt for the thorax sagittal inclination during body-weight transfer. These results reinforce the existence of different gait patterns, which correlate upper body and pelvis motion measures. The results also suggest that frontal and sagittal trunk attitude should be considered carefully when treating a patient with impaired gait. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

An aggressive vertebral hemangioma in pregnancy: a case report.

PubMed

Slimani, Ouafae; Jayi, Sofia; Fdili Alaoui, Fatimazahra; Bouguern, Hakima; Chaara, Hekmat; Fikri, Ghizlane; Alaoui Rachidi, Siham; Sqalli Houssaini, Nadia; Himmich, Mariam; Abdelilah Melhouf, Moulay

2014-06-18

Pregnancy-related compressive myelopathy secondary to vertebral hemangioma is a rare occurrence and its treatment antepartum is rare. A 19-year-old North African woman in her 38th week of pregnancy presented with paraplegia that progressed within 2 days after a rapidly progressive weakness of her lower limbs. Magnetic resonance imaging studies showed compression of her spinal cord in front of the fourth thoracic vertebra for suspected tuberculous spondylitis. A Caesarean section was done followed by corpectomy with a bone graft because we intraoperatively discovered a vertebral hemangioma. Pathology showed an aggressive hemangioma. At any term of pregnancy, extensive neurological involvement which is rapidly progressive due to compression should be considered for immediate decompression.

Complete duplication of bladder and urethra in a sagittal plane in a male infant: case report and literature review.

PubMed

Coker, Alisa M; Allshouse, Michael J; Koyle, Martin A

2008-08-01

Complete duplication of the bladder and urethra is a rare entity. It may occur in the coronal and sagittal planes, and is often associated with other organ system anomalies, in particular of the gastrointestinal tract. We report an unusual variant of sagittal duplication of the bladder, in a male, associated with rudimentary hindgut duplication, and review the literature pertaining to this unusual anomaly.

Real time coarse orientation detection in MR scans using multi-planar deep convolutional neural networks

NASA Astrophysics Data System (ADS)

Bhatia, Parmeet S.; Reda, Fitsum; Harder, Martin; Zhan, Yiqiang; Zhou, Xiang Sean

2017-02-01

Automatically detecting anatomy orientation is an important task in medical image analysis. Specifically, the ability to automatically detect coarse orientation of structures is useful to minimize the effort of fine/accurate orientation detection algorithms, to initialize non-rigid deformable registration algorithms or to align models to target structures in model-based segmentation algorithms. In this work, we present a deep convolution neural network (DCNN)-based method for fast and robust detection of the coarse structure orientation, i.e., the hemi-sphere where the principal axis of a structure lies. That is, our algorithm predicts whether the principal orientation of a structure is in the northern hemisphere or southern hemisphere, which we will refer to as UP and DOWN, respectively, in the remainder of this manuscript. The only assumption of our method is that the entire structure is located within the scan's field-of-view (FOV). To efficiently solve the problem in 3D space, we formulated it as a multi-planar 2D deep learning problem. In the training stage, a large number coronal-sagittal slice pairs are constructed as 2-channel images to train a DCNN to classify whether a scan is UP or DOWN. During testing, we randomly sample a small number of coronal-sagittal 2-channel images and pass them through our trained network. Finally, coarse structure orientation is determined using majority voting. We tested our method on 114 Elbow MR Scans. Experimental results suggest that only five 2-channel images are sufficient to achieve a high success rate of 97.39%. Our method is also extremely fast and takes approximately 50 milliseconds per 3D MR scan. Our method is insensitive to the location of the structure in the FOV.

A Novel Junctional Tether Weave Technique for Adult Spinal Deformity: 2-Dimensional Operative Video.

PubMed

Buell, Thomas J; Mullin, Jeffrey P; Nguyen, James H; Taylor, Davis G; Garces, Juanita; Mazur, Marcus D; Buchholz, Avery L; Shaffrey, Mark E; Yen, Chun-Po; Shaffrey, Christopher I; Smith, Justin S

2018-06-05

Proximal junctional kyphosis (PJK) is a common problem after multilevel spine instrumentation for adult spinal deformity. Various anti-PJK techniques such as junctional tethers for ligamentous augmentation have been proposed. We present an operative video demonstrating technical nuances of junctional tether "weave" application. A 70-yr-old male with prior L2-S1 instrumented fusion presented with worsening back pain and posture. Imaging demonstrated pathological loss of lumbar lordosis (flat back deformity), proximal junctional failure, and pseudarthrosis. The patient had severe global and segmental sagittal malalignment, with sagittal vertical axis (SVA, C7-plumbline) measuring 22.3 cm, pelvic incidence (PI) 55°, lumbar lordosis (LL) 8° in kyphosis, pelvic tilt (PT) 30°, and thoracic kyphosis (TK) 6°. The patient gave informed consent for surgery and use of imaging for medical publication. Briefly, surgery first involved re-instrumentation with bilateral pedicle screws from T10 to S1. After right-sided iliac screw fixation (left-sided iliac screw fixation was not performed due to extensive prior iliac crest bone graft harvesting), we then completed a L2-3 Smith-Petersen osteotomy, extended L4 pedicle subtraction osteotomy, and L3-4 interbody arthrodesis with a 12° lordotic cage (9 × 14 × 40 mm). Cobalt Chromium rods were placed spanning the instrumentation bilaterally, and accessory supplemental rods spanning the PSO were attached. An anti-PJK junctional tether "weave" was then implemented using 4.5 mm polyethylene tape (Mersilene tape [Ethicon, Somerville, New Jersey]). Postoperative imaging demonstrated improved alignment (SVA 2.8 cm, PI 55°, LL 53°, PT 25°, TK 45°) and no significant neurological complications occurred during convalescence or at 6 mo postop.

Do Lordotic Cages Provide Better Segmental Lordosis Versus Nonlordotic Cages in Lateral Lumbar Interbody Fusion (LLIF)?

PubMed

Sembrano, Jonathan N; Horazdovsky, Ryan D; Sharma, Amit K; Yson, Sharon C; Santos, Edward R G; Polly, David W

2017-05-01

A retrospective comparative radiographic review. To evaluate the radiographic changes brought about by lordotic and nonlordotic cages on segmental and regional lumbar sagittal alignment and disk height in lateral lumbar interbody fusion (LLIF). The effects of cage design on operative level segmental lordosis in posterior interbody fusion procedures have been reported. However, there are no studies comparing the effect of sagittal implant geometry in LLIF. This is a comparative radiographic analysis of consecutive LLIF procedures performed with use of lordotic and nonlordotic interbody cages. Forty patients (61 levels) underwent LLIF. Average age was 57 years (range, 30-83 y). Ten-degree lordotic PEEK cages were used at 31 lumbar interbody levels, and nonlordotic cages were used at 30 levels. The following parameters were measured on preoperative and postoperative radiographs: segmental lordosis; anterior and posterior disk heights at operative level; segmental lordosis at supra-level and subjacent level; and overall lumbar (L1-S1) lordosis. Measurement changes for each cage group were compared using paired t test analysis. The use of lordotic cages in LLIF resulted in a significant increase in lordosis at operative levels (2.8 degrees; P=0.01), whereas nonlordotic cages did not (0.6 degrees; P=0.71) when compared with preoperative segmental lordosis. Anterior and posterior disk heights were significantly increased in both groups (P<0.01). Neither cage group showed significant change in overall lumbar lordosis (lordotic P=0.86 vs. nonlordotic P=0.25). Lordotic cages provided significant increase in operative level segmental lordosis compared with nonlordotic cages although overall lumbar lordosis remained unchanged. Anterior and posterior disk heights were significantly increased by both cages, providing basis for indirect spinal decompression.

A comparison of needle tip localization accuracy using 2D and 3D trans-rectal ultrasound for high-dose-rate prostate cancer brachytherapy treatment planning

NASA Astrophysics Data System (ADS)

Hrinivich, W. Thomas; Hoover, Douglas A.; Surry, Kathleen; Edirisinghe, Chandima; Montreuil, Jacques; D'Souza, David; Fenster, Aaron; Wong, Eugene

2016-03-01

Background: High-dose-rate brachytherapy (HDR-BT) is a prostate cancer treatment option involving the insertion of hollow needles into the gland through the perineum to deliver a radioactive source. Conventional needle imaging involves indexing a trans-rectal ultrasound (TRUS) probe in the superior/inferior (S/I) direction, using the axial transducer to produce an image set for organ segmentation. These images have limited resolution in the needle insertion direction (S/I), so the sagittal transducer is used to identify needle tips, requiring a manual registration with the axial view. This registration introduces a source of uncertainty in the final segmentations and subsequent treatment plan. Our lab has developed a device enabling 3D-TRUS guided insertions with high S/I spatial resolution, eliminating the need to align axial and sagittal views. Purpose: To compare HDR-BT needle tip localization accuracy between 2D and 3D-TRUS. Methods: 5 prostate cancer patients underwent conventional 2D TRUS guided HDR-BT, during which 3D images were also acquired for post-operative registration and segmentation. Needle end-length measurements were taken, providing a gold standard for insertion depths. Results: 73 needles were analyzed from all 5 patients. Needle tip position differences between imaging techniques was found to be largest in the S/I direction with mean+/-SD of -2.5+/-4.0 mm. End-length measurements indicated that 3D TRUS provided statistically significantly lower mean+/-SD insertion depth error of -0.2+/-3.4 mm versus 2.3+/-3.7 mm with 2D guidance (p < .001). Conclusions: 3D TRUS may provide more accurate HDR-BT needle localization than conventional 2D TRUS guidance for the majority of HDR-BT needles.

Graft extrusion in both the coronal and sagittal planes is greater after medial compared with lateral meniscus allograft transplantation but is unrelated to early clinical outcomes.

PubMed

Lee, Dae-Hee; Lee, Chang-Rack; Jeon, Jin-Ho; Kim, Kyung-Ah; Bin, Seong-Il

2015-01-01

Graft extrusion after meniscus allograft transplantation (MAT) may be affected by horn fixation, which differs between medial and lateral MAT. Few studies have compared graft extrusion, especially sagittal extrusion, after medial and lateral MAT. In patients undergoing medial and lateral MAT, graft extrusion is likely similar and not correlated with postoperative Lysholm scores. Cohort study; Level of evidence, 2. Meniscus graft extrusion in the coronal and sagittal planes was compared in 51 knees undergoing medial MAT and 84 undergoing lateral MAT. Distances from the anterior and posterior articular cartilage margins to the anterior (anterior cartilage meniscus distance [ACMD]) and posterior (posterior cartilage meniscus distance [PCMD]) horns, respectively, were assessed on immediate postoperative magnetic resonance imaging and compared in patients undergoing medial and lateral MAT. Correlations between coronal and sagittal graft extrusion and between extrusion and the Lysholm score were compared in the 2 groups. In the coronal plane, mean absolute (4.3 vs 2.7 mm, respectively; P<.001) and relative (39% vs 21%, respectively; P<.001) graft extrusions were significantly greater for medial than lateral MAT. In the sagittal plane, mean absolute and relative ACMD and PCMD values were significantly greater for medial than lateral MAT (P<.001 each). For both medial and lateral MAT, mean absolute and relative ACMDs were significantly larger than PCMDs (P<.001 each). Graft extrusion>3 mm in the coronal plane was significantly more frequent in the medial (78%) than in the lateral (35%) MAT group. In the sagittal plane, the frequencies of ACMDs (72% vs 39%, respectively) and PCMDs (23% vs 4%, respectively) >3 mm were also significantly greater in the medial than in the lateral MAT group. Coronal and sagittal extrusions were not correlated with postoperative Lysholm scores for both medial and lateral MAT. The amount and incidence of graft extrusion were greater after medial than lateral MAT in both the coronal and sagittal planes. In the sagittal plane, graft extrusion was greater and more frequent on the anterior than the posterior horn in both medial and lateral MAT. However, graft extrusion was not correlated with early clinical outcomes after both medial and lateral MAT. © 2014 The Author(s).

INJURIES OF THE SAGITTAL GROOVE OF THE PROXIMAL PHALANX IN WARMBLOOD HORSES DETECTED WITH LOW-FIELD MAGNETIC RESONANCE IMAGING: 19 CASES (2007-2016).

PubMed

Gold, Sarah J; Werpy, Natasha M; Gutierrez-Nibeyro, Santiago D

2017-05-01

Sagittal groove injuries of the proximal phalanx are an important cause of lameness in performance horses. The purpose of this retrospective case series study was to describe standing low-field magnetic resonance imaging (MRI) characteristics of these injuries in a group of Warmblood horses. Horses with an MRI diagnosis of sagittal groove injuries involving the proximal phalanx and that had follow-up MRI and clinical outcome information were included. Findings from clinical examinations, diagnostic tests, and other imaging modalities were recorded. All MRI studies were retrieved for re-evaluation by an experienced, board-certified veterinary radiologist. A total of 19 horses met inclusion criteria. All horses had MRI lesions consistent with unilateral or bilateral sagittal groove injuries of the proximal phalanx and abnormal mineralization of the sagittal ridge of the third metacarpal/metatarsal bone. Fifteen horses (79%) had concurrent osteoarthritis of the affected metacarpophalangeal/metatarsophalangeal joint. Eighteen horses received conservative therapy and all horses still had osseous abnormalities detected at the time of follow-up MRI. Thirteen horses (68.5%) were still lame at the time of follow-up, whereas the other six horses (31.5%) had become sound and returned to the previous level of exercise. Findings indicated that, for mature Warmblood horses, acute or chronic injuries of the sagittal groove of the proximal phalanx may have variable standing low-field MRI characteristics. Based on this sample of 19 horses, findings also indicated that the prognosis for performance soundness in horses diagnosed with sagittal groove injury of the proximal phalanx and concurrent osteoarthritis is poor. © 2017 American College of Veterinary Radiology.

Cervical spinal stenosis and sports-related cervical cord neurapraxia in children.

PubMed

Boockvar, J A; Durham, S R; Sun, P P

2001-12-15

Congenital spinal stenosis has been demonstrated to contribute to cervical cord neurapraxia after cervical spinal cord injury in adult athletes. A sagittal canal diameter <14 mm and/or a Torg ratio (sagittal diameter of the spinal canal: midcervical sagittal vertebral body diameter) of <0.8 are indicative of significant cervical spinal stenosis. Although sports-related cervical spine injuries are common in children, the role of congenital cervical stenosis in the etiology of these injuries remains unclear. The authors measured the sagittal canal diameter and the Torg ratio in children presenting with cervical cord neurapraxia resulting from sports-related cervical spinal cord injuries to determine the presence of congenital spinal stenosis. A total of 13 children (9 male, 4 female) presented with cervical cord neurapraxia after a sports-related cervical spinal cord injury. Age ranged from 7 to 15 years (mean +/- SD, 11.5 +/- 2.7 years). The sports involved were football (n = 4), wrestling (n = 2), hockey (n = 2), and soccer, gymnastics, baseball, kickball, and pogosticking (n = 1 each). Lateral cervical spine radiographs were used to determine the sagittal canal diameter and the Torg ratio at C4. The sagittal canal diameter (mean +/- SD, 17.58 +/- 1.63 mm) and the Torg ratio (mean +/- SD, 1.20 +/- 0.24) were normal in all of these children. Using the sagittal canal diameter and the Torg ratio as a measurement of congenital spinal stenosis, the authors did not find evidence of congenital cervical spinal stenosis in a group of children with sports-related cervical spinal cord neurapraxia. The occurrence of cervical cord neurapraxia in pediatric patients can be attributed to the mobility of the pediatric spine rather than to congenital cervical spinal stenosis.

Agreement Between Visual Assessment and 2-Dimensional Analysis During Jump Landing Among Healthy Female Athletes.

PubMed

Rabin, Alon; Einstein, Ofira; Kozol, Zvi

2018-04-01

  Altered movement patterns, including increased frontal-plane knee movement and decreased sagittal-plane hip and knee movement, have been associated with several knee disorders. Nevertheless, the ability of clinicians to visually detect such altered movement patterns during high-speed athletic tasks is relatively unknown.   To explore the association between visual assessment and 2-dimensional (2D) analysis of frontal-plane knee movement and sagittal-plane hip and knee movement during a jump-landing task among healthy female athletes.   Cross-sectional study.   Gymnasiums of participating volleyball teams.   A total of 39 healthy female volleyball players (age = 21.0 ± 5.2 years, height = 172.0 ± 8.6 cm, mass = 64.2 ± 7.2 kg) from Divisions I and II of the Israeli Volleyball Association.   Frontal-plane knee movement and sagittal-plane hip and knee movement during jump landing were visually rated as good, moderate, or poor based on previously established criteria. Frontal-plane knee excursion and sagittal-plane hip and knee excursions were measured using free motion-analysis software and compared among athletes with different visual ratings of the corresponding movements.   Participants with different visual ratings of frontal-plane knee movement displayed differences in 2D frontal-plane knee excursion ( P < .01), whereas participants with different visual ratings of sagittal-plane hip and knee movement displayed differences in 2D sagittal-plane hip and knee excursions ( P < .01).   Visual ratings of frontal-plane knee movement and sagittal-plane hip and knee movement were associated with differences in the corresponding 2D hip and knee excursions. Visual rating of these movements may serve as an initial screening tool for detecting altered movement patterns during jump landings.

Sagittal-lung CT measurements in the evaluation of asthma-COPD overlap syndrome: a distinctive phenotype from COPD alone.

PubMed

Qu, Yanjuan; Cao, Yiyuan; Liao, Meiyan; Lu, Zhiyan

2017-07-01

This study aimed at investigating the capability of sagittal-lung computed tomography (CT) measurements in differentiating chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome (ACOS). Clinical and high-resolution CT of 229 patients including 123 pure COPD patients and 106 ACOS patients were included. Sagittal-lung CT measurements in terms of bilateral lung height (LH), anterior-posterior lung diameter (APLD), diaphragm height (DH), and anterior sterno-diaphragmatic angle (ASDA), as well as inter-pulmonary septum length (IPSL) on axial images were measured both before and after bronchodilator (BD) administration. Comparisons of clinical characteristics and CT measurements between patient groups were performed. All pre-BD quantitative sagittal features measuring diaphragm flattening and hyperinflation were not significantly different between patients with COPD and patients with ACOS (P values all >0.05). Following BD administration, the ACOS patients exhibited lower left LH, bilateral APLD, and bilateral ASDA, but higher right DH, compared to pure COPD patients (P values all <0.05). Right LH, left DH and IPSL were not significantly different between patient groups. Besides, variations of all sagittal-lung CT measurements were significantly larger in patients with ACOS than in patients with pure COPD (P values all <0.001) and showed high performance in differentiating these two kinds of patient, with diagnostic sensitivities ranging from 76.4 to 97.2%, specificities ranging from 86.2 to 100.0%, and accuracies ranging from 80.9 to 90.7%. Sagittal-lung CT measurements allow for differentiating patients with ACOS from those with pure COPD. The ACOS patients had larger post-BD variations of sagittal-lung CT measurements than patients with pure COPD.

The angle of inclination of the native ACL in the coronal and sagittal planes.

PubMed

Reid, Jonathan C; Yonke, Bret; Tompkins, Marc

2017-04-01

The purpose of this cross-sectional study was to evaluate the angle of inclination of the native anterior cruciate ligament (ACL) in both the sagittal and coronal planes and to evaluate these findings based on sex, height, BMI, and skeletal maturity. Inclusion criteria for the study included patients undergoing routine magnetic resonance imaging (MRI) of the knee at a single outpatient orthopedic center who had an intact ACL on MRI. Measurements of the angle of inclination were made on MRIs in both the sagittal and coronal planes. Patients were compared based on sex, height, BMI, and skeletal maturity. One-hundred and eighty-eight patients were included (36 skeletally immature/152 skeletally mature; 98 male/90 female). The overall angle of inclination was 74.3° ± 4.8° in the coronal plane and 46.9° ± 4.9° in the sagittal plane. Skeletally immature patients (coronal: 71.8° ± 6.1°; sagittal: 44.7° ± 5.5°) were significantly different in both coronal and sagittal planes (P = 0.04 and 0.01, respectively) from skeletally mature patients (coronal: 75.3° ± 4.7°; sagittal: 47.4° ± 4.7°). There were no differences based on sex, height, or BMI. There are differences between the angle of inclination findings in this study and other studies, which could be due to MRI and measurement techniques. Clinically, skeletal maturity may be important to account for when using the ACL angle of inclination to evaluate anatomic ACL reconstruction. Prognostic retrospective study, Level of evidence III.

Revision surgery for posterior stabilized thoracolumbar fracture using mini-open anterior approach and expandable cage.

PubMed

Zhao, Jian; Schaser, Klaus-Dieter; Zhang, Feng

2010-05-01

To evaluate the surgical techniques and outcomes of revision surgery for compromised posterior stabilization or insufficient neurological decompression using anterior mini-open approach and expandable cage. From August 2005 to June 2008, a total of 235 patients were operated on in our center for thoracolumbar fractures with dorsal transpedicular stabilization. Twenty-six of these patients underwent revision surgery, the main reasons being back pain and stagnant neurological recovery. The surgical procedure comprised a single-level thoracolumbar corpectomy and/or canal clearance, followed by an expandable cage reconstruction. The average interval between primary and revision surgery was 5 months (range, 3-11 months). A transthoracic (n= 11) or transthoracic transdiaphragmatic (n= 15) mini-open approach was conducted using a table-mounted retractor. The operating time averaged 105 min (range, 95-135 min) for the transthoracic approach and 152 min (range, 120-190 min) for the transthoracic plus transdiaphragmatic approach. The overall mean blood loss was 780 ml (range, 550-1700 ml). Over time, the pre-operative neurological deficit improved in 6/7 patients by at least one Frankel/American Spinal Injury Association (ASIA) grade. On a visual analogue scale (VAS) from 0 to 10, the mean local thoracolumbar back pain was relieved significantly from 6.8 before operation to 3.8 at 3 months, 2.4 at 6 months, and 1.5 at 12 months postoperatively. None of the patients developed intercostal neuralgia or post-thoracotomy pain syndromes. For patients with compromised stabilization or insufficient neurological decompression after primary dorsal transpedicular stabilization for thoracolumbar fracture, anterior revision surgery can produce good results. The mini-open anterior approach for corpectomy in the thoracolumbar spine is safe, reliable, and economical. The expandable cage is an excellent alternative for anterior reconstruction. © 2010 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.

Precision and accuracy of age estimates obtained from anal fin spines, dorsal fin spines, and sagittal otoliths for known-age largemouth bass

USGS Publications Warehouse

Klein, Zachary B.; Bonvechio, Timothy F.; Bowen, Bryant R.; Quist, Michael C.

2017-01-01

Sagittal otoliths are the preferred aging structure for Micropterus spp. (black basses) in North America because of the accurate and precise results produced. Typically, fisheries managers are hesitant to use lethal aging techniques (e.g., otoliths) to age rare species, trophy-size fish, or when sampling in small impoundments where populations are small. Therefore, we sought to evaluate the precision and accuracy of 2 non-lethal aging structures (i.e., anal fin spines, dorsal fin spines) in comparison to that of sagittal otoliths from known-age Micropterus salmoides (Largemouth Bass; n = 87) collected from the Ocmulgee Public Fishing Area, GA. Sagittal otoliths exhibited the highest concordance with true ages of all structures evaluated (coefficient of variation = 1.2; percent agreement = 91.9). Similarly, the low coefficient of variation (0.0) and high between-reader agreement (100%) indicate that age estimates obtained from sagittal otoliths were the most precise. Relatively high agreement between readers for anal fin spines (84%) and dorsal fin spines (81%) suggested the structures were relatively precise. However, age estimates from anal fin spines and dorsal fin spines exhibited low concordance with true ages. Although use of sagittal otoliths is a lethal technique, this method will likely remain the standard for aging Largemouth Bass and other similar black bass species.

Lower extremity joint coupling variability during gait in young adults with and without chronic ankle instability.

PubMed

Lilley, Thomas; Herb, Christopher C; Hart, Joseph; Hertel, Jay

2018-06-01

Chronic ankle instability (CAI) is a condition resulting from a lateral ankle sprain. Shank-rearfoot joint-coupling variability differences have been found in CAI patients; however, joint-coupling variability (VCV) of the ankle and proximal joints has not been explored. Our purpose was to analyse VCV in adults with and without CAI during gait. Four joint-coupling pairs were analysed: knee sagittal-ankle sagittal, knee sagittal-ankle frontal, hip frontal-ankle sagittal and hip frontal-ankle frontal. Twenty-seven adults participated (CAI:n = 13, Control:n = 14). Lower extremity kinematics were collected during walking (4.83 km/h) and jogging (9.66 km/h). Vector-coding was used to assess the stride-to-stride variability of four coupling pairs. During walking, CAI patients exhibited higher VCV than healthy controls for knee sagittal-ankle frontal in latter parts of stance thru mid-swing. When jogging, CAI patients demonstrated lower VCV with specific differences occurring across various intervals of gait. The increased knee sagittal-ankle frontal VCV in CAI patients during walking may indicate an adaptation to deal with the previously identified decrease in variability in transverse plane shank and frontal plane rearfoot coupling during walking; while the decreased ankle-knee and ankle-hip VCV identified in CAI patients during jogging may represent a more rigid, less adaptable sensorimotor system ambulating at a faster speed.

[Plain radiographs of the spine: static and relationships between spine and pelvis].

PubMed

Morvan, G; Wybier, M; Mathieu, P; Vuillemin, V; Guerini, H

2008-05-01

Man, with his erect posture, evolves in a world subject to the laws of gravity. His spine reflects these constraints. The morphology and static of human spine and biomechanical relationships between spine and pelvis are in direct relation with bipedia. Owing to this position the pelvis widened and straightened, characteristic sagittal spinal curves appeared and the perispinal muscles were deeply reorganized. Each pelvis is characterized by an important anatomical landmark: the pelvic incidence that reflects the sagittal morphology of the pelvis. Based on this anatomical characteristic, a chain of reactions determines the more efficient equilibrium of the whole body in the sagittal plane in term of energy consumption. Incidence affects the sacral slope, which determines lumbar lordosis, which itself influences pelvic tilt, thoracic kyphosis, and even hip and knee position. All these landmarks can easily be studied on a sagittal radiograph. Knowledge of these functional relationships is essential to understand the origin of low back pain, sagittal imbalance and above all before surgical treatment of spine disorders especially when arthrodesis is considered.

Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion.

PubMed

Rothenfluh, Dominique A; Mueller, Daniel A; Rothenfluh, Esin; Min, Kan

2015-06-01

Several risk factors and causes of adjacent segment disease have been debated; however, no quantitative relationship to spino-pelvic parameters has been established so far. A retrospective case-control study was carried out to investigate spino-pelvic alignment in patients with adjacent segment disease compared to a control group. 45 patients (ASDis) were identified that underwent revision surgery for adjacent segment disease after on average 49 months (7-125), 39 patients were selected as control group (CTRL) similar in the distribution of the matching variables, such as age, gender, preoperative degenerative changes, and numbers of segments fused with a mean follow-up of 84 months (61-142) (total n = 84). Several radiographic parameters were measured on pre- and postoperative radiographs, including lumbar lordosis measured (LL), sacral slope, pelvic incidence (PI), and tilt. Significant differences between ASDis and CTRL groups on preoperative radiographs were seen for PI (60.9 ± 10.0° vs. 51.7 ± 10.4°, p = 0.001) and LL (48.1 ± 12.5° vs. 53.8 ± 10.8°, p = 0.012). Pelvic incidence was put into relation to lumbar lordosis by calculating the difference between pelvic incidence and lumbar lordosis (∆PILL = PI-LL, ASDis 12.5 ± 16.7° vs. CTRL 3.4 ± 12.1°, p = 0.001). A cutoff value of 9.8° was determined by logistic regression and ROC analysis and patients classified into a type A (∆PILL <10°) and a type B (∆PILL ≥10°) alignment according to pelvic incidence-lumbar lordosis mismatch. In type A spino-pelvic alignment, 25.5 % of patients underwent revision surgery for adjacent segment disease, whereas 78.3 % of patients classified as type B alignment had revision surgery. Classification of patients into type A and B alignments yields a sensitivity for predicting adjacent segment disease of 71 %, a specificity of 81 % and an odds ratio of 10.6. In degenerative disease of the lumbar spine a high pelvic incidence with diminished lumbar lordosis seems to predispose to adjacent segment disease. Patients with such pelvic incidence-lumbar lordosis mismatch exhibit a 10-times higher risk for undergoing revision surgery than controls if sagittal malalignment is maintained after lumbar fusion surgery.

Postural profile and falls of osteoporotic women.

PubMed

Karakasidou, Palina; Skordilis, Emmanouil K; Dontas, Ismene; Lyritis, George P

2012-01-01

1. To compare postural alignment in erect standing between osteoporotic fallers, osteoporotic non-fallers and healthy women. 2. To compare BMI, number of fractures and intensity of pain between osteoporotic fallers and non-fallers. Thirty-six osteoporotic women with vertebral fractures and 40 healthy women participated in the study. Spinal curvatures were assessed with a digital inclinometer. Photographic measurements of knee, hip, shoulder and head were carried out in sagittal plane. Significant differences were found between osteoporotic fallers and healthy women in the head (p=0.040), and thoracic angles (p=0.001). Significant differences were found between fallers and non-fallers in BMI (p=0.000), number of fractures (p=0.033) and pain (p=0.005), with fallers being heavier, with less fractures and pain than non-fallers. Osteoporotic fallers probably differ from osteoporotic non-fallers and healthy women. Researchers and clinicians may consider, in the future, the above differences when planning research and clinical intervention in this field. Replication studies are necessary to confirm the present findings.

Proposal for a trigonometric method to evaluate the abduction angle of the lower limbs in neonates.

PubMed

Lima, Thaís; Alves, Cyntia; Funayama, Carolina A R

2008-12-01

It is difficult to precisely measure articular arc movement in newborns using a goniometer. This article proposes an objective method based on trigonometry for the evaluation of lower limb abduction. With the newborn aligned in the dorsal decubitus position, 2 points are marked at the level of the medial malleolus, one on the sagittal line and the other at the end of the abduction. Using the right-sided line between these 2 points and a line from the medial malleolus to the reference point at the anterior superior iliac spine or umbilical scar, an isosceles triangle is drawn, and half of the inferential abduction angle is obtained by calculating the sine. Twenty healthy full-term newborns comprise the study cohort. Intersubject and intrasubject variability among the abduction angle values (mean [SD], 37 degrees [4] degrees) is low. This method is advantageous because the measurement is precise and because the sine can be used without approximation.

An aggressive vertebral hemangioma in pregnancy: a case report

PubMed Central

2014-01-01

Introduction Pregnancy-related compressive myelopathy secondary to vertebral hemangioma is a rare occurrence and its treatment antepartum is rare. Case presentation A 19-year-old North African woman in her 38th week of pregnancy presented with paraplegia that progressed within 2 days after a rapidly progressive weakness of her lower limbs. Magnetic resonance imaging studies showed compression of her spinal cord in front of the fourth thoracic vertebra for suspected tuberculous spondylitis. A Caesarean section was done followed by corpectomy with a bone graft because we intraoperatively discovered a vertebral hemangioma. Pathology showed an aggressive hemangioma. Conclusion At any term of pregnancy, extensive neurological involvement which is rapidly progressive due to compression should be considered for immediate decompression. PMID:24943121

Resection of a ventral intramedullary cervical spinal cord cavernous malformation through an anterior approach.

PubMed

Weil, Alexander G; Bhatia, Sanjiv

2014-09-01

Ventrally-located intramedullary cervical spinal cord cavernomas are rare entities in the pediatric population. Surgical access to these lesions is challenging. The authors present the complete resection of a symptomatic ventral cervical intramedullary cavernoma through an anterior approach in a 15-year-old boy. The lesion was accessed following left anterolateral dissection, C3-4 discectomy and C3/C4 partial corpectomy. The authors will discuss the rationale for intervening in this patient and for selecting this anterior approach over other approaches, such as the anterolateral, posterolateral or posterior approach. The steps, pitfalls and pearls of this surgical approach will be demonstrated in a detailed video. The video can be found here: http://youtu.be/-ARTp6g13hgs.

Sagittal band, boutonniere, and pulley injuries in the athlete.

PubMed

Grandizio, Louis Christopher; Klena, Joel Christian

2017-03-01

While hand injuries occur frequently in the athletic population, sagittal band ruptures, boutonniere deformities, and pulley ruptures are infrequently encountered. These injuries represent diagnostic challenges and can result in significant impairment. Early recognition with appropriate treatment is necessary to maximize recovery and minimize return to athletic competition. This review will focus on the underlying mechanism, pathophysiology of injury, diagnosis, and treatment of each of these injuries. With respect to sagittal band ruptures, boutonniere deformities, and pulley ruptures, the recent literature has been limited in scope. For sagittal band injuries, current efforts have focused on alternative techniques for sagittal band reconstruction. Little progress has been made in recent years with respect to boutonniere injuries in the athletic population; prevention of fixed deformities remains the backbone of treatment. The exact contribution from individual and combined pulley injuries in the creation of bowstringing remains controversial. Recent anatomical studies have failed to definitively answer the question of what degree of rupture is necessary to create symptomatic bowstringing. Favorable outcomes, with respect to both preventing bowstringing and returning to full athletic participation, have been newly reported following pulley reconstruction in rock climbers. Due to the infrequent nature of sagittal band ruptures, boutonniere deformities, and pulley ruptures, current treatment is mostly guided by historically established methods, limited case series, and case reports. Nonsurgical treatment remains the mainstay for most injuries and, if employed early, often precludes the need for surgery. Further anatomical and clinical research, including outcome studies, is necessary in guiding treatment algorithms.

Effects of ipsilateral anterior thigh soft tissue stretching on passive unilateral straight-leg raise.

PubMed

Clark, S; Christiansen, A; Hellman, D F; Hugunin, J W; Hurst, K M

1999-01-01

Randomized 3-group pretest-posttest with blind assessment of outcome. The purpose of this study was to examine the effect of sagittal plane hold-relax exercise applied to the ipsilateral anterior thigh, and prone positioning on passive unilateral straight-leg raise measurements. Straight-leg raising has been viewed as a measurement for hamstring muscle length, but literature suggests that other structures may affect this measurement. Sixty subjects (45 men, 15 women) qualified for inclusion into the study based on a straight-leg raise measurement of < or = 65 degrees. Subjects were randomly assigned to one of three groups: control, static stretch, or sagittal plane hold-relax exercise. Pretest and posttest straight-leg raise measurements of the right lower extremity were performed for each subject. A 1-way ANOVA of the change scores showed a significant difference between groups. A Tukey post hoc analysis of the change scores showed that both treatment groups' means differed significantly from the control group and from each other, with the sagittal plane hold-relax group exhibiting the largest change (mean of 7.8 degrees +/- 2.8 degrees). The results of this study show that sagittal plane hold-relax exercise and passive prone results of this study show that sagittal plane hold-relax and passive prone positioning can significantly increase straight-leg raise range of motion, however the sagittal plane hold-relax stretching of the anterior thigh is more effective than passive prone positioning.

Efficacy of a Pelvic Lateral Positioner With a Mechanical Cup Navigator Based on the Anatomical Pelvic Plane in Total Hip Arthroplasty.

PubMed

Iwakiri, Kentaro; Kobayashi, Akio; Ohta, Yoichi; Minoda, Yukihide; Takaoka, Kunio; Nakamura, Hiroaki

2017-12-01

The acetabular component orientation in total hip arthroplasty (THA) is of critical importance to the good clinical results. However, traditional widely used cup alignment guides for cup placement are reported to be relatively unreliable. The present study aims at comparing a novel cup alignment guide, which can be attached to our anatomical pelvic plane (APP) pelvic lateral positioner for reducing discrepancies in sagittal pelvic tilt and indicate a targeted cup angle based on the APP, with a conventional cup alignment guide. The subjects were 136 hips of 136 patients who underwent unilateral THA using the APP positioner. The procedure was performed with the conventional cup alignment guide (conventional group; 60 hips) and with the novel cup navigator (mechanical navigator group; 76 hips). Postoperative cup angles and discrepancies of postoperative cup angles (inclination and anteversion angles) from the targeted angles were compared between the 2 groups to evaluate the usefulness of these navigators. The mean cup angles in the conventional group were 39.0° ± 5.3° for the inclination angle and 21.7° ± 6.4° for the anteversion angle, whereas those in the mechanical navigator group were 40.6° ± 3.2° and 18.3° ± 4.6°, respectively (P = .018, P < .0001). The discrepancies from the targeted angles were 3.5° ± 3.1° for the inclination angle and 4.6° ± 3.4° for the anteversion angle in the conventional group and 2.3° ± 2.3° and 3.2° ± 2.7°, respectively, in the mechanical navigator group (P = .020, P = .012). The mechanical cup navigator easily attachable to the APP positioner is a tool that can improve the accuracy of cup placement in a simple, economical, and noninvasive manner in THA via the lateral position. Copyright © 2017 Elsevier Inc. All rights reserved.

Post-Traumatic Bifrontoparietal Extradural Hematoma with Superior Sagittal Sinus Detachment: A Case Report and Review of the Literature.

PubMed

Giannakaki, Venetia; Triantafyllou, Triantafyllos; Drossos, Dimitrios; Papapetrou, Konstantinos

2016-09-01

To present, to our knowledge, the first case of a single bilateral extradural hematoma due to superior sagittal sinus detachment that was treated conservatively with an excellent outcome. Bilateral extradural hematomas are a rare condition, accounting for only 2%-5% of all extradural hematomas. They can be either 2 distinct hematomas on either side or 1 single bilateral hematoma mostly due to sagittal sinus injury, with the latter being the most rare owing to the firm attachment of the sinus to its subperiosteal loggia. These hematomas usually require immediate surgical evacuation, as patients present with decreased level of consciousness, and have good postoperative outcomes. We present a bilateral extradural hematoma due to superior sagittal sinus injury, which was treated conservatively. The patient had an excellent recovery, with no residual neurological deficits and a Glasgow outcome scale of 5 on discharge. Bilateral extradural hematomas due to superior sagittal sinus injury almost always require surgical intervention. We present a patient who was treated conservatively with an excellent outcome and we also perform a review of the current literature. Copyright © 2016 Elsevier Inc. All rights reserved.

Diffraction crystal for sagittally focusing x-rays

DOEpatents

Ice, Gene E.; Sparks, Jr., Cullie J.

1984-01-01

The invention is a new type of diffraction crystal designed for sagittally focusing photons of various energies. The invention is based on the discovery that such focusing is not obtainable with conventional crystals because of distortion resulting from anticlastic curvature. The new crystal comprises a monocrystalline base having a front face contoured for sagittally focusing photons and a back face provided with rigid, upstanding, stiffening ribs restricting anticlastic curvature. When mounted in a suitable bending device, the reflecting face of the crystal can be adjusted to focus photons having any one of a range of energies.

Diffraction crystals for sagittally focusing x-rays

DOEpatents

Ice, G.E.; Sparks, C.J. Jr.

1982-06-07

The invention is a new type of diffraction crystal designed for sagittally focusing photons of various energies. The invention is based on the discovery that such focusing is not obtainable with conventional crystals because of distortion resulting from anticlastic curvature. The new crystal comprises a monocrystalline base having a front face contoured for sagittally focusing photons and a back face provided with rigid, upstanding, stiffening ribs restricting anticlastic curvature. When mounted in a suitable bending device, the reflecting face of the crystal can be adjusted to focus photons having any one of a range of energies.

Alphabet Soup: Sagittal Balance Correction Osteotomies of the Spine-What Radiologists Should Know.

PubMed

Takahashi, T; Kainth, D; Marette, S; Polly, D

2018-04-01

Global sagittal malalignment has been demonstrated to have correlation with clinical symptoms and is a key component to be restored in adult spinal deformity. In this article, various types of sagittal balance-correction osteotomies are reviewed primarily on the basis of the 3 most commonly used procedures: Smith-Petersen osteotomy, pedicle subtraction osteotomy, and vertebral column resection. Familiarity with the expected imaging appearance and commonly encountered complications seen on postoperative imaging studies following correction osteotomies is crucial for accurate image interpretation. © 2018 by American Journal of Neuroradiology.

Investigation of sagittal image acquisition for 4D-MRI with body area as respiratory surrogate.

PubMed

Liu, Yilin; Yin, Fang-Fang; Chang, Zheng; Czito, Brian G; Palta, Manisha; Bashir, Mustafa R; Qin, Yujiao; Cai, Jing

2014-10-01

The authors have recently developed a novel 4D-MRI technique for imaging organ respiratory motion employing cine acquisition in the axial plane and using body area (BA) as a respiratory surrogate. A potential disadvantage associated with axial image acquisition is the space-dependent phase shift in the superior-inferior (SI) direction, i.e., different axial slice positions reach the respiratory peak at different respiratory phases. Since respiratory motion occurs mostly in the SI and anterior-posterior (AP) directions, sagittal image acquisition, which embeds motion information in these two directions, is expected to be more robust and less affected by phase-shift than axial image acquisition. This study aims to develop and evaluate a 4D-MRI technique using sagittal image acquisition. The authors evaluated axial BA and sagittal BA using both 4D-CT images (11 cancer patients) and cine MR images (6 healthy volunteers and 1 cancer patient) by comparing their corresponding space-dependent phase-shift in the SI direction (δSPS (SI)) and in the lateral direction (δSPS (LAT)), respectively. To evaluate sagittal BA 4D-MRI method, a motion phantom study and a digital phantom study were performed. Additionally, six patients who had cancer(s) in the liver were prospectively enrolled in this study. For each patient, multislice sagittal MR images were acquired for 4D-MRI reconstruction. 4D retrospective sorting was performed based on respiratory phases. Single-slice cine MRI was also acquired in the axial, coronal, and sagittal planes across the tumor center from which tumor motion trajectories in the SI, AP, and medial-lateral (ML) directions were extracted and used as references from comparison. All MR images were acquired in a 1.5 T scanner using a steady-state precession sequence (frame rate ∼ 3 frames/s). 4D-CT scans showed that δSPS (SI) was significantly greater than δSPS (LAT) (p-value: 0.012); the median phase-shift was 16.9% and 7.7%, respectively. Body surface motion measurement from axial and sagittal MR cines also showed δSPS (SI) was significantly greater than δSPS (LAT). The median δSPS (SI) and δSPS (LAT) was 11.0% and 9.2% (p-value = 0.008), respectively. Tumor motion trajectories from 4D-MRI matched with those from single-slice cine MRI: the mean (±SD) absolute differences in tumor motion amplitude between the two were 1.5 ± 1.6 mm, 2.1 ± 1.9 mm, and 1.1 ± 1.0 mm in the SI, ML, and AP directions from this patient study. Space-dependent phase shift is less problematic for sagittal acquisition than for axial acquisition. 4D-MRI using sagittal acquisition was successfully carried out in patients with hepatic tumors.

A 3D reconstruction of pancreas development in the human embryos during embryonic period (Carnegie stages 15-23).

PubMed

Radi, M; Gaubert, J; Cristol-Gaubert, R; Baecker, V; Travo, P; Prudhomme, M; Godlewski, G; Prat-Pradal, D

2010-01-01

The goal in this paper was to rebuild a three dimensional (3D) reconstruction of the dorsal and ventral pancreatic buds, in the human embryos, at Carnegie stages 15-23. The early development of the pancreas is studied by tissue observation and reconstruction by a computer-assisted method, using a light micrograph images from consecutive serial sagittal sections (diameter 7 microm) of ten human embryos ranging from Carnegie stages 15-23, CRL 7-27 mm, fixed, dehydrated and embedded in paraffin, were stained alternately with haematoxylin-eosin or Heindenhain'Azan. The images were digitalized by Canon Camera 350 EOS D. The serial views were aligned automatically by software, manual alignment was performed, the data were analysed following segmentation and threshold. The two buds were clearly identified at stage 15. In stage 16, both pancreatic buds were in final position, and begin to merge in stage 17. From stage 18 to the stage 23, surrounding connective tissue differentiated. In the stage 23, the morphology of the pancreas was definitive. The superior portion of the anterior face of the pancreas's head was arising from the dorsal bud. The rest of the head including the uncinate process emanated from the ventral bud. The 3D computer-assisted reconstruction of the human pancreas visualized the relationships between the two pancreatic buds. This explains the disposition and the modality of the components fusion. This embryologic development permits a better understanding of congenital abnormalities.

The Relationship between Neck Pain and Cervical Alignment in Young Female Nursing Staff.

PubMed

Kim, Jang-Hun; Kim, Joo Han; Kim, Jong-Hyun; Kwon, Taek-Hyun; Park, Yoon-Kwan; Moon, Hong Joo

2015-09-01

Degenerative changes in the cervical spine are commonly accompanied by cervical kyphosis which can cause neck pain. This study examined the relationship between neck pain and cervical alignment. A total of 323 female nursing staff from our hospital were enrolled. Sagittal radiographs of the cervical spine, Body Mass Index (BMI), Visual Analogue Scale (VAS) measures of neck and arm pain, Neck Disability Index (NDI) and the Short Form (36) Health Survey (SF-36 scores) were obtained and reviewed retrospectively. Global lordosis (GL) of the cervical spine was measured on radiograph images. Correlations between GL and questionnaire scores were investigated using the following three methods : 1) correlation between GL and questionnaire scores among the entire sample; 2) subgroup analysis of patients with "kyphosis (KYP) : GL scores<0" vs. those with "lordosis (LOR) : GL scores>0" on questionnaire measures; and 3) subgroup analysis of patients with pain vs. those without pain, on GL and questionnaire measures. There was no significant correlation between GL and any questionnaire measure. There was a significant difference between the mean GLs of the KYP and LOR groups, but there were no group differences in BMI, age or any questionnaire measures. There was no difference between the pain (n=92) and pain-free (n=231) groups in age, BMI or GL, but there were differences in neck, and arm pain, and physical function and NDI scores. Our data suggest that kyphotic deformity was not associated with neck pain.

Comparing the Effectiveness of Sagittal Balance, Foraminal Stenosis, and Preoperative Cord Rotation in Predicting Postoperative C5 Palsy.

PubMed

Chugh, Arunit J S; Weinberg, Douglas S; Alonso, Fernando; Eubanks, Jason D

2017-11-01

Retrospective cohort review. To determine whether preoperative cord rotation is independently correlated with C5 palsy when analyzed alongside measures of sagittal balance and foraminal stenosis. Postoperative C5 palsy is a well-documented complication of cervical procedures with a prevalence of 4%-8%. Recent studies have shown a correlation with preoperative spinal cord rotation. There have been few studies, however, that have examined the role of sagittal balance and foraminal stenosis in the development of C5 palsy. A total of 77 patients who underwent cervical decompression-10 of whom developed C5 palsy-were reviewed. Sagittal balance was assessed using curvature angle and curvature index on radiographs and magnetic resonance image (MRI). Cord rotation was assessed on axial MRI. C4-C5 foraminal stenosis was assessed on sagittal MRI using area measurements and a grading scale. Demographics and information on surgical approach were gathered from chart review. Correlation with C5 palsy was performed by point-biserial, χ, and regression analyses. Point-biserial analysis indicated that only cord rotation showed significance (P<0.01). There was no statistical significance shown with surgical approach, sex, or age. In addition, changes in sagittal balance did not correlate with presence of C5 palsy. Logistic regression model yielded cord rotation as the only significant independent predictor of C5 palsy. For every degree of axial cord rotation, the likelihood ratio for suffering a C5 palsy was 3.93 (95% confidence interval, 2.01-8.66; P<0.05). This supports the independent capability of preoperative cord rotation to predict postoperative C5 palsy. Lack of correlation with measures of neuroforaminal stenosis potentially points to mechanisms other than direct compression as the etiology. In addition, the lack of correlation with postoperative changes in sagittal balance hints that measures of curvature angle and curvature index may not be appropriate to accurately predict this complication. Level 3.

Transforaminal Anterior Release for the Treatment of Fixed Sagittal Imbalance and Segmental Kyphosis, Minimum 2-Year Follow-Up Study.

PubMed

Sweet, Fred A; Sweet, Andrea

2015-09-01

Retrospective review of prospectively accrued patient cohort. To report minimum 2 years' follow-up after a single-surgeon series of 47 consecutive patients in whom fixed sagittal imbalance or segmental kyphosis was treated with a novel unilateral transforaminal annular release. Fixed sagittal imbalance has been treated most recently with pedicle subtraction osteotomy with great success but is associated with significant blood loss and neurologic risk. Forty-seven consecutive patients with fixed sagittal imbalance (n = 29) or segmental kyphosis (n = 18) were treated by a single surgeon with a single-level transforaminal anterior release (TFAR) to effect an opening wedge correction. Sagittal and coronal correction was performed with in situ rod contouring. An interbody cage was captured in the disc space with rod compression. Radiographic and clinical outcome analysis was performed with a minimum 2-year follow-up (range 2-7.8 years). The average increase in lordosis was 36° (range 24°-56°) in the fixed sagittal deformity group. Coronal corrections averaged 34° (range 18°-48°). The average improvement in plumb line was 13.6 cm. There were four pseudarthroses, one at the TFAR. Average blood loss was 578 mL (range 200-1,200). One patient had a transient grade 4/5 anterior tibialis weakness. There were no vascular injuries or permanent neurologic deficits. There were significant improvements in the Oswestry Disability Index (p < .001) and Scoliosis Research Society Questionnaire scores (p = .003). Eighty-four percent of patients reported improvement in pain, self-image, and satisfaction with the procedure. TFAR is a useful procedure for correcting segmental kyphosis and fixed sagittal imbalance with relatively low blood loss and was found to be neurologically safe in this single-surgeon series. Therapeutic study, Level IV (case series, no control group). Copyright © 2015 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Relationship between movement time and hip moment impulse in the sagittal plane during sit-to-stand movement: a combined experimental and computer simulation study.

PubMed

Inai, Takuma; Takabayashi, Tomoya; Edama, Mutsuaki; Kubo, Masayoshi

2018-04-27

The association between repetitive hip moment impulse and the progression of hip osteoarthritis is a recently recognized area of study. A sit-to-stand movement is essential for daily life and requires hip extension moment. Although a change in the sit-to-stand movement time may influence the hip moment impulse in the sagittal plane, this effect has not been examined. The purpose of this study was to clarify the relationship between sit-to-stand movement time and hip moment impulse in the sagittal plane. Twenty subjects performed the sit-to-stand movement at a self-selected natural speed. The hip, knee, and ankle joint angles obtained from experimental trials were used to perform two computer simulations. In the first simulation, the actual sit-to-stand movement time obtained from the experiment was entered. In the second simulation, sit-to-stand movement times ranging from 0.5 to 4.0 s at intervals of 0.25 s were entered. Hip joint moments and hip moment impulses in the sagittal plane during sit-to-stand movements were calculated for both computer simulations. The reliability of the simulation model was confirmed, as indicated by the similarities in the hip joint moment waveforms (r = 0.99) and the hip moment impulses in the sagittal plane between the first computer simulation and the experiment. In the second computer simulation, the hip moment impulse in the sagittal plane decreased with a decrease in the sit-to-stand movement time, although the peak hip extension moment increased with a decrease in the movement time. These findings clarify the association between the sit-to-stand movement time and hip moment impulse in the sagittal plane and may contribute to the prevention of the progression of hip osteoarthritis.

Influence of lumbar lordosis restoration on thoracic curve and sagittal position in lumbar degenerative kyphosis patients.

PubMed

Jang, Jee-Soo; Lee, Sang-Ho; Min, Jun-Hong; Maeng, Dae Hyeon

2009-02-01

A retrospective study. To determine postsurgical correlations between thoracic and lumbar sagittal curves in lumbar degenerative kyphosis (LDK) and to determine predictability of spontaneous correction of thoracic curve and sacral angle after surgical restoration of lumbar lordosis and fusion. To our knowledge, there are only a limited number of articles about the relationship between thoracic and lumbar curve in sagittal thoracic compensated LDK. Retrospective review of 53 consecutive patients treated with combined anterior and posterior spinal arthrodesis. We included patients with sagittal thoracic compensated LDK caused by sagittal imbalance in this study. Total lumbar lordosis, thoracic kyphosis, sacral slope, and C7 plumb line were measured on the pre- and postoperative whole spine lateral views. Postoperative changes in thoracic kyphosis, sacral slope, and C7 plumb line according to the surgical lumbar lordosis restoration were measured and evaluated. The mean preoperative sagittal imbalance by plumb line was 78.3 mm (+/-76.5); this improved to 13.6 mm (+/-25) after surgery (P < 0.0001). Mean lumbar lordosis was 9.4 degrees (+/-19.2) before surgery and increased to 38.4 degrees (+/-13.1) at follow-up (P < 0.0001). Mean thoracic kyphosis was 1.1 degrees (+/-12.7) before surgery and increased to 17.6 degrees (+/-12.2) at follow-up (P < 0.0001). Significant preoperative correlations existed between kyphosis and lordosis (r = 0.772, P < 0.0001) and between lordosis and sacral slope (r = 0.785, P < 0.0001). Postoperative lumbar lordosis is correlated to thoracic kyphosis increase (r = 0.620, P < 0.0001). Postoperative lumbar lordosis is correlated to sacral slope increase (r = 0.722, P < 0.0001). Reciprocal relationship exists between lumbar lordosis and thoracic kyphosis in sagittal thoracic compensated LDK. Surgical restoration of lumbar lordosis for LDK brings about high level of statistical correlation to thoracic kyphosis improvement. At the same time, the reciprocal relationship is maintained.

Does Shoe Collar Height Influence Ankle Joint Kinematics and Kinetics in Sagittal Plane Maneuvers?

PubMed Central

Yang, Yang; Fang, Ying; Zhang, Xini; He, Junliang; Fu, Weijie

2017-01-01

The Objective of the study is to investigate the effects of basketball shoes with different collar heights on ankle kinematics and kinetics and athletic performance in different sagittal plane maneuvers. Twelve participants who wore high-top and low-top basketball shoes (hereafter, HS and LS, respectively) performed a weight-bearing dorsiflexion (WB-DF) maneuver, drop jumps (DJs), and lay-up jumps (LJs). Their sagittal plane kinematics and ground reaction forces were recorded using the Vicon motion capture system and Kistler force plates simultaneously. Moreover, ankle dorsiflexion and plantarflexion angles, moment, power, stiffness, and jump height were calculated. In the WB-DF test, the peak ankle dorsiflexion angle (p = 0.041) was significantly smaller in HS than in LS. Additionally, the peak ankle plantarflexion moment (p = 0.028) and power (p = 0.022) were significantly lower in HS than in LS during LJs but not during DJs. In both jumping maneuvers, no significant differences were found in the jump height or ankle kinematics between the two shoe types. According to the WB-DF test, increasing shoe collar height can effectively reduce the ankle range of motion in the sagittal plane. Although the HS did not restrict the flexion–extension performance of the ankle joint during two jumping maneuvers, an increased shoe collar height can reduce peak ankle plantarflexion moment and peak power during the push-off phase in LJs. Therefore, a higher shoe collar height should be used to circumvent effects on the partial kinetics of the ankle joint in the sagittal plane. Key points An increased shoe collar height effectively reduced ankle joint ROM in the sagittal plane in weight-bearing dorsiflexion maneuver. Shoe collar height did not affect sagittal plane ankle kinematics and had no effect on performance during realistic jumping. Shoe collar height can affect the ankle plantarflexion torque and peak power during the push-off phase in lay-up jump. PMID:29238255

Clinical Evaluation of positioning verification using digital tomosynthesis (DTS) based on bony anatomy and soft tissues for prostate image-guided radiation therapy (IGRT)

PubMed Central

Yoo, Sua; Wu, Q. Jackie; Godfrey, Devon; Yan, Hui; Ren, Lei; Das, Shiva; Lee, William R.; Yin, Fang-Fang

2008-01-01

Purpose To evaluate on-board digital tomosynthesis (DTS) for patient positioning in comparison with 2D-radiographs and 3D-CBCT. Methods and Materials A total of 92 image sessions from 9 prostate cancer patients were analyzed. An on-board image set was registered to a corresponding reference image set. Four pairs of image sets were used; DRR vs. on-board orthogonal paired radiograph for the 2D method, coronal-reference-DTS (RDTS) vs. on-board coronal-DTS for the coronal-DTS method, sagittal-RDTS vs. on-board sagittal-DTS for the sagittal-DTS method, and planning CT vs. CBCT for the CBCT method. Registration results were compared. Results The systematic errors in all methods were less than 1 mm/1°. When registering bony anatomy, the mean vector differences were 0.21±0.11 cm between 2D and CBCT, 0.11±0.08 cm between CBCT and coronal-DTS, and 0.14±0.07 cm between CBCT and sagittal-DTS. The correlation of CBCT to DTS was stronger (coefficients=0.92–0.95) than the correlation between 2D and CBCT or DTS (coefficients=0.81–0.83). When registering soft tissue, the mean vector differences were 0.18±0.11 cm between CBCT and coronal-DTS and 0.29±0.17 cm between CBCT and sagittal-DTS. The correlation coefficients of CBCT to sagittal-DTS and to coronal-DTS were 0.84 and 0.92, respectively. Conclusions DTS could provide equivalent results to CBCT when bony anatomy is used as landmarks for prostate IGRT. For soft tissue-based positioning verification, coronal-DTS produced equivalent results to CBCT and sagittal-DTS alone was insufficient. DTS could allow comparable soft tissue-based target localization with faster scanning time and less imaging dose compared to CBCT. PMID:19100923

The role of rigid vs. dynamic instrumentation for stabilization of the degenerative lumbosacral spine.

PubMed

Korovessis, Panagiotis; Papazisis, Zisis; Lambiris, Elias

2002-01-01

This is a prospective comparative randomised study to compare the immediately postoperative effects of a rigid versus dynamic instrumentation for degenerative spine disease and stenosis on the standing sagittal lumbar spine alignment and to investigate if a dynamic spine system can replace the commonly used rigid systems in order to avoid the above mentioned disadvantages of rigid fixation. 15 randomly selected patients received the rigid instrumentation SCS and an equal number of randomly selected patients the dynamic TWINFLEX device for spinal stenosis associated degenerative lumbar disease. The age of the patients, who received rigid and dynamic instrumentation was 65 +/- 9 years and 62 +/- 10 years respectively. All patients had standing spine radiographs preoperatively and three months postoperatively. The parameters that were measured and compared pre- to postoperatively were: lumbar lordosis (L1-S1), total lumbar lordosis (T12-S1), sacral tilt, distal lordosis (L4-S1), intervertebral angulation, vertebral inclination and disc index. The instrumented levels in the spines that received rigid and dynamic instrumentation were 3.5 +/- 0.53 and 3 +/- 0.7 respectively. The instrumented levels from L3 to L5 were 23, the lumbosacral junction was instrumented in 3 patients of group A and in 4 patients of group B. Lumbar lordosis did not significantly change postoperatively, while total lordosis was significantly (P=0.04) increased in the patients who received the rigid instrumentation, while it was significantly (P=0.012) decreased in the group B. Intervertebral angulation of the non-instrumented level L1-L2 was increased in the group A (P=0.01), while the dynamic instrumentation increased (P=0.02) the intervertebral inclination of the adjacent level L2-L3, immediately above the uppermost instrumented level. Distal lordosis and sacral tilt did not change in any patient in both groups. Both instrumentations did not change the lateral vertebral inclination of L1 to L5 vertebrae. Rigid instrumentation increased the lordotic inclination of L5 (P=0.03) and of S1 (P=0.03). Rigid instrumentation increased (P=0.04) the intervertebral angulation at the uppermost instrumented level L3-L4 The most significant change in vertebral angulation was achieved at the instrumented level L4-L5 by the dynamic (P=0.007) and rigid (0.05). The disc index at the level L2-L3 was increased by both instrumentation [dynamic P=0.007 and rigid (P=0.02)]. The index L3-L4 was increased following dynamic fixation (P=0.0007). The disc index L4-L5 was postoperatively increased by both types of instrumentation (rigid P=0.006, dynamic P=0.02). The disc index L5-S1 did not significantly change postoperatively by either system. Both rigid and dynamic instrumentations restored lumbar lordosis, sacral tilt, distal lordosis and increased the foraminal diameter at the level L4-L5 resulting in an indirect decompression of the nerve roots at this level . Both rigid and dynamic instrumentations applied in the lumbosacral spine to treat degenerative disease secured L3 to S1 sagittal spine profile close to preoperative levels, that should theoretically guarantee a pain-free postoperative course. This study supports the belief that the dynamic system can be used with the same indications with the rigid in degenerative lumbar spine because it can offer equally good short-term results regarding sagittal spine alignment while simultaneously it has the previously mentioned advantages (avoidance stress shielding etc).

1975 Memorial Award Paper. Image generation and display techniques for CT scan data. Thin transverse and reconstructed coronal and sagittal planes.

PubMed

Glenn, W V; Johnston, R J; Morton, P E; Dwyer, S J

1975-01-01

The various limitations to computerized axial tomographic (CT) interpretation are due in part to the 8-13 mm standard tissue plane thickness and in part to the absence of alternative planes of view, such as coronal or sagittal images. This paper describes a method for gathering multiple overlapped 8 mm transverse sections, subjecting these data to a deconvolution process, and then displaying thin (1 mm) transverse as well as reconstructed coronal and sagittal CT images. Verification of the deconvolution technique with phantom experiments is described. Application of the phantom results to human post mortem CT scan data illustrates this method's faithful reconstruction of coronal and sagittal tissue densities when correlated with actual specimen photographs of a sectioned brain. A special CT procedure, limited basal overlap scanning, is proposed for use on current first generation CT scanners without hardware modification.

A late neurological complication following posterior correction surgery of severe cervical kyphosis.

PubMed

Hojo, Yoshihiro; Ito, Manabu; Abumi, Kuniyoshi; Kotani, Yoshihisa; Sudo, Hideki; Takahata, Masahiko; Minami, Akio

2011-06-01

Though a possible cause of late neurological deficits after posterior cervical reconstruction surgery was reported to be an iatrogenic foraminal stenosis caused not by implant malposition but probably by posterior shift of the lateral mass induced by tightening screws and plates, its clinical features and pathomechanisms remain unclear. The aim of this retrospective clinical review was to investigate the clinical features of these neurological complications and to analyze the pathomechanisms by reviewing pre- and post-operative imaging studies. Among 227 patients who underwent cervical stabilization using cervical pedicle screws (CPSs), six patients who underwent correction of cervical kyphosis showed postoperative late neurological complications without any malposition of CPS (ND group). The clinical courses of the patients with deficits were reviewed from the medical records. Radiographic assessment of the sagittal alignment was conducted using lateral radiographs. The diameter of the neural foramen was measured on preoperative CT images. These results were compared with the other 14 patients who underwent correction of cervical kyphosis without late postoperative neurological complications (non-ND group). The six patients in the ND group showed no deficits in the immediate postoperative periods, but unilateral muscle weakness of the deltoid and biceps brachii occurred at 2.8 days postoperatively on average. Preoperative sagittal alignment of fusion area showed significant kyphosis in the ND group. The average of kyphosis correction in the ND was 17.6° per fused segment (range 9.7°-35.0°), and 4.5° (range 1.3°-10.0°) in the non-ND group. A statistically significant difference was observed in the degree of preoperative kyphosis and the correction angles at C4-5 between the two groups. The diameter of the C4-5 foramen on the side of deficits was significantly smaller than that of the opposite side in the ND group. Late postoperative neurological complications after correction of cervical kyphosis were highly associated with a large amount of kyphosis correction, which may lead foraminal stenosis and enhance posterior drift of the spinal cord. These factors may lead to both compression and traction of the nerves, which eventually cause late neurological deficits. To avoid such complications, excessive kyphosis correction should not be performed during posterior surgery to avoid significant posterior shift of the spinal cord and prophylactic foraminotomies are recommended if narrow neuroforamina were evident on preoperative CT images. Regardless of revision decompression or observation, the majority of this late neurological complication showed complete recovery over time.

C1 lateral mass screw-induced occipital neuralgia: a report of two cases.

PubMed

Conroy, Eimear; Laing, Alan; Kenneally, Rory; Poynton, A R

2010-03-01

C1-2 polyaxial screw-rod fixation is a relatively new technique. While recognizing the potential for inadvertent vertebral artery injury, there have been few reports in the literature outlining all the possible complications. Aim of this study is to review all cases of C1 lateral mass screws insertion with emphasis on the evaluation of potential structures at risk during the procedure. We retrospectively reviewed all patients in our unit who had C1 lateral mass screw insertion over a 2-year period. The C1 lateral mass screw was inserted as part of an atlantoaxial stabilization or incorporated into a modular occiput/subaxial construct. Outcome measures included clinical and radiological parameters. Clinical indicators included age, gender, neurologic status, surgical indication and the number of levels stabilized. Intraoperative complications including blood loss, vertebral artery injury or dural tears were recorded. Postoperative pain distribution and neurological deficit were recorded. Radiological indicators included postoperative plain radiographs to assess sagittal alignment and to check for screw malposition or construct failure. A total of 18 lateral mass screws were implanted in 9 patients. There were three male and six female patients who had C1 lateral mass screw insertion in this unit. Two patients had atlantoaxial stabilization for C2 fracture. There were four patients with rheumatoid arthritis whose C1 lateral mass screws were inserted as part of an occipitocervical or subaxial cervical stabilization. There was no vertebral artery injury, no cerebrospinal fluid leak and minimal blood loss in all patients. Three patients developed postoperative occipital neuralgia. This neuralgia was transient, in one of the patients having settled at 6-week follow-up. In the other two patients the neuralgia was unresolved at time of latest follow-up but was adequately controlled with appropriate pain management. Postoperatively no patient had radiographic evidence of construct failure and all demonstrated excellent sagittal alignment. It has been reported that the absence of threads on the upper portion of the long shank screw may protect against neural irritation. However, insertion of the C1 lateral mass screw necessitates careful caudal retraction of the C2 dorsal root ganglion. The insertion point for the C1 lateral mass screw is at the junction of the C1 posterior arch and the midpoint of the posterior inferior part of the C1 lateral mass. Two patients in our series suffered occipital neuralgia post-insertion of C1 lateral mass screws. This highlights the potential for damage to the C2 nerve root during C1 lateral mass screw placement.

C1 lateral mass screw-induced occipital neuralgia: a report of two cases

PubMed Central

Laing, Alan; Kenneally, Rory; Poynton, A. R.

2009-01-01

C1–2 polyaxial screw-rod fixation is a relatively new technique. While recognizing the potential for inadvertent vertebral artery injury, there have been few reports in the literature outlining all the possible complications. Aim of this study is to review all cases of C1 lateral mass screws insertion with emphasis on the evaluation of potential structures at risk during the procedure. We retrospectively reviewed all patients in our unit who had C1 lateral mass screw insertion over a 2-year period. The C1 lateral mass screw was inserted as part of an atlantoaxial stabilization or incorporated into a modular occiput/subaxial construct. Outcome measures included clinical and radiological parameters. Clinical indicators included age, gender, neurologic status, surgical indication and the number of levels stabilized. Intraoperative complications including blood loss, vertebral artery injury or dural tears were recorded. Postoperative pain distribution and neurological deficit were recorded. Radiological indicators included postoperative plain radiographs to assess sagittal alignment and to check for screw malposition or construct failure. A total of 18 lateral mass screws were implanted in 9 patients. There were three male and six female patients who had C1 lateral mass screw insertion in this unit. Two patients had atlantoaxial stabilization for C2 fracture. There were four patients with rheumatoid arthritis whose C1 lateral mass screws were inserted as part of an occipitocervical or subaxial cervical stabilization. There was no vertebral artery injury, no cerebrospinal fluid leak and minimal blood loss in all patients. Three patients developed postoperative occipital neuralgia. This neuralgia was transient, in one of the patients having settled at 6-week follow-up. In the other two patients the neuralgia was unresolved at time of latest follow-up but was adequately controlled with appropriate pain management. Postoperatively no patient had radiographic evidence of construct failure and all demonstrated excellent sagittal alignment. It has been reported that the absence of threads on the upper portion of the long shank screw may protect against neural irritation. However, insertion of the C1 lateral mass screw necessitates careful caudal retraction of the C2 dorsal root ganglion. The insertion point for the C1 lateral mass screw is at the junction of the C1 posterior arch and the midpoint of the posterior inferior part of the C1 lateral mass. Two patients in our series suffered occipital neuralgia post-insertion of C1 lateral mass screws. This highlights the potential for damage to the C2 nerve root during C1 lateral mass screw placement. PMID:19856190

Lower Extremity Energy Absorption and Biomechanics During Landing, Part I: Sagittal-Plane Energy Absorption Analyses

PubMed Central

Norcross, Marc F.; Lewek, Michael D.; Padua, Darin A.; Shultz, Sandra J.; Weinhold, Paul S.; Blackburn, J. Troy

2013-01-01

Context: Eccentric muscle actions of the lower extremity absorb kinetic energy during landing. Greater total sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing has been associated with landing biomechanics considered high risk for anterior cruciate ligament (ACL) injury. We do not know whether groups with different INI EA magnitudes exhibit meaningful differences in ACL-related landing biomechanics and whether INI EA might be useful to identify ACL injury-risk potential. Objective: To compare biomechanical factors associated with noncontact ACL injury among sagittal-plane INI EA groups and to determine whether an association exists between sex and sagittal-plane INI EA group assignment to evaluate the face validity of using sagittal-plane INI EA to identify ACL injury risk. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: A total of 82 (41 men, 41 women; age = 21.0 ± 2.4 years, height = 1.74 ± 0.10 m, mass = 70.3 ± 16.1 kg) healthy, physically active individuals volunteered. Intervention(s): We assessed landing biomechanics using an electromagnetic motion-capture system and force plate during a double-legged jump-landing task. Main Outcome Measure(s): Total INI EA was used to group participants into high, moderate, and low tertiles. Sagittal- and frontal-plane knee kinematics; peak vertical and posterior ground reaction forces (GRFs); anterior tibial shear force; and internal hip extension, knee extension, and knee varus moments were identified and compared across groups using 1-way analyses of variance. We used a χ2 analysis to compare male and female representation in the high and low groups. Results: The high group exhibited greater knee-extension moment and posterior GRFs than both the moderate (P < .05) and low (P < .05) groups and greater anterior tibial shear force than the low group (P < .05). No other group differences were noted. Women were not represented more than men in the high group (χ2 = 1.20, P = .27). Conclusions: Greater sagittal-plane INI EA likely indicates greater ACL loading, but it does not appear to influence frontal-plane biomechanics related to ACL injury. Women were not more likely than men to demonstrate greater INI EA, suggesting that quantification of sagittal-plane INI EA alone is not sufficient to infer ACL injury-risk potential. PMID:23944382

Lower extremity energy absorption and biomechanics during landing, part I: sagittal-plane energy absorption analyses.

PubMed

Norcross, Marc F; Lewek, Michael D; Padua, Darin A; Shultz, Sandra J; Weinhold, Paul S; Blackburn, J Troy

2013-01-01

Eccentric muscle actions of the lower extremity absorb kinetic energy during landing. Greater total sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing has been associated with landing biomechanics considered high risk for anterior cruciate ligament (ACL) injury. We do not know whether groups with different INI EA magnitudes exhibit meaningful differences in ACL-related landing biomechanics and whether INI EA might be useful to identify ACL injury-risk potential. To compare biomechanical factors associated with noncontact ACL injury among sagittal-plane INI EA groups and to determine whether an association exists between sex and sagittal-plane INI EA group assignment to evaluate the face validity of using sagittal-plane INI EA to identify ACL injury risk. Descriptive laboratory study. Research laboratory. A total of 82 (41 men, 41 women; age = 21.0 ± 2.4 years, height = 1.74 ± 0.10 m, mass = 70.3 ± 16.1 kg) healthy, physically active individuals volunteered. We assessed landing biomechanics using an electromagnetic motion-capture system and force plate during a double-legged jump-landing task. Total INI EA was used to group participants into high, moderate, and low tertiles. Sagittal- and frontal-plane knee kinematics; peak vertical and posterior ground reaction forces (GRFs); anterior tibial shear force; and internal hip extension, knee extension, and knee varus moments were identified and compared across groups using 1-way analyses of variance. We used a χ (2) analysis to compare male and female representation in the high and low groups. The high group exhibited greater knee-extension moment and posterior GRFs than both the moderate (P < .05) and low (P < .05) groups and greater anterior tibial shear force than the low group (P < .05). No other group differences were noted. Women were not represented more than men in the high group (χ(2) = 1.20, P = .27). Greater sagittal-plane INI EA likely indicates greater ACL loading, but it does not appear to influence frontal-plane biomechanics related to ACL injury. Women were not more likely than men to demonstrate greater INI EA, suggesting that quantification of sagittal-plane INI EA alone is not sufficient to infer ACL injury-risk potential.

Measurement of lumbar spine intervertebral motion in the sagittal plane using videofluoroscopy.

PubMed

Harvey, Steven; Hukins, David; Smith, Francis; Wardlaw, Douglas; Kader, Deiary

2016-08-10

Static radiographic techniques are unable to capture the wealth of kinematic information available from lumbar spine sagittal plane motion. Demonstration of a viable non-invasive technique for acquiring and quantifying intervertebral motion of the lumbar spine in the sagittal plane. Videofluoroscopic footage of sagittal plane lumbar spine flexion-extension in seven symptomatic volunteers (mean age = 48 yrs) and one asymptomatic volunteer (age = 54 yrs) was recorded. Vertebral bodies were digitised using customised software employing a novel vertebral digitisation scheme that was minimally affected by out-of-plane motion. Measurement errors in intervertebral rotation (± 1°) and intervertebral displacement (± 0.5 mm) compare favourably with the work of others. Some subjects presenting with an identical condition (disc prolapse) exhibited a similar column vertebral flexion-extension relative to S1 (L3: max. 5.9°, min. 5.6°), while in others (degenerative disc disease) there was paradoxically a significant variation in this measurement (L3: max. 28.1°, min. 0.7°). By means of a novel vertebral digitisation scheme and customised digitisation/analysis software, sagittal plane intervertebral motion data of the lumbar spine data has been successfully extracted from videofluoroscopic image sequences. Whilst the intervertebral motion signatures of subjects in this study differed significantly, the available sample size precluded the inference of any clinical trends.

The lumbar lordosis index: a new ratio to detect spinal malalignment with a therapeutic impact for sagittal balance correction decisions in adult scoliosis surgery.

PubMed

Boissière, Louis; Bourghli, Anouar; Vital, Jean-Marc; Gille, Olivier; Obeid, Ibrahim

2013-06-01

Sagittal malalignment is frequently observed in adult scoliosis. C7 plumb line, lumbar lordosis and pelvic tilt are the main factors to evaluate sagittal balance and the need of a vertebral osteotomy to correct it. We described a ratio: the lumbar lordosis index (ratio lumbar lordosis/pelvic incidence) (LLI) and analyzed its relationships with spinal malalignment and vertebral osteotomies. 53 consecutive patients with a surgical adult scoliosis had preoperative and postoperative full spine EOS radiographies to measure spino-pelvic parameters and LLI. The lack of lordosis was calculated after prediction of theoretical lumbar lordosis. Correlation analysis between the different parameters was performed. All parameters were correlated with spinal malalignment but LLI is the most correlated parameter (r = -0.978). It is also the best parameter in this study to predict the need of a spinal osteotomy (r = 1 if LLI <0.5). LLI is a statistically validated parameter for sagittal malalignment analysis. It can be used as a mathematical tool to detect spinal malalignment in adult scoliosis and guides the surgeon decision of realizing a vertebral osteotomy for adult scoliosis sagittal correction. It can be used as well for the interpretation of clinical series in adult scoliosis.

Accuracy and Reproducibility Using Patient-Specific Instrumentation in Total Ankle Arthroplasty.

PubMed

Daigre, Justin; Berlet, Gregory; Van Dyke, Bryan; Peterson, Kyle S; Santrock, Robert

2017-04-01

Implant survivorship is dependent on accuracy of implantation and successful soft tissue balancing. System instrumentation for total ankle arthroplasty implantation has a key influence on surgeon accuracy and reproducibility. The purpose of this study was to determine the accuracy and reproducibility of implant position with patient-specific guides for total ankle arthroplasty across multiple surgeons at multiple facilities. This retrospective, multicenter study included 44 patients who received a total ankle implant (INBONE II Total Ankle System; Wright Medical Technology, Memphis, TN) using PROPHECY patient-specific guides from January 2012 to December 2014. Forty-four patients with an average age of 63.0 years underwent total ankle arthroplasty using this preoperative patient-specific system. Preoperative computed tomography (CT) scans were obtained to assess coronal plane deformity, assess mechanical and anatomic alignment, and build patient-specific guides that referenced bony anatomy. The mean preoperative coronal deformity was 4.6 ± 4.6 degrees (range, 14 degrees varus to 17 degrees valgus). The first postoperative weightbearing radiographs were used to measure coronal and sagittal alignment of the implant vs the anatomic axis of the tibia. In 79.5% of patients, the postoperative implant position of the tibia corresponded to the preoperative plan of the tibia within 3 degrees of the intended target, within 4 degrees in 88.6% of patients, and within 5 degrees in 100% of patients. The tibial component coronal size was correctly predicted in 98% of cases, whereas the talar component was correctly predicted in 80% of cases. The use of patient-specific instrumentation for total ankle arthroplasty provided reliable alignment and reproducibility in the clinical situation similar to that shown in cadaveric testing. This study has shown that the preoperative patient-specific instrumentation provided for accuracy and reproducibility of ankle arthroplasty implantation in a cohort across multiple surgeons and facilities. Level III, retrospective comparative series.

Running in ostriches (Struthio camelus): three-dimensional joint axes alignment and joint kinematics.

PubMed

Rubenson, Jonas; Lloyd, David G; Besier, Thor F; Heliams, Denham B; Fournier, Paul A

2007-07-01

Although locomotor kinematics in walking and running birds have been examined in studies exploring many biological aspects of bipedalism, these studies have been largely limited to two-dimensional analyses. Incorporating a five-segment, 17 degree-of-freedom (d.f.) kinematic model of the ostrich hind limb developed from anatomical specimens, we quantified the three-dimensional (3-D) joint axis alignment and joint kinematics during running (at approximately 3.3 m s(-1)) in the largest avian biped, the ostrich. Our analysis revealed that the majority of the segment motion during running in the ostrich occurs in flexion/extension. Importantly, however, the alignment of the average flexion/extension helical axes of the knee and ankle are rotated externally to the direction of travel (37 degrees and 21 degrees , respectively) so that pure flexion and extension at the knee will act to adduct and adbuct the tibiotarsus relative to the plane of movement, and pure flexion and extension at the ankle will act to abduct and adduct the tarsometatarsus relative to the plane of movement. This feature of the limb anatomy appears to provide the major lateral (non-sagittal) displacement of the lower limb necessary for steering the swinging limb clear of the stance limb and replaces what would otherwise require greater adduction/abduction and/or internal/external rotation, allowing for less complex joints, musculoskeletal geometry and neuromuscular control. Significant rotation about the joints' non-flexion/extension axes nevertheless occurs over the running stride. In particular, hip abduction and knee internal/external and varus/valgus motion may further facilitate limb clearance during the swing phase, and substantial non-flexion/extension movement at the knee is also observed during stance. Measurement of 3-D segment and joint motion in birds will be aided by the use of functionally determined axes of rotation rather than assumed axes, proving important when interpreting the biomechanics and motor control of avian bipedalism.

Impact of spine alignment on the rotator cuff in long-term wheelchair users.

PubMed

Kentar, Yasser; Brunner, Manuela; Bruckner, Thomas; Hug, Andreas; Raiss, Patric; Zeifang, Felix; Loew, Markus; Almansour, Haidara; Akbar, Michael

2018-06-01

We investigated the impact of poor seated posture on the prevalence of rotator cuff tears (RCTs) among wheelchair-dependent individuals with long-standing paraplegia. The study included 319 patients. Lateral radiographs of the spine were collected from a database and analyzed to assess the global spinopelvic alignment (SPA). Magnetic resonance images of both shoulders were obtained to detect the presence of cuff tears. Patients were divided into 2 groups: Group RCT-I included all patients with cuff tears (right, left, or bilateral), whereas group RCT-II consisted exclusively of patients with bilateral cuff tears. We used the classification systems developed by Kendall et al and Roussouly et al to assess the sagittal spine alignment and SPA, respectively. Univariate and multivariate analyses were performed. To fit both models (groups RCT-I and RCT-II) to the data, the 4 spine curves according to Roussouly et al were subdivided into 2 groups: Group SPA-I included both type 1 and type 2, whereas group SPA-II included both type 3 and type 4. Magnetic resonance images showed a cuff tear in 192 patients (60.19%) (group RCT-I). Among those, 37 patients (11.60%) had tears in both shoulders (group RCT-II). In group RCT-I, 70.31% of the patients had a kyphotic-lordotic posture. The kyphotic-lordotic posture, a longer duration, and a more rostral neurologic level of injury were highly associated with cuff tear prevalence. In group RCT-II, the multivariate analysis showed that only the duration of spinal cord injury was significantly associated with RCTs. Thoracic hyperkyphosis was associated with a markedly high rate of RCTs. The data from this study may provide support for developing preventive strategies. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Association of baseline knee sagittal dynamic joint stiffness during gait and 2-year patellofemoral cartilage damage worsening in knee osteoarthritis.

PubMed

Chang, A H; Chmiel, J S; Almagor, O; Guermazi, A; Prasad, P V; Moisio, K C; Belisle, L; Zhang, Y; Hayes, K; Sharma, L

2017-02-01

Knee sagittal dynamic joint stiffness (DJS) describes the biomechanical interaction between change in external knee flexion moment and flexion angular excursion during gait. In theory, greater DJS may particularly stress the patellofemoral (PF) compartment and thereby contribute to PF osteoarthritis (OA) worsening. We hypothesized that greater baseline knee sagittal DJS is associated with PF cartilage damage worsening 2 years later. Participants all had OA in at least one knee. Knee kinematics and kinetics during gait were recorded using motion capture systems and force plates. Knee sagittal DJS was computed as the slope of the linear regression line for knee flexion moments vs angles during the loading response phase. Knee magnetic resonance imaging (MRI) scans were obtained at baseline and 2 years later. We assessed the association between baseline DJS and baseline-to-2-year PF cartilage damage worsening using logistic regression with generalized estimating equations (GEE). Our sample had 391 knees (204 persons): mean age 64.2 years (SD 10.0); body mass index (BMI) 28.4 kg/m 2 (5.7); 76.5% women. Baseline knee sagittal DJS was associated with baseline-to-2-year cartilage damage worsening in the lateral (OR = 5.35, 95% CI: 2.37-12.05) and any PF (OR = 2.99, 95% CI: 1.27-7.04) compartment. Individual components of baseline DJS (i.e., change in knee moment or angle) were not associated with subsequent PF disease worsening. Capturing the concomitant effect of knee kinetics and kinematics during gait, knee sagittal DJS is a potentially modifiable risk factor for PF disease worsening. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Radius morphology and its effects on rotation with contoured and noncontoured plating of the proximal radius.

PubMed

Rupasinghe, Shavantha L; Poon, Peter C

2012-05-01

The radius has a sagittal bow and a coronal bow. Fractures are often treated with volar anterior plating. However, the sagittal bow is often overlooked when plating. This study looks at radial morphology and the effect of plating the proximal radius with straight plates and then contoured plates bowed in the sagittal plane. We report our findings and their effect on forearm rotation. Morphology was investigated in 14 radii. Attention was paid to the proximal shaft of the radius and its sagittal bow; from this, 6-, 7-, and 8-hole plates were contoured to fit this bow. A simple transverse fracture was then made at the apex of this bow in 23 cadaver arms. Supination and pronation were compared when plating with a straight plate and a contoured plate. Ten cadavers underwent ulna plating at the same level. The effect on rotation of fractures plated in the distal-third shaft was also measured. A significant reduction in rotation was found when a proximal radius fracture was plated with a straight plate compared with a contoured plate: 10.8°, 12.8°, and 21.7° for 6-, 7-, and 8-hole plates, respectively (P < .05). Forearm rotation was decreased further when a longer plate was used. Ulna or distal shaft plating did not reduce rotation. This study has shown a significant sagittal bow of the proximal shaft of the radius. Plating this with contoured plates in the sagittal plane improves rotation when compared with straight plates. Additional ulna plating is not a source of reduced forearm rotation. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

[Sagittal otolith morphology and the relationship between its mass and the age of Liza haematocheila in the Yangtze Estuary, China].

PubMed

Ji, Yan; Zhao, Feng; Yang, Qin; Ma, Rong Rong; Yang, Gang; Zhang, Tao; Zhuang, Ping

2018-03-01

To examine the relationship of morphological characters of sagittal otolith and the age of Liza haematocheila in the Yangtze Estuary, we analyzed the morphological parameters of 324 pairs of otoliths extracted from 358 L. haematocheila specimens from the Yangtze Estuary in February to June of 2017. The results showed that sagittal otolith had rostrum, antirostrum and obvious central notch. The size and shape of sagittal otolith significantly changed with their growth, from regular melon seeds shape outline to long narrow leaf shape and increasing irregular wavy outline. The average density of sagittal otolith was 1.52 mg·mm -2 . The average rectangularity was 0.68. The length of sagittal otolith was 0.021%-0.047% of entire body length (BL), the width was 0.009%-0.021% of entire BL, and the mass was 0.045‰-0.731‰ of the entire body mass (BM). Otolith length (OL), otolith width (OW) and otolith mass (OM) were all significantly related to the BL, with the determination coefficient for OW and OM model being the highest (R 2 =0.928). The relationship between OM and BL was described best by exponential regression: OM=0.0009BL 1.8737 (R 2 =0.967). The relationships between OM and age (A), BL and A were well fitted by multinomial regressions, respectively: OM=2.9262A 2 +4.8437A+2.1894 (R 2 =0.847), BL=-3.2248A 2 +102.54A+38.373 (R 2 =0.858). In addition, OM was linearly correlated with A. The estimated otolith's ages from the model did not significantly variate from the real ages counting from annulus counts. Therefore, OM could be an effective parameter for the age estimation of L. haematocheila.

Sagittal MRI often overestimates the degree of cerebellar tonsillar ectopia: a potential for misdiagnosis of the Chiari I malformation.

PubMed

Tubbs, R Shane; Yan, Huang; Demerdash, Amin; Chern, Joshua J; Fries, Fabian N; Oskouian, Rod J; Oakes, W Jerry

2016-07-01

We hypothesized that by using coronal MRI, Chiari I malformation could be more precisely diagnosed, would provide simple anatomic landmarks, would provide information regarding asymmetry of hindbrain herniation, and would be a better method for analyzing the tonsillar herniation postoperatively when the opisthion has been removed. Fifty consecutive pediatric patients diagnosed with Chiari I malformation had comparison between the measurements of their caudally descended cerebellar tonsils on midsagittal and coronal MRI images. On MRI coronal imaging, tonsillar asymmetry was found in 48 patients. Maximal left tonsillar descent was 20.9 mm, and maximal right tonsillar descent was 17.4 mm. On MRI sagittal imaging, tonsillar descent ranged from 5 to 27.4 mm. Fifty-eight % of patients had syringomyelia. Five patients (10 %) on coronal MRI were found to have both cerebellar tonsils that were less than 3 mm below the foramen magnum. However, all of these patients had greater than 3 mm of tonsillar ectopia on sagittal imaging. Nineteen patients (38 %) on coronal MRI were found to have one of the cerebellar tonsils that were less than 3 mm below the foramen magnum. Similarly, each of these had greater than 3 mm of tonsillar ecotpia as measured on midsagittal MRI. Also, based on these findings, Chiari I malformation is almost always an asymmetrical tonsillar ectopia. Sagittal MRI overestimates the degree of tonsillar ectopia in patients with Chiari I malformation. Misdiagnosis may occur if sagittal imaging alone is used. The cerebellar tonsils are paramedian structures, and this should be kept in mind when interpreting midline sagittal MRI.

Association of Baseline Knee Sagittal Dynamic Joint Stiffness during Gait and 2-year Patellofemoral Cartilage Damage Worsening in Knee Osteoarthritis

PubMed Central

Chang, Alison H.; Chmiel, Joan S.; Almagor, Orit; Guermazi, Ali; Prasad, Pottumarthi V.; Moisio, Kirsten C.; Belisle, Laura; Zhang, Yunhui; Hayes, Karen; Sharma, Leena

2016-01-01

Objective Knee sagittal dynamic joint stiffness (DJS) describes the biomechanical interaction between change in external knee flexion moment and flexion angular excursion during gait. In theory, greater DJS may particularly stress the patellofemoral (PF) compartment and thereby contribute to PF osteoarthritis (OA) worsening. We hypothesized that greater baseline knee sagittal DJS is associated with PF cartilage damage worsening 2 years later. Methods Participants all had OA in at least one knee. Knee kinematics and kinetics during gait were recorded using motion capture systems and force plates. Knee sagittal DJS was computed as the slope of the linear regression line for knee flexion moments vs. angles during the loading response phase. Knee MRI scans were obtained at baseline and 2 years later. We assessed the association between baseline DJS and baseline-to-2-year PF cartilage damage worsening using logistic regression with generalized estimating equations. Results Our sample had 391 knees (204 persons): mean age 64.2 years (SD 10.0); BMI 28.4 kg/m2 (5.7); 76.5% women. Baseline knee sagittal DJS was associated with baseline-to-2-year cartilage damage worsening in the lateral (OR=5.35, 95% CI: 2.37–12.05) and any PF (OR=2.99, 95% CI: 1.27–7.04) compartment. Individual components of baseline DJS (i.e., change in knee moment or angle) were not associated with subsequent PF disease worsening. Conclusion Capturing the concomitant effect of knee kinetics and kinematics during gait, knee sagittal DJS is a potentially modifiable risk factor for PF disease worsening. PMID:27729289

Rotation in total knee arthroplasty: no difference between patient-specific and conventional instrumentation.

PubMed

Parratte, Sébastien; Blanc, Guillaume; Boussemart, Thomas; Ollivier, Matthieu; Le Corroller, Thomas; Argenson, Jean-Noël

2013-10-01

It was our hypothesis that patient-specific instrumentation (PSI) can improve the accuracy of the rotational alignment in TKA based on the concept of the system and on the potential to clearly identify pre-operatively during planning the classical anatomical landmarks that serve as references to set-up the rotation both for the femur and tibia. In this prospective comparative randomized study, 40 patients (20 in each group) operated in our institution between September 2012 and January 2013 by the 2 senior authors were included. Randomization of patients into one of the two groups was done by the Hospital Informatics Department with the use of a systematic sampling method. All patients received the same cemented high-flex mobile bearing TKA. In the PSI group, implant position was compared to the planed position using previously validated dedicated software. The position of the implants (frontal and sagittal) was compared in the 2 groups on standard X-rays, and the rotational position was analysed on post-operative CT-scan. 90 % of the patients add <2° or mm of difference between the planned position of the implants and the obtained position, except for the tibial rotation where the variations were much higher. Mean HKA was 179° (171-185) in the PSI group with 4 outliers (2 varus: 171° and 172°:184° and 185°) and 178.3° with 2 outliers (171° and 176°) in the control group. No difference was observed between the two groups concerning the frontal and sagittal position of the implants on the ML and AP X-rays. No significant difference of femoral rotation was observed between the two groups with a mean of 0.4° in the PSI group and 0.2° in the control group (p: n.s). Mean tibial rotation was 8° of internal rotation in the PSI group and 15° of internal rotation in the standard group (p: n.s). Based on our results, we were unable to confirm our hypothesis as PSI cannot improve rotation in TKA. More work needs to be done to more clearly define the place of PSI in TKA, to keep on improving the accuracy of the system and to better define the individual targets in TKA in terms of frontal, sagittal and rotational positioning of the implant for each patient. Prospective comparative randomized study, Level II.

[Evaluation of the clinical results of non-surgical treatment for pediatric sagittal fracture of mandibular condyle].

PubMed

Liu, Chang-kui; Tan, Xin-ying; Xu, Juan; Liu, Hua-wei; Liu, San-xia; Hu, Min

2013-11-01

To investigate the clinical results of occlusal splint in the treatment of sagittal fracture of mandibular condyle (SFMC) in children. Thirty-nine patients (48 condyles)aged 3-8 years with sagittal fracture of mandibular condyle were included in this study. All the patients were treated by occlusal splint.Slight open occlusion was maintained by occlusal splint for 3-6 months. Clinical and radiological examination was performed six mouths and every year after treatment. Good mandibular function was observed in 39 patients. Maximal mouth opening over 35 mm was achieved at 6 months. But 11 of the 39 patients presented with deviation on mouth opening at 6 months. The radiology showed an complete remodeling in 32 condyles (28 patients) and partial remodeling in 16 condyles (11 patients). Poor remodelling was not observed in any patients. Good clinical results can be obtained by using occlusal splint in the treatment of pediatric sagittal fracture of mandibular condyle.

A comparison of economy and sagittal plane trunk movements among back-, back/front- and head-loading.

PubMed

Hudson, Sean; Cooke, Carlton; Davies, Simeon; West, Sacha; Gamieldien, Raeeq; Low, Chris; Lloyd, Ray

2018-05-14

It has been suggested that freedom of movement in the trunk could influence load carriage economy. This study aimed to compare the economy and sagittal plane trunk movements associated with three load carriage methods that constrain posture differently. Eighteen females walked at 3 km.h -1 with loads of 0, 3, 6, 9, 12, 15 and 20 kg carried on the back, back/front and head. Load carriage economy was assessed using the Extra Load Index (ELI). Change in sagittal plane trunk forward lean and trunk angle excursion from unloaded to loaded walking were assessed. Results show no difference in economy between methods (p = 0.483), despite differences in the change in trunk forward lean (p = 0.001) and trunk angle excursion (p = 0.021) from unloaded to loaded walking. We conclude that economy is not different among the three methods of load carriage, despite significant differences in sagittal plane trunk movements.

A Proposal of New Reference System for the Standard Axial, Sagittal, Coronal Planes of Brain Based on the Serially-Sectioned Images

PubMed Central

Park, Jin Seo; Park, Hyo Seok; Shin, Dong Sun; Har, Dong-Hwan; Cho, Zang-Hee; Kim, Young-Bo; Han, Jae-Yong; Chi, Je-Geun

2010-01-01

Sectional anatomy of human brain is useful to examine the diseased brain as well as normal brain. However, intracerebral reference points for the axial, sagittal, and coronal planes of brain have not been standardized in anatomical sections or radiological images. We made 2,343 serially-sectioned images of a cadaver head with 0.1 mm intervals, 0.1 mm pixel size, and 48 bit color and obtained axial, sagittal, and coronal images based on the proposed reference system. This reference system consists of one principal reference point and two ancillary reference points. The two ancillary reference points are the anterior commissure and the posterior commissure. And the principal reference point is the midpoint of two ancillary reference points. It resides in the center of whole brain. From the principal reference point, Cartesian coordinate of x, y, z could be made to be the standard axial, sagittal, and coronal planes. PMID:20052359

Improved accuracy of component alignment with the implementation of image-free navigation in total knee arthroplasty.

PubMed

Rosenberger, Ralf E; Hoser, Christian; Quirbach, Sebastian; Attal, Rene; Hennerbichler, Alfred; Fink, Christian

2008-03-01

Accuracy of implant positioning and reconstruction of the mechanical leg axis are major requirements for achieving good long-term results in total knee arthroplasty (TKA). The purpose of the present study was to determine whether image-free computer navigation technology has the potential to improve the accuracy of component alignment in TKA cohorts of experienced surgeons immediately and constantly. One hundred patients with primary arthritis of the knee underwent the unilateral total knee arthroplasty. The cohort of 50 TKAs implanted with conventional instrumentation was directly followed by the cohort of the very first 50 computer-assisted TKAs. All surgeries were performed by two senior surgeons. All patients received the Zimmer NexGen total knee prosthesis (Zimmer Inc., Warsaw, IN, USA). There was no variability regarding surgeons or surgical technique, except for the use of the navigation system (StealthStation) Treon plus Medtronic Inc., Minnesota, MI, USA). Accuracy of implant positioning was measured on postoperative long-leg standing radiographs and standard lateral X-rays with regard to the valgus angle and the coronal and sagittal component angles. In addition, preoperative deformities of the mechanical leg axis, tourniquet time, age, and gender were correlated. Statistical analyses were performed using the SPSS 15.0 (SPSS Inc., Chicago, IL, USA) software package. Independent t-tests were used, with significance set at P < 0.05 (two-tailed) to compare differences in mean angular values and frontal mechanical alignment between the two cohorts. To compute the rate of optimally implanted prostheses between the two groups we used the chi(2) test. The average postoperative radiological frontal mechanical alignment was 1.88 degrees of varus (range 6.1 degrees of valgus-10.1 degrees of varus; SD 3.68 degrees ) in the conventional cohort and 0.28 degrees of varus (range 3.7 degrees -6.0 degrees of varus; SD 1.97 degrees ) in the navigated cohort. Including all criteria for optimal implant alignment, 16 cases (32%) in the conventional cohort and 31 cases (62%) in the navigated cohort have been implanted optimally. The average difference in tourniquet time was modest with additional 12.9 min in the navigated cohort compared to the conventional cohort. Our findings suggest that the experienced knee surgeons can improve immediately and constantly the accuracy of component orientation using an image-free computer-assisted navigation system in TKA. The computer-assisted technology has shown to be easy to use, safe, and efficient in routine knee replacement surgery. We believe that navigation is a key technology for various current and future surgical alignment topics and minimal-invasive lower limb surgery.

The effects of the sagittal plane malpositioning of the patella and concomitant quadriceps hypotrophy on the patellofemoral joint: a finite element analysis.

PubMed

Aksahin, Ertugrul; Kocadal, Onur; Aktekin, Cem N; Kaya, Defne; Pepe, Murad; Yılmaz, Serdar; Yuksel, H Yalcin; Bicimoglu, Ali

2016-03-01

Anterior knee pain is a common symptom after intramedullary nailing in tibia shaft fracture. Moreover, patellofemoral malalignment is also known to be a major reason for anterior knee pain. Patellofemoral malalignment predisposes to increased loading in patellar cartilage. In the previous study, we have demonstrated the quadriceps atrophy and patellofemoral malalignment after intramedullary nailing due to tibia shaft fracture. In this study, our aim was to clarify the effects of quadriceps atrophy and patellofemoral malalignment with the pathologic loading on the joint cartilage. Mesh models of patellofemoral joint were constructed with CT images and integrated with soft tissue components such as menisci and ligaments. Physiological and sagittal tilt models during extension and flexion at 15°, 30° and 60° were created generating eight models. All the models were applied with 137 N force to present the effects of normal loading and 115.7 N force for the simulation of quadriceps atrophy. Different degrees of loading were applied to evaluate the joint contact area and pressure value with the finite element analysis. There was increased patellofemoral contact area in patellar tilt models with respect to normal models. The similar loading patterns were diagnosed in all models at 0° and 15° knee flexion when 137 N force was applied. Higher loading values were obtained at 30° and 60° knee flexions in sagittal tilt models. Furthermore, in the sagittal tilt models, in which the quadriceps atrophy was simulated, the loadings at 30° and 60° knee flexion were higher than in the physiological ones. Sagittal malalignment of the patellofemoral joint is a new concept that results in different loading patterns in the patellofemoral joint biomechanics. This malalignment in sagittal plane leads to increased loading values on the patellofemoral joint at 30° and 60° of the knee flexions. This new concept should be kept in mind during the course of diagnosis and treatment in patients with anterior knee pain. Definition of the exact biomechanical effects of the sagittal tilting will lead to the development of new treatment modalities.

How does sagittal imbalance affect the appropriateness of surgical indications and selection of procedure in the treatment of degenerative scoliosis? Findings from the RAND/UCLA Appropriate Use Criteria study.

PubMed

Daubs, Michael D; Brara, Harsimran S; Raaen, Laura B; Chen, Peggy Guey-Chi; Anderson, Ashaunta T; Asch, Steven M; Nuckols, Teryl K

2018-05-01

Degenerative lumbar scoliosis (DLS) is often associated with sagittal imbalance, which may affect patients' health outcomes before and after surgery. The appropriateness of surgery and preferred operative approaches has not been examined in detail for patients with DLS and sagittal imbalance. The goals of this article were to describe what is currently known about the relationship between sagittal imbalance and health outcomes among patients with DLS and to determine how indications for surgery in patients with DLS differ when sagittal imbalance is present. This study included a literature review and an expert panel using the RAND/University of California at Los Angeles (UCLA) Appropriateness Method. To develop appropriate use criteria for DLS, researchers at the RAND Corporation recently employed the RAND/UCLA Appropriateness Method, which involves a systematic review of the literature and multidisciplinary expert panel process. Experts reviewed a synopsis of published literature and rated the appropriateness of five common operative approaches for 260 different clinical scenarios. In the present work, we updated the literature review and compared panelists' ratings in scenarios where imbalance was present versus absent. This work was funded by the Collaborative Spine Research Foundation, a group of surgical specialty societies and device manufacturers. On the basis of 13 eligible studies that examined sagittal imbalance and outcomes in patients with DLS, imbalance was associated with worse functional status in the absence of surgery and worse symptoms and complications postoperatively. Panelists' ratings demonstrated a consistent pattern across the diverse clinical scenarios. In general, when imbalance was present, surgery was more likely to be appropriate or necessary, including in some situations where surgery would otherwise be inappropriate. For patients with moderate to severe symptoms and imbalance, a deformity correction procedure was usually appropriate and frequently necessary, except in some patients with severe risk factors for complications. Conversely, procedures that did not correct imbalance, when present, were usually inappropriate. Clinical experts agreed that sagittal imbalance is a major factor affecting both when surgery is appropriate and which type of procedure is preferred among patients with DLS. Copyright © 2018 Elsevier Inc. All rights reserved.

X-linked hypophosphatemic rickets and sagittal craniosynostosis: three patients requiring operative cranial expansion: case series and literature review.

PubMed

Jaszczuk, Phillip; Rogers, Gary F; Guzman, Raphael; Proctor, Mark R

2016-05-01

A defect in a phosphate-regulating gene leads to the most common form of rickets: X-linked hypophosphatemic rickets (XLH) or vitamin D-resistant rickets (VDDR). XLH has been associated with craniosynostosis, the sagittal suture being the most commonly involved. We present three patients with rickets and symptomatic sagittal suture craniosynostosis all of whom presented late (>2 years of age). Two had a severe phenotype and papilledema, while the third presented with an osseous bulging near the anterior fontanel and experienced chronic headaches. All underwent successful cranial vault expansion. Rachitic patients with scaphocephaly should be screened for craniosynostosis.

Pediatric occipitocervical fusion: long-term radiographic changes in curvature, growth, and alignment.

PubMed

Martinez-Del-Campo, Eduardo; Turner, Jay D; Soriano-Baron, Hector; Newcomb, Anna G U S; Kalb, Samuel; Theodore, Nicholas

2016-11-01

OBJECTIVE The authors assessed the rate of vertebral growth, curvature, and alignment for multilevel constructs in the cervical spine after occipitocervical fixation (OCF) in pediatric patients and compared these results with those in published reports of growth in normal children. METHODS The authors assessed cervical spine radiographs and CT images of 18 patients who underwent occipitocervical arthrodesis. Measurements were made using postoperative and follow-up images available for 16 patients to determine cervical alignment (cervical spine alignment [CSA], C1-7 sagittal vertical axis [SVA], and C2-7 SVA) and curvature (cervical spine curvature [CSC] and C2-7 lordosis angle). Seventeen patients had postoperative and follow-up images available with which to measure vertebral body height (VBH), vertebral body width (VBW), and vertical growth percentage (VG%-that is, percentage change from postoperative to follow-up). Results for cervical spine growth were compared with normal parameters of 456 patients previously reported on in 2 studies. RESULTS Ten patients were girls and 8 were boys; their mean age was 6.7 ± 3.2 years. Constructs spanned occiput (Oc)-C2 (n = 2), Oc-C3 (n = 7), and Oc-C4 (n = 9). The mean duration of follow-up was 44.4 months (range 24-101 months). Comparison of postoperative to follow-up measures showed that the mean CSA increased by 1.8 ± 2.9 mm (p < 0.01); the mean C2-7 SVA and C1-7 SVA increased by 2.3 mm and 2.7 mm, respectively (p = 0.3); the mean CSC changed by -8.7° (p < 0.01) and the mean C2-7 lordosis angle changed by 2.6° (p = 0.5); and the cumulative mean VG% of the instrumented levels (C2-4) provided 51.5% of the total cervical growth (C2-7). The annual vertical growth rate was 4.4 mm/year. The VBW growth from C2-4 ranged from 13.9% to 16.6% (p < 0.001). The VBW of C-2 in instrumented patients appeared to be of a smaller diameter than that of normal patients, especially among those aged 5 to < 10 years and 10-15 years, with an increased diameter at the immediately inferior vertebral bodies compensating for the decreased width. No cervical deformation, malalignment, or detrimental clinical status was evident in any patient. CONCLUSIONS The craniovertebral junction and the upper cervical spine continue to present normal growth, curvature, and alignment parameters in children with OCF constructs spanning a distance as long as Oc-C4.

Three dimensional ultrasonography for advanced neurosonography (Neurosofe-3d). Analysis of acquisition-related factors influencing the quality of the brain volumes.

PubMed

Maiz, Nerea; Alonso, Ignacio; Belar, María; Burgos, Jorge; Irasarri, Ana; Molina, Francisca S; de Paco, Catalina; Pijoan, José I; Plasencia, Walter; Rodó, Carlota; Rodríguez, M Angeles; Tajada, Mauricio; Tubau, Albert

2016-11-01

To evaluate the acquisition-related factors influencing the quality of the brain volumes for further study of advanced neurosonography. This was a prospective multicentre study. Five centres were asked to include five cases each, acquiring two volumes per case, at different gestational ages. Ten operators performed an advanced neurosonography per case. The potential influence of the following factors on the number of evaluable structures was assessed: vaginal/ abdominal acquisition, position of the head, gestational age, subjective quality of the volume and the acquiring operator itself. Four hundred and thirty-two evaluations were included in the study. A total of 80% of the structures were evaluated satisfactorily in the axial plane, 67.1% and 55.1% in the coronal and sagittal plane, respectively. Sagittal volumes acquired transvaginally had a better quality than those acquired transabdominally. Gestational age affected the quality of axial and sagittal volumes (p < 0.001), and the best quality was obtained between 20 and 27 weeks. In axial and sagittal volumes, the head position influenced the percentage of structures visualized (p < 0.001, p < 0.001). Factors affecting the quality of the volume for advanced neurosonography are gestational age, fetal head position, transvaginal acquisition in sagittal volumes, the acquiring operator and the subjective quality of the volume. © 2016 John Wiley & Sons, Ltd. © 2016 John Wiley & Sons, Ltd.

Increased conformity offers diminishing returns for reducing total knee replacement wear.

PubMed

Fregly, Benjamin J; Marquez-Barrientos, Carlos; Banks, Scott A; DesJardins, John D

2010-02-01

Wear remains a significant problem limiting the lifespan of total knee replacements (TKRs). Though increased conformity between TKR components has the potential to decrease wear, the optimal amount and planes of conformity have not been investigated. Furthermore, differing conformities in the medial and lateral compartments may provide designers the opportunity to address both wear and kinematic design goals simultaneously. This study used a computational model of a Stanmore knee simulator machine and a previously validated wear model to investigate this issue for simulated gait. TKR geometries with different amounts and planes of conformity on the medial and lateral sides were created and tested in two phases. The first phase utilized a wide range of sagittal and coronal conformity combinations to blanket a physically realistic design space. The second phase performed a focused investigation of the conformity conditions from the first phase to which predicted wear volume was sensitive. For the first phase, sagittal but not coronal conformity was found to have a significant effect on predicted wear volume. For the second phase, increased sagittal conformity was found to decrease predicted wear volume in a nonlinear fashion, with reductions gradually diminishing as conformity increased. These results suggest that TKR geometric design efforts aimed at minimizing wear should focus on sagittal rather than coronal conformity and that at least moderate sagittal conformity is desirable in both compartments.

Fusion-nonfusion hybrid construct versus anterior cervical hybrid decompression and fusion: a comparative study for 3-level cervical degenerative disc diseases.

PubMed

Ding, Fan; Jia, Zhiwei; Wu, Yaohong; Li, Chao; He, Qing; Ruan, Dike

2014-11-01

A retrospective analysis. This study aimed to compare the safety and efficacy between the fusion-nonfusion hybrid construct (HC: anterior cervical corpectomy and fusion plus artificial disc replacement, ACCF plus cADR) and anterior cervical hybrid decompression and fusion (ACHDF: anterior cervical corpectomy and fusion plus discectomy and fusion, ACCF plus ACDF) for 3-level cervical degenerative disc diseases (cDDD). The optimal anterior technique for 3-level cDDD remains uncertain. Long-segment fusion substantially induced biomechanical changes at adjacent levels, which may lead to symptomatic adjacent segment degeneration. Hybrid surgery consisting of ACDF and cADR has been reported with good results for 2-level cDDD. In this context, ACCF combining with cADR may be an alternative to ACHDF for 3-level cDDD. Between 2009 and 2012, 28 patients with 3-level cDDD who underwent HC (n=13) and ACHDF (15) were retrospectively reviewed. Clinical assessments were based on Neck Disability Index, Japanese Orthopedic Association disability scale, visual analogue scale, Japanese Orthopedic Association recovery rate, and Odom criteria. Radiological analysis included range of motion of C2-C7 and adjacent segments and cervical lordosis. Perioperative parameters, radiological adjacent-level changes, and the complications were also assessed. HC showed better Neck Disability Index improvement at 12 and 24 months, as well as Japanese Orthopedic Association and visual analogue scale improvement at 24 months postoperatively (P<0.05). HC had better outcome according to Odom criteria but not significantly (P>0.05). The range of motion of C2-C7 and adjacent segments was less compromised in HC (P<0.05). Both 2 groups showed significant lordosis recovery postoperatively (P<0.05), but no difference was found between groups (P>0.05). The incidence of adjacent-level degenerative changes and complications was higher in ACHDF but not significantly (P>0.05). HC may be an alternative to ACHDF for 3-level cDDD due to the equivalent or superior early clinical outcomes, less compromised C2-C7 range of motion, and less impact at adjacent levels. 3.

Is lateral stabilization enough in thoracolumbar burst fracture reconstruction? A biomechanical investigation.

PubMed

Panchal, Ripul R; Matheis, Erika A; Gudipally, Manasa; Hussain, Mir M; Kim, Kee D; Bucklen, Brandon S

2015-10-01

Traditional reconstruction for burst fractures involves columnar support with posterior fixation at one or two levels cephalad/caudad; however, some surgeons choose to only stabilize the vertebral column. The aim was to distinguish biomechanical differences in stability between a burst fracture stabilized through a lateral approach using corpectomy spacers of different end plate sizes with and without integrated screws and with and without posterior fixation. This was an in vitro biomechanical study assessing thoracolumbar burst fracture stabilization. Six human spines (T11-L3) were tested on a six-degrees-of-freedom simulator enabling unconstrained range of motion (ROM) at ±6 N·m in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) after a simulated burst fracture at L1. Expandable corpectomy spacers with/without integrated screws (Fi/F; FORTIFY Integrated/FORTIFY; Globus Medical, Inc., Audubon, PA, USA) were tested with different end plate sizes (21×23 mm, 22×40-50 mm). Posterior instrumentation (PI) via bilateral pedicle screws and rods was used one level above and one level below the burst fracture. Lateral plate (LP) fixation was tested. Devices were tested in the following order: intact; Fi21×23; Fi21×23+PI; F21×23+PI+LP; F21×23+LP; F22×40-50+LP; F22×40-50+PI+LP; Fi22×40-50+PI; Fi22×40-50. In FE and AR, constructs without PI showed no significant difference (p<.05) in stability compared with intact. In LB, F22×40-50+LP showed a significant increase in stability relative to intact, but no other construct without PI reached significance. In FE and LB, circumferential constructs were significantly more stable than intact. In AR, no construct showed significant differences in motion when compared with the intact condition. Constructs without posterior fixation were the least stable of all tested constructs. Circumferential fixation provided greater stability in FE and LB than lateral fixation and intact. Axial rotation showed no significant differences in any construct compared with the intact state. Copyright © 2015 Elsevier Inc. All rights reserved.

Three-dimensional growth dynamics of the liver in the human fetus.

PubMed

Szpinda, Michał; Paruszewska-Achtel, Monika; Woźniak, Alina; Badura, Mateusz; Mila-Kierzenkowska, Celestyna; Wiśniewski, Marcin

2015-07-01

The fetal liver is indubitably the earliest and the most severely affected organ by abnormal fetal growth. The size of the fetal liver assessed by three-dimensional ultrasonography is indispensable in determining the status of fetal growth, nutrition and maturity, and in the early recognition and monitoring fetal micro- and macrosomias. The aim of the present study was to measure the human fetal liver length, transverse and sagittal diameters to establish their age-specific reference intervals, the 3rd, 10th, 50th, 90th, and 97th smoothed centile curves, and the relative growth of the liver calculated for the 50th centile. Using anatomical, digital (NIS-Elements AR 3.0, Nikon) and statistical methods (one-way ANOVA test for paired data and post hoc RIR Tukey test, Shapiro-Wilk test, Fisher's test, Student's t test, the Altman-Chitty method), length, transverse and sagittal diameters of the liver for the 3rd, 10th, 50th, 90th, and 97th centiles were assessed in 69 human fetuses of both sexes (32 males and 37 females) aged 18-30 weeks, derived from spontaneous abortions or stillbirths. No male-female differences (P > 0.05) concerning the three parameters studied were found. During the study period, the fetal liver increased tri-dimensionally: in length from 19.51 ± 1.02 to 39.65 ± 7.05 mm, in transverse diameter from 29.44 ± 3.73 to 53.13 ± 5.31 mm, and in sagittal diameter from 22.97 ± 3.79 to 43.22 ± 5.49 mm. The natural logarithmic models were found to fit the data with gestational age (P < 0.001) in the following five cutoff points: 3rd, 10th, 50th, 90th and 97th centiles. The values of liver parameters in relation to gestational age in weeks were calculated by the following logarithmic regressions: y = -82.778 + 35.752 × ln(age) ± Z × (-2.778 + 0.308 × age) for liver length, y = -123.06 + 52.668 × ln(age) ± Z × (3.156 + 0.049 × age) for liver transverse diameter, and y = -108.94 + 46.052 × ln(age) ± Z × (-0.541 + 0.188 × age) for liver sagittal diameter. For the 50th centile, at the range of 18-30 weeks, the growth rates per week were gradually decreasing from 1.93 to 1.21 mm for length, from 2.85 to 1.79 mm for transverse diameter, and from 2.49 to 1.56 mm for sagittal diameter of the liver (P < 0.05). During the study period both the length-to-transverse diameter ratio and the sagittal-to-transverse diameter ratio of the liver changed little, attaining the values of 0.71 ± 0.11 and 0.87 ± 0.12, respectively. The fetal liver does not reveal sex differences in its length, transverse and sagittal diameters. The fetal liver length, transverse and sagittal diameters grow logarithmically. The regression equations for the estimation of the mean and standard deviation of liver length, transverse and sagittal diameters allow for calculating any desired centiles according to gestational age. The three-dimensional evolution of the fetal liver follows proportionately. The age-specific reference intervals for evolving liver length, transverse and sagittal diameters constitute the normative values of potential relevance in monitoring normal fetal development and screening for disturbances in fetal growth.

Time to development, clinical and radiographic characteristics, and management of proximal junctional kyphosis following adult thoracolumbar instrumented fusion for spinal deformity.

PubMed

Reames, Davis L; Kasliwal, Manish K; Smith, Justin S; Hamilton, D Kojo; Arlet, Vincent; Shaffrey, Christopher I

2015-03-01

A retrospective review. To study time to development, clinical and radiographic characteristics, and management of proximal junctional kyphosis (PJK) following thoracolumbar instrumented fusion for adult spinal deformity (ASD). PJK continues to be a common mode of failure following ASD surgery. Although literature exists on possible risk factors, data on management remain limited. A retrospective review of medical records of 289 consecutive ASD patients who underwent posterior segmental instrumentation incorporating at least 5 segments was conducted. PJK was defined as proximal kyphotic angle >10 degrees. PJK occurred in 32 patients (11%) at a mean follow-up of 34 months (range, 1.3-61.9±19 mo). Sixteen (50%) patients were revised (mean, 1.7 revisions; range, 1-3) at a mean follow-up of 9.6 months (range, 0.7-40 mo); primary indications for revision were pain (n=16), myelopathy (n=6), instability (n=4), and instrumentation protrusion (n=2). Comparison of preindex and postindex surgery radiographic parameters demonstrated significant improvement in mean lumbar lordosis (24 vs. 42 degrees, P<0.001), pelvic incidence-lumbar lordosis mismatch (30 vs. 11 degrees, P<0.001), and pelvic tilt (29 vs. 23 degrees, P<0.011). The mean T5-T12 kyphosis worsened (30 vs. 53 degrees, P<0.001) and the mean global sagittal spinal alignment failed to improve (9.6 vs. 8.0 cm, P=0.76). There was no apparent relationship between the absolute PJK angle and revision surgery (P>0.05). The patients in this series who developed PJK had substantial preoperative positive sagittal malalignment that remained inadequately corrected following surgery, likely resulting from a combination of inadequate surgical correction and a significant compensatory increase in thoracic kyphosis. In the absence of direct relationship between a greater PJK angle and worse clinical outcome, clinical symptoms and neurological status rather than absolute reliance on radiographic parameters should drive the decision to pursue revision surgery.

High accuracy in knee alignment and implant placement in unicompartmental medial knee replacement when using patient-specific instrumentation.

PubMed

Volpi, P; Prospero, E; Bait, C; Cervellin, M; Quaglia, A; Redaelli, A; Denti, M

2015-05-01

The influence of patient-specific instrumentations on the accuracy of unicompartmental medial knee replacement remains unclear. The goal of this study was to examine the ability of patient-specific instrumentation to accurately reproduce postoperatively what the surgeon had planned preoperatively. Twenty consecutive patients (20 knees) who suffered from isolated unicompartmental medial osteoarthritis of the knee and underwent medial knee replacement using newly introduced magnetic resonance imaging-based patient-specific instrumentation were assessed. This assessment recorded the following parameters: (1) the planned and the postoperative mechanical axis acquired through long-leg AP view radiographies; (2) the planned and the postoperative tibial slope acquired by means of standard AP and lateral view radiographies; and (3) the postoperative fit of the implanted components to the bone in coronal and sagittal planes. The hypothesis of the study was that there was no statistically significant difference between postoperative results and preoperatively planned values. The study showed that (1) the difference between the postoperative mechanical axis (mean 1.9° varus ± 1.2° SD) and the planned mechanical axis (mean 1.8° varus ± 1.2° SD) was not statistically significant; (2) the difference between the postoperative tibial slope (mean 5.2° ± 0.6° SD) and the planned tibial slope (mean 5.4° ± 0.6° SD) was statistically significant (p = 0.008); and (3) the postoperative component fit to bone in the coronal and sagittal planes was accurate in all cases; nevertheless, in one knee, all components were implanted one size smaller than preoperatively planned. Moreover, in two additional cases, one size thinner and one size thicker of the polyethylene insert were used. This study suggests that overall patient-specific instrumentation was highly accurate in reproducing postoperatively what the surgeon had planned preoperatively in terms of mechanical axis, tibial slope and component fit to bone. IV.

[Clinical and radiographic outcomes of navigation-assisted versus conventional total knee arthroplasty].

PubMed

Li, Xiaohui; Yu, Jianhua; Gong, Yuekun; Ren, Kaijing; Liu, Jun

2015-04-21

To assess the early postoperative clinical and radiographic outcomes after navigation-assisted or standard instrumentation total knee arthroplasty (TKA). From August 2007 to May 2008, 60 KSS-A type patients underwent 67 primary TKA operations by the same surgical team. Twenty-two operations were performed with the Image-free navigation system with an average age of 64.5 years while the remaining 45 underwent conventional manual procedures with an average age of 66 years. Their preoperative demographic and functional data had no statistical differences (P>0.05). The operative duration, blood loss volume and hospitalization days were compared for two groups. And radiographic data included coronal femoral component angle, coronal tibial component angle, sagittal femoral component angle, sagittal tibial component angle and coronal tibiofemoral angle after one month. And functional assessment scores were evaluated at 1, 3 and 6 months postoperatively. Operative duration was significantly longer for computer navigation (P<0.05). The average blood loss volume was 555.26 ml in computer navigation group and 647.56 ml in conventional manual method group (P<0.05). And hospitalization stay was shorter in computer navigation group than that in conventional method group (7.74 vs 8.68 days) (P=0.04). The alignment deviation was better in computer-assisted group than that in conventional manual method group (P<0.05). The percentage of patients with a coronal tibiofemoral angle within ±3 of ideal value was 95.45% for computer-assisted mini-invasive TKA group and 80% for conventional TKA group (P=0.003). The Knee Society Clinical Rating Score was higher in computer-assisted group than that in conventional manual method group at 1 and 3 montha post-operation. However, no statistical inter-group difference existed at 6 months post-operation. Navigation allows a surgeon to precisely implant the components for TKA. And it offers faster functional recovery and shorter hospitalization stay. At 6 months post-operation, there is no statistical inter-group difference in KSS scores.

Sagittal Plane Correction Using the Lateral Transpsoas Approach: A Biomechanical Study on the Effect of Cage Angle and Surgical Technique on Segmental Lordosis.

PubMed

Melikian, Rojeh; Yoon, Sangwook Tim; Kim, Jin Young; Park, Kun Young; Yoon, Caroline; Hutton, William

2016-09-01

Cadaveric biomechanical study. To determine the degree of segmental correction that can be achieved through lateral transpsoas approach by varying cage angle and adding anterior longitudinal ligament (ALL) release and posterior element resection. Lordotic cage insertion through the lateral transpsoas approach is being used increasingly for restoration of sagittal alignment. However, the degree of correction achieved by varying cage angle and ALL release and posterior element resection is not well defined. Thirteen lumbar motion segments between L1 and L5 were dissected into single motion segments. Segmental angles and disk heights were measured under both 50 N and 500 N compressive loads under the following conditions: intact specimen, discectomy (collapsed disk simulation), insertion of parallel cage, 10° cage, 30° cage with ALL release, 30° cage with ALL release and spinous process (SP) resection, 30° cage with ALL release, SP resection, facetectomy, and compression with pedicle screws. Segmental lordosis was not increased by either parallel or 10° cages as compared with intact disks, and contributed small amounts of lordosis when compared with the collapsed disk condition. Placement of 30° cages with ALL release increased segmental lordosis by 10.5°. Adding SP resection increased lordosis to 12.4°. Facetectomy and compression with pedicle screws further increased lordosis to approximately 26°. No interventions resulted in a decrease in either anterior or posterior disk height. Insertion of a parallel or 10° cage has little effect on lordosis. A 30° cage insertion with ALL release resulted in a modest increase in lordosis (10.5°). The addition of SP resection and facetectomy was needed to obtain a larger amount of correction (26°). None of the cages, including the 30° lordotic cage, caused a decrease in posterior disk height suggesting hyperlordotic cages do not cause foraminal stenosis. N/A.

Calculation of the Target Lumbar Lordosis Angle for Restoring an Optimal Pelvic Tilt in Elderly Patients With Adult Spinal Deformity.

PubMed

Yamato, Yu; Hasegawa, Tomohiko; Kobayashi, Sho; Yasuda, Tatsuya; Togawa, Daisuke; Arima, Hideyuki; Oe, Shin; Iida, Takahiro; Matsumura, Akira; Hosogane, Naobumi; Matsumoto, Morio; Matsuyama, Yukihiro

2016-02-01

This investigation consisted of a cross-sectional study and a retrospective multicenter case series. This investigation sought to identify the ideal lumbar lordosis (LL) angle for restoring an optimal pelvic tilt (PT) in patients with adult spinal deformity (ASD). To achieve successful corrective fusion in ASD patients with sagittal imbalance, it is essential to correct the sagittal spinal alignment and obtain a suitable pelvic inclination. We determined the LL angle that would restore the optimal PT following ASD surgery. The cross-sectional study included 184 elderly volunteers (mean age 64 years) with an Oswestry Disability Index score less than 20%. The relationship between PT or LL and the pelvic incidence (PI) in normal individuals was investigated. The second study included 116 ASD patients (mean age 66 years) who underwent thoracolumbar corrective fusion at 1 of 4 spine centers. The postoperative PT values were calculated using the parameters measured. On the basis of these studies, an ideal LL angle was determined. In the cross-sectional study, the linear regression equation for the optimal PT as a function of PI was "optimal PT = 0.47 × PI - 7.5." In the second study, the postoperative PT was determined as a function of PI and corrected LL, using the equation "postoperative PT = 0.7 × PI - 0.5 × corrected LL + 8.1." The target LL angle was determined by mathematically equalizing the PTs of these 2 equations: "target LL = 0.45 × PI + 31.8." The ideal LL angle can be determined using the equation "LL = 0.45 × PI + 31.8," which can be used as a reference during surgical planning in ASD cases. 4.

Advantages and Disadvantages of Adult Spinal Deformity Surgery and Its Impact on Health-Related Quality of Life.

PubMed

Yoshida, Go; Boissiere, Louis; Larrieu, Daniel; Bourghli, Anouar; Vital, Jean Marc; Gille, Olivier; Pointillart, Vincent; Challier, Vincent; Mariey, Remi; Pellisé, Ferran; Vila-Casademunt, Alba; Perez-Grueso, Francisco Javier Sánchez; Alanay, Ahmet; Acaroglu, Emre; Kleinstück, Frank; Obeid, Ibrahim

2017-03-15

Prospective multicenter study of adult spinal deformity (ASD) surgery. To clarify the effect of ASD surgery on each health-related quality of life (HRQOL) subclass/domain. For patients with ASD, surgery offers superior radiological and HRQOL outcomes compared with nonoperative care. HRQOL may, however, be affected by surgical advantages related to corrective effects, yielding adequate spinopelvic alignment and stability or disadvantages because of long segment fusion. The study included 170 consecutive patients with ASD from a multicenter database with more than 2-year follow-up period. We analyzed each HRQOL domain/subclass (short form-36 items, Oswestry Disability Index, Scoliosis Research Society-22 [SRS-22] questionnaire), and radiographic parameters preoperatively and at 1 and 2 years postoperatively. We divided the patients into two groups each based on lowest instrumented vertebra (LIV; above L5 or S1 to ilium) or surgeon-determined preoperative pathology (idiopathic or degenerative). Improvement rate (%) was calculated as follows: 100 × |pre.-post.|/preoperative points (%) (+, advantages; -, disadvantages). The scores of all short form-36 items and SRS-22 subclasses improved at 1 and 2 years after surgery, regardless of LIV location and preoperative pathology. Personal care and lifting in Oswestry Disability Index were, however, not improved after 1 year. These disadvantages were correlated to sagittal modifiers of SRS-Schwab classification similar to other HRQOL. The degree of personal care disadvantage mainly depended on LIV location and preoperative pathology. Although personal care improved after 2 years postoperatively, no noticeable improvements in lifting were recorded. HRQOL subclass analysis indicated two disadvantages of ASD surgery, which were correlated to sagittal radiographic measures. Fusion to the sacrum or ilium greatly restricted the ability to stretch or bend, leading to limited daily activities for at least 1 year postoperatively, although this effect may subside after another year. Consequently, spinal surgeons should note the effect of surgical treatment on each HRQOL domain and counsel patients about the implications of surgery. 4.

Minimizing Alteration of Posterior Tibial Slope During Opening Wedge High Tibial Osteotomy: a Protocol with Experimental Validation in Paired Cadaveric Knees

PubMed Central

Westermann, Robert W; DeBerardino, Thomas; Amendola, Annunziato

2014-01-01

Introduction The High Tibial Osteotomy (HTO) is a reliable procedure in addressing uni- compartmental arthritis with associated coronal deformities. With osteotomy of the proximal tibia, there is a risk of altering the tibial slope in the sagittal plane. Surgical techniques continue to evolve with trends towards procedure reproducibility and simplification. We evaluated a modification of the Arthrex iBalance technique in 18 paired cadaveric knees with the goals of maintaining sagittal slope, increasing procedure efficiency, and decreasing use of intraoperative fluoroscopy. Methods Nine paired cadaveric knees (18 legs) underwent iBalance medial opening wedge high tibial osteotomies. In each pair, the right knee underwent an HTO using the modified technique, while all left knees underwent the traditional technique. Independent observers evaluated postoperative factors including tibial slope, placement of hinge pin, and implant placement. Specimens were then dissected to evaluate for any gross muscle, nerve or vessel injury. Results Changes to posterior tibial slope were similar using each technique. The change in slope in traditional iBalance technique was -0.3° ±2.3° and change in tibial slope using the modified iBalance technique was -0.4° ±2.3° (p=0.29). Furthermore, we detected no differences in posterior tibial slope between preoperative and postoperative specimens (p=0.74 traditional, p=0.75 modified). No differences in implant placement were detected between traditional and modified techniques. (p=0.85). No intraoperative iatrogenic complications (i.e. lateral cortex fracture, blood vessel or nerve injury) were observed in either group after gross dissection. Discussion & Conclusions Alterations in posterior tibial slope are associated with HTOs. Both traditional and modified iBalance techniques appear reliable in coronal plane corrections without changing posterior tibial slope. The present modification of the Arthrex iBalance technique may increase the efficiency of the operation and decrease radiation exposure to patients without compromising implant placement or global knee alignment. PMID:25328454

Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation

PubMed Central

Chen, Wei-Hua; Jiang, Lei-Sheng

2006-01-01

Pyogenic vertebral osteomyelitis responds well to conservative treatment at early stage, but more complicated and advanced conditions, including mechanical spinal instability, epidural abscess formation, neurologic deficits, and refractoriness to antibiotic therapy, usually require surgical intervention. The subject of using metallic implants in the setting of infection remains controversial, although more and more surgeons acknowledge that instrumentation can help the body to combat the infection rather than to interfere with it. The combination of radical debridement and instrumentation has lots of merits such as, restoration and maintenance of the sagittal alignment of the spine, stabilization of the spinal column and reduction of bed rest period. This issue must be viewed in the context of the overall and detailed health conditions of the subjecting patient. We think the culprit for the recurrence of infection is not the implants itself, but is the compromised general health condition of the patients. In this review, we focus on surgical treatment of pyogenic vertebral osteomyelitis with special attention to the role of spinal instrumentation in the presence of pyogenic infection. PMID:17106664

Ultrasound anatomy in the normal neonatal and infant foot: an anatomic introduction to ultrasound assessment of foot deformities.

PubMed

Aurell, Y; Johansson, A; Hansson, G; Wallander, H; Jonsson, K

2002-09-01

The aim of this study was to establish guidelines for US assessment of the talo-crural, the talo-navicular and the calcaneo-cuboid joints during the first year of life, which could serve as a reference while studying foot deformities. The feet of 54 healthy children were examined at birth and at the age of 4, 7 and 12 months by using three easily defined and reproducible US projections. With a medial projection the relation of the navicular in relation to the medial malleolus and the head of the talus was studied. A lateral projection revealed the calcaneo-cuboid relationship and a dorsal projection the talo-navicular alignment in the sagittal plane. Normal values for measurements of these cartilaginous relationships were established for the different age groups. Intra- and inter-observer reliability was assessed and found to be acceptable ( r=0.53-0.90, Pearson correlation coefficient). With US it is possible to obtain reproducible planes of investigation that give reliable information about the talo-crural, the talo-navicular and the calcaneo-cuboid relationships during the first year of life.

Pott disease in the thoracolumbar spine with marked kyphosis and progressive paraplegia necessitating posterior vertebral column resection and anterior reconstruction with a cage.

PubMed

Pappou, Ioannis P; Papadopoulos, Elias C; Swanson, Andrew N; Mermer, Matthew J; Fantini, Gary A; Urban, Michael K; Russell, Linda; Cammisa, Frank P; Girardi, Federico P

2006-02-15

Case report. To report on a patient with Pott disease, progressive neurologic deficit, and severe kyphotic deformity, who had medical treatment fail and required posterior/anterior decompression with instrumented fusion. Treatment options will be discussed. Tuberculous spondylitis is an increasingly common disease worldwide, with an estimated prevalence of 800,000 cases. Surgical treatment consisting of extensive posterior decompression/instrumented fusion and 3-level posterior vertebral column resection, followed by anterior debridement/fusion with cage reconstruction. Neurologic improvement at 6-month follow-up (Frankel B to Frankel D), with evidence of radiographic fusion. A 70-year-old patient with progressive Pott paraplegia and severe kyphotic deformity, for whom medical treatment failed is presented. A posterior vertebral column resection, multiple level posterior decompression, and instrumented fusion, followed by an anterior interbody fusion with cage was used to decompress the spinal cord, restore sagittal alignment, and debride the infection. At 6-month follow-up, the patient obtained excellent pain relief, correction of deformity, elimination of the tuberculous foci, and significant recovery of neurologic function.

Walking in circles: a modelling approach

PubMed Central

Maus, Horst-Moritz; Seyfarth, Andre

2014-01-01

Blindfolded or disoriented people have the tendency to walk in circles rather than on a straight line even if they wanted to. Here, we use a minimalistic walking model to examine this phenomenon. The bipedal spring-loaded inverted pendulum exhibits asymptotically stable gaits with centre of mass (CoM) dynamics and ground reaction forces similar to human walking in the sagittal plane. We extend this model into three dimensions, and show that stable walking patterns persist if the leg is aligned with respect to the body (here: CoM velocity) instead of a world reference frame. Further, we demonstrate that asymmetric leg configurations, which are common in humans, will typically lead to walking in circles. The diameter of these circles depends strongly on parameter configuration, but is in line with empirical data from human walkers. Simulation results suggest that walking radius and especially direction of rotation are highly dependent on leg configuration and walking velocity, which explains inconsistent veering behaviour in repeated trials in human data. Finally, we discuss the relation between findings in the model and implications for human walking. PMID:25056215

Analysis of anatomic periarticular tibial plate fit on normal adults.

PubMed

Goyal, Kanu S; Skalak, Anthony S; Marcus, Randall E; Vallier, Heather A; Cooperman, Daniel R

2007-08-01

Implant manufacturers are producing anatomically contoured periarticular plates to improve the treatment of proximal tibia fractures. We assessed the accuracy of the designation anatomic. We applied eight-hole medial and lateral anatomically contoured periarticular plates to 101 cadaveric tibiae. The tibiae and the plate fits were mapped, quantified, and analyzed using a MicroScribe G2LX digitizer, Rhinoceros software, and MATLAB software. By corresponding the clinical appearance of good fit with our digital findings, we created numerical criteria for plate fit in three planes: coronal (volume of free space between the plate and bone), sagittal (alignment with the tibial plateau and shaft), and axial (match in curvature between the proximal horizontal part of the plate and the tibial plateau). An anatomic fit should mirror the shape of the tibia in all three planes, and only four medial and four lateral plate fits qualified. Recognizing and understanding the substantial variations in fit that exist between anatomically contoured plates and the tibia may help lead to a more stable fixation and prevent malreduction of the fracture and/or soft tissue impingement.

Image-Guided Internal Fixation of an Oblique Sagittal Split Fracture of C1 Lateral Mass with Motion Preservation: A Technical Report.

PubMed

Malcolm, James G; Tan, Lee A; Johnson, Andrew K

2017-07-20

A sagittal split fracture of the C1 lateral mass is an unstable subtype of C1 fractures and has a high propensity for developing late deformities and pain with nonoperative management. A primary internal fixation of this type of fracture has been recently described with good clinical outcomes and preservation of motion. We present a modified technique of primary internal fixation using an obliquely inserted C1 lag screw with imaging guidance. We successfully treated a 55-year-old woman with a unilateral C1 oblique sagittal split fracture who failed nonoperative management. Technical nuances are discussed with a review of pertinent literature.

Various methods for assessing static lower extremity alignment: implications for prospective risk-factor screenings.

PubMed

Nguyen, Anh-Dung; Boling, Michelle C; Slye, Carrie A; Hartley, Emily M; Parisi, Gina L

2013-01-01

Accurate, efficient, and reliable measurement methods are essential to prospectively identify risk factors for knee injuries in large cohorts. To determine tester reliability using digital photographs for the measurement of static lower extremity alignment (LEA) and whether values quantified with an electromagnetic motion-tracking system are in agreement with those quantified with clinical methods and digital photographs. Descriptive laboratory study. Laboratory. Thirty-three individuals participated and included 17 (10 women, 7 men; age = 21.7 ± 2.7 years, height = 163.4 ± 6.4 cm, mass = 59.7 ± 7.8 kg, body mass index = 23.7 ± 2.6 kg/m2) in study 1, in which we examined the reliability between clinical measures and digital photographs in 1 trained and 1 novice investigator, and 16 (11 women, 5 men; age = 22.3 ± 1.6 years, height = 170.3 ± 6.9 cm, mass = 72.9 ± 16.4 kg, body mass index = 25.2 ± 5.4 kg/m2) in study 2, in which we examined the agreement among clinical measures, digital photographs, and an electromagnetic tracking system. We evaluated measures of pelvic angle, quadriceps angle, tibiofemoral angle, genu recurvatum, femur length, and tibia length. Clinical measures were assessed using clinically accepted methods. Frontal- and sagittal-plane digital images were captured and imported into a computer software program. Anatomic landmarks were digitized using an electromagnetic tracking system to calculate static LEA. Intraclass correlation coefficients and standard errors of measurement were calculated to examine tester reliability. We calculated 95% limits of agreement and used Bland-Altman plots to examine agreement among clinical measures, digital photographs, and an electromagnetic tracking system. Using digital photographs, fair to excellent intratester (intraclass correlation coefficient range = 0.70-0.99) and intertester (intraclass correlation coefficient range = 0.75-0.97) reliability were observed for static knee alignment and limb-length measures. An acceptable level of agreement was observed between clinical measures and digital pictures for limb-length measures. When comparing clinical measures and digital photographs with the electromagnetic tracking system, an acceptable level of agreement was observed in measures of static knee angles and limb-length measures. The use of digital photographs and an electromagnetic tracking system appears to be an efficient and reliable method to assess static knee alignment and limb-length measurements.

Three dimensional structure of the distal condyles of the third metacarpal bone of the horse.

PubMed

Boyde, A; Haroon, Y; Jones, S J; Riggs, C M

1999-03-01

This study examined the three-dimensional (3D) microarchitecture of regions of the equine third metacarpal bone (McIII) commonly involved in distal condylar fractures. Limbs were obtained from Thoroughbred horses (neonates to age 24 years) destroyed for inoperable fractures and a variety of other conditions. Beams, blocks and sections were cut in the principal axes, some embedded in PMMA and others examined unembedded. Several methods were used to study the 3D structure, including conventional and confocal optical microscopy, scanning electron microscopy (SEM) and radiography. The mineralised articular cartilage tends to cleave in the sagittal plane. Proximal to the subchondral bone, the main trabeculae are robust plates running in the sagittal direction with less significant mediolateral connections. Small blood vessel canals lie inside the sagittal plates. This structure gives maximum strength and protection in the sagittal plane in which the bone rotates, but offers minimal resistance to fracture propagation in this plane. The anatomical course of the common distal condylar fractures of the third metacarpal bones can be explained by underlying anisotropic structural features of the mineralised tissues.

[Extramedullary fixation combined with intramedullary fixation in the surgical reduction of sagittal mandibular condylar fractures].

PubMed

Chuanjun, Chen; Xiaoyang, Chen; Jing, Chen

2016-10-01

This study aimed to evaluate the clinical effect of extramedullary fixation combined with intramedullary fixation during the surgical reduction of sagittal mandibular condylar fractures. Twenty-four sagittal fractures of the mandibular condyle in18 patients were fixed by two appliances: intramedullary with one long-screw osteosynthesis or Kirschner wire and extramedullary with one micro-plate. The radiologically-recorded post-operative stability-associated com-plications included the screw/micro-plate loosening, micro-plate twisting, micro-plate fractures, and fragment rotation. The occluding relations, the maximalinter-incisal distances upon mouth opening, and the mandibular deflection upon mouth opening were evaluated based on follow-up clinical examination. Postoperative panoramic X-ray and CT scans showed good repositioning of the fragment, with no redislocation or rotation, no screw/plate loosening, and no plate-twisting or fracture. Clinical examination showed that all patients regained normal mandibular movements, ideal occlusion, and normal maximal inter-incisal distances upon mouth opening. Extramedullary fixation combined with intramedullary fixation is highly recommended for sagittal condylar fractures because of the anti-rotation effect of the fragment and the reasonable place-ment of the fixation appliances.

Clinical and radiological outcomes after treatment of sagittal fracture of mandibular condyle (SFMC) by using occlusal splint in children.

PubMed

Liu, Chang-Kui; Meng, Fan-Wen; Tan, Xin-Ying; Xu, Juan; Liu, Hua-Wei; Liu, San-Xia; Huang, Hai-Tao; Yan, Rong-Zeng; Hu, Min; Hu, Kai-Jin

2014-02-01

This study was designed to investigate the effects of occlusal splints in the treatment of sagittal fractures of the mandibular condyle in children. From January 1995 to December 2011, 37 sagittal fractures of the mandibular condyle in 30 patients aged 4-8 years old were included in this study. All the patients were treated with 1-2mm occlusal splints in the molar region. The mouths of the patients were kept slightly open by the occlusal splints for 3-6 months, and we reviewed the clinical and radiological remodelling of the affected condyles after treatment. Excellent (n=20) and good (n=10) clinical outcomes were achieved with full radiological remodelling seen in 19 and partial remodelling in 11. Treatment with occlusal splints is effective in delivering good results and function with minimal morbidity in children with sagittal fractures of the condyle, while permitting ongoing remodelling and growth in the short term. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Bent Bragg–Laue monochromator for high-energy X-rays

DOE PAGES

Shi, Xianbo; Xu, Wenqian; Yakovenko, Andrey; ...

2017-07-26

A bent Bragg–Laue monochromator (BLM) is proposed for high-energy X-ray (~25–60 keV) beamlines. The BLM has the unique feature of bi-directional focusing. A sagittally bent Laue crystal can focus the large horizontal fan of a bending magnet or wiggler source. A meridionally bent Bragg crystal focuses the beam vertically and corrects for the anticlastic bending effects of the Laue crystal. This monochromator geometry relies on the crystal orientations being optimized. We show that the focusing condition and Rowland condition can be simultaneously satisfied at a given energy. A detailed ray tracings indicate that a BLM can provide similar energy resolutionmore » and higher flux density compared to a sagittally bent double-Laue monochromator configuration. A prototype BLM with a symmetric Bragg crystal and an asymmetric Laue crystal was tested. Matching of the bend radii of the two crystals in the meridional direction was demonstrated. Generally, the horizontal acceptance of the sagittally bent Laue crystal is limited by the large curvature. This horizontal BLM acceptance could be increased by translating the Laue crystal along its sagittal bending axis.« less

Bad splits in bilateral sagittal split osteotomy: systematic review of fracture patterns.

PubMed

Steenen, S A; Becking, A G

2016-07-01

An unfavourable and unanticipated pattern of the mandibular sagittal split osteotomy is generally referred to as a 'bad split'. Few restorative techniques to manage the situation have been described. In this article, a classification of reported bad split pattern types is proposed and appropriate salvage procedures to manage the different types of undesired fracture are presented. A systematic review was undertaken, yielding a total of 33 studies published between 1971 and 2015. These reported a total of 458 cases of bad splits among 19,527 sagittal ramus osteotomies in 10,271 patients. The total reported incidence of bad split was 2.3% of sagittal splits. The most frequently encountered were buccal plate fractures of the proximal segment (types 1A-F) and lingual fractures of the distal segment (types 2A and 2B). Coronoid fractures (type 3) and condylar neck fractures (type 4) have seldom been reported. The various types of bad split may require different salvage approaches. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Bent Bragg–Laue monochromator for high-energy X-rays

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shi, Xianbo; Xu, Wenqian; Yakovenko, Andrey

A bent Bragg–Laue monochromator (BLM) is proposed for high-energy X-ray (~25–60 keV) beamlines. The BLM has the unique feature of bi-directional focusing. A sagittally bent Laue crystal can focus the large horizontal fan of a bending magnet or wiggler source. A meridionally bent Bragg crystal focuses the beam vertically and corrects for the anticlastic bending effects of the Laue crystal. This monochromator geometry relies on the crystal orientations being optimized. We show that the focusing condition and Rowland condition can be simultaneously satisfied at a given energy. A detailed ray tracings indicate that a BLM can provide similar energy resolutionmore » and higher flux density compared to a sagittally bent double-Laue monochromator configuration. A prototype BLM with a symmetric Bragg crystal and an asymmetric Laue crystal was tested. Matching of the bend radii of the two crystals in the meridional direction was demonstrated. Generally, the horizontal acceptance of the sagittally bent Laue crystal is limited by the large curvature. This horizontal BLM acceptance could be increased by translating the Laue crystal along its sagittal bending axis.« less

Can axial-based nodal size criteria be used in other imaging planes to accurately determine "enlarged" head and neck lymph nodes?

PubMed

Bartlett, Eric S; Walters, Thomas D; Yu, Eugene

2013-01-01

Objective. We evaluate if axial-based lymph node size criteria can be applied to coronal and sagittal planes. Methods. Fifty pretreatment computed tomographic (CT) neck exams were evaluated in patients with head and neck squamous cell carcinoma (SCCa) and neck lymphadenopathy. Axial-based size criteria were applied to all 3 imaging planes, measured, and classified as "enlarged" if equal to or exceeding size criteria. Results. 222 lymph nodes were "enlarged" in one imaging plane; however, 53.2% (118/222) of these were "enlarged" in all 3 planes. Classification concordance between axial versus coronal/sagittal planes was poor (kappa = -0.09 and -0.07, resp., P < 0.05). The McNemar test showed systematic misclassification when comparing axial versus coronal (P < 0.001) and axial versus sagittal (P < 0.001) planes. Conclusion. Classification of "enlarged" lymph nodes differs between axial versus coronal/sagittal imaging planes when axial-based nodal size criteria are applied independently to all three imaging planes, and exclusively used without other morphologic nodal data.

Can Axial-Based Nodal Size Criteria Be Used in Other Imaging Planes to Accurately Determine “Enlarged” Head and Neck Lymph Nodes?

PubMed Central

Bartlett, Eric S.; Walters, Thomas D.; Yu, Eugene

2013-01-01

Objective. We evaluate if axial-based lymph node size criteria can be applied to coronal and sagittal planes. Methods. Fifty pretreatment computed tomographic (CT) neck exams were evaluated in patients with head and neck squamous cell carcinoma (SCCa) and neck lymphadenopathy. Axial-based size criteria were applied to all 3 imaging planes, measured, and classified as “enlarged” if equal to or exceeding size criteria. Results. 222 lymph nodes were “enlarged” in one imaging plane; however, 53.2% (118/222) of these were “enlarged” in all 3 planes. Classification concordance between axial versus coronal/sagittal planes was poor (kappa = −0.09 and −0.07, resp., P < 0.05). The McNemar test showed systematic misclassification when comparing axial versus coronal (P < 0.001) and axial versus sagittal (P < 0.001) planes. Conclusion. Classification of “enlarged” lymph nodes differs between axial versus coronal/sagittal imaging planes when axial-based nodal size criteria are applied independently to all three imaging planes, and exclusively used without other morphologic nodal data. PMID:23984099

Reliability of Beta angle in assessing true anteroposterior apical base discrepancy in different growth patterns

PubMed Central

Sundareswaran, Shobha; Kumar, Vinay

2015-01-01

Introduction: Beta angle as a skeletal anteroposterior dysplasia indicator is known to be useful in evaluating normodivergent growth patterns. Hence, we compared and verified the accuracy of Beta angle in predicting sagittal jaw discrepancy among subjects with hyperdivergent, hypodivergent and normodivergent growth patterns. Materials and Methods: Lateral cephalometric radiographs of 179 patients belonging to skeletal Classes I, II, and III were further divided into normodivergent, hyperdivergent, and hypodivergent groups based on their vertical growth patterns. Sagittal dysplasia indicators - angle ANB, Wits appraisal, and Beta angle values were measured and tabulated. The perpendicular point of intersection on line CB (Condylion-Point B) in Beta angle was designated as ‘X’ and linear dimension XB was evaluated. Results: Statistically significant increase was observed in the mean values of Beta angle and XB distance in the vertical growth pattern groups of both skeletal Class I and Class II patients thus pushing them toward Class III and Class I, respectively. Conclusions: Beta angle is a reliable indicator of sagittal dysplasia in normal and horizontal patterns of growth. However, vertical growth patterns significantly increased Beta angle values, thus affecting their reliability as a sagittal discrepancy assessment tool. Hence, Beta angle may not be a valid tool for assessment of sagittal jaw discrepancy in patients exhibiting vertical growth patterns with skeletal Class I and Class II malocclusions. Nevertheless, Class III malocclusions having the highest Beta angle values were unaffected. PMID:25810649

The stability of mandibular prognathism corrected by bilateral sagittal split osteotomies: a comparison of bi-cortical osteosynthesis and mono-cortical osteosynthesis.

PubMed

Hsu, S S-P; Huang, C-S; Chen, P K-T; Ko, E W-C; Chen, Y-R

2012-02-01

This study evaluated the differences in surgical changes and post-surgical changes between bi-cortical and mono-cortical osteosynthesis (MCO) in the correction of skeletal Class III malocclusion with bilateral sagittal split osteotomies (BSSOs). Twenty-five patients had bi-cortical osteosynthesis (BCO), 32 patients had mono-cortical fixation. Lateral and postero-anterior cephalometric radiographs, taken at the time of surgery, before surgery, 1 month after surgery, and on completion of orthodontic treatment (mean 9.9 months after surgery), were obtained for evaluation. Cephalometric analysis and superimposition were used to investigate the surgical and post-surgical changes. Independent t-test was performed to compare the difference between the two groups. Pearson's correlations were tested to evaluate the factors related to the relapse of the mandible. The sagittal relapse rate was 20% in the bi-cortical and 25% in the mono-cortical group. The forward-upward rotation of the mandible in the post-surgical period contributed most of the sagittal relapse. There were no statistically significant differences in sagittal and vertical changes between the two groups during surgery and in the post-surgical period. No factors were found to correlate with post-surgical relapse, but the intergonial width increased more in the bi-cortical group. The study suggested that both methods of skeletal fixation had similar postoperative stability. Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

An algorithm based on OmniView technology to reconstruct sagittal and coronal planes of the fetal brain from volume datasets acquired by three-dimensional ultrasound.

PubMed

Rizzo, G; Capponi, A; Pietrolucci, M E; Capece, A; Aiello, E; Mammarella, S; Arduini, D

2011-08-01

To describe a novel algorithm, based on the new display technology 'OmniView', developed to visualize diagnostic sagittal and coronal planes of the fetal brain from volumes obtained by three-dimensional (3D) ultrasonography. We developed an algorithm to image standard neurosonographic planes by drawing dissecting lines through the axial transventricular view of 3D volume datasets acquired transabdominally. The algorithm was tested on 106 normal fetuses at 18-24 weeks of gestation and the visualization rates of brain diagnostic planes were evaluated by two independent reviewers. The algorithm was also applied to nine cases with proven brain defects. The two reviewers, using the algorithm on normal fetuses, found satisfactory images with visualization rates ranging between 71.7% and 96.2% for sagittal planes and between 76.4% and 90.6% for coronal planes. The agreement rate between the two reviewers, as expressed by Cohen's kappa coefficient, was > 0.93 for sagittal planes and > 0.89 for coronal planes. All nine abnormal volumes were identified by a single observer from among a series including normal brains, and eight of these nine cases were diagnosed correctly. This novel algorithm can be used to visualize standard sagittal and coronal planes in the fetal brain. This approach may simplify the examination of the fetal brain and reduce dependency of success on operator skill. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Can a Single Sagittal Magnetic Resonance Imaging Slice Represent Whole Fatty Infiltration in Chronic Rotator Cuff Tears at the Supraspinatus?

PubMed

Lee, Yong-Beom; Yang, Cheol-Jung; Li, Cheng Zhen; Zhuan, Zhong; Kwon, Seung-Cheol; Noh, Kyu-Cheol

2018-03-01

This study aimed to investigate whether fatty infiltration (FI) measured on a single sagittal magnetic resonance imaging (MRI) slice can represent FI of the whole supraspinatus muscle. This study retrospectively reviewed the MRIs of 106 patients (age 50-79 years) divided into three rotator cuff tear-size groups: medium, large, and massive. Fat mass and muscle mass on all T1-weighted sagittal MRI scans (FA and MA) were measured. Of the total MRI scans, the Y-view was defined as the most lateral image of the junction of the scapular spine with the scapular body on the oblique sagittal T1-weighted image. Fat mass and muscle mass seen on this Y-view single slice were recorded as F1 and M1, respectively. Fat mass and muscle mass were also assessed on MRI scans lateral and medial to the Y-view. The means of fat mass and muscle mass on these three slices were recorded as F3 and M3, respectively. Average FI ratios (fat mass/muscle mass) of the three assessment methods (F1/M1, FA/MA, and F3/M3) were compared. Intraclass correlation coefficients (ICCs) were calculated for inter- and intraobserver reliability. ICCs showed higher reliability (> 0.8) for all measurements. F1/M1 values were not statistically different from FA/MA and F3/M3 values ( p > 0.05), except in males with medium and large tears. F3/M3 and FA/MA were not statistically different. The difference between F1/M1 and FA/MA did not exceed 2%. A single sagittal MRI slice can represent the whole FI in chronic rotator cuff tears, except in some patient groups. We recommend measurement of FI using a single sagittal MRI slice, given the effort required for repeated measurements.

Can a Single Sagittal Magnetic Resonance Imaging Slice Represent Whole Fatty Infiltration in Chronic Rotator Cuff Tears at the Supraspinatus?

PubMed Central

Lee, Yong-Beom; Yang, Cheol-Jung; Li, Cheng Zhen; Zhuan, Zhong; Kwon, Seung-Cheol

2018-01-01

Background This study aimed to investigate whether fatty infiltration (FI) measured on a single sagittal magnetic resonance imaging (MRI) slice can represent FI of the whole supraspinatus muscle. Methods This study retrospectively reviewed the MRIs of 106 patients (age 50–79 years) divided into three rotator cuff tear-size groups: medium, large, and massive. Fat mass and muscle mass on all T1-weighted sagittal MRI scans (FA and MA) were measured. Of the total MRI scans, the Y-view was defined as the most lateral image of the junction of the scapular spine with the scapular body on the oblique sagittal T1-weighted image. Fat mass and muscle mass seen on this Y-view single slice were recorded as F1 and M1, respectively. Fat mass and muscle mass were also assessed on MRI scans lateral and medial to the Y-view. The means of fat mass and muscle mass on these three slices were recorded as F3 and M3, respectively. Average FI ratios (fat mass/muscle mass) of the three assessment methods (F1/M1, FA/MA, and F3/M3) were compared. Intraclass correlation coefficients (ICCs) were calculated for inter- and intraobserver reliability. Results ICCs showed higher reliability (> 0.8) for all measurements. F1/M1 values were not statistically different from FA/MA and F3/M3 values (p > 0.05), except in males with medium and large tears. F3/M3 and FA/MA were not statistically different. The difference between F1/M1 and FA/MA did not exceed 2%. Conclusions A single sagittal MRI slice can represent the whole FI in chronic rotator cuff tears, except in some patient groups. We recommend measurement of FI using a single sagittal MRI slice, given the effort required for repeated measurements. PMID:29564048

Use of computer-assisted design and manufacturing to localize dural venous sinuses during reconstructive surgery for craniosynostosis.

PubMed

Iyer, Rajiv R; Wu, Adela; Macmillan, Alexandra; Musavi, Leila; Cho, Regina; Lopez, Joseph; Jallo, George I; Dorafshar, Amir H; Ahn, Edward S

2018-01-01

Cranial vault remodeling surgery for craniosynostosis carries the potential risk of dural venous sinus injury given the extensive bony exposure. Identification of the dural venous sinuses can be challenging in patients with craniosynostosis given the lack of accurate surface-localizing landmarks. Computer-aided design and manufacturing (CAD/CAM) has allowed surgeons to pre-operatively plan these complex procedures in an effort to increase reconstructive efficiency. An added benefit of this technology is the ability to intraoperatively map the dural venous sinuses based on pre-operative imaging. We utilized CAD/CAM technology to intraoperatively map the dural venous sinuses for patients undergoing reconstructive surgery for craniosynostosis in an effort to prevent sinus injury, increase operative efficiency, and enhance patient safety. Here, we describe our experience utilizing this intraoperative technology in pediatric patients with craniosynostosis. We retrospectively reviewed the charts of children undergoing reconstructive surgery for craniosynostosis using CAD/CAM surgical planning guides at our institution between 2012 and 2016. Data collected included the following: age, gender, type of craniosynostosis, estimated blood loss, sagittal sinus deviation from the sagittal suture, peri-operative outcomes, and hospital length of stay. Thirty-two patients underwent reconstructive cranial surgery for craniosynostosis, with a median age of 11 months (range, 7-160). Types of synostosis included metopic (6), unicoronal (6), sagittal (15), lambdoid (1), and multiple suture (4). Sagittal sinus deviation from the sagittal suture was maximal in unicoronal synostosis patients (10.2 ± 0.9 mm). All patients tolerated surgery well, and there were no occurrences of sagittal sinus, transverse sinus, or torcular injury. The use of CAD/CAM technology allows for accurate intraoperative dural venous sinus localization during reconstructive surgery for craniosynostosis and enhances operative efficiency and surgeon confidence while minimizing the risk of patient morbidity.

How to measure kyphosis in everyday clinical practice: a reliability study on different methods.

PubMed

Zaina, Fabio; Donzelli, Sabrina; Lusini, Monia; Negrini, Stefano

2012-01-01

The sagittal plane measures have a relevant role both in Idiopathic Scoliosis (AIS) and in Hyperkyphosis (HK) management. Nevertheless, clinical tools for everyday use are scarce and not adequately studied. To assess the repeatability of different methods for the collection of the sagittal profile of patients with spinal deformities during everyday clinics. We performed 4 different studies in 4 different populations of AIS and HK patients. In the first study we reported the normative data and measurement error of the plumbline measures in a general population of 180 adolescents. In the second study we compared the sagittal distances from the plumbline of C7, T12, L3, and Sagittal Index (SI = C7+L3) with the measures of the Video Rasterstereography at the same levels and the angles of kyphosis and lordosis in 100 AIS patients. In the third study we evaluated the intra and inter-rater repeatability and the measurement error of kyphosis and lordosis angles measured with the Inclimed in 100 AIS patients. In the last study we evaluated the repeatability of the sagittal distances from the plumbline, by using a 1 mm change instead of 5 mm in a population of 40 patients. repeatability has been evaluated according to Bland and Altman, to identify the limits of variation that are clinically significant. Results. Study 1: the normative data were: females: 34 ± 11 mm for C7; 34 ± 15 mm for L3, males: 34 ± 10 mm for C7; 48 ± 10 mm for L3;. Study 2: a coefficient of correlation was calculated in order to compare measures. Study 3: the k value for Inclimed varied from fair to good. Study 4: the repeatability was fair for this measure. Some clinical instruments are now available for sagittal plane assessment in AIS and hyperkyphosis. The results of the present study report the limits during measurements in a clinical setting of parameters that are routinely collected by some clinicians.

Sci-Thur AM: YIS – 03: Combining sagittally-reconstructed 3D and live-2D ultrasound for high-dose-rate prostate brachytherapy needle segmentation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hrinivich, Thomas; Hoover, Douglas; Surry, Kathlee

Ultrasound-guided high-dose-rate prostate brachytherapy (HDR-BT) needle segmentation is performed clinically using live-2D sagittal images. Organ segmentation is then performed using axial images, introducing a source of geometric uncertainty. Sagittally-reconstructed 3D (SR3D) ultrasound enables both needle and organ segmentation, but suffers from shadow artifacts. We present a needle segmentation technique augmenting SR3D with live-2D sagittal images using mechanical probe tracking to mitigate image artifacts and compare it to the clinical standard. Seven prostate cancer patients underwent TRUS-guided HDR-BT during which the clinical and proposed segmentation techniques were completed in parallel using dual ultrasound video outputs. Calibrated needle end-length measurements were usedmore » to calculate insertion depth errors (IDEs), and the dosimetric impact of IDEs was evaluated by perturbing clinical treatment plan source positions. The proposed technique provided smaller IDEs than the clinical approach, with mean±SD of −0.3±2.2 mm and −0.5±3.7mm respectively. The proposed and clinical techniques resulted in 84% and 43% of needles with IDEs within ±3mm, and IDE ranges across all needles of [−7.7mm, 5.9mm] and [−9.3mm, 7.7mm] respectively. The proposed and clinical IDEs lead to mean±SD changes in the volume of the prostate receiving the prescription dose of −0.6±0.9% and −2.0±5.3% respectively. The proposed technique provides improved HDR-BT needle segmentation accuracy over the clinical technique leading to decreased dosimetric uncertainty by eliminating the axial-to-sagittal registration, and mitigates the effect of shadow artifacts by incorporating mechanically registered live-2D sagittal images.« less

How is sagittal balance acquired during bipedal gait acquisition? Comparison of neonatal and adult pelves in three dimensions. Evolutionary implications.

PubMed

Tardieu, Christine; Bonneau, Noémie; Hecquet, Jérôme; Boulay, Christophe; Marty, Catherine; Legaye, Jean; Duval-Beaupère, Geneviève

2013-08-01

We compare adult and intact neonatal pelves, using a pelvic sagittal variable, the angle of sacral incidence, which presents significant correlations with vertebral curvature in adults and plays an important role in sagittal balance of the trunk on the lower limbs. Since the lumbar curvature develops in the child in association with gait acquisition, we expect a change in this angle during growth which could contribute to the acquisition of sagittal balance. To understand the mechanisms underlying the sagittal balance in the evolution of human bipedalism, we also measure the angle of incidence of hominid fossils. Fourty-seven landmarks were digitized on 50 adult and 19 intact neonatal pelves. We used a three-dimensional model of the pelvis (DE-VISU program) which calculates the angle of sacral incidence and related functional variables. Cross-sectional data from newborns and adults show that the angle of sacral incidence increases and becomes negatively correlated with the sacro-acetabular distance. During ontogeny the sacrum becomes curved, tends to sink down between the iliac blades as a wedge and moves backward in the sagittal plane relative to the acetabula, thus contributing to the backwards displacement of the center of gravity of the trunk. A chain of correlations links the degree of the sacral slope and of the angle of incidence, which is tightly linked with the lumbar lordosis. We sketch a model showing the coordinated changes occurring in the pelvis and vertebral column during the acquisition of bipedalism in infancy. In the australopithecine pelves, Sts 14 and AL 288-1, and in the Homo erectus Gona pelvis the angle of sacral incidence reaches the mean values of humans. Discussing the incomplete pelves of Ardipithecus ramidus, Australopithecus sediba and the Nariokotome Boy, we suggest how the functional linkage between pelvis and spine, observed in humans, could have emerged during hominid evolution. Copyright © 2013 Elsevier Ltd. All rights reserved.

Thoracolumbar imbalance analysis for osteotomy planification using a new method: FBI technique.

PubMed

Le Huec, J C; Leijssen, P; Duarte, M; Aunoble, S

2011-09-01

Treatment of spine imbalance by posterior osteotomy is a valuable technique. Several surgical techniques have been developed and proposed to redress the vertebral column in harmonious kyphosis in order to recreate correct sagittal alignment. Although surgical techniques proved to be adequate, preoperative planning still is mediocre. Multiple suggestions have been proposed, from cutting tracing paper to ingenious mathematical formulas and computerised models. The analysis of the pelvic parameters to try to recover the initial shape of the spine before the spine imbalance occurred is very important to avoid mistakes during the osteotomy planification. The authors proposed their method for the osteotomy planning paying attention to the pelvic, and spine parameters and in accordance with Roussouly's classification. The pre operative planning is based on a full-body X-ray including the spine from C1 to the femoral head and the first 10 cm of the femur shaft. Using all the balance parameters provided, a formula name FBI is proposed. Calculation of the osteotomy is basic goniometry, the midpoint of the C7 inferior plateau (point a) is transposed horizontally on the projected future C7 plumb line (point b) crossing posterior S1 plateau on a sagittal X-ray. These are the first two reference points. A third reference point is made on the anterior wall of the selected vertebra for osteotomy at mid height of the pedicle (point c) mainly L4 vertebra. These three points form a triangle with the tip being the third reference point. The angle represented by this triangle is the theoretical angle of the osteotomy. Two more angles should be measured and eventually added. The femur angulation measured as the inclination of the femoral axis to the vertical. And a third angle named the compensatory pelvic tilt to integrate the type of pelvis. If the pelvic tilt is between 15 and 25° or is higher than 25° you must add 5 or 10°, respectively. This compensatory tilt is based on a clinical analysis of operated patients. This planification was applied in a retrospective study of 18 patients and showed why in some cases improper correction was performed and prospectively in 8 cases with good clinical outcomes and correct spinal alignment. Sometimes it is necessary to find an acceptable compromise when rebalancing the spine paying attention to the general parameters of the patients like: age, osteoporosis, systemic disease etc. This FBI technique can be used even for small lordosis restoration: it gave a good evaluation of the amount of correction needed and then the surgeon had the choice to use the appropriate technique to obtain a good balance.

Radiologically defining horizontal gaze using EOS imaging-a prospective study of healthy subjects and a retrospective audit.

PubMed

Hey, Hwee Weng Dennis; Tan, Kimberly-Anne; Ho, Vivienne Chien-Lin; Azhar, Syifa Bte; Lim, Joel-Louis; Liu, Gabriel Ka-Po; Wong, Hee-Kit

2018-06-01

As sagittal alignment of the cervical spine is important for maintaining horizontal gaze, it is important to determine the former for surgical correction. However, horizontal gaze remains poorly-defined from a radiological point of view. The objective of this study was to establish radiological criteria to define horizontal gaze. This study was conducted at a tertiary health-care institution over a 1-month period. A prospective cohort of healthy patients was used to determine the best radiological criteria for defining horizontal gaze. A retrospective cohort of patients without rigid spinal deformities was used to audit the incidence of horizontal gaze. Two categories of radiological parameters for determining horizontal gaze were tested: (1) the vertical offset distances of key identifiable structures from the horizontal gaze axis and (2) imaginary lines convergent with the horizontal gaze axis. Sixty-seven healthy subjects underwent whole-body EOS radiographs taken in a directed standing posture. Horizontal gaze was radiologically defined using each parameter, as represented by their means, 95% confidence intervals (CIs), and associated 2 standard deviations (SDs). Subsequently, applying the radiological criteria, we conducted a retrospective audit of such radiographs (before the implementation of a strict radioimaging standardization). The mean age of our prospective cohort was 46.8 years, whereas that of our retrospective cohort was 37.2 years. Gender was evenly distributed across both cohorts. The four parameters with the lowest 95% CI and 2 SD were the distance offsets of the midpoint of the hard palate (A) and the base of the sella turcica (B), the horizontal convergents formed by the tangential line to the hard palate (C), and the line joining the center of the orbital orifice with the internal occipital protuberance (D). In the prospective cohort, good sensitivity (>98%) was attained when two or more parameters were used. Audit using Criterion B+D yielded compliance rates of 76.7%, a figure much closer to that of A+B+C+D (74.8%). From a practical viewpoint, Criterion B+D were most suitable for clinical use and could be simplified to the "3-6-12 rule" as a form of cursory assessment. Verbal instructions in the absence of stringent postural checks only ensured that ~75% of subjects achieved horizontal gaze. Fulfillment of Criterion B+D is sufficient to evaluate for horizontal gaze. Further criteria can be added to increase sensitivity. Verbal instructions alone yield high rates of inaccuracy when attempting to image patients in horizontal gaze. Apart from improving methods for obtaining radiographs, a radiological definition of horizontal gaze should be routinely applied for better evaluation of sagittal spinal alignment. Copyright © 2017 Elsevier Inc. All rights reserved.

The influence of sagittal profile alteration and final lordosis on the clinical outcome of cervical spondylotic myelopathy. A Delta-Omega-analysis.

PubMed

Koeppen, Daniel; Piepenbrock, Claudia; Kroppenstedt, Stefan; Čabraja, Mario

2017-01-01

Decompression and maintaining or restoring a cervical lordosis are major goals in the surgical treatment of cervical spondylotic myelopathy (CSM). Numerous studies support the assumption that cervical lordosis is a key factor for neurological recovery and pain reduction. However, even kyphotic patients can be asymptomatic. The balance of the spine is subject of an increasing number of publications. The main purpose of the study was to evaluate the validity of lordotic alignment on the course of CSM and to set this parameter in context with well-validated tools, namely the modified Japanese Orthopaedic Association scoring system (mJOAS) and the visual analogue scale (VAS), to predict and measure the clinical outcome after surgery. This is a retrospective study with prospectively collected data of a heterogeneous cohort. The authors analyzed the records of 102 patients suffering from CSM that underwent decompressive surgery and instrumentation. Clinical outcome was assessed by using the mJOAS, VAS and Odom's criteria. The radiological analysis involved comparison of pre- and postoperative radiographs. The patients were divided into subgroups to be able to compare the influence of various amounts of correction (3 Delta-groups: <0°, 1-7° and ≥8°) and final lordosis (4 Omega-groups: 0-7°, 8-14°, 15-21°, ≥22°). 219 levels were fused in 102 patients. Surgery improved the clinical outcome of all groups significantly. A lordotic profile was achieved in all analyzed groups. Patients that showed small lordosis after surgery (<8°) did not have an inferior clinical outcome compared to patients with larger cervical lordosis (>14°). The comparison of Odom's criteria showed that preoperatively kyphotic patients benefitted more from surgery than lordotic patients (p = 0.029), but no differences could be seen comparing neck pain and neurological improvement. The improvement of pain and neurological impairment measured by VAS and mJOAS supports the statistical impact and validity of the data despite comparatively small numbers of patients. The lack of postoperative kyphosis is a major limitation of the study to encompass the impact of sagittal alignment on clinical outcome. Decompression and stabilization appear to be key elements of surgical treatment of CSM. While the achievement of cervical lordosis remains a major goal of surgery, clinical improvement is not hindered in patients who show small lordosis. However, kyphosis should be eliminated in symptomatic patients. The terms "balance" and "physiologic lordosis" remain complex entities without clear definition. To check the results of our study controlled randomized trials to validate and determine the exact role of cervical balance on the course of CSM would be helpful.

The influence of sagittal profile alteration and final lordosis on the clinical outcome of cervical spondylotic myelopathy. A Delta-Omega-analysis

PubMed Central

Koeppen, Daniel; Piepenbrock, Claudia; Kroppenstedt, Stefan; Čabraja, Mario

2017-01-01

Purpose Decompression and maintaining or restoring a cervical lordosis are major goals in the surgical treatment of cervical spondylotic myelopathy (CSM). Numerous studies support the assumption that cervical lordosis is a key factor for neurological recovery and pain reduction. However, even kyphotic patients can be asymptomatic. The balance of the spine is subject of an increasing number of publications. The main purpose of the study was to evaluate the validity of lordotic alignment on the course of CSM and to set this parameter in context with well-validated tools, namely the modified Japanese Orthopaedic Association scoring system (mJOAS) and the visual analogue scale (VAS), to predict and measure the clinical outcome after surgery. Methods This is a retrospective study with prospectively collected data of a heterogeneous cohort. The authors analyzed the records of 102 patients suffering from CSM that underwent decompressive surgery and instrumentation. Clinical outcome was assessed by using the mJOAS, VAS and Odom’s criteria. The radiological analysis involved comparison of pre- and postoperative radiographs. The patients were divided into subgroups to be able to compare the influence of various amounts of correction (3 Delta-groups: <0°, 1–7° and ≥8°) and final lordosis (4 Omega-groups: 0–7°, 8–14°, 15–21°, ≥22°). Results 219 levels were fused in 102 patients. Surgery improved the clinical outcome of all groups significantly. A lordotic profile was achieved in all analyzed groups. Patients that showed small lordosis after surgery (<8°) did not have an inferior clinical outcome compared to patients with larger cervical lordosis (>14°). The comparison of Odom’s criteria showed that preoperatively kyphotic patients benefitted more from surgery than lordotic patients (p = 0.029), but no differences could be seen comparing neck pain and neurological improvement. The improvement of pain and neurological impairment measured by VAS and mJOAS supports the statistical impact and validity of the data despite comparatively small numbers of patients. The lack of postoperative kyphosis is a major limitation of the study to encompass the impact of sagittal alignment on clinical outcome. Conclusions Decompression and stabilization appear to be key elements of surgical treatment of CSM. While the achievement of cervical lordosis remains a major goal of surgery, clinical improvement is not hindered in patients who show small lordosis. However, kyphosis should be eliminated in symptomatic patients. The terms “balance” and “physiologic lordosis” remain complex entities without clear definition. To check the results of our study controlled randomized trials to validate and determine the exact role of cervical balance on the course of CSM would be helpful. PMID:28430792

Spinal pedicle subtraction osteotomy for fixed sagittal imbalance patients

PubMed Central

Hyun, Seung-Jae; Kim, Yongjung J; Rhim, Seung-Chul

2013-01-01

In addressing spinal sagittal imbalance through a posterior approach, the surgeon now may choose from among a variety of osteotomy techniques. Posterior column osteotomies such as the facetectomy or Ponte or Smith-Petersen osteotomy provide the least correction, but can be used at multiple levels with minimal blood loss and a lower operative risk. Pedicle subtraction osteotomies provide nearly 3 times the per-level correction of Ponte/Smith-Petersen osteotomies; however, they carry increased technical demands, longer operative time, and greater blood loss and associated significant morbidity, including neurological injury. The literature focusing on pedicle subtraction osteotomy for fixed sagittal imbalance patients is reviewed. The long-term overall outcomes, surgical tips to reduce the complications and suggestions for their proper application are also provided. PMID:24340276

Image-Guided Internal Fixation of an Oblique Sagittal Split Fracture of C1 Lateral Mass with Motion Preservation: A Technical Report

PubMed Central

Malcolm, James G; Johnson, Andrew K

2017-01-01

A sagittal split fracture of the C1 lateral mass is an unstable subtype of C1 fractures and has a high propensity for developing late deformities and pain with nonoperative management. A primary internal fixation of this type of fracture has been recently described with good clinical outcomes and preservation of motion. We present a modified technique of primary internal fixation using an obliquely inserted C1 lag screw with imaging guidance. We successfully treated a 55-year-old woman with a unilateral C1 oblique sagittal split fracture who failed nonoperative management. Technical nuances are discussed with a review of pertinent literature. PMID:28948116

Effect of Preoperative Molding Helmet in Patients With Sagittal Synostosis.

PubMed

Hashmi, Asra; Marupudi, Neena I; Sood, Sandeep; Rozzelle, Arlene

2017-06-01

In our practice, the authors found that molding helmet used for plagiocephaly preoperatively, in patients with sagittal synostosis, decreased bathrocephaly, forehead bossing, and improved posterior vertex, as well as Cephalic Index (CI). This prompted us to investigate the impact of preoperative molding helmet in patients with sagittal synostosis. A prospective study was performed on patients undergoing surgical correction of sagittal synostosis, over a 5-year period. Patients were categorized into 2 groups. "No Helmet group" only had surgical correction, and "Helmet group" had preoperative molding helmet, prior to surgical correction. Cephalic Index for the 2 groups was compared using t-test. There were 40 patients in the No Helmet group and 18 patients in the Helmet group. For No Helmet group, mean CI at presentation, immediately preoperative, and postoperatively was 0.70 (±0.045), 0.70 (±0.020), and 0.80 (±0.030), respectively, and for Helmet group, it was 0.69 (±0.023), 0.73 (±0.036), and 0.83 (±0.036), respectively. There was no statistically significant difference between CI of the 2 groups at presentation (P = 0.45). Comparison of postoperative CI did show a statistically significant difference between the groups (P = 0.01). For Helmet group, on comparison of CI at presentation and preoperative CI (after helmet therapy), a statistically significant improvement in CI was observed (P = 0.0004). Our results suggest that preoperative molding helmet can decrease bathrocephaly, forehead bossing, and improve posterior vertex as well as CI, prior to surgery and thus can be used as a valuable adjunct in patients with sagittal synostosis.

Radiographic diagnosis of sagittal plane rotational displacement in pelvic fractures: a cadaveric model and clinical case study.

PubMed

Shui, Xiaolong; Ying, Xiaozhou; Kong, Jianzhong; Feng, Yongzeng; Hu, Wei; Guo, Xiaoshan; Wang, Gang

2015-08-01

Our objective was to measure the sagittal plane rotational (flexion and extension) displacement of hemipelvis radiologically and analyze the ratio of flexion and extension displacement of unstable pelvic fractures. We used 8 cadaveric models to study the radiographic evidence of pelvic fractures in the sagittal plane. We performed pelvic osteotomy on 8 cadavers to simulate anterior and posterior pelvic ring injury. Radiological data were measured in the flexion and extension group under different angles (5°, 10°, 15°, 20°, and 25°). We retrospectively reviewed 164 patients who were diagnosed with a unilateral fracture of the pelvis. Pelvic ring displacement was identified and recorded radiographically in cadaveric models. The flexion and extension displacement of pelvic fractures was measured in terms of the vertical distance of fracture from the top of iliac crest to the pubic tubercle (CD) or from the top of iliac crest to the lowest point of ischial tuberosity (AB). Fifty-seven pelves showed flexion displacement and 15 showed extension displacement. Closed reduction including internal fixation and external fixation was successfully used in 141 cases (86.0 %). The success rates of closed reduction in flexion and extension displacement groups were 77 and 73 %, respectively, which were lower than in unstable pelvic ring fractures. The sagittal plane rotation (flexion and extension) displacement of pelvic fractures could be measured by special points and lines on the radiographs. Minimally invasive reduction should be based on clearly identified differences between the sagittal plane rotation and the vertical displacement of pelvic fractures.

Standardized way for imaging of the sagittal spinal balance.

PubMed

Morvan, Gérard; Mathieu, Philippe; Vuillemin, Valérie; Guerini, Henri; Bossard, Philippe; Zeitoun, Frédéric; Wybier, Marc

2011-09-01

Nowadays, conventional or digitalized teleradiography remains the most commonly used tool for the study of the sagittal balance, sometimes with secondary digitalization. The irradiation given by this technique is important and the photographic results are often poor. Some radiographic tables allow the realization of digitalized spinal radiographs by simultaneous translation of X-ray tube and receptor. EOS system is a new, very low dose system which gives good quality images, permits a simultaneous acquisition of upright frontal and sagittal views, is able to cover in the same time the spine and the lower limbs and study the axial plane on 3D envelope reconstructions. In the future, this low dose system should take a great place in the study of the pelvispinal balance. On the lateral view, several pelvic (incidence, pelvic tilt, sacral slope) and spinal (lumbar lordosis, thoracic kyphosis, Th9 sagittal offset, C7 plumb line) parameters are drawn to define the pelvispinal balance. All are interdependent. Pelvic incidence is an individual anatomic characteristic that corresponds to the "thickness" of the pelvis and governs the spinal balance. Pelvis and spine, in a harmonious whole, can be compared to an accordion, more or less compressed or stretched.

Metacarpal geometry changes during Thoroughbred race training are compatible with sagittal-plane cantilever bending.

PubMed

Merritt, J S; Davies, H M S

2010-11-01

Bending of the equine metacarpal bones during locomotion is poorly understood. Cantilever bending, in particular, may influence the loading of the metacarpal bones and surrounding structures in unique ways. We hypothesised that increased amounts of sagittal-plane cantilever bending may govern changes to the shape of the metacarpal bones of Thoroughbred racehorses during training. We hypothesised that this type of bending would require a linear change to occur in the combined second moment of area of the bones for sagittal-plane bending (I) during race training. Six Thoroughbred racehorses were used, who had all completed at least 4 years of race training at a commercial stable. The approximate change in I that had occurred during race training was computed from radiographic measurements at the start and end of training using a simple model of bone shape. A significant (P < 0.001), approximately linear pattern of change in I was observed in each horse, with the maximum change occurring proximally and the minimum change occurring distally. The pattern of change in I was compatible with the hypothesis that sagittal-plane cantilever bending governed changes to the shape of the metacarpal bones during race training. © 2010 EVJ Ltd.

Automatic extraction of the mid-sagittal plane using an ICP variant

NASA Astrophysics Data System (ADS)

Fieten, Lorenz; Eschweiler, Jörg; de la Fuente, Matías; Gravius, Sascha; Radermacher, Klaus

2008-03-01

Precise knowledge of the mid-sagittal plane is important for the assessment and correction of several deformities. Furthermore, the mid-sagittal plane can be used for the definition of standardized coordinate systems such as pelvis or skull coordinate systems. A popular approach for mid-sagittal plane computation is based on the selection of anatomical landmarks located either directly on the plane or symmetrically to it. However, the manual selection of landmarks is a tedious, time-consuming and error-prone task, which requires great care. In order to overcome this drawback, previously it was suggested to use the iterative closest point (ICP) algorithm: After an initial mirroring of the data points on a default mirror plane, the mirrored data points should be registered iteratively to the model points using rigid transforms. Finally, a reflection transform approximating the cumulative transform could be extracted. In this work, we present an ICP variant for the iterative optimization of the reflection parameters. It is based on a closed-form solution to the least-squares problem of matching data points to model points using a reflection. In experiments on CT pelvis and skull datasets our method showed a better ability to match homologous areas.

[Morphometric anatomic study and clinical significance of lunate fossa].

PubMed

Aldemir, Cengiz; Önder, Merve; Doğan, Ali; Duygun, Fatih; Oğuz, Nurettin

2015-01-01

This study aims to investigate the depth, transverse and sagittal diameters of lunate fossa which is a significant structure of the wrist in terms of reducing the risk for volar plate screws, which are administered in distal radius fractures, from penetrating into the joint. Depth, transverse and sagittal diameters of lunate fossa in 50 right and 50 left adult dried radius bones without distal tip damage were measured by using MicroscribeG2X from the MicroScribe G series. Mean lunate fossa depth: left 2.419886±0.51 mm/right 2.543052±0.78 mm, mean lunate fossa sagittal diameter: left 19.656±1.57 mm/right 18.796±1.53 mm, mean lunate fossa transverse diameter: left 11.382±0.65 mm/right 11.106±0.91 mm. There was no statistically significant difference between right and left depth values of lunate fossa (p=0.320), whereas there was statistically significant difference between right and left transverse and sagittal diameters (p=0.006, p=0.048). Measurements involving depth of lunate fossa may guide the development of new anatomic plates and decrease complications like the penetration of screw into joint whilst volar plate administrations.

Gender difference of ankle stability in the sagittal and frontal planes.

PubMed

Hanzlick, Harrison; Hyunglae Lee

2017-07-01

This paper offers quantification of ankle stability in relation to simulated haptic environments of varying stiffness. This study analyzes the stability trends of male and female subjects independently over a wide range of simulated environments after subjects were exposed to vigorous position perturbation. Ankle stability was quantified for both degrees-of-freedom of the ankle in the sagittal and frontal planes. Subjects' stability consistently decreased when exposed to environments of negative simulated stiffness. In the frontal plane, male and female subjects exhibited nearly identical stability levels. In the sagittal plane, however, male subjects demonstrated marginally more stability than female subjects in environments with negative stiffness. Results of this study are beneficial to understanding situations in which the ankle is likely to lose stability, potentially resulting in injury.

Long-term Clinical and Radiographic Outcomes of Pedicle Subtraction Osteotomy for Fixed Sagittal Imbalance: Does Level of Proximal Fusion Affect the Outcome? Minimum 5-Year Follow-up.

PubMed

Yagi, Mitsuru; King, Akilah B; Cunningham, Matthew E; Boachie-Adjei, Oheneba

2013-03-01

Retrospective case series of surgically treated adult patients with fixed sagittal imbalance. To assess clinical and radiographic changes after pedicle subtraction osteotomy (PSO) to treat adult fixed sagittal imbalance. Although recent reports have shown favorable clinical outcomes for PSO, few reports have published long-term follow-up outcomes. It is also unknown whether long-term outcomes are correlated with the level of proximal fusion and the radiographic changes that are observed after PSO. We reviewed the charts, X-rays, and postoperative SRS-22 and Oswestry Disability Index (ODI) scores of 32 adult patients who presented with fixed sagittal imbalance and were treated with lumbar PSO. Long fusions were defined as those proximal to T6, and short fusions were defined as those below T8. Measured radiographic parameters included thoracic kyphosis, lumbar lordosis (LL), sacral slope, pelvic incidence, and sagittal balance (SVA). Statistical analysis included Student t test and chi-square test. A p value of < .05 and a confidence interval of 95% were considered statistically significant. Among the reviewed cases were 23 women and 9 men, with a mean age of 50.9 years (range, 33-76 years) and a mean follow-up 8.6 years (range, 5-16 years). The LL increased from -16.0° preoperatively to -52.1° postoperatively. This metric decreased to -51.0° at final follow-up. The SVA decreased from 10.4 cm preoperatively to 3.6 cm postoperatively. The SVA increased to 5.4 cm at the final follow-up visit. There were 17 long fusions and 15 short fusions. The SRS scores at the final follow-up time point were: total, 3.63; function, 3.59; pain, 3.68; self-image, 3.46; mental health, 3.56; satisfaction, 4.26. A total of 16 patients exhibited minimal disability, 11 exhibited moderate disability, and 2 exhibited severe disability in ODI scores at the final follow-up visit (average, 28.2%). The SRS and ODI scores were not significantly different between groups (p = .64 for SRS; p = .59 for ODI). We observed no significant differences between groups with respect to the LL, sacral slope, or pelvic incidence. The observed increase in SVA at the final follow-up visit was significantly larger in the short fusion group compared with the increase we observed in the long fusion group (p = .03). The thoracic kyphosis (T5-T12) and proximal junctional angle at the final follow-up visit also significantly increased in patients who underwent a short fusion (p < .001). A total of 14 major complications occurred in 12 patients (8 in the short fusion group and 6 in the long fusion group) (p = .43). Eight patients required additional surgery to treat these complications. In a group of adults presenting with fixed sagittal imbalance, PSO provided good sagittal balance and maintained favorable clinical outcomes in both the short and long fusion groups despite a slight decrease in the SVA and a high complication rate. The data suggest that the loss of sagittal balance may be attributed to increase global and junctional kyphosis in short fusion groups, and should be monitored for long-term outcomes. Particular attention should be paid to the long-term deterioration of the SVA in adults who present with fixed sagittal imbalance after PSO. Copyright © 2013 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

The Lumbar Pelvic Angle, the Lumbar Component of the T1 Pelvic Angle, Correlates With HRQOL, PI-LL Mismatch, and it Predicts Global Alignment.

PubMed

Protopsaltis, Themistocles S; Lafage, Renaud; Smith, Justin S; Passias, Peter G; Shaffrey, Christopher I; Kim, Han Jo; Mundis, Gregory M; Ames, Christopher P; Burton, Douglas C; Bess, Shay; Klineberg, Eric; Hart, Robert A; Schwab, Frank J; Lafage, Virginie

2018-05-15

Prospective multicenter analysis of adult spinal deformity (ASD) patients. The aim of this study was to introduce the lumbar pelvic angle (LPA), a novel parameter of spinopelvic alignment. The T1 pelvic angle (TPA), a measure of global spinopelvic alignment, correlates with health-related quality of life (HRQOL), but it may not be measureable on all intraoperative x-rays. In patients with previous interbody fusion at L5-S1, the plane of the S1 endplate can be blurred, creating error in pelvic incidence and lumbar lordosis (PI-LL) measure. The LPA is more readily measured on intraoperative imaging than the TPA. ASD patients were included with either coronal Cobb angle >20°, sagittal vertical axis (SVA) >5 cm, thoracic kyphosis >60°, or pelvic tilt (PT) >25°. Measures of disability included Oswestry Disability Index (ODI), Scoliosis Research Society (SRS), and Short Form (SF)-36. Baseline and 2-year follow-up radiographic and HRQOL outcomes were evaluated. Linear regressions compared LPA with radiographic parameters and HRQOL. A total of 852 ASD patients (407 operative) were enrolled (mean age 53.7). Baseline LPA correlated with PI-LL (r = 0.79), PT (r = 0.78), TPA (r = 0.82), and SVA (r = 0.61) (all P < 0.001). PI-LL, LPA, and TPA correlated with ODI (r = 0.42/0.29/0.45), SF-36 physical component score (-0.43/-0.28/-0.45) SRS (-0.354/-0.23/-0.37) with all P < 0.001. At 2 years' follow-up, LPA correlated with PI-LL (r = 0.77), PT (r = 0.78), TPA (r = 0.83), and SVA (r = 0.57) (all P < 0.001). Categorizing patients by increasing LPA (<7°; 7°-15°; >15°) revealed progressive increases in all HRQOL, PI-LL (-3.2°/12.7°/32.4°), and TPA (9.7°/20.1°/34.6°) with all P < 0.001. Moderate disability (ODI = 40) corresponded to LPA 10.1°, PI-LL 12.6°, and TPA 20.6°. Mild disability (ODI = 20) corresponded to LPA 7.2°, PI-LL 4.2°, and TPA 14.7°. LPA correlates with TPA, PI-LL, and HRQOL in ASD patients. LPA can be used as an intraoperative tool to gauge correction with a target LPA of <7.2°. LPA predicts global alignment, as it correlates with baseline and 2-year TPA and SVA. Along with the cervical-thoracic pelvic angle and TPA, LPA completes the fan of spinopelvic alignment. 3.

Radiological evaluation of ankle arthrodesis with Ilizarov fixation compared to internal fixation.

PubMed

Morasiewicz, Piotr; Dejnek, Maciej; Urbański, Wiktor; Dragan, Szymon Łukasz; Kulej, Mirosław; Dragan, Szymon Feliks

2017-07-01

We asked whether the type of ankle joint arthrodesis stabilization will affect: (1) rate of union, (2) rate of adjacted-joint arthritis, (3) malalignment of the ankle joint. We retrospectively radiological studied 62 patients who underwent ankle arthrodesis with Ilizarov external fixator stabilization (group 1,n=29) or internal stabilization (group 2,n=33) from 2006 to 2015. Radiologic outcomes were mesure by: (1) rate of union, (2) rate of adjacent-joint arthritis, (3) malalignment of the ankle joint. The Levene's test,Mann-Whitney U test and Students t-test were used to the statistical analyses. Ankle fusion was achieved in 100% of patients treated with external fixation and in 88% with internal stabilization. Desired frontal plane alignment was achieved in 100% of patients with external fixation and 76% with internal stabilization. Desired sagittal plane alignment was achieved in 100% of external fixation and 85% of internal stabilization. A total of 14 (48.3%) patients from group 1 showed a radiographic evidence of pre-existing adjacent-joint OA. The radiographic evidence of pre-existing adjacent-joint OA was also found in 27(81.8%) subjects from group 2. Alterations of adjacent joints were also found on postoperative radiograms of 19 (65.5%) patients subjected to Ilizarov fixation and in all 33 patients from group 2. Ilizarov fixation of ankle arthrodesis is associated with lower prevalence of adjacent-joint OA and ankle joint misalignment,and with higher fusion rates than after internal fixation.Although achieving a complex ankle fusion is generally challenging,radiological outcomes after fixation with the Ilizarov apparatus are better than after internal stabilization. Copyright © 2017 Elsevier Ltd. All rights reserved.

The anisotropic nature of the human vocal fold: an ex vivo study.

PubMed

Rohlfs, Anna-Katharina; Goodyer, Eric; Clauditz, Till; Hess, Markus; Kob, Malte; Koops, Susan; Püschel, Klaus; Roemer, Frank W; Müller, Frank

2013-05-01

The purpose of this study was to measure the relationship between the shear elastic properties of vocal fold with respect to the direction of applied stress. There is extensive published material that quantifies the shear viscoelastic properties of the vocal fold, but as much of these data were obtained using rotating parallel plate rheometers, which are unable to resolve out difference of the shear elastic behaviour with respect to direction, there is very little data that indicates anisotropic behaviour. To overcome this gap in knowledge, the team devised an apparatus that is capable of applying a shear stress in a known direction. A series of measurements were taken at the mid-membranous position, in the transverse and longitudinal directions. Point-specific measurements were performed using fourteen human cadaver excised larynges, which were hemi-sectioned to expose the vocal fold. An extremely low sinusoidal shear force of 1 g was applied tangentially to the membrane surface in both the longitudinal and transverse direction, and the resultant shear strain was measured. With the probe applied to the intact vocal fold, the average ratio of the elasticity in the transverse with respect to the longitudinal direction was 0.55. Further investigation using histological staining of collagens in the lamina propria indicates that there is a visible difference in the general alignment of collagen fibres when comparing the coronal and the sagittal sections. Our conclusion is that there is a quantifiable difference between the shear elastic response of the lamina propria in the longitudinal and transverse directions, and that this could be explained by the difference in alignment of collagen fibres within the lamina propria.

Cross-sectional study of neck pain and cervical sagittal alignment in air force pilots.

PubMed

Moon, Bong Ju; Choi, Kyong Ho; Yun, Chul; Ha, Yoon

2015-05-01

There is a high prevalence of neck pain in air force pilots; however, the causes are not clear and are considered work-related. Kyphotic changes in the cervical spine have been known to cause neck pain. In this study, we investigated the association between neck pain and cervical kyphosis in air force pilots. This is a cross-sectional study of 63 Republic of South Korea Air Force pilots. We examined the C2-7 absolute rotation angle (ARA) using the posterior tangent method and other radiologic parameters on whole spine lateral radiographs. We divided the participants into a neck pain group (N = 32) and no neck pain group (N = 31), and subsequently analyzed the difference in radiographic parameters and clinical data between the two groups. There were no significant differences found in age, body mass index, total flight time, or aerobic or anaerobic exercise between the neck pain and control groups. The fighter pilots had higher 1-yr prevalence of neck pain than nonfighter pilots (84.4% vs. 15.6%). The lower C2-7 ARA (OR = 0.91, 95% CI 0.846, 0.979) and fighter type aircrafts (OR = 3.93, 95% CI 1.104, 13.989) were associated with neck pain. Fighter pilots experienced neck pain more frequently than the nonfighter pilots. Those fighter pilots suffering from neck pain were shown to have more kyphotic changes in the cervical spine than control pilots through evaluation of whole spine lateral radiographs using the posterior tangent method. These key findings suggest that the forces involved in flying a fighter type aircraft may affect cervical alignment and neck pain.

C3 Vertebral Metastases From Tongue Adenoid Cystic Carcinoma: A Rare Case Report.

PubMed

Feng, Helin; Wang, Jin; Guo, Peng; Xu, Jianfa; Feng, Jiangang

2015-07-01

We report a rare case involving a patient with C3 vertebral body metastasis secondary to adenoid cystic carcinoma of the tongue.Five years after local resection of the primary tumor, magnetic resonance imaging showed a metastasis located in the left posterior border of the C3 vertebral body. Additionally, multiple pulmonary metastases were identified by computed tomography. Based on these findings, the patient underwent C2-3, C3-4 discectomy; C3 corpectomy; and titanium mesh fusion with a Zephir plate. The diagnosis was confirmed by the pathology findings. During 6 months of follow-up, the patient showed improvement and return of function of the cervical vertebrae, with no serious complications.Because of the scarcity of cases of vertebral metastases from tumors of the tongue in the literature, we have reported this case to add to the available evidence regarding this rarely encountered condition.

Primary Eosinophilic Granuloma of Adult Cervical Spine Presenting as a Radiculomyelopathy

PubMed Central

Bang, Woo-Seok; Cho, Dae-Chul; Sung, Joo-Kyung

2013-01-01

We report a case of 29-year-old man diagnosed as a primary eosinophilic granuloma (EG) lesion of the seventh cervical vertebra. He had paresthesia on both arms, and grasping weakness for 10 days. Cervical magnetic resonance image (MRI) showed an enhancing mass with ventral epidural bulging and cord compression on the seventh cervical vertebra. Additionally, we performed spine series MRI, bone scan and positive emission tomography for confirmation of other bone lesions. These studies showed no other pathological lesions. He underwent anterior cervical corpectomy of the seventh cervical vertebra and plate fixation with iliac bone graft. After surgical management, neurological symptoms were much improved. Histopathologic evaluation confirmed the diagnosis of EG. There was no evidence of tumor recurrence at 12 months postoperative cervical MRI follow-up. We reported symptomatic primary EG of cervical spine successfully treated with surgical resection. PMID:24044083

Bone marrow necrosis secondary to imatinib usage, mimicking spinal metastasis on magnetic resonance imaging and FDG-PET/CT.

PubMed

Aras, Yavuz; Akcakaya, Mehmet Osman; Unal, Seher N; Bilgic, Bilge; Unal, Omer Faruk

2012-01-01

Imatinib mesylate has become the treatment of choice for gastrointestinal stromal tumors (GISTs) and has made a revolutionary impact on survival rates. Bone marrow necrosis is a very rare adverse event in malignant GIST. Bone metastases are also rarely encountered in the setting of this disease. The authors report on a patient with malignant GIST who developed a bone lesion, mimicking spinal metastasis on both MR imaging and FDG-PET/CT. Corpectomy and anterior fusion was performed, but the pathology report was consistent with bone marrow necrosis. Radiological and clinical similarities made the distinction between metastasis and bone marrow necrosis challenging for the treating physicians. Instead of radical surgical excision, more conservative methods such as percutaneous or endoscopic bone biopsies may be more useful for pathological confirmation, even though investigations such as MR imaging and FDG-PET/CT indicate metastatic disease.

Management of symptomatic vertebral haemangioma in a resource challenged environment.

PubMed

Adeolu, Augustine A; Balogun, James A; Adeleye, Amos O; Adeoye, Peter O; Okolo, Clement A; Ogbole, Godwin I

2010-07-01

Vertebral haemangiomas are benign lesions and often asymptomatic. They are more common in the thoracic spine where they may become symptomatic with varying presentations. We present two teenage girls who presented with progressive, nontraumatic paraparesis with no background history of chronic cough or underlying medical illness. The radiologic investigations were suggestive of vertebral haemangiomas of the thoracic spine. They had surgery: transthoracic approach with corpectomy and fusion with iliac crest autograft. The posterior stabilisation in the first patient was with Rush nails and circlage wire and only circlage wire in the second patient. The first patient's post-operative recovery was complicated by graft extrusion necessitating re-opening thoracotomy and graft replacement. They are, however, both ambulant at discharge and have remained so 13 and 15 months post-surgery. We have presented two cases with rewarding outcomes in the face of 'adaptive' instrumentation due to limited resources.

Abnormal rate of intraoperative and postoperative implant positioning outliers using "MRI-based patient-specific" compared to "computer assisted" instrumentation in total knee replacement.

PubMed

Ollivier, M; Tribot-Laspiere, Q; Amzallag, J; Boisrenoult, P; Pujol, N; Beaufils, P

2016-11-01

The aim of this study was to analyze first intraoperative alignment and reason to abandon the use of patient-specific instrumentation using intraoperative CAS measurement, secondly assess by postoperative CT analysis if CI, based on preoperative 3D-MRI data, improved postoperative component positioning (including femoral rotation) and lower limb alignment as compared with results obtained with CAS. In this randomized controlled trial, 80 consecutive patients scheduled to undergo TKA were enrolled. Eligible knees were randomized to the group of PSI-TKAs (n = 40) or to the group of CAS-TKAs (n = 40). In the CAS group, CAS determined and controlled cutting block positioning in each plane. In the PSI group, CAS allowed to measure adequacy of intraoperative alignment including femoral component rotation. At 3 months after surgery, implants position were measured and analyzed with full-weight bearing plain radiographs and CT scan. Intraoperatively, there was a significant difference concerning Sagittal Femoral mechanical, Frontal tibial mechanical angle and tibial slope between the two groups (respectively p = 0.01, p = 0.02, p = 0.046). Custom instrumentation was abandoned intraoperatively in seven knees (17.5 %). Abnormal tibial cuts were responsible of the abandon in three out of seven cases, femoral cut in 1/7 and dual abnormalities in 3/7. Postoperatively, tibial slope outliers percentage was higher in the patient specific instrumentation group with six patients (18.18 %) versus one patient (2.5 %) in the CAS group (p = 0.041). Patient specific instrumentation was associated with an important number of hazardous cut and a higher rate of outliers in our series and thus should be used with caution as related to. This study is the first to our acknowledgement to compare intra-operative ancillary and implant positioning of PSI-TKA and CAS-TKA. High rate of malposition are sustained by our findings, as such PSI-TKA should be used with caution, by surgeons capable to switch to conventional instrumentation intra-operatively. Randomized control trial, Level I.

Lumbar Spine Alignment in Six Common Postures: An ROM Analysis With Implications for Deformity Correction.

PubMed

Hey, Hwee Weng Dennis; Lau, Eugene Tze-Chun; Tan, Kimberly-Anne; Lim, Joel L; Choong, Denise; Lau, Leok-Lim; Liu, Ka-Po G; Wong, Hee-Kit

2017-10-01

A cross-sectional study of prospectively collected data. To compare lumbar spine alignment in six common postures, and estimate loss in range of motion (ROM) relative to standing. Ideal position for fusion of lumbar spine remains unknown. Although surgical fusion is necessary for deformity correction and symptom relief, the final position in which the vertebrae are immobilized should provide maximum residual function. Data were collected prospectively from 70 patients with low back pain recruited over a year. All subjects had x-rays performed in slump sitting, forward bending, supine, half squatting, standing, and backward bending postures. ROM quantified in terms of sagittal global and segmental Cobb angles was measured from L1 to S1. Loss of ROM relative to standing was calculated for each posture. Analysis of variance and unpaired t tests were used to identify differences in alignment between postures. Slump sitting gives the greatest lumbar flexion followed by forward bending, and supine postures (P < 0.001). Backward bending produces greater lumbar extension than standing (P = 0.035). Half-squatting and standing postures were not significantly different (P = 0.938). For all postures, L4-5 and L5-S1 segments remained in lordosis, with L4-5 having greater ROM than L5-S1. L1-2 turns kyphotic in lying supine, L2-3 at forward bending, and L3-4 at slump sitting in the form of a "kyphosing cascade." Should the entire lumbar spine be fused in standing position from L1-S1, there would likely be a mean loss of 47.6° of lumbar flexion and 5.9° of lumbar extension. The present study demonstrates the extent of flexibility required of the lumbar spine in assuming various postures. It also enables comparison of the differences in degree of motion occurring in the lumbar spine, both across postures and across segments. Significant loss in ROM, particularly flexion, is anticipated with fusion modeled after the lordotic standing lumbar spine. 2.

Zebrin II Is Expressed in Sagittal Stripes in the Cerebellum of Dragon Lizards (Ctenophorus sp.).

PubMed

Wylie, Douglas R; Hoops, Daniel; Aspden, Joel W; Iwaniuk, Andrew N

2016-01-01

Aldolase C, also known as zebrin II (ZII), is a glycolytic enzyme that is expressed in cerebellar Purkinje cells of the vertebrate cerebellum. In both mammals and birds, ZII is expressed heterogeneously, such that there are sagittal stripes of Purkinje cells with high ZII expression (ZII+) alternating with stripes of Purkinje cells with little or no expression (ZII-). In contrast, in snakes and turtles, ZII is not expressed heterogeneously; rather all Purkinje cells are ZII+. Here, we examined the expression of ZII in the cerebellum of lizards to elucidate the evolutionary origins of ZII stripes in Sauropsida. We focused on the central netted dragon (Ctenophorus nuchalis) but also examined cerebellar ZII expression in 5 other dragon species (Ctenophorus spp.). In contrast to what has been observed in snakes and turtles, we found that in these lizards, ZII is heterogeneously expressed. In the posterior part of the cerebellum, on each side of the midline, there were 3 sagittal stripes consisting of Purkinje cells with high ZII expression (ZII+) alternating with 2 sagittal stripes with weaker ZII expression (ZIIw). More anteriorly, most of the Purkinje cells were ZII+, except laterally, where the Purkinje cells did not express ZII (ZII-). Finally, all Purkinje cells in the auricle (flocculus) were ZII-. Overall, the parasagittal heterogeneous expression of ZII in the cerebellum of lizards is similar to that in mammals and birds, and contrasts with the homogenous ZII+ expression seen in snakes and turtles. We suggest that a sagittal heterogeneous expression of ZII represents the ancestral condition in stem reptiles which was lost in snakes and turtles. © 2017 S. Karger AG, Basel.

Feedforward ankle strategy of balance during quiet stance in adults

PubMed Central

Gatev, Plamen; Thomas, Sherry; Kepple, Thomas; Hallett, Mark

1999-01-01

We studied quiet stance investigating strategies for maintaining balance. Normal subjects stood with natural stance and with feet together, with eyes open or closed. Kinematic, kinetic and EMG data were evaluated and cross-correlated.Cross-correlation analysis revealed a high, positive, zero-phased correlation between anteroposterior motions of the centre of gravity (COG) and centre of pressure (COP), head and COG, and between linear motions of the shoulder and knee in both sagittal and frontal planes. There was a moderate, negative, zero-phased correlation between the anteroposterior motion of COP and ankle angular motion.Narrow stance width increased ankle angular motion, hip angular motion, mediolateral sway of the COG, and the correlation between linear motions of the shoulder and knee in the frontal plane. Correlations between COG and COP and linear motions of the shoulder and knee in the sagittal plane were decreased. The correlation between the hip angular sway in the sagittal and frontal planes was dependent on interaction between support and vision.Low, significant positive correlations with time lags of the maximum of cross-correlation of 250-300 ms were found between the EMG activity of the lateral gastrocnemius muscle and anteroposterior motions of the COG and COP during normal stance. Narrow stance width decreased both correlations whereas absence of vision increased the correlation with COP.Ankle mechanisms dominate during normal stance especially in the sagittal plane. Narrow stance width decreased the role of the ankle and increased the role of hip mechanisms in the sagittal plane, while in the frontal plane both increased.The modulation pattern of the lateral gastrocnemius muscle suggests a central program of control of the ankle joint stiffness working to predict the loading pattern. PMID:9882761

Anterior center-edge angle on sagittal CT: a comparison of normal hips to dysplastic hips.

PubMed

Monazzam, Shafagh; Williams, Karly Ann; Shelton, Trevor J; Calafi, Arash; Haus, Brian M

2018-05-01

The anterior center-edge angle (ACEA) describes anterior acetabular coverage on false profile radiographs. Variability associated with pelvic tilt, radiographic projection, and identifying the true anterior edge, causes discrepancies in measuring an accurate ACEA. Computed tomography (CT) has the potential of improving the accuracy of ACEA. However, because the ACEA on sagittal CT has been shown to not be equivalent to ACEA on false profile radiographs, the normal range of ACEA on CT currently remains unknown and cannot reliably be used to determine over/under coverage. We therefore asked: what is the normal variation of ACEA corrected for pelvic tilt on sagittal CT and how does this compare to dysplastic hips? A retrospective review was conducted on patients 10-35 who underwent CT for non-orthopedic related issues and patients with known hip dysplasia. The ACEA was measured on a sagittal slice corresponding to the center of the femoral head on the axial slice and adjusted for pelvic tilt. A statistical comparison was then performed. A total of 320 normal patients and 22 patients with hip dysplasia were reviewed. The mean ACEA for all ages was 50° ± 8°, (range: 23-81º), with a larger mean ACEA for males (51°) than females (49°). The ACEA mean for dysplastic hips was 30° ± 11° with a statistically significant difference in mean from the normal hip group ( p < 0.0001). The ACEA can be reliably measured on sagittal CT and significantly differs from dysplastic hips. ACEA measurements above 66° or below 34° may represent anterior over and under coverage.

Comparison between Awake Endoscopy and Computed Tomography to Define Lingual Tonsil Hypertrophy.

PubMed

Tang, Jessica A; Gorelick, Gleb; Friedman, Michael

2017-11-01

Objectives To analyze correlations between endoscopic lingual tonsil grade (LTG) by the Friedman Lingual Tonsil Hypertrophy grading system and computed tomography (CT) measurements of lingual tonsil thickness (LTT). Study Design Retrospective chart review. Setting Single-center database, September 2016 to April 2017. Subjects and Methods Patients who received CT covering base of tongue and endoscopic LTG were included. LTT was measured on axial and sagittal CT. LTT measurements were compared against endoscopic LTG. One-way analysis of variance with Tukey's post hoc adjustment for multiple comparisons was performed. Results Seventy-five charts were included for a total of 150 LTT measurements. Axial CT measurements of LTG 1 and LTG 2 were each significantly different from LTG 3 ( P < .001 for both), and LTG 1 and LTG 2 also differed significantly ( P = .010). Mean sagittal CT measurements were significantly different between LTG 1 and LTG 3 ( P < .001) and between LTG 2 and LTG 3 ( P = .002) but not between LTG 1 and LTG 2 ( P = .186). Those without lingual tonsil hypertrophy had a mean axial CT thickness of 6.45 ± 1.39 mm and mean sagittal CT thickness of 6.58 ± 1.53 mm, which was significantly different from both the mean axial CT thickness of 8.48 ± 1.52 mm and the mean sagittal CT thickness of 8.07 ± 1.16 mm in the LTG 3 group ( P < .001 for both). Threshold analysis showed a potential cutoff of approximately 7.5 mm on axial and sagittal CT for defining clinically significant lingual tonsil hypertrophy. Conclusion Awake endoscopy grading of lingual tonsil hypertrophy is a subjective measurement that seems to correlate with objective CT measurements. LTT measurements of LTG 1 and LTG 2 on awake endoscopy differed significantly from LTG 3.

Noninvasive Optoelectronic Assessment of Induced Sagittal Imbalance Using the Vicon System.

PubMed

Ould-Slimane, Mourad; Latrobe, Charles; Michelin, Paul; Chastan, Nathalie; Dujardin, Franck; Roussignol, Xavier; Gauthé, Rémi

2017-06-01

Spinal diseases often induce gait disorders with multifactorial origins such as lumbar pain, radicular pain, neurologic complications, or spinal deformities. However, radiography does not permit an analysis of spinal dynamics; therefore, sagittal balance dynamics during gait remain largely unexplored. This prospective and controlled pilot study assessed the Vicon system for detecting sagittal spinopelvic imbalance, to determine the correlations between optoelectronic and radiographic parameters. Reversible anterior sagittal imbalance was induced in 24 healthy men using a thoracolumbar corset. Radiographic, optoelectronic, and comparative analyses were conducted. Corset wearing induced significant variations in radiographic parameters indicative of imbalance; the mean C7-tilt and d/D ratio increased by 15° ± 7.4° and 359%, respectively, whereas the mean spinosacral angle decreased by 16.8° ± 8° (all P < 0.001). The Vicon system detected the imbalance; the mean spinal angle increased by 15.4° ± 5.6° (P < 0.01), the mean floor projection of the C7S1 vector (C7'S1') increased by 126.3 ± 51.9 mm (P < 0.001), and the mean C7-T10-S1 angle decreased by 9.8° ± 3° (P < 0.001). Variations in C7'S1' were significantly correlated with d/D ratio (ρ = 0.58; P < 0.05) and C7-tilt (ρ = 0.636; P < 0.05) variations. Corset wearing induced radiographically confirmed anterior sagittal imbalance detected using the Vicon system. Optoelectronic C7'S1' correlated with radiographic C7-tilt and d/D ratio. Copyright © 2017 Elsevier Inc. All rights reserved.

Three-dimensional reproducibility of natural head position.

PubMed

Weber, Diana W; Fallis, Drew W; Packer, Mark D

2013-05-01

Although natural head position has proven to be reliable in the sagittal plane, with an increasing interest in 3-dimensional craniofacial analysis, a determination of its reproducibility in the coronal and axial planes is essential. This study was designed to evaluate the reproducibility of natural head position over time in the sagittal, coronal, and axial planes of space with 3-dimensional imaging. Three-dimensional photographs were taken of 28 adult volunteers (ages, 18-40 years) in natural head position at 5 times: baseline, 4 hours, 8 hours, 24 hours, and 1 week. Using the true vertical and horizontal laser lines projected in an iCAT cone-beam computed tomography machine (Imaging Sciences International, Hatfield, Pa) for orientation, we recorded references for natural head position on the patient's face with semipermanent markers. By using a 3-dimensional camera system, photographs were taken at each time point to capture the orientation of the reference points. By superimposing each of the 5 photographs on stable anatomic surfaces, changes in the position of the markers were recorded and assessed for parallelism by using 3dMDvultus (3dMD, Atlanta, Ga) and software (Dolphin Imaging & Management Solutions, Chatsworth, Calif). No statistically significant differences were observed between the 5 time points in any of the 3 planes of space. However, a statistically significant difference was observed between the mean angular deviations of 3 reference planes, with a hierarchy of natural head position reproducibility established as coronal > axial > sagittal. Within the parameters of this study, natural head position was found to be reproducible in the sagittal, coronal, and axial planes of space. The coronal plane had the least variation over time, followed by the axial and sagittal planes. Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Differences of Sagittal Lumbosacral Parameters between Patients with Lumbar Spondylolysis and Normal Adults

PubMed Central

Yin, Jin; Peng, Bao-Gan; Li, Yong-Chao; Zhang, Nai-Yang; Yang, Liang; Li, Duan-Ming

2016-01-01

Background: Recent studies have suggested an association between elevated pelvic incidence (PI) and the development of lumbar spondylolysis. However, there is still lack of investigation for Han Chinese people concerning the normal range of spinopelvic parameters and relationship between abnormal sagittal parameters and lumbar diseases. The objective of the study was to investigate sagittal lumbosacral parameters of adult lumbar spondylolysis patients in Han Chinese population. Methods: A total of 52 adult patients with symptomatic lumbar spondylolysis treated in the General Hospital of Armed Police Force (Beijing, China) were identified as the spondylolysis group. All the 52 patients were divided into two subgroups, Subgroup A: 36 patients with simple lumbar spondylolysis, and Subgroup B: 16 patients with lumbar spondylolysis accompanying with mild lumbar spondylolisthesis (slip percentage <30%). Altogether 207 healthy adults were chosen as the control group. All patients and the control group took lumbosacral lateral radiographs. Seven sagittal lumbosacral parameters, including PI, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), L5 incidence, L5 slope, and sacral table angle (STA), were measured in the lateral radiographs. All the parameters aforementioned were compared between the two subgroups and between the spondylolysis group and the control group with independent-sample t-test. Results: There were no statistically significant differences of all seven sagittal lumbosacral parameters between Subgroup A and Subgroup B. PI, PT, SS, and LL were higher (P < 0.05) in the spondylolysis group than those in the control group, but STA was lower (P < 0.001) in the spondylolysis group. Conclusions: Current study results suggest that increased PI and decreased STA may play important roles in the pathology of lumbar spondylolysis in Han Chinese population. PMID:27174324

Differences of Sagittal Lumbosacral Parameters between Patients with Lumbar Spondylolysis and Normal Adults.

PubMed

Yin, Jin; Peng, Bao-Gan; Li, Yong-Chao; Zhang, Nai-Yang; Yang, Liang; Li, Duan-Ming

2016-05-20

Recent studies have suggested an association between elevated pelvic incidence (PI) and the development of lumbar spondylolysis. However, there is still lack of investigation for Han Chinese people concerning the normal range of spinopelvic parameters and relationship between abnormal sagittal parameters and lumbar diseases. The objective of the study was to investigate sagittal lumbosacral parameters of adult lumbar spondylolysis patients in Han Chinese population. A total of 52 adult patients with symptomatic lumbar spondylolysis treated in the General Hospital of Armed Police Force (Beijing, China) were identified as the spondylolysis group. All the 52 patients were divided into two subgroups, Subgroup A: 36 patients with simple lumbar spondylolysis, and Subgroup B: 16 patients with lumbar spondylolysis accompanying with mild lumbar spondylolisthesis (slip percentage <30%). Altogether 207 healthy adults were chosen as the control group. All patients and the control group took lumbosacral lateral radiographs. Seven sagittal lumbosacral parameters, including PI, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), L5 incidence, L5 slope, and sacral table angle (STA), were measured in the lateral radiographs. All the parameters aforementioned were compared between the two subgroups and between the spondylolysis group and the control group with independent-sample t- test. There were no statistically significant differences of all seven sagittal lumbosacral parameters between Subgroup A and Subgroup B. PI, PT, SS, and LL were higher (P < 0.05) in the spondylolysis group than those in the control group, but STA was lower (P < 0.001) in the spondylolysis group. Current study results suggest that increased PI and decreased STA may play important roles in the pathology of lumbar spondylolysis in Han Chinese population.

Occlusal traits and orthodontic treatment need in 7‐ to 10‐year‐olds in Estonia

PubMed Central

Saag, Mare; Svedström‐Oristo, Anna‐Liisa; Peltomäki, Timo; Vinkka‐Puhakka, Heli

2017-01-01

Abstract The aim of this study was to evaluate the distribution of occlusal traits and orthodontic treatment need and complexity in Estonian 7‐ to 10‐year‐old children. This data provides solid information for planning of orthodontic care. Data of 392 Estonian children (198 girls and 194 boys, mean age 9.0 years, range 7.1–10.4 years) was analysed in this cross‐sectional study. Assessed traits included first molar and canine sagittal relationship, overjet, overbite, crowding, midline diastema, crossbite, and scissor bite. Orthodontic treatment need and complexity were assessed using the Index of Complexity, Outcome, and Need. Parents' opinion regarding their child's teeth was determined using a questionnaire. The most prevalent occlusal traits were canine class I sagittal relationship (73.7%), midline diastema (73.0%), molar class I sagittal relationship (57.4%), and overbite ≥3.5 mm (51.8%). According to the Index of Complexity, Outcome, and Need, 64.3% of Estonian elementary school children were in need of orthodontic treatment. Treatment complexity was simple in 12.5%, mild in 38.8%, moderate in 22.7%, difficult in 14.0%, and very difficult in 12.0% of the children. Approximately 66.4% of the parents felt that their child needed orthodontic treatment. This study confirms earlier findings indicating that the most frequent sagittal relationship is class I in the first molars and class I in the canines. However, the sagittal relationship was asymmetric in more than half of the children. Correlation between objectively defined treatment need and parents' desire for treatment was high in Estonia. PMID:29744185

Comparing Outcomes and Cost of 3 Surgical Treatments for Sagittal Synostosis: A Retrospective Study Including Procedure-Related Cost Analysis.

PubMed

Garber, Sarah T; Karsy, Michael; Kestle, John R W; Siddiqi, Faizi; Spanos, Stephen P; Riva-Cambrin, Jay

2017-10-01

Neurosurgical techniques for repair of sagittal synostosis include total cranial vault (TCV) reconstruction, open sagittal strip (OSS) craniectomy, and endoscopic strip (ES) craniectomy. To evaluate outcomes and cost associated with these 3 techniques. Via retrospective chart review with waiver of informed consent, the last consecutive 100 patients with sagittal synostosis who underwent each of the 3 surgical correction techniques before June 30, 2013, were identified. Clinical, operative, and process of care variables and their associated specific charges were analyzed along with overall charge. The study included 300 total patients. ES patients had fewer transfusion requirements (13% vs 83%, P < .001) than TCV patients, fewer days in intensive care (0.3 vs 1.3, P < .001), and a shorter overall hospital stay (1.8 vs 4.2 d, P < .001), and they required fewer revisions (1% vs 6%, P = .05). The mean charge for the endoscopic procedure was $21 203, whereas the mean charge for the TCV reconstruction was $45 078 (P < .001). ES patients had more preoperative computed tomography scans (66% vs 44%, P = .003) than OSS patients, shorter operative times (68 vs 111 min, P < .001), and required fewer revision procedures (1% vs 8%, P < .001). The mean charge for the endoscopic procedure was $21 203 vs $20 535 for the OSS procedure (P = .62). The ES craniectomy for sagittal synostosis appeared to have less morbidity and a potential cost savings compared with the TCV reconstruction. The charges were similar to those incurred with OSS craniectomy, but patients had a shorter length of stay and fewer revisions. Copyright © 2017 by the Congress of Neurological Surgeons

5D CNS+ Software for Automatically Imaging Axial, Sagittal, and Coronal Planes of Normal and Abnormal Second-Trimester Fetal Brains.

PubMed

Rizzo, Giuseppe; Capponi, Alessandra; Persico, Nicola; Ghi, Tullio; Nazzaro, Giovanni; Boito, Simona; Pietrolucci, Maria Elena; Arduini, Domenico

2016-10-01

The purpose of this study was to test new 5D CNS+ software (Samsung Medison Co, Ltd, Seoul, Korea), which is designed to image axial, sagittal, and coronal planes of the fetal brain from volumes obtained by 3-dimensional sonography. The study consisted of 2 different steps. First in a prospective study, 3-dimensional fetal brain volumes were acquired in 183 normal consecutive singleton pregnancies undergoing routine sonographic examinations at 18 to 24 weeks' gestation. The 5D CNS+ software was applied, and the percentage of adequate visualization of brain diagnostic planes was evaluated by 2 independent observers. In the second step, the software was also tested in 22 fetuses with cerebral anomalies. In 180 of 183 fetuses (98.4%), 5D CNS+ successfully reconstructed all of the diagnostic planes. Using the software on healthy fetuses, the observers acknowledged the presence of diagnostic images with visualization rates ranging from 97.7% to 99.4% for axial planes, 94.4% to 97.7% for sagittal planes, and 92.2% to 97.2% for coronal planes. The Cohen κ coefficient was analyzed to evaluate the agreement rates between the observers and resulted in values of 0.96 or greater for axial planes, 0.90 or greater for sagittal planes, and 0.89 or greater for coronal planes. All 22 fetuses with brain anomalies were identified among a series that also included healthy fetuses, and in 21 of the 22 cases, a correct diagnosis was made. 5D CNS+ was efficient in successfully imaging standard axial, sagittal, and coronal planes of the fetal brain. This approach may simplify the examination of the fetal central nervous system and reduce operator dependency.

Is Postoperative Intensive Care Unit Care Necessary following Cranial Vault Remodeling for Sagittal Synostosis?

PubMed

Wolfswinkel, Erik M; Howell, Lori K; Fahradyan, Artur; Azadgoli, Beina; McComb, J Gordon; Urata, Mark M

2017-12-01

Of U.S. craniofacial and neurosurgeons, 94 percent routinely admit patients to the intensive care unit following cranial vault remodeling for correction of sagittal synostosis. This study aims to examine the outcomes and cost of direct ward admission following primary cranial vault remodeling for sagittal synostosis. An institutional review board-approved retrospective review was undertaken of the records of all patients who underwent primary cranial vault remodeling for isolated sagittal craniosynostosis from 2009 to 2015 at a single pediatric hospital. Patient demographics, perioperative course, and outcomes were recorded. One hundred ten patients met inclusion criteria with absence of other major medical problems. Average age at operation was 6.7 months, with a mean follow-up of 19.8 months. Ninety-eight patients (89 percent) were admitted to a general ward for postoperative care, whereas the remaining 12 (11 percent) were admitted to the intensive care unit for preoperative or perioperative concerns. Among ward-admitted patients, there were four (3.6 percent) minor complications; however, there were no major adverse events, with none necessitating intensive care unit transfers from the ward and no mortalities. Average hospital stay was 3.7 days. The institution's financial difference in cost of intensive care unit stay versus ward bed was $5520 on average per bed per day. Omitting just one intensive care unit postoperative day stay for this patient cohort would reduce projected health care costs by a total of $540,960 for the study period. Despite the common practice of postoperative admission to the intensive care unit following cranial vault remodeling for sagittal craniosynostosis, the authors suggest that postoperative care be considered on an individual basis, with only a small percentage requiring a higher level of care. Therapeutic, III.

[Osteosynthesis in the Surgical Treatment of Prognathism: State of The Art].

PubMed

Durão, Nuno; Amarante, José

2017-03-31

Prognathism is a common skeletal facial abnormality, associated with class III malocclusion, often with repercussions in quality of life. In addition to orthodontic treatment, sagittal split ramus osteotomy is the most common technique for its correction, and segment osteosynthesis is an important element of the post-surgical outcome. A search for relevant literature was conducted in the PubMed/MEDLINE database and in other relevant sources. The stability of different fixation methods, their repercussions on inferior alveolar nerve lesions, and the type of material are among the most researched subjects. Recent research about the type of osteosynthesis applied in the sagittal split ramus osteotomy for mandibular setback is discussed. Miniplates appear to be the better option for fixation of sagittal split osteotomy for mandibular setback. Bioabsorbable osteosynthesis may be an acceptable alternative to titanium.

3-D scapular kinematics during arm elevation: effect of motion velocity.

PubMed

Fayad, F; Hoffmann, G; Hanneton, S; Yazbeck, C; Lefevre-Colau, M M; Poiraudeau, S; Revel, M; Roby-Brami, A

2006-11-01

No three-dimensional (3-D) data exist on the influence of motion velocity on scapular kinematics. The effect of arm elevation velocity has been studied only in a two-dimensional setting. Thirty healthy subjects performed dominant (right) arm elevation in two planes, sagittal and frontal, and at slow and fast self-selected arm speed. Scapular orientation and humeral elevation were measured at 30 Hz recording frequency with use of a 6-degree-of-freedom electromagnetic system (Polhemus Fastraka). Motion was computed according to the International Society of Biomechanics standards. Scapular orientation was also determined with the arm held in different static positions. We obtained a full 3-D kinematic description of scapula achieving a reliable, complex 3-D motion during humeral elevation and lowering. The maximal sagittal arm elevation showed a characteristic "M"-shape pattern of protraction/retraction curve. Scapular rotations did not differ significantly between slow and fast movements. Moreover, protraction/retraction and tilt angular values did not differ significantly between static and dynamic tasks. However, scapular lateral rotation values differed between static and dynamic measurements during sagittal and frontal arm elevation. Lateral scapular rotation appears to be less in static than in dynamic measurement, particularly in the sagittal plane. Interpolation of statically recorded positions of the bones cannot reflect the kinematics of the scapula.

Comparison between anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion for the treatment of cervical spondylotic myelopathy: a meta-analysis

PubMed Central

Fei, Qi; Li, Jinjun; Su, Nan; Wang, Bingqiang; Li, Dong; Meng, Hai; Wang, Qi; Lin, Jisheng; Ma, Zhao; Yang, Yong

2015-01-01

Background Whether anterior cervical discectomy with fusion (ACDF) or anterior cervical corpectomy with fusion (ACCF) is superior in the treatment of cervical spondylotic myelopathy remains controversial. Therefore, we conducted a meta-analysis to quantitatively compare the efficacy and safety of ACDF and ACCF in the treatment of cervical spondylotic myelopathy. Methods PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, People’s Republic of China), and CNKI (China National Knowledge Infrastructure, People’s Republic of China) were systematically searched to identify all available studies comparing efficacy and safety between patients receiving ACDF and ACCF. The weighted mean difference (WMD) was pooled to compare the Japanese Orthopaedic Association scores, visual analog scale scores, hospital stay, operation time, and blood loss. The risk ratio was pooled to compare the incidence of complications and fusion rate. Pooled estimates were calculated by using a fixed-effects model or a random-effects model according to the heterogeneity among studies. Results Eighteen studies (17 observational studies and one randomized controlled trial) were included in this meta-analysis. Our results suggest that hospital stay (WMD =−1.33, 95% confidence interval [CI]: −2.29, −0.27; P=0.014), operation time (WMD =−26.9, 95% CI: −46.13, −7.67; P=0.006), blood loss (WMD =−119.36, 95% CI: −166.94, −71.77; P=0.000), and incidence of complications (risk ratio =0.51, 95% CI: 0.33, 0.80; P=0.003) in the ACDF group were significantly less than that in the ACCF group. However, other clinical outcomes, including post-Japanese Orthopaedic Association score (WMD =−0.27, 95% CI: −0.57, 0.03; P=0.075), visual analog scale score (WMD =0.03, 95% CI: −1.44, 1.50; P=0.970), and fusion rate (risk ratio =1.04, 95% CI: 0.99, 1.09; P=0.158), between the two groups were not significantly different. Conclusion Evidence from the meta-analysis of 18 studies demonstrated that surgical options of cervical spondylotic myelopathy using ACDF or ACCF seemed to have similar clinical outcomes. However, ACDF was found to be superior to ACCF in terms of hospital stay, operation time, blood loss, and incidence of complications. PMID:26604771

Functional data analysis on ground reaction force of military load carriage increment

NASA Astrophysics Data System (ADS)

Din, Wan Rozita Wan; Rambely, Azmin Sham

2014-06-01

Analysis of ground reaction force on military load carriage is done through functional data analysis (FDA) statistical technique. The main objective of the research is to investigate the effect of 10% load increment and to find the maximum suitable load for the Malaysian military. Ten military soldiers age 31 ± 6.2 years, weigh 71.6 ± 10.4 kg and height of 166.3 ± 5.9 cm carrying different military load range from 0% body weight (BW) up to 40% BW participated in an experiment to gather the GRF and kinematic data using Vicon Motion Analysis System, Kirstler force plates and thirty nine body markers. The analysis is conducted in sagittal, medial lateral and anterior posterior planes. The results show that 10% BW load increment has an effect when heel strike and toe-off for all the three planes analyzed with P-value less than 0.001 at 0.05 significant levels. FDA proves to be one of the best statistical techniques in analyzing the functional data. It has the ability to handle filtering, smoothing and curve aligning according to curve features and points of interest.

Extreme skeletal open bite correction with vertical elastics.

PubMed

Cruz-Escalante, Marco Antonio; Aliaga-Del Castillo, Aron; Soldevilla, Luciano; Janson, Guilherme; Yatabe, Marilia; Zuazola, Ricardo Voss

2017-11-01

Severe skeletal open bites may be ideally treated with a combined surgical-orthodontic approach. Alternatively, compensations may be planned to camouflage the malocclusion with orthodontics alone. This case report describes the treatment of an 18-year-old man who presented with a severe open bite involving the anterior and posterior teeth up to the first molars, increased vertical dimension, bilateral Class III molar relationship, bilateral posterior crossbite, dental midline deviation, and absence of the maxillary right canine and the mandibular left first premolar. A treatment plan including the extraction of the mandibular right first premolar and based on uprighting and vertical control of the posterior teeth, combined with extrusion of the anterior teeth using multiloop edgewise archwire mechanics and elastics was chosen. After 6 months of alignment and 2 months of multiloop edgewise archwire mechanics, the open bite was significantly reduced. After 24 months of treatment, anterior teeth extrusion, posterior teeth intrusion, and counterclockwise mandibular rotation were accomplished. Satisfactory improvement of the overbite, overjet, sagittal malocclusion, and facial appearance were achieved. The mechanics used in this clinical case demonstrated good and stable results for open-bite correction at the 2-year posttreatment follow-up.

A modified, lingually supported cantilevered Herbst appliance.

PubMed

Snodgrass, D

1996-01-01

This new, fixed-functional appliance/Herbst/Bioprogressive system is designed for patient comfort and mandatory compliance. It also combines the positive clinical effects of four fixed-functional systems. It allows rapid palatal expansion of the upper arch, alveolar uprighting of the lower arch, upper and lower incisor alignment, and sagittal correction of Class II malocclusions to occur simultaneously with one appliance fixed in both arches. It is indicated for use in growing patients with skeletal Class II malocclusions. The ideal timing for treatment is the late mixed dentition. Being able to remove the appliance after one year with the upper second bicuspids erupting slightly Class III so the clinician can immediately begin fixed finishing mechanics would be ideal. This new Herbst design will reduce the frequency of orthognathic surgery and upper bicuspid extraction to camouflage Class II malocclusions. At the same time, it gives total control to the clinician in treating some more difficult, non-compliant patients. Fixed-functional appliances, which improve treatment efficiency and treatment results and provide for patient comfort, while at the same time give the treating clinician almost total control of the three planes of facial growth will open new doors for orthodontic treatment and research in the next century.

Varus deformity of the left lower extremity causing degenerative lesion of the posterior horn of the left medial meniscus in a patient with Paget's disease of bone.

PubMed

Al Kaissi, Ali; Ganger, Rudolf; Mindler, Gabriel; Klaushofer, Klaus; Grill, Franz

2014-01-01

We report on a 42-year-old woman who presented with persistent pain in her left knee with no history of trauma. Sagittal T1-weighted MRI of the left knee showed discontinuity between the anterior and posterior horns of the left medial meniscus, causing effectively the development of degenerative lesion of the posterior horn. The latter was correlated to varus deformity of the left lower extremity associated with subsequent narrowing of the medial knee joint. The unusual craniofacial contour of the patient, the skeletal survey and the elevated serum alkaline phosphatase were compatible with the diagnosis of Paget's disease of the bone. To alleviate the adverse effect of the mal-alignment of the left femur onto the left knee, corrective osteotomy of the left femoral diaphysis by means of fixators was performed. To the best of our knowledge this is the first clinical report describing the management and the pathological correlation of a unilateral varus deformity of the femoral shaft and degenerative lesions of the left knee in a patient with Paget's disease of the bone.

The influence of foot position on scrum kinetics during machine scrummaging.

PubMed

Bayne, Helen; Kat, Cor-Jacques

2018-05-23

The purpose of this study was to investigate the effect of variations in the alignment of the feet on scrum kinetics during machine scrummaging. Twenty nine rugby forwards from amateur-level teams completed maximal scrum efforts against an instrumented scrum machine, with the feet in parallel and non-parallel positions. Three-dimensional forces, the moment about the vertical axis and sagittal plane joint angles were measured during the sustained pushing phase. There was a decrease in the magnitude of the resultant force and compression force in both of the non-parallel conditions compared to parallel and larger compression forces were associated with more extended hip and knee angles. Scrummaging with the left foot forward resulted in the lateral force being directed more towards the left and the turning moment becoming more clockwise. These directional changes were reversed when scrummaging with the right foot forward. Scrummaging with the right foot positioned ahead of the left may serve to counteract the natural clockwise wheel of the live scrum and could be used to achieve an anti-clockwise rotation of the scrum for tactical reasons. However, this would be associated with lower resultant forces and a greater lateral shear force component directed towards the right.

Standardising the clinical assessment of coronal knee laxity.

PubMed

Clarke, Jon V; Wilson, William T; Wearing, Scott C; Picard, Frederic; Riches, Philip E; Deakin, Angela H

2012-09-01

Clinical laxity tests are used for assessing knee ligament injuries and for soft tissue balancing in total knee arthroplasty. This study reports the development and validation of a quantitative technique of assessing collateral knee laxity through accurate measurement of potential variables during routine clinical examination. The hypothesis was that standardisation of a clinical stress test would result in a repeatable range of laxity measurements. Non-invasive infrared tracking technology with kinematic registration of joint centres gave real-time measurement of both coronal and sagittal mechanical tibiofemoral alignment Knee flexion, moment arm and magnitude of the applied force were all measured and standardised. Three clinicians then performed six knee laxity examinations on a single volunteer using a target moment of 18 Nm. Standardised laxity measurements had small standard deviations (within 1. 1 degree) for each clinician and similar mean values between clinicians, with the valgus laxity assessment (mean of 3 degrees) being slightly more consistent than varus (means of 4 degrees or 5 degrees). The manual technique of coronal knee laxity assessment was successfully quantified and standardised, leading to a narrow range of measurements (within the accuracy of the measurement system). Minimising the subjective variables of clinical examination could improve current knowledge of soft tissue knee behaviour.

Varus deformity of the left lower extremity causing degenerative lesion of the posterior horn of the left medial meniscus in a patient with Paget’s disease of bone

PubMed Central

Al Kaissi, Ali; Ganger, Rudolf; Mindler, Gabriel; Klaushofer, Klaus; Grill, Franz

2014-01-01

We report on a 42-year-old woman who presented with persistent pain in her left knee with no history of trauma. Sagittal T1-weighted MRI of the left knee showed discontinuity between the anterior and posterior horns of the left medial meniscus, causing effectively the development of degenerative lesion of the posterior horn. The latter was correlated to varus deformity of the left lower extremity associated with subsequent narrowing of the medial knee joint. The unusual craniofacial contour of the patient, the skeletal survey and the elevated serum alkaline phosphatase were compatible with the diagnosis of Paget’s disease of the bone. To alleviate the adverse effect of the mal-alignment of the left femur onto the left knee, corrective osteotomy of the left femoral diaphysis by means of fixators was performed. To the best of our knowledge this is the first clinical report describing the management and the pathological correlation of a unilateral varus deformity of the femoral shaft and degenerative lesions of the left knee in a patient with Paget’s disease of the bone. PMID:25276115

[Significance of the sagittal profile and reposition of grade III-V spondylolisthesis].

PubMed

Dick, W; Elke, R

1997-09-01

The deformity in severe spondylolisthesis consists of two components: the parallel anterocaudad slip of the spondylolisthetic vertebra, and its tilt into kyphotic malposition. The influence of the two components is very different: the anterocaudad slippage has not much impact on the sagittal profile of the spine and is easily compensated for by a slight increase in lumbar lordosis. The kyphotic deformity has a high impact on trunk imbalance and the sagittal profile. There are two compensation mechanisms: hyperlordosis of the lumbar spine to its anatomical extremes and-if that is not sufficient-verticalisation of the sacral bone, performed by contracture of the hamstrings and uprighting of the pelvis around the hip joints. The latter mechanism is followed by functional disadvantages. Therefore, correction of the kyphosis of L5 may be considered during operative treatment if the lumbosacral kyphosis (angle delta) is less than 85 degrees and the sacral inclination less than 35 degrees.

Dorsal free graft urethroplasty for urethral stricture by ventral sagittal urethrotomy approach.

PubMed

Asopa, H S; Garg, M; Singhal, G G; Singh, L; Asopa, J; Nischal, A

2001-11-01

To explore the feasibility of applying a dorsal free graft to treat urethral stricture by the ventral sagittal urethrotomy approach without mobilizing the urethra. Twelve patients with long or multiple strictures of the anterior urethra were treated by a dorsal free full-thickness preputial or buccal mucosa graft. The urethra was not separated from the corporal bodies and was opened in the midline over the stricture. The floor of the urethra was incised, and an elliptical raw area was created over the tunica on which a free full-thickness graft of preputial or buccal mucosa was secured. The urethra was retubularized in one stage. After a follow-up of 8 to 40 months, one recurrence developed and required dilation. The ventral sagittal urethrotomy approach for dorsal free graft urethroplasty is not only feasible and successful, but is easy to perform.

Analysis of Spinopelvic Parameters with L5 as the New Sacrum after Fusion in High-Grade Spondylolisthesis: A Possible Explanation for Satisfactory Results with In-Situ Fusion

PubMed Central

Das, Gurudip; Aiyer, Siddharth Narasimhan; Kanna, Rishi Mugesh; Shetty, Ajoy Prasad

2018-01-01

Study Design Retrospective case series. Purpose To correlate functional outcomes with spinopelvic parameters in patients with high-grade spondylolisthesis (HGS) treated with instrumented in-situ surgery or reduction and fusion. Overview of Literature Satisfactory functional outcomes are reported with reduction and in-situ fusion strategies in HGS. However, reasons for this are unclear. We hypothesize that following lumbosacral fusion, the L5 becomes part of the sacrum, which improves spinopelvic parameters, resulting in equivalent functional outcomes in both surgical methods. Methods Twenty-six patients undergoing HGS (reduction group A, 13; in-situ group B, 13) were clinically evaluated using the Oswestry Disability Index (ODI), short form-12 (SF-12), and Visual Analogue Scale (VAS) scores. Spinopelvic parameters, including pelvic incidence, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), lumbosacral kyphosis (LSK) angle, and sacrofemoral distance (SFD) were measured preoperatively from S1 and postoperatively from L5 as the new sacrum at 1 year follow-up. Sagittal alignment was assessed using the sagittal vertical axis. Results Both groups were comparable in terms of age, sex, severity of slip, and preoperative spinopelvic parameters (p>0.05). Postoperative VAS, SF-12, and ODI scores significantly improved in both groups (p<0.05). Compared with preoperative values, the mean postoperative PT, SFD, and LSK significantly changed in both groups. In reduction group, PT changed from 26.98° to 10.78°, SFD from 61.24 to 33.56 mm, and LSK from 74.76° to 109.61° (p<0.05). In in-situ fusion group PT changed from 26.78° to 11.08°, SFD from 62.9 to 36.99 mm, and LSK from 67.23° to 113.38° (p<0.05 for all). In both groups, SS and LL did not change significantly (p>0.05). Conclusions After fusion, the L5 becomes the new sacrum and influences spinopelvic parameters to change favorably. This possibly explains why reduction and in-situ fusion achieve equivalent functional outcomes in HGS. PMID:29503689

Analysis of Spinopelvic Parameters with L5 as the New Sacrum after Fusion in High-Grade Spondylolisthesis: A Possible Explanation for Satisfactory Results with In-Situ Fusion.

PubMed

Rajasekaran, Shanmuganathan; Das, Gurudip; Aiyer, Siddharth Narasimhan; Kanna, Rishi Mugesh; Shetty, Ajoy Prasad

2018-02-01

Retrospective case series. To correlate functional outcomes with spinopelvic parameters in patients with high-grade spondylolisthesis (HGS) treated with instrumented in-situ surgery or reduction and fusion. Satisfactory functional outcomes are reported with reduction and in-situ fusion strategies in HGS. However, reasons for this are unclear. We hypothesize that following lumbosacral fusion, the L5 becomes part of the sacrum, which improves spinopelvic parameters, resulting in equivalent functional outcomes in both surgical methods. Twenty-six patients undergoing HGS (reduction group A, 13; in-situ group B, 13) were clinically evaluated using the Oswestry Disability Index (ODI), short form-12 (SF-12), and Visual Analogue Scale (VAS) scores. Spinopelvic parameters, including pelvic incidence, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), lumbosacral kyphosis (LSK) angle, and sacrofemoral distance (SFD) were measured preoperatively from S1 and postoperatively from L5 as the new sacrum at 1 year follow-up. Sagittal alignment was assessed using the sagittal vertical axis. Both groups were comparable in terms of age, sex, severity of slip, and preoperative spinopelvic parameters ( p >0.05). Postoperative VAS, SF-12, and ODI scores significantly improved in both groups ( p <0.05). Compared with preoperative values, the mean postoperative PT, SFD, and LSK significantly changed in both groups. In reduction group, PT changed from 26.98° to 10.78°, SFD from 61.24 to 33.56 mm, and LSK from 74.76° to 109.61° ( p <0.05). In in-situ fusion group PT changed from 26.78° to 11.08°, SFD from 62.9 to 36.99 mm, and LSK from 67.23° to 113.38° ( p <0.05 for all). In both groups, SS and LL did not change significantly ( p >0.05). After fusion, the L5 becomes the new sacrum and influences spinopelvic parameters to change favorably. This possibly explains why reduction and in-situ fusion achieve equivalent functional outcomes in HGS.

Joint Angular Velocity in Spastic Gait and the Influence of Muscle-Tendon Lengthening*

PubMed Central

GRANATA, KEVIN P.; ABEL, MARK F.; DAMIANO, DIANE L.

2006-01-01

Background Joint angular velocity (the rate of flexion and extension of a joint) is related to the dynamics of muscle activation and force generation during walking. Therefore, the goal of this research was to examine the joint angular velocity in normal and spastic gait and changes resulting from muscle-tendon lengthening (recession and tenotomy) in patients who have spastic cerebral palsy. Methods The gait patterns of forty patients who had been diagnosed with spastic cerebral palsy (mean age, 8.3 years; range, 3.7 to 14.8 years) and of seventy-three age-matched, normally developing subjects were evaluated with three-dimensional motion analysis and electromyography. The patients who had cerebral palsy were evaluated before muscle-tendon lengthening and nine months after treatment. Results The gait patterns of the patients who had cerebral palsy were characterized by increased flexion of the knee in the stance phase, premature plantar flexion of the ankle, and reduced joint angular velocities compared with the patterns of the normally developing subjects. Even though muscle-tendon lengthening altered sagittal joint angles in gait, the joint angular velocities were generally unchanged at the hip and knee. Only the ankle demonstrated modified angular velocities, including reduced dorsiflexion velocity at foot-strike and improved dorsiflexion velocity through midstance, after treatment. Electromyographic changes included reduced amplitude of the gastrocnemius-soleus during the loading phase and decreased knee coactivity (the ratio of quadriceps and hamstring activation) at toe-off. Principal component analyses showed that, compared with joint-angle data, joint angular velocity was better able to discriminate between the gait patterns of the normal and cerebral palsy groups. Conclusions This study showed that muscle-tendon lengthening corrects biomechanical alignment as reflected by changes in sagittal joint angles. However, joint angular velocity and electromyographic data suggest that the underlying neural input remains largely unchanged at the hip and knee. Conversely, electromyographic changes and changes in velocity in the ankle indicate that the activation pattern of the gastrocnemius-soleus complex in response to stretch was altered by recession of the complex. PMID:10682726

Selection of Fusion Levels Using the Fulcrum Bending Radiograph for the Management of Adolescent Idiopathic Scoliosis Patients with Alternate Level Pedicle Screw Strategy: Clinical Decision-making and Outcomes.

PubMed

Samartzis, Dino; Leung, Yee; Shigematsu, Hideki; Natarajan, Deepa; Stokes, Oliver; Mak, Kin-Cheung; Yao, Guanfeng; Luk, Keith D K; Cheung, Kenneth M C

2015-01-01

Selecting fusion levels based on the Luk et al criteria for operative management of thoracic adolescent idiopathic scoliosis (AIS) with hook and hybrid systems yields acceptable curve correction and balance parameters; however, it is unknown whether utilizing a purely pedicle screw strategy is effective. Utilizing the fulcrum bending radiographic (FBR) to assess curve flexibility to select fusion levels, the following study assessed the efficacy of pedicle screw fixation with alternate level screw strategy (ALSS) for thoracic AIS. A retrospective study with prospective radiographic data collection/analyses (preoperative, postoperative 1-week and minimum 2-year follow-up) of 28 operative thoracic AIS patients undergoing ALSS was performed. Standing coronal/sagittal and FBR Cobb angles, FBR flexibility, fulcrum bending correction index (FBCI), trunkal shift, radiographic shoulder height (RSH), and list were assessed on x-rays. Fusion level selection was based on the Luk et al criteria and compared to conventional techniques. In the primary curve, the mean preoperative and postoperative 1 week and last follow-up standing coronal Cobb angles were 59.9, 17.2 and 20.0 degrees, respectively. Eighteen patients (64.3%) had distal levels saved (mean: 1.6 levels) in comparison to conventional techniques. Mean immediate and last follow-up FBCIs were 122.6% and 115.0%, respectively. Sagittal alignment did not statistically differ between any assessment intervals (p>0.05). A decrease in trunkal shift was noted from preoperative to last follow-up (p = 0.003). No statistically significant difference from preoperative to last follow-up was noted in RSH and list (p>0.05). No "add-on" of other vertebra or decompensation was noted and all patients achieved fusion. This is the first report to note that using the FBR for decision-making in selecting fusion levels in thoracic AIS patients undergoing management with pedicle screw constructs (e.g. ALSS) is a cost-effective strategy that can achieve clinically-relevant deformity correction that is maintained and without compromising fusion levels.

Quantitative evaluation of the lumbosacral sagittal alignment in degenerative lumbar spinal stenosis

PubMed Central

Makirov, Serik K.; Jahaf, Mohammed T.; Nikulina, Anastasia A.

2015-01-01

Goal of the study This study intends to develop a method of quantitative sagittal balance parameters assessment, based on a geometrical model of lumbar spine and sacrum. Methods One hundred eight patients were divided into 2 groups. In the experimental group have been included 59 patients with lumbar spinal stenosis on L1-5 level. Forty-nine healthy volunteers without history of any lumbar spine pathlogy were included in the control group. All patients have been examined with supine MRI. Lumbar lordosis has been adopted as circular arc and described either anatomical (lumbar lordosis angle), or geometrical (chord length, circle segment height, the central angle, circle radius) parameters. Moreover, 2 sacral parameters have been assessed for all patients: sacral slope and sacral deviation angle. Both parameters characterize sacrum disposition in horizontal and vertical axis respectively. Results Significant correlation was observed between anatomical and geometrical lumbo-sacral parameters. Significant differences between stenosis group and control group were observed in the value of the “central angle” and “sacral deviation” parameters. We propose additional parameters: lumbar coefficient, as ratio of the lordosis angle to the segmental angle (Kl); sacral coefficient, as ratio of the sacral tilt (ST) to the sacral deviation (SD) angle (Ks); and assessment modulus of the mathematical difference between sacral and lumbar coefficients has been used for determining lumbosacral balance (LSB). Statistically significant differences between main and control group have been obtained for all described coefficients (p = 0.006, p = 0.0001, p = 0.0001, accordingly). Median of LSB value of was 0.18 and 0.34 for stenosis and control groups, accordingly. Conclusion Based on these results we believe that that spinal stenosis is associated with an acquired deformity that is measureable by the described parameters. It's possible that spinal stenosis occurs in patients with an LSB of 0.2 or less, so this value can be predictable for its development. It may suggest that spinal stenosis is more likely to occur in patients with the spinal curvature of this type because of abnormal distribution of the spine loads. This fact may have prognostic significance for develop vertebral column disease and evaluation of treatment results. PMID:26767160

Lower extremity energy absorption and biomechanics during landing, part II: frontal-plane energy analyses and interplanar relationships.

PubMed

Norcross, Marc F; Lewek, Michael D; Padua, Darin A; Shultz, Sandra J; Weinhold, Paul S; Blackburn, J Troy

2013-01-01

Greater sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing is consistent with sagittal-plane biomechanics that likely increase anterior cruciate ligament (ACL) loading, but it does not appear to influence frontal-plane biomechanics. We do not know whether frontal-plane INI EA is related to high-risk frontal-plane biomechanics. To compare biomechanics among INI EA groups, determine if women are represented more in the high group, and evaluate interplanar INI EA relationships. Descriptive laboratory study. Research laboratory. Participants included 82 (41 men, 41 women; age = 21.0 ± 2.4 years, height = 1.74 ± 0.10 m, mass = 70.3 ± 16.1 kg) healthy, physically active volunteers. We assessed landing biomechanics with an electromagnetic motion-capture system and force plate. We calculated frontal- and sagittal-plane total, hip, knee, and ankle INI EA. Total frontal-plane INI EA was used to create high, moderate, and low tertiles. Frontal-plane knee and hip kinematics, peak vertical and posterior ground reaction forces, and peak internal knee-varus moment (pKVM) were identified and compared across groups using 1-way analyses of variance. We used a χ (2) analysis to evaluate male and female allocation to INI EA groups. We used simple, bivariate Pearson product moment correlations to assess interplanar INI EA relationships. The high-INI EA group exhibited greater knee valgus at ground contact, hip adduction at pKVM, and peak hip adduction than the low-INI EA group (P < .05) and greater peak knee valgus, pKVM, and knee valgus at pKVM than the moderate- (P < .05) and low- (P < .05) INI EA groups. Women were more likely than men to be in the high-INI EA group (χ(2) = 4.909, P = .03). Sagittal-plane knee and frontal-plane hip INI EA (r = 0.301, P = .006) and sagittal-plane and frontal-plane ankle INI EA were associated (r = 0.224, P = .04). No other interplanar INI EA relationships were found (P > .05). Greater frontal-plane INI EA was associated with less favorable frontal-plane biomechanics that likely result in greater ACL loading. Women were more likely than men to use greater frontal-plane INI EA. The magnitudes of sagittal- and frontal-plane INI EA were largely independent.

The addition of a sagittal image fusion improves the prostate cancer detection in a sensor-based MRI /ultrasound fusion guided targeted biopsy.

PubMed

Günzel, Karsten; Cash, Hannes; Buckendahl, John; Königbauer, Maximilian; Asbach, Patrick; Haas, Matthias; Neymeyer, Jörg; Hinz, Stefan; Miller, Kurt; Kempkensteffen, Carsten

2017-01-13

To explore the diagnostic benefit of an additional image fusion of the sagittal plane in addition to the standard axial image fusion, using a sensor-based MRI/US fusion platform. During July 2013 and September 2015, 251 patients with at least one suspicious lesion on mpMRI (rated by PI-RADS) were included into the analysis. All patients underwent MRI/US targeted biopsy (TB) in combination with a 10 core systematic prostate biopsy (SB). All biopsies were performed on a sensor-based fusion system. Group A included 162 men who received TB by an axial MRI/US image fusion. Group B comprised 89 men in whom the TB was performed with an additional sagittal image fusion. The median age in group A was 67 years (IQR 61-72) and in group B 68 years (IQR 60-71). The median PSA level in group A was 8.10 ng/ml (IQR 6.05-14) and in group B 8.59 ng/ml (IQR 5.65-12.32). In group A the proportion of patients with a suspicious digital rectal examination (DRE) (14 vs. 29%, p = 0.007) and the proportion of primary biopsies (33 vs 46%, p = 0.046) were significantly lower. The rate of PI-RADS 3 lesions were overrepresented in group A compared to group B (19 vs. 9%; p = 0.044). Classified according to PI-RADS 3, 4 and 5, the detection rates of TB were 42, 48, 75% in group A and 25, 74, 90% in group B. The rate of PCa with a Gleason score ≥7 missed by TB was 33% (18 cases) in group A and 9% (5 cases) in group B; p-value 0.072. An explorative multivariate binary logistic regression analysis revealed that PI-RADS, a suspicious DRE and performing an additional sagittal image fusion were significant predictors for PCa detection in TB. 9 PCa were only detected by TB with sagittal fusion (sTB) and sTB identified 10 additional clinically significant PCa (Gleason ≥7). Performing an additional sagittal image fusion besides the standard axial fusion appears to improve the accuracy of the sensor-based MRI/US fusion platform.

Exploiting Inherent Robustness and Natural Dynamics in the Control of Bipedal Walking Robots

DTIC Science & Technology

2000-06-01

physical models of bipedal walking. The insight gained from these models is used in the development of three planar (motion only in the sagittal plane ...ground is implemented and tested in simulation. The dynamics of the sagittal plane are suffciently decoupled from the dynamics of the frontal and...transverse planes such that control of each can be treated separately. We achieve three-dimensional walking by adding lateral balance to the planar algorithms

Quantitative Evaluation of Brain Stem Atrophy Using Magnetic Resonance Imaging in Adult Patients with Alexander Disease.

PubMed

Yoshida, Tomokatsu; Yasuda, Rei; Mizuta, Ikuko; Nakagawa, Masanori; Mizuno, Toshiki

2017-01-01

Brain MRI in adult patients with Alexander disease (AxD) mainly shows atrophy in the medulla oblongata. However, currently there is no quantitative standard for assessing this atrophy. In this study, we quantitatively evaluated the brain stem of AxD patients with glial fibrillary acidic protein (GFAP) mutation using conventional MRI to evaluate its usefulness as an aid to diagnosing AxD in daily clinical practice. Nineteen AxD patients with GFAP mutation were compared with 14 patients negative for GFAP mutation in whom AxD was suspected due to "atrophy of the medulla oblongata." In the GFAP mutation-positive group, the sagittal diameter of the medulla oblongata, the ratio of the diameter of the medulla oblongata to that of the midbrain (MO/MB), and the ratio of the sagittal diameter of the medulla oblongata to that of the pons (MO/Po) were significantly smaller compared to those of the GFAP mutation-negative group (p < 0.01). The sensitivity and specificity of each parameter were 87.5 and 92.3%, 91.7 and 81.3%, and 88.2 and 100% with a sagittal diameter of the medulla oblongata <9.0 mm, MO/MB <0.60, and sagittal MO/Po <0.46, respectively. These parameters can provide very useful information to differentially diagnose AxD from other disorders associated with brain stem atrophy in adult patients. © 2017 S. Karger AG, Basel.

Sex differences in lower extremity kinematics and patellofemoral kinetics during running.

PubMed

Almonroeder, Thomas G; Benson, Lauren C

2017-08-01

The incidence of patellofemoral pain (PFP) is 2 times greater in females compared with males of similar activity levels; however, the exact reason for this discrepancy remains unclear. Abnormal mechanics of the hip and knee in the sagittal, frontal, and transverse planes have been associated with an increased risk of PFP. The purpose of this study was to compare the mechanics of the lower extremity in males and females during running in order to better understand the reason(s) behind the sex discrepancy in PFP. Three-dimensional kinematic and kinetic data were collected as male and female participants completed overground running trials at a speed of 4.0 m · s -1 (±5%). Patellofemoral joint stress (PFJS) was estimated using a sagittal plane knee model. The kinematics of the hip and knee in the frontal and transverse planes were also analysed. Male participants demonstrated significantly greater sagittal plane peak PFJS in comparison with the female participants (P < .001, ES = 1.9). However, the female participants demonstrated 3.5° greater peak hip adduction and 3.4° greater peak hip internal rotation (IR). As a result, it appears that the sex discrepancy in PFP is more likely to be related to differences in the kinematics of the hip in the frontal and transverse planes than differences in sagittal plane PFJS.

Movement compatibility for configurations of displays located in three cardinal orientations and ipsilateral, contralateral and overhead controls.

PubMed

Chan, Alan H S; Hoffmann, Errol R

2012-01-01

Stereotype strength and reversibility were determined for displays that were in the Front, Right and Left orientations relative to the operator, along with rotary, horizontally and vertically-moving controls located in the overhead, left-sagittal and right-sagittal planes. In each case, responses were made using the left and right hands. The arrangements used were (i) rotary control with a circular display (ii) horizontal/transverse control moving forward/rearward in the left and right-sagittal planes or transversely in the overhead plane and (iii) vertical/longitudinal control moving vertically in the left and right-sagittal planes and longitudinally in the overhead plane. These are all combinations not previously researched. Stereotype strength varied with display plane, type of control and plane of control. Models for the stereotype strength are developed, showing the contribution of various components to the overall stereotype strength. The major component for horizontally-moving controls comes from the "visual field" model of Worringham and Beringer (1998); for the rotary control important factors are "clockwise-for-clockwise" and the hand/control location effect (Hoffmann, 2009a). Vertically-moving controls are governed by a simple 'up-for-up' relationship between displays and controls. Overall stereotype strength is a maximum when all components add positively. Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Ipsilateral wrist-ankle movements in the sagittal plane encoded in extrinsic reference frame.

PubMed

Muraoka, Tetsuro; Ishida, Yuki; Obu, Takashi; Crawshaw, Larry; Kanosue, Kazuyuki

2013-04-01

When performing oscillatory movements of two joints in the sagittal plane, there is a directional constraint for performing such movements. Previous studies could not distinguish whether the directional constraint reflected movement direction encoded in the extrinsic (outside the body) reference frame or in the intrinsic (the participants' torso/head) reference frame since participants performed coordinated movements in a sitting position where the torso/head was stationary relative to the external world. In order to discern the reference frame in the present study, participants performed paced oscillatory movements of the ipsilateral wrist and ankle in the sagittal plane in a standing position so that the torso/head moved relative to the external world. The coordinated movements were performed in one of two modes of coordination, moving the hand upward concomitant with either ankle plantarflexion or ankle dorsiflexion. The same directional mode relative to extrinsic space was more stable and accurate as compared with the opposite directional mode. When forearm position was changed from the pronated position to the supinated position, similar results were obtained, indicating that the results were independent of a particular coupling of muscles. These findings suggest that the directional constraint on ipsilateral joints movements in the sagittal plane reflects movement direction encoded in the extrinsic reference frame. Copyright © 2013 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.

Biomechanical evaluation of sagittal maxillary internal distraction osteogenesis in unilateral cleft lip and palate patient and noncleft patients: a three-dimensional finite element analysis.

PubMed

Olmez, Sultan; Dogan, Servet; Pekedis, Mahmut; Yildiz, Hasan

2014-09-01

To compare the pattern and amount of stress and displacement during maxillary sagittal distraction osteogenesis (DO) between a patient with unilateral cleft lip and palate (UCLP) and a noncleft patient. Three-dimensional finite element models for both skulls were constructed. Displacements of the surface landmarks and stress distributions in the circummaxillary sutures were analyzed after an anterior displacement of 6 mm was loaded to the elements where the inferior plates of the distractor were assumed to be fixed and were below the Le Fort I osteotomy line. In sagittal plane, more forward movement was found on the noncleft side in the UCLP model (-6.401 mm on cleft side and -6.651 mm on noncleft side for the central incisor region). However, similar amounts of forward movement were seen in the control model. In the vertical plane, a clockwise rotation occurred in the UCLP model, whereas a counterclockwise rotation was seen in the control model. The mathematical UCLP model also showed higher stress values on the sutura nasomaxillaris, frontonasalis, and zygomatiomaxillaris on the cleft side than on the normal side. Not only did the sagittal distraction forces produce advancement forces at the intermaxillary sutures, but more stress was also present on the sutura nasomaxillaris, sutura frontonasalis, and sutura zygomaticomaxillaris on the cleft side than on the noncleft side.

Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health.

PubMed

Christensen, Sanne Toftgaard; Hartvigsen, Jan

2008-01-01

The purposes of this study were to (1) determine whether sagittal spinal curves are associated with health in epidemiological studies, (2) estimate the strength of such associations, and (3) consider whether these relations are likely to be causal. A systematic critical literature review of epidemiological (cross-sectional, case-control, cohort) studies published before 2008 including studies identified in the CINAHL, EMBASE, Mantis, and Medline databases was performed using a structured checklist and a quality assessment. Level of evidence analysis was performed as outlined by van Tulder et al (Spine. 2003;28:1290-9), and the strength of associations were determined using the procedure outlined by Hemingway and Marmot (BMJ. 1999;318:1460-7). Quality of the included articles were assessed by our own scoring system based on the STrengthening the Reporting of OBservational studies in Epidemiology checklist. Studies scoring maximum points (4/4 or 3/3) were considered to be of higher quality. Fifty-four original studies were included. We found no strong evidence for any association between sagittal spinal curves and any health outcomes including spinal pain. The included studies were generally of low methodological quality. There is moderate evidence for association between sagittal spinal curves and 4 health outcomes as follows: temporomandibular disorders (no odds ratios [ORs] provided), pelvic organ prolapse (OR, 3.18; 95% confidence interval [CI], 1.46-96.93), daily function (OR range, 1.8-3.7; 95% CI range, 1.1-6.3), and death (OR, 1.40; 95% CI, 1.08-1.91). These associations are however unlikely to be causal. Evidence from epidemiological studies does not support an association between sagittal spinal curves and health including spinal pain. Further research of better methodological quality may affect this conclusion, and causal effects cannot be determined in a systematic review.

A prospective study on infectious complications in orthognathic surgery.

PubMed

Spaey, Yannick J E; Bettens, Rolf M A; Mommaerts, Maurice Y; Adriaens, Jo; Van Landuyt, Herman W; Abeloos, Johan V S; De Clercq, Calix A S; Lamoral, Philippe R B; Neyt, Luc F

2005-02-01

According to an earlier study in 2000, 4.7% of patients undergoing corrective facial orthopaedic surgery in this unit suffered a postoperative wound infection. In 1998, the Belgian Government recommended stricter rules for infection prophylaxis and a new antibiotic protocol similar to that proposed by Peterson (1990) was implemented in this unit. The new protocol was to be evaluated. Eight hundred and ten consecutive patients were selected receiving orthognathic surgery (Le Fort I-type osteotomies, sagittal split osteotomies, segmental and chin osteotomies). Cefazolin 1g was administered intravenously on induction of general anaesthesia and repeated at 4h intervals for the duration of surgery. No antibiotics were administered postoperatively. The observation period was 6 weeks. When an infection occurred, appropriate culture specimens were obtained according to a standardized protocol. Fifty-one infections (6.8%) were diagnosed, 33 with purulent exudates occurring spontaneously or after incision and drainage. Ninety-two per cent of these infections occurred in the sagittal split area, 6% in the maxillary region and 2% in the chin region. Infections in the sagittal split area were further analysed. A reduction in infection rate from 6.6 to 2.6% was noted following a change in practice when fibrin glue was used in the wound instead of a drain in the sagittal split wound. Of the 30 aerobic cultures, 12 contained normal mucosal flora, of which 9 were Streptococcus species. In 11 of the 30 anaerobic cultures the identified species belonged to the Bacteroides group. This bacterium is resistant to cefazolin but sensitive to amoxicillin-clavulanate and for a high percentage also to clindamycin. All the other cultures were sterile. The infections occurring almost exclusively in the sagittal split osteotomy site can be partially explained by wound contamination upon removal of the drain. It is suggested that for prophylaxis cefazolin is replaced by amoxicillin-clavulanate.

Three-Dimensional Ankle Moments and Nonlinear Summation of Rat Triceps Surae Muscles

PubMed Central

Tijs, Chris; van Dieën, Jaap H.; Baan, Guus C.; Maas, Huub

2014-01-01

The Achilles tendon and epimuscular connective tissues mechanically link the triceps surae muscles. These pathways may cause joint moments exerted by each muscle individually not to sum linearly, both in magnitude and direction. The aims were (i) to assess effects of sagittal plane ankle angle (varied between 150° and 70°) on isometric ankle moments, in both magnitude and direction, exerted by active rat triceps surae muscles, (ii) to assess ankle moment summation between those muscles for a range of ankle angles and (iii) to assess effects of sagittal plane ankle angle and muscle activation on Achilles tendon length. At each ankle angle, soleus (SO) and gastrocnemius (GA) muscles were first excited separately to assess ankle-angle moment characteristics and subsequently both muscles were excited simultaneously to investigate moment summation. The magnitude of ankle moment exerted by SO and GA, the SO direction in the transverse and sagittal planes, and the GA direction in the transverse plane were significantly affected by ankle angle. SO moment direction in the frontal and sagittal planes were significantly different from that of GA. Nonlinear magnitude summation varied between 0.6±2.9% and −3.6±2.9%, while the nonlinear direction summation varied between 0.3±0.4° and −0.4±0.7° in the transverse plane, between 0.5±0.4° and 0.1±0.4° in the frontal plane, and between 3.0±7.9° and 0.3±2.3° in the sagittal plane. Changes in tendon length caused by SO contraction were significantly lower than those during contraction of GA and GA+SO simultaneously. Thus, moments exerted by GA and SO sum nonlinearly both in the magnitude and direction. The limited degree of nonlinear summation may be explained by different mechanisms acting in opposite directions. PMID:25360524

Biomechanical evaluation of fracture fixation constructs using a variable-angle locked periprosthetic femur plate system.

PubMed

Hoffmann, Martin F; Burgers, Travis A; Mason, James J; Williams, Bart O; Sietsema, Debra L; Jones, Clifford B

2014-07-01

In the United States there are more than 230,000 total hip replacements annually, and periprosthetic femoral fractures occur in 0.1-4.5% of those patients. The majority of these fractures occur at the tip of the stem (Vancouver type B1). The purpose of this study was to compare the biomechanically stability and strength of three fixation constructs and identify the most desirable construct. Fifteen medium adult synthetic femurs were implanted with a hip prosthesis and were osteotomized in an oblique plane at the level of the implant tip to simulate a Vancouver type B1 periprosthetic fracture. Fractures were fixed with a non-contact bridging periprosthetic proximal femur plate (Zimmer Inc., Warsaw, IN). Three proximal fixation methods were used: Group 1, bicortical screws; Group 2, unicortical screws and one cerclage cable; and Group 3, three cerclage cables. Distally, all groups had bicortical screws. Biomechanical testing was performed using an axial-torsional testing machine in three different loading modalities (axial compression, lateral bending, and torsional/sagittal bending), next in axial cyclic loading to 10,000 cycles, again in the three loading modalities, and finally to failure in torsional/sagittal bending. Group 1 had significantly greater load to failure and was significantly stiffer in torsional/sagittal bending than Groups 2 and 3. After cyclic loading, Group 2 had significantly greater axial stiffness than Groups 1 and 3. There was no difference between the three groups in lateral bending stiffness. The average energy absorbed during cyclic loading was significantly lower in Group 2 than in Groups 1 and 3. Bicortical screw placement achieved the highest load to failure and the highest torsional/sagittal bending stiffness. Additional unicortical screws improved axial stiffness when using cable fixation. Lateral bending was not influenced by differences in proximal fixation. To treat periprosthetic fractures, bicortical screw placement should be attempted to maximize load to failure and torsional/sagittal bending stiffness. Copyright © 2014 Elsevier Ltd. All rights reserved.

Sagittal and transversal plane deformity in thoracic scoliosis.

PubMed

Kotwicki, Tomasz

2002-01-01

The aim of the study was to assess the sagittal and transversal plane deformity of the spine in thoracic scoliosis by the mean of 3-D radiographic analysis. 46 patients admitted for surgery for thoracic idiopathic scoliosis underwent preoperative radiographic assessment. All patients presented the same pattern of the coronal plane deformity: single right thoracic curve (Lenke 1, King 3). Neither lumbar nor proximal thoracic structural curve were present. The Cobb angle varied from 41gamma to 77 gamma (mean 55,4 gamma +/- 8,6 gamma). Long cassette standing antero-posterior and lateral radiographs were analysed. Three-dimensional reconstruction with Rachis 91TM software was performed for each pair of radiographs. The following parameters were assessed: sagittal thoracic Cobb angle (Th4-Th12), upper thoracic kyphosis angle (Th5-Th8), lower thoracic kyphosis angle (Th9-Th12), superior and inferior hemi-curve sagittal angles, lumbar lordosis, sacral slope, sacral incidence, vertebral plate index, segmental vertebral axial rotation throughout the thoracic and lumbar spine. Results showed great variability of parameters assessed. The non-harmonious distribution of kyphosis was demonstrated in the thoracic spine. Local Th9-Th12 hypokyphosis and adjacent local Th5-Th8 hyperkyphosis constitute the most typical sagittal pathologies. So called normokyphotic curves were composed of one hyperkyphotic and one hypokyphotic zone. Th1-Th4 segment revealed two patterns of segmental rotation distribution: a purely compensatory curve with no vertebral axial rotation or a rotated curve presenting the morphology intermediate between Lenke 1 and Lenke 2 types (or King 3 and King 5). curves presenting the same coronal plane deformity differ in their morphology assessed in the two other planes; global thoracic kyphosis angle is a misleading parameter because it covers hypo- and hyperkyphotic zones; local distal thoracic (Th9-Th12) hypokyphosis is present in idiopathic thoracic scoliosis.

Imaging and histological features of central subchondral osteophytes in racehorses with metacarpophalangeal joint osteoarthritis.

PubMed

Olive, J; D'Anjou, M A; Girard, C; Laverty, S; Theoret, C L

2009-12-01

Marginal osteophytes represent a well known component of osteoarthritis in man and animals. Conversely, central subchondral osteophytes (COs), which are commonly present in human knees with osteoarthritis, have not been reported in horses. To describe and compare computed radiography (CR), single-slice computed tomography (CT), 1.5 Tesla magnetic resonance imaging (MRI), and histological features of COs in equine metacarpophalangeal joints with macroscopic evidence of naturally-occurring osteoarthritis. MRI sequences (sagittal spoiled gradient recalled echo [SPGR] with fat saturation, sagittal T2-weighted fast spin echo with fat saturation [T2-FS], dorsal and transverse T1-weighted gradient-recalled echo [GRE], and sagittal T2*-weighted gradient echo with fast imaging employing steady state acquisition [FIESTA]), as well as transverse and reformatted sagittal CTI and 4 computed radiographic (CR) views of 20 paired metacarpophalangeal joints were acquired ex vivo. Following macroscopic evaluation, samples were harvested in predetermined sites of the metacarpal condyle for subsequent histology. The prevalence and detection level of COs was determined for each imaging modality. Abnormalities consistent with COs were clearly depicted on MRI, using the SPGR sequence, in 7/20 (35%) joints. They were identified as a focal hypointense protuberance from the subchondral plate into the cartilage, at the palmarodistal aspect (n=7) and/or at the very dorsal aspect (n=2) of the metacarpal condyle. COs were visible but less obvious in 5 of the 7 joints using FIESTA and reformatted sagittal CT, and were not identifiable on T2-FS, T1-GRE or CR. Microscopically, they consisted of dense bone protruding into the calcified cartilage and disrupting the tidemarks, and they were consistently associated with overlying cartilage defects. Subchondral osteophytes are a feature of osteoarthritis of equine metacarpophalangeal joints and they may be diagnosed using 1.5 Tesla MRI and CT. Central subchondral osteophytes on MRI represent indirect evidence of cartilage damage in horses.

An Assessment of Correlation between Dermatoglyphic Patterns and Sagittal Skeletal Discrepancies

PubMed Central

Philip, Biju; Madathody, Deepika; Mathew, Manu; Paul, Jose; Dlima, Johnson Prakash

2017-01-01

Introduction Investigators over years have been fascinated by dermatoglyphic patterns which has led to the development of dermatoglyphics as a science with numerous applications in various fields other than being the best and most widely used method for personal identification. Aim To assess the correlation between dermatoglyphic patterns and sagittal skeletal discrepancies. Materials and Methods A total of 180 patients, aged 18-40 years, were selected from those who attended the outpatient clinic of the Deparment of Orthodontics and Dentofacial Orthopedics, Mar Baselios Dental College, Kothamangalam, Kerala, India. The fingerprints of both hands were taken by ink and stamp method after proper hand washing. The patterns of arches, loops and whorls in fingerprints were assessed. The total ridge count was also evaluated. Data was also sent to the fingerprint experts for expert evaluation. The sagittal jaw relation was determined from the patient’s lateral cephalogram. The collected data was then statistically analyzed using Chi-square tests, ANOVA and Post-hoc tests and a Multinomial regression prediction was also done. Results A significant association was observed between the dermatoglyphic pattern exhibited by eight fingers and the sagittal skeletal discrepancies (p<0.05). An increased distribution of whorl pattern was observed in the skeletal Class II with maxillary excess group and skeletal Class II with mandibular deficiency group while an increased distribution of loop pattern was seen in the skeletal Class III with mandibular excess group and skeletal Class III with maxillary deficiency group. Higher mean of total ridge count was also seen in the groups of skeletal Class II with maxillary excess and skeletal Class II with mandibular deficiency. Multinomial regression predicting skeletal pattern with respect to the fingerprint pattern showed that the left thumb impression fits the best model for predicting the skeletal pattern. Conclusion There was a significant association between dermatoglyphic patterns and sagittal skeletal discrepancies. Dermatoglyphics could serve as a cost effective screening tool of these craniofacial problems. PMID:28511506

Outcome following subluxation of mobile articulating spacers in two-stage revision total knee arthroplasty.

PubMed

Lanting, Brent A; Lau, Adrian; Teeter, Matthew G; Howard, James L

2017-03-01

Infection after total knee arthroplasty (TKA) is a severe complication. It is usually treated with two-stage revision and implantation of a cement spacer. Few studies describe the complications associated with a mobile articulating spacer. This study examined the subluxation of articulating antibiotic spacers in knees and correlated it with prospectively collected early outcome scores after implantation of a revision prosthesis. Staged revisions for 72 infected primary total knee arthroplasties between 2004 and 2012 were examined. The mean age of the patients was 70.2 ± 10.8 years, with 40 right and 32 left knees. Sagittal and coronal subluxation was measured using radiographs prior to second-stage revision and grouped to be within (Group 1) or outside (Group 2) one standard deviation from the mean. Medical Outcomes Study Short Form-12 (SF-12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS) were obtained via patient-administered questionnaire. Statistical analysis was carried out to look at the correlation between subluxation and outcome. Significant improvements were observed between the interim outcome scores prior to implantation of a revision prosthesis and scores obtained after second-stage revision. Debonding occurred in 5.6%, and one dislocation was found. Mean coronal subluxation was 4.8 ± 5.5% of the tibia width, in the lateral direction. Coronal subluxation did not affect SF12, WOMAC or KSS outcome scores. Mean sagittal subluxation was 6.1 ± 16.4% posteriorly. However, sagittal subluxation had a significant influence on Knee Society Scores, with Group 2 having a lower mean Knee Society Function Score of 39.3 than Group 1 (60.2) (p = 0.045). Sagittal subluxation did not affect SF12 or WOMAC scores. Sagittal subluxation of the knee may influence the early to midterm outcome scores following a staged revision TKA for infection.

Sagittal Thoracic and Lumbar Spine Profiles in Upright Standing and Lying Prone Positions Among Healthy Subjects: Influence of Various Biometric Features.

PubMed

Salem, Walid; Coomans, Ysaline; Brismée, Jean-Michel; Klein, Paul; Sobczak, Stéphane; Dugailly, Pierre-Michel

2015-08-01

A prospective study was performed on the assessment of both thoracic and lumbar spine sagittal profiles (from C7 to S1). To propose a new noninvasive method for measuring the spine curvatures in standing and lying prone positions and to analyze their relationship with various biometric characteristics. Modifications of spine curvatures (i.e. lordosis or kyphosis) are of importance in the development of spinal disorders. Studies have emphasized the development of new devices to measure the spine sagittal profiles using a noninvasive and low-cost method. To date, it has not been applied for analyzing both lumbar and thoracic alterations for various positioning. Seventy-five healthy subjects (mean 22.6 ± 4.3 yr) were recruited to participate in this study. Thoracic and lumbar sagittal profiles were assessed in standing and lying prone positions using a 3D digitizer. In addition, several biometric data were collected including maximal trunk isometric strength for flexion and extension movement. Statistical analysis consisted in data comparisons of spine profiles and a multivariate analysis including biometric features, to classify individuals considering low within- and high between-variability. Kyphosis and lordosis angles decreased significantly from standing to lying prone position by an average of 13.4° and 16.6°, respectively. Multivariate analysis showed a sample clustering of 3 homogenous subgroups. The first group displayed larger lordosis and flexibility, and had low data values for height, weight, and strength. The second group had lower values than the overall trend of the whole sample, whereas the third group had larger score values for the torques, height, weight, waist, body mass index, and kyphosis angle but a reduced flexibility. The present results demonstrate a significant effect of the positioning on both thoracic and lumbar spine sagittal profiles and highlight the use of cluster analysis to categorize subgroups after biometric characteristics including curvature measurement. N/A.

Key-Vertebral Screws Strategy for Main Thoracic Curve Correction in Patients With Adolescent Idiopathic Scoliosis.

PubMed

Li, Jingfeng; Cheung, Kenneth M C; Samartzis, Dino; Ganal-Antonio, Anne K B; Zhu, Xiaodong; Li, Ming; Luk, Keith D K

2016-10-01

The following study was a prospective radiographic and retrospective clinical data assessment of adolescent idiopathic scoliosis (AIS) patients who had undergone a key-vertebral screws strategy (KVSS) at a single institution, with a minimum of 2 years' follow-up. The aim of the study was to introduce the KVSS for the operative treatment of AIS of the main thoracic curve, and to address the role of the fulcrum-bending radiograph (FBR) in predicting the outcome of surgical management by this method. The application of multilevel pedicle screws for the main thoracic curve in AIS patients is popular in an effort to provide spinal stability, enhance fusion outcome, and provide optimal curve correction. However, with the application of pedicle screw also comes a potential risk for soft tissue and neural injury and increased health care costs. It remains unknown whether limited screw placement can provide proper curve correction without compromising patient outcome. A total of 17 consecutive patients with AIS extending to the main thoracic spine, who had undergone posterior fusion and fixation by the KVSS, a procedure in which screws are placed at important strategic points in the spine (ie, bilaterally at the upper and lower end segments of the fusion block, apical vertebra on the convex side, adjacent cephalad, and caudal screw placement on the concave side), at a single institution, with a minimum of 2 year' follow-up, were included. The assessment of preoperative standing posteroanterior and sagittal, FBR, and postoperative standing posteroanterior and sagittal plain radiographs were assessed in all patients. The flexibility of the curve as well as the fulcrum-bending correction index (FBCI) were calculated for all patients. Postoperatively, radiographs were assessed at the immediate (ie, 1 wk) and last follow-up. Clinical assessment entailed evaluation of patient demographics and the presence of any intraoperative or postoperative complications. The mean age at the time of surgery was 15.6 years. The mean follow-up was 39.8 months. The average FBR flexibility was 62.2%. The mean immediate curve correction was 71.2%, which did not differ in comparison with the last follow-up assessment (P>0.05). The mean immediate and last follow-up FBCIs were 119.3% and 112.5%, respectively (P=0.079). A significant negative correlation was found between immediate FBCI to that of the FBR curve flexibility (r=-0.706; P=0.002), which remained similar on the last follow-up (r=-0.681; P=0.003). Sagittal alignment did not significantly change from the immediate to last follow-up (P=0.163) Fusion was achieved in all patients. No instrumentation-related complications were noted. Key-vertebral screws strategy is a safe and cost-effective method for the surgical treatment of the main thoracic curve in AIS patients. Moreover, in the context of this strategy, the FBR may have some predictive utility in the correction of the main thoracic curve in AIS patients.

Sagittal balance, a useful tool for neurosurgeons?

PubMed

Villard, Jimmy; Ringel, Florian; Meyer, Bernhard

2014-01-01

New instrumentation techniques have made any correction of the spinal architecture possible. Sagittal balance has been described as an important parameter for assessing spinal deformity in the early 1970s, but over the last decade its importance has grown with the published results in terms of overall quality of life and fusion rate. Up until now, most of the studies have concentrated on spinal deformity surgery, but its use in the daily neurosurgery practice remains uncertain and may warrant further studies.

Mechanical and photoelastic analysis of conventional screws and cannulated screws for sagittal split osteotomy fixation: a comparative study.

PubMed

Lima, Cristina Jardelino de; Falci, Saulo Gabriel Moreira; Rodrigues, Danillo Costa; Marchiori, Érica Cristina; Moreira, Roger Willian Fernandes

2015-12-01

The aim of the present study was to use mechanical and photoelastic tests to compare the performance of cannulated screws with solid-core screws in sagittal split osteotomy fixation. Ten polyurethane mandibles, with a prefabricated sagittal split ramus osteotomy, were fixed with an L inverted technique and allocated to each group as follows: cannulated screw group (CSG), fixed with three 2.3-cannulated screws; and solid-core screw group (SCSG), fixed with three 2.3-solid-core screws. Vertical linear loading tests were performed. The differences between mean values were analyzed through T test for independent samples. The photoelastic test was carried out using a polariscope. The results revealed differences between the two groups only at 1 mm of displacement, in which the cannulated-screw revealed more resistance. Photoelastic test showed higher stress concentration close to mandibular branch in the solid-core group. Cannulated screws performed better than solid-core ones in a mechanical test at 1-mm displacement and photoelastic tests.

Current concepts on the sagittal balance and classification of spondylolysis and spondylolisthesis☆☆☆

PubMed Central

Tebet, Marcos Antonio

2014-01-01

Treatment of spondylolysis and spondylolisthesis remains a challenge for orthopaedic surgeons, neurosurgeons and paediatrics. In spondylolisthesis, it has been clearly demonstrated over the past decade that spino-pelvic morphology is abnormal and that it can be associated to an abnormal sacro-pelvic orientation as well as to a disturbed global sagittal balance of spine. This article presents the SDSG (Spinal Deformity Study Group) classification of lumbosacral spondylolisthesis. The proper treatment of spondylolisthesis is dependent on recognizing the type of slip, sacro-pelvic balance and overall sagittal balance and its natural history. Although a number of clinical radiographic features have been identified as risk factors, their role as primary causative factors or secondary adaptative changes is not clear. The conservative treatment of adult isthmic spondylolisthesis results in good outcome in the majority of cases. Of those patients who fail conservative treatment, success with surgery is quite good, with significant improvement in neurologic function in those patients with deficits, as well as improvement in patients with back pain. PMID:26229765

Management of a growing Skeletal Class II Patient: A Case Report.

PubMed

Sharma, Narendra Shriram

2013-01-01

Sagittal and transverse discrepancies often coexist in skeletal class II malocclusions. Orthopedic growth modification can work well in such cases, provided that the remaining pubertal growth is adequate and that the clinician can provide timely treatment to coincide with the peak growth period. The transverse discrepancy is generally corrected first, establishing a proper base for the sagittal correction to follow. For example, in a skeletal class II case with a narrow maxillary arch and retrusive mandible, maxillary expansion is performed initially to facilitate functional mandibular advancement. The present article illustrates an exception to this rule, in a case where sagittal correction was undertaken before transverse correction to make optimal use of the patient's pubertal growth spurt in first phase followed by a second phase of fixed appliance therapy during adolescence to achieve optimal results. How to cite this article: Sharma NS. Management of a growing Skeletal Class II Patient: A Case Report. Int J Clin Pediatr Dent 2013;6(1):48-54.

Fluctuating asymmetry and fractal dimension of the sagittal suture as indicators of inbreeding depression in dama and dorcas gazelles

USGS Publications Warehouse

Alados, Concepcion L.; Escos, Juan; Emlen, John M.

1995-01-01

The effects of inbreeding on the developmental instability of skulls of dorcas (Gazella dorcas) and dama (G. dama) gazelles were investigated. In total, 132 dorcas gazelle skulls and 74 dama gazelle skulls from the Estación Experimental de Zonas Aridas in Almera, Spain, were measured. The fluctuating asymmetry of 9 meristic characters, consisting of the numbers of foramina on the two sides of the skull and mandible, was calculated. Although only the foramen infraorbitalis showed a significant increase in asymmetry with inbreeding in dorcas gazelles, the sum of the foramina in 5 of the skull regions clearly indicates an increase in asymmetry with inbreeding in both dorcas and dama gazelles. The fractal dimension of the sagittal suture was calculated by means of the coastline method. A greater effect of inbreeding on the sagittal suture in dama than in dorcas gazelle was observed, in concordance with the more evident deleterious effects of inbreeding depression in dama than in dorcas gazelles.

Inter- and intraobserver repeatability of the Salford Gait Tool: an observation-based clinical gait assessment tool.

PubMed

Toro, Brigitte; Nester, Christopher J; Farren, Pauline C

2007-03-01

To evaluate the inter- and intraobserver repeatability of the Salford Gait Tool (SF-GT), a new observation-based gait assessment tool for evaluating sagittal plane cerebral palsy (CP) gait. Masked comparative evaluation. University in the United Kingdom. A convenience sample of 23 pediatric physical therapists with varying degrees of clinical experience recruited from the Greater Manchester area. Participants viewed videotapes of the sagittal plane gait of 13 children and used the SF-GT to analyze their 13 different gait styles on 2 occasions. Eleven children had hemiplegic, diplegic, or quadriplegic CP and 2 were neurologically intact. Inter- and intraobserver repeatability of hip, knee, and ankle joint positions at 6 different phases of the gait cycle. The SF-GT demonstrated good interobserver (77%) and intraobserver (75%) repeatability. We have established that the SF-GT is a repeatable clinical assessment tool with which to guide the diagnosis, treatment planning, and evaluation of interventions by pediatric physical therapists of sagittal plane gait deviations in CP.

Improved ankle push-off power following cheilectomy for hallux rigidus: a prospective gait analysis study.

PubMed

Smith, Sheryl M; Coleman, Scott C; Bacon, Stacy A; Polo, Fabian E; Brodsky, James W

2012-06-01

There is limited objective scientific information on the functional effects of cheilectomy. The purpose of this study was to test the hypothesis that cheilectomy for hallux rigidus improves gait by increasing ankle push-off power. Seventeen patients with symptomatic Stage 1 or Stage 2 hallux rigidus were studied. Pre- and postoperative first metatarsophalangeal (MTP) range of motion and AOFAS hallux scores were recorded. A gait analysis was performed within 4 weeks prior to surgery and repeated at a minimum of 1 year after surgery. Gait analysis was done using a three-dimensional motion capture system and a force platform embedded in a 10-m walkway. Gait velocity sagittal plane ankle range of motion and peak sagittal plane ankle push-off power were analyzed. Following cheilectomy, significant increases were noted for first MTP range of motion and AOFAS hallux score. First MTP motion improved an average of 16.7 degrees, from means of 33.9 degrees preoperatively to 50.6 degrees postoperatively (p<0.001). AOFAS hallux score increased from 62 to 81 (p<0.007). As demonstrated through gait anaylsis, a significant increase in postoperative peak sagittal plane ankle push-off power from 1.71±0.92 W/kg to 2.05±0.75 W/kg (p<0.04). In addition to clinically increased range of motion and improved AOFAS Hallux score, first MTP joint cheilectomy produced objective improvement in gait, as measured by increased peak sagittal-plane ankle push-off power.

Peripheral refraction and retinal contour in stable and progressive myopia.

PubMed

Faria-Ribeiro, Miguel; Queirós, António; Lopes-Ferreira, Daniela; Jorge, Jorge; González-Méijome, José Manuel

2013-01-01

To compare the patterns of relative peripheral astigmatic refraction (tangential and sagittal power errors) and eccentric eye length between progressing and stable young-adult myopes. Sixty-two right eyes of 62 white patients participated in the study, of which 30 were nonprogressing myopes (NP group) for the last 2 years and 32 were progressing myopes (P group). Groups were matched for mean spherical refraction, axial length, and age. Peripheral refraction and eye length were measured along the horizontal meridian up to 35 and 30 degrees of eccentricity, respectively. There were statistically significant differences between groups (p < 0.001) in the nasal retina for the astigmatic components of peripheral refraction. The P group presented a hyperopic relative sagittal focus at 35 degrees in the nasal retina of +1.00 ± 0.83 diopters, as per comparison with a myopic relative sagittal focus of -0.10 ± 0.98 diopters observed in the NP group (p < 0.001). Retinal contour in the P group had a steeper shape in the nasal region than that in the NP group (t test, p = 0.001). An inverse correlation was found (r = -0.775; p < 0.001) between retinal contour and peripheral refraction. Thus, steeper retinas presented a more hyperopic trend in the periphery. Stable and progressing myopes of matched age, axial length, and central refraction showed significantly different characteristics in their peripheral retinal shape and astigmatic components of tangential and sagittal power errors. The present findings may help explain the mechanisms that regulate ocular growth in humans.

Correlation between direction and severity of temporomandibular joint disc displacement and reduction ability during mouth opening.

PubMed

Litko, M; Berger, M; Szkutnik, J; Różyło-Kalinowska, I

2017-12-01

The most common temporomandibular joint (TMJ) internal derangement is an abnormal relationship of the disc with respect to the mandibular condyle, articular eminence and glenoid fossa-disc displacement. The aim of our study was to analyse the correlation between partial/complete disc displacement in the intercuspal position (IP) and its reduction in the open-mouth position (OMP) in both oblique sagittal and coronal planes on magnetic resonance imaging (MRI) in patients with temporomandibular disorders. Multisection MRI analysis of 382 TMJs was conducted in 191 patients with disc displacement according to the RDC/TMD criteria (148 women, 43 men; aged 14-60 years). The disc position was evaluated on all oblique sagittal and coronal images in the IP and the OMP. Univariate logistic regression analysis showed that the severity of disc displacement in the sagittal plane is a statistically significant predictor of reduction ability during mouth opening (B = 3.118; P < .001). Moreover, the severity of disc displacement in both planes is also a significant predictor of disc reduction in OMP (B = 2.200; P < .05). In conclusion, reduction ability during mouth opening is associated with the severity of disc displacement in IP, in both sagittal and coronal planes. Multisection analysis of all MR images allows distinguishing the correct disc position from disc displacement and can improve the ability to distinguish between various stages of TMJ internal derangement. © 2017 John Wiley & Sons Ltd.

Morphometric differences of nasopalatine canal based on 3D classifications: descriptive analysis on CBCT.

PubMed

Fernández-Alonso, A; Suárez-Quintanilla, J A; Rapado-González, O; Suárez-Cunqueiro, María Mercedes

2015-09-01

This descriptive retrospective study analyzed differences among sagittal, coronal and axial NC groups based on the dimensions of nasopalatine canal (NC), buccal bone plate (BBP) and palatal bone plate (PBP) to canal. Measurements were made on 224 CBCTs for NC, BBP and PBP on the three anatomic planes at three levels: level 1, when the incisive foramen is completely closed on the axial plane; level 2, at the midpoint of NC length (NCL) on the sagittal plane; and level 3, at the foramina of Stenson on the sagittal plane. ANOVA tests with post hoc tests were used. The intraclass correlation coefficient and Kappa test were used for evaluating the intraobserver agreement. Regarding coronal classification, these significant differences were found: BBP length (BL)level 1 was lower for the two parallel canals group; PBP length (PL)level 1 was lower for single canal group; and NCL was lower for Y-type canal group. Regarding axial classification, these significant differences were found: LPlevel 1 was lower for 3.1-3 group; PBP width (PW)level 3 was the greatest for 3.1-3; and LPlevel 3 was lower for 1.1. Presurgical evaluation with CBCT in premaxillae region should include analysis on coronal and axial planes and not only on sagittal plane seeing as morphometric differences were found on coronal and axial planes. Following the morphological coronal classification, two parallel canals presented a higher NCL, a higher LP and a lower LV at inferior edge of alveolar ridge.

Transverse dental compensation in relation to sagittal and transverse skeletal discrepancies in skeletal Class III patients.

PubMed

Ahn, Jaechan; Kim, Sung-Jin; Lee, Ji-Yeon; Chung, Chooryung J; Kim, Kyung-Ho

2017-01-01

The purposes of this study were to compare the buccolingual inclinations of the posterior teeth in skeletal Class III patients with and without facial asymmetry with those of skeletal Class I patients and to investigate their relationships with sagittal and transverse skeletal discrepancies. Sixty-three skeletal Class III adult patients were divided into 2 groups according to the degree of menton deviation: a symmetry group with deviation less than 2 mm (n = 30), and an asymmetry group with deviation greater than 4 mm (n = 33). The control group comprised 25 skeletal Class I patients. The buccolingual inclinations of the posterior teeth measured on cone-beam computed tomography images were compared among the 3 groups, and regression analysis was performed to investigate the relationships between the inclinations and the sagittal and transverse skeletal discrepancies. The symmetry group showed greater buccal inclinations of the maxillary posterior teeth and lingual inclinations of the mandibular second molars than did the control, and this was correlated with the ANB angles. The deviated sides in the asymmetry group showed the greatest transverse dental compensation, which was correlated with menton deviation, whereas the nondeviated sides showed no significant transverse dental compensation. Transverse dental compensation is closely related to sagittal and transverse skeletal discrepancy in skeletal Class III patients. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Isolated sagittal craniosynostosis: definition, classification, and surgical indications.

PubMed

Massimi, Luca; Caldarelli, Massimo; Tamburrini, Gianpiero; Paternoster, Giovanna; Di Rocco, Concezio

2012-09-01

Sagittal craniosynostosis (SC) remains the most common type of synostosis, accounting for about a half of all forms. It would result from a mesenchymal disorder involving the intramembranous ossification of the sagittal suture and leading to its early fusion. No specific data on the etiologic factors are currently available. The premature ossification of the sagittal suture can result in three main types of SC, according to the different segment prevalently involved: anterior, posterior, and complete SC. The diagnosis is easily obtained by clinical examination. However, a radiological work up (3D CT scan) may be necessary to rule out hidden venous or cranial anomalies possibly associated with most severe cases, or for the surgical planning. The most common indication for surgery is the improvement of the cosmetic appearance of the skull, since a cranial deformation may have a significant psychological impact on affected subjects. To relieve from raised intracranial pressure is a further indication to surgery. Although an increased intracranial pressure can be demonstrated in a minority of affected children at diagnosis, indeed, it can present later (usually after the second/third year of life) with chronic symptoms. The role of surgery in the preservation of cognitive functions in scaphocephalic patients does not seem to be relevant, since minor anomalies of the cerebral development associated with SC would occur independently from the cranial shape. On the other hand, the surgical correction may show a protective effect on some visual skills, like the ability to fix and follow, and the fixation shift.

Planer orientation of the bilateral semicircular canals in dizzy patients.

PubMed

Aoki, Sachiko; Takei, Yasuhiko; Suzuki, Kazufumi; Masukawa, Ai; Arai, Yasuko

2012-10-01

Recent development of 3-dimensional analysis of eye movement enabled to detect the eye rotation axis, which is used to determine the responsible semicircular canal(s) in dizzy patients. Therefore, the knowledge of anatomical orientation of bilateral semicircular canals is essential, as all 6 canals influence the eye movements. Employing the new head coordinate system suitable for MR imaging, we calculated the angles of semicircular canal planes of both ears in 11 dizzy patients who had normal caloric response in both ears. The angles between adjacent canal pairs were nearly perpendicular in both ears. The angle between the posterior canal planes and head sagittal plane was 51° and significantly larger the angle between the anterior canal planes and head sagittal plane, which was 35°. The angle between the horizontal canal plane and head sagittal plane was almost orthogonal. Pairs of contralateral synergistic canal planes were not parallel, forming 10° between right and left horizontal canal planes, 17° between right anterior and left posterior canal planes and 19° between the right posterior and left anterior canal planes. Our measurement of the angles of adjacent canal pairs and the angle between each semicircular canal and head sagittal plane coincided with those of previous reports obtained from CT images and skull specimens. However, the angles between contralateral synergistic canal planes were more parallel than those of previous reports. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Sagittal and vertical load-deflection and permanent deformation of transpalatal arches connected with palatal implants: an in-vitro study.

PubMed

Crismani, Adriano G; Celar, Ales G; Burstone, Charles J; Bernhart, Thomas G; Bantleon, Hans-Peter; Mittlboeck, Martina

2007-06-01

The purposes of this laboratory investigation were to (1) measure the sagittal and vertical deflection of loaded transpalatal arches (TPAs) connected to a palatal implant, (2) measure the extent of permanent deformation of the connecting TPA in the sagittal and vertical directions, (3) test various wire dimensions in terms of deflection behavior, and (4) evaluate soldering vs laser welding vs adhesive bonding of TPAs in terms of load deflection behavior. Stainless steel wires of 6 dimensions were tested: 0.8 x 0.8, 0.9, 1, 1.1, 1.2, and 1.2 x 1.2 mm. For each dimension, 10 specimens were soldered to the palatal implant abutment, 10 were laser welded, and 10 were adhesively bonded to the implant abutment (total, 180 specimens). The measuring device applied increments of force of 50 cN, from 0 to 500 cN. Then the specimens were unloaded. The values were statistically described and analyzed with ANOVA and Wilcoxon rank sum tests. Absolute orthodontic anchorage without deformation of TPAs was not observed with the wire dimensions tested. To prevent loss of anchorage greater than 370 mum (sagittal deflection of 1.2 x 1.2 mm adhesively bonded TPA at 500 cN force level), wires thicker than 1.2 x 1.2 mm or cast anchorage elements must be considered for clinical practice. However, larger cross sections might cause more patient discomfort, and laboratory procedures increase costs.

Determining the sagittal relationship between the maxilla and the mandible: a cephalometric analysis to clear up the confusion.

PubMed

Davis, Glen S; Cannon, James L; Messersmith, Marion L

2013-01-01

Establishing the sagittal jaw relationship is a key component to developing a diagnosis when treating an orthodontic patient. Several measurements, including the Wits Appraisal, ANB angle and nasion perpendicular have been and are currently used by practitioners to diagnose the sagittal jaw relationship. Unfortunately, all of these measurements have their limitations. The Cannon Analysis was created in an attempt to help overcome these limitations. One hundred untreated patients from the Vanderbilt University Medical Center database were selected, and their initial lateral cephalometric radiographs were digitally traced utilizing the Cannon Cephalometric Analysis. All of these patients had an orthognathic profile, a Class I occlusion and a good skeletal balance as judged by the authors. Normative values were established for the Cannon Analysis and then broken down by sex and age (8-11, 12-18, 19 and over). An example case was analyzed using the Cannon Analysis and several diagnostic scenarios were reviewed. The variance or difference between Porion to A Point (Po-A) and Porion to B Point (Po-B) was found to be 12.6 mm. This value remained relatively constant throughout life, with only slightly higher values for males versus females. The Cannon Analysis is an effective way to accurately establish the sagittal jaw relationship since it is not affected by the anterior / posterior position of nasion, the steepness of the mandibular plane angle, nor an improperly drawn occlusal plane.

Knee joint passive stiffness and moment in sagittal and frontal planes markedly increase with compression.

PubMed

Marouane, H; Shirazi-Adl, A; Adouni, M

2015-01-01

Knee joints are subject to large compression forces in daily activities. Due to artefact moments and instability under large compression loads, biomechanical studies impose additional constraints to circumvent the compression position-dependency in response. To quantify the effect of compression on passive knee moment resistance and stiffness, two validated finite element models of the tibiofemoral (TF) joint, one refined with depth-dependent fibril-reinforced cartilage and the other less refined with homogeneous isotropic cartilage, are used. The unconstrained TF joint response in sagittal and frontal planes is investigated at different flexion angles (0°, 15°, 30° and 45°) up to 1800 N compression preloads. The compression is applied at a novel joint mechanical balance point (MBP) identified as a point at which the compression does not cause any coupled rotations in sagittal and frontal planes. The MBP of the unconstrained joint is located at the lateral plateau in small compressions and shifts medially towards the inter-compartmental area at larger compression forces. The compression force substantially increases the joint moment-bearing capacities and instantaneous angular rigidities in both frontal and sagittal planes. The varus-valgus laxities diminish with compression preloads despite concomitant substantial reductions in collateral ligament forces. While the angular rigidity would enhance the joint stability, the augmented passive moment resistance under compression preloads plays a role in supporting external moments and should as such be considered in the knee joint musculoskeletal models.

The risk of sacrificing the PCL in cruciate retaining total knee arthroplasty and the relationship to the sagittal inclination of the tibial plateau.

PubMed

Sessa, Pasquale; Fioravanti, Giulio; Giannicola, Giuseppe; Cinotti, Gianluca

2015-01-01

In cruciate retaining total knee arthroplasty (TKA), a partial avulsion of PCL may occur when en-bloc tibial osteotomy is performed. We evaluated the effects of a tibial cut performed with different degrees of posterior slope on PCL insertion and whether the results are affected by the sagittal inclination of the patient's tibial plateau. We selected 83 MRIs of knees showing mild or no degenerative changes. The effects of a simulated tibial cut performed with a posterior slope of 0°, 3°, 5° and parallel to the patient's tibial plateau inclination on PCL insertion in the proximal tibia were investigated. The results were correlated with the degree of posterior inclination of the tibial plateau. Every angle we used for the tibial cut caused a PCL avulsion greater than 50%. The percentage of PCL avulsion significantly increased with increasing the posterior slope of the tibial cut. Patients with sagittal tibial plateau inclination <5° showed greater PCL avulsion than those with sagittal inclination >8°. Most of the PCL insertion is likely to be sacrificed when resection of the proximal tibia is performed en-block. The risk of PCL avulsion is reduced in patients showing a marked posterior inclination of the tibial plateau, but even in this group of patients a surgical technique aimed at sparing most of the PCL insertion is necessary. Copyright © 2014 Elsevier B.V. All rights reserved.

3D Navigation-guided Resection of Giant Ventral Cervical Intradural Schwannoma With 360-Degree Stabilization.

PubMed

Hussain, Ibrahim; Navarro-Ramirez, Rodrigo; Lang, Gernot; Härtl, Roger

2018-06-01

Giant schwannomas are defined as intradural extramedullary tumors that span >2 vertebral body lengths. Although uncommon, these lesions can cause significant mass effect on the spinal cord and subsequent neurologic compromise. Gross total resection is the goal of operative intervention, however, is extremely challenging in cases where the tumor occupies a ventral, midline position within the lower cervical thecal sac. Using a representative case presentation, we describe an adult male with insidious progression of upper extremity radicular pain and paresthesias, found to have a ventral, solid/cystic C5-C7 giant schwannoma. We demonstrate the step-by-step surgical technique for an anterior approach 2-level cervical corpectomy, microsurgical resection of an intradural giant schwannoma, watertight dural closure, and lastly 360-degrees instrumented stabilization of the cervicothoracic spine. In addition we incorporate the utilization of a portable intraoperative computed tomography for stereotactic localization and 3-dimensional navigation-guided screw implantation. Finally, we discuss various preoperative, perioperative, and postoperative considerations that can have profound impact on successful outcomes.

[Influence of disc height on outcome of posterolateral fusion].

PubMed

Drain, O; Lenoir, T; Dauzac, C; Rillardon, L; Guigui, P

2008-09-01

Experimentally, posterolateral fusion only provides incomplete control of flexion-extension, rotation and lateral inclination forces. The stability deficit increases with increasing height of the anterior intervertebral space, which for some warrants the adjunction of an intersomatic arthrodesis in addition to the posterolateral graft. Few studies have been devoted to the impact of disc height on the outcome of posterolateral fusion. The purpose of this work was to investigate the spinal segment immobilized by the posterolateral fusion: height of the anterior intervertebral space, the clinical and radiographic impact of changes in disc height, and the short- and long-term impact of disc height measured preoperatively on clinical and radiographic outcome. In order to obtain a homogeneous group of patients, the series was limited to patients undergoing posterolateral arthrodesis for degenerative spondylolisthesis, in combination with radicular release. This was a retrospective analysis of a consecutive series of 66 patients with mean 52 months follow-up (range 3-63 months). A dedicated self-administered questionnaire was used to collect data on pre- and postoperative function, the SF-36 quality of life score, and patient satisfaction. Pre- and postoperative (early, one year, last follow-up) radiographic data were recorded: olisthesic level, disc height, intervertebral angle, intervertebral mobility (angular, anteroposterior), and global measures of sagittal balance (thoracic kyphosis, lumbar lordosis, T9 sagittal tilt, pelvic version, pelvic incidence, sacral slope). SpineView was used for all measures. Univariate analysis searched for correlations between variation in disc height and early postoperative function and quality of fusion at last follow-up. Multivariate analysis was applied to the following preoperative parameters: intervertebral angle, disc height, intervertebral mobility, sagittal balance parameters, use of osteosynthesis or not. At the olisthesic level, there was a 30% mean decrease in disc height and intervertebral angle. These variations were not correlated with functional outcome or quality of fusion observed at last follow-up. Disc height preoperatively did not affect these variations. The only factor correlated with decreased disc height was T9 sagittal tilt: disc height decreased more when T9 sagittal tilt approached 0 degrees . In this very restricted context (retrospective study, short arthrodesis for degenerative spondylolisthesis), we were unable to find any evidence supporting the notion that high disc height is an argument which should favor complementary intersomatic arthrodesis in combination with posterolateral fusion. Analysis of the spinal balance in the sagittal plane would probably allow a more pertinent assessment of the specific needs of individual patients.

Influence of intentional femoral component flexion in navigated TKA on gap balance and sagittal anatomy.

PubMed

Roßkopf, J; Singh, P K; Wolf, P; Strauch, M; Graichen, H

2014-03-01

Navigation has proven its ability to accurately restore coronal leg axis; however, for a good clinical outcome, other factors such as sagittal anatomy and balanced gaps are at least as important. In a gap-balanced technique, the size of the flexion gap is equalled to that of the extension gap. Flexion of the femoral component has been described as a theoretical possibility to balance flexion and extension gap. Aim of this study was to assess whether intentional femoral component flexion is helpful in balancing TKA gaps and in restoring sagittal anatomy. One hundred and thirty-one patients with TKA were included in this study. Implantation was performed in a navigated, gap-balanced, tibia-first technique. The femoral component flexion needed to equal flexion to extension gap was calculated based upon the navigation data. The sagittal diameter, the anterior and posterior offset were measured pre- and postoperatively based on the lateral radiographs. Medial and lateral gaps in extension and flexion as well as flexion/extension gap differences pre- and postoperatively were analysed. Additionally range of motion (ROM) and patient satisfaction (SF 12) were obtained. To achieve equal flexion and extension gap, the femoral component was flexed in 120 out of 131 patients showing mean flexion of 2.9° (SD 2.2°; navigation data) and 3.1° (SD 2.0°; radiological analysis), respectively. Based on this technique, it was possible to balance the extension gap (<2 mm difference) in 130 out of 131 patients (99%) and the flexion gap in 119 out of 131 (91%). The difference between extension and flexion gap was reduced from 39 to 24 out of 131 patients (81%) on the medial side and from 69 to 28 on the lateral side (79%). The sagittal diameter was restored in 114 out of 131 cases (87%); however, anterior offset was significantly reduced by 1.3 mm (SD 3.9°), and posterior offset was significantly increased by 1.6 mm (SD 3.3°). No correlation between any navigation and radiological parameter was found with ROM and SF 12. The navigation-based, gap-balanced technique allows intentional flexion of the femoral component in order to balance gaps in more than 90% of primary TKA cases. Simultaneously, the sagittal diameter is restored in 87% of patients. However, to achieve equal gaps, the posterior offset is significantly increased by 1.6 mm and the femoral component is flexed by 3°. To evaluate the effect of this technique on the clinical outcome, future studies are needed. II.

Fracture of fusion mass after hardware removal in patients with high sagittal imbalance.

PubMed

Sedney, Cara L; Daffner, Scott D; Stefanko, Jared J; Abdelfattah, Hesham; Emery, Sanford E; France, John C

2016-04-01

As spinal fusions become more common and more complex, so do the sequelae of these procedures, some of which remain poorly understood. The authors report on a series of patients who underwent removal of hardware after CT-proven solid fusion, confirmed by intraoperative findings. These patients later developed a spontaneous fracture of the fusion mass that was not associated with trauma. A series of such patients has not previously been described in the literature. An unfunded, retrospective review of the surgical logs of 3 fellowship-trained spine surgeons yielded 7 patients who suffered a fracture of a fusion mass after hardware removal. Adult patients from the West Virginia University Department of Orthopaedics who underwent hardware removal in the setting of adjacent-segment disease (ASD), and subsequently experienced fracture of the fusion mass through the uninstrumented segment, were studied. The medical records and radiological studies of these patients were examined for patient demographics and comorbidities, initial indication for surgery, total number of surgeries, timeline of fracture occurrence, risk factors for fracture, as well as sagittal imbalance. All 7 patients underwent hardware removal in conjunction with an extension of fusion for ASD. All had CT-proven solid fusion of their previously fused segments, which was confirmed intraoperatively. All patients had previously undergone multiple operations for a variety of indications, 4 patients were smokers, and 3 patients had osteoporosis. Spontaneous fracture of the fusion mass occurred in all patients and was not due to trauma. These fractures occurred 4 months to 4 years after hardware removal. All patients had significant sagittal imbalance of 13-15 cm. The fracture level was L-5 in 6 of the 7 patients, which was the first uninstrumented level caudal to the newly placed hardware in all 6 of these patients. Six patients underwent surgery due to this fracture. The authors present a case series of 7 patients who underwent surgery for ASD after a remote fusion. These patients later developed a fracture of the fusion mass after hardware removal from their previously successfully fused segment. All patients had a high sagittal imbalance and had previously undergone multiple spinal operations. The development of a spontaneous fracture of the fusion mass may be related to sagittal imbalance. Consideration should be given to reimplanting hardware for these patients, even across good fusions, to prevent spontaneous fracture of these areas if the sagittal imbalance is not corrected.

[COMPARISON OF EFFECTIVENESS AND CHANGE OF SAGITTAL SPINO-PELVIC PARAMETERS BETWEEN MINIMALLY INVASIVE TRANSFORAMINAL AND CONVENTIONAL OPEN POSTERIOR LUMBAR INTERBODY FUSIONS IN TREATMENT OF LOW-DEGREE ISTHMIC LUMBAR SPONDYLOLISTHESIS].

PubMed

Sun, Xin; Zeng, Rong; Li, Guangsheng; Wei, Bo; Hu, Zibing; Lin, Hao; Chen, Guanghua; Chen, Siyuan; Sun, Jiecong

2015-12-01

To compare the effectiveness and changes of sagittal spino-pelvic parameters between minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion in treatment of the low-degree isthmic lumbar spondylolisthesis. Between May 2012 and May 2013, 86 patients with single segmental isthmic lumbar spondylolisthesis (Meyerding degree I or II) were treated by minimally invasive transforaminal lumbar interbody fusion (minimally invasive group) in 39 cases, and by open posterior lumbar interbody fusion in 47 cases (open group). There was no significant difference in gender, age, disease duration, degree of lumbar spondylolisthesis, preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between 2 groups (P>0.05). The following sagittal spino-pelvic parameters were compared between 2 groups before and after operation: the percentage of slipping (PS), intervertebral height, angle of slip (AS), thoracolumbar junction (TLJ), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), spino-sacral angle (SSA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Pearson correlation analysis of the changes between pre- and post-operation was done. Primary healing of incision was obtained in all patients of 2 groups. The postoperative hospital stay of minimally invasive group [(5.1 ± 1.6) days] was significantly shorter than that of open group [(7.2 ± 2.1) days] (t = 2.593, P = 0.017). The patients were followed up 11-20 months (mean, 15 months). The reduction rate was 68.53% ± 20.52% in minimally invasive group, and was 64.21% ± 30.21% in open group, showing no significant difference (t = 0.725, P = 0.093). The back and leg pain VAS scores, and ODI at 3 months after operation were significantly reduced when compared with preoperative ones (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). The postoperative other sagittal spino-pelvic parameters were significantly improved (P < 0.05) except PI (P > 0.05), but there was no significant difference between 2 groups (P > 0.05). The correlation analysis showed that ODI value was related to the SVA, SSA, PT, and LL (P < 0.05). Both minimally invasive transforaminal lumbar interbody fusion and conventional open posterior lumbar interbody fusion can significantly improve the sagittal spino-pelvic parameters in the treatment of low-degree isthmic lumbar spondylolisthesis. The reconstruction of SVA, SSA, PT, and LL are related to the quality of life.

Lower Extremity Energy Absorption and Biomechanics During Landing, Part II: Frontal-Plane Energy Analyses and Interplanar Relationships

PubMed Central

Norcross, Marc F.; Lewek, Michael D.; Padua, Darin A.; Shultz, Sandra J.; Weinhold, Paul S.; Blackburn, J. Troy

2013-01-01

Context: Greater sagittal-plane energy absorption (EA) during the initial impact phase (INI) of landing is consistent with sagittal-plane biomechanics that likely increase anterior cruciate ligament (ACL) loading, but it does not appear to influence frontal-plane biomechanics. We do not know whether frontal-plane INI EA is related to high-risk frontal-plane biomechanics. Objective: To compare biomechanics among INI EA groups, determine if women are represented more in the high group, and evaluate interplanar INI EA relationships. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: Participants included 82 (41 men, 41 women; age = 21.0 ± 2.4 years, height = 1.74 ± 0.10 m, mass = 70.3 ± 16.1 kg) healthy, physically active volunteers. Intervention(s): We assessed landing biomechanics with an electromagnetic motion-capture system and force plate. Main Outcome Measure(s): We calculated frontal- and sagittal-plane total, hip, knee, and ankle INI EA. Total frontal-plane INI EA was used to create high, moderate, and low tertiles. Frontal-plane knee and hip kinematics, peak vertical and posterior ground reaction forces, and peak internal knee-varus moment (pKVM) were identified and compared across groups using 1-way analyses of variance. We used a χ2 analysis to evaluate male and female allocation to INI EA groups. We used simple, bivariate Pearson product moment correlations to assess interplanar INI EA relationships. Results: The high–INI EA group exhibited greater knee valgus at ground contact, hip adduction at pKVM, and peak hip adduction than the low–INI EA group (P < .05) and greater peak knee valgus, pKVM, and knee valgus at pKVM than the moderate– (P < .05) and low– (P < .05) INI EA groups. Women were more likely than men to be in the high–INI EA group (χ2 = 4.909, P = .03). Sagittal-plane knee and frontal-plane hip INI EA (r = 0.301, P = .006) and sagittal-plane and frontal-plane ankle INI EA were associated (r = 0.224, P = .04). No other interplanar INI EA relationships were found (P > .05). Conclusions: Greater frontal-plane INI EA was associated with less favorable frontal-plane biomechanics that likely result in greater ACL loading. Women were more likely than men to use greater frontal-plane INI EA. The magnitudes of sagittal- and frontal-plane INI EA were largely independent. PMID:23944381

Bilambdoid and posterior sagittal synostosis: the Mercedes Benz syndrome.

PubMed

Moore, M H; Abbott, A H; Netherway, D J; Menard, R; Hanieh, A

1998-09-01

A consistent pattern of craniosynostosis in the sagittal and bilateral lambdoid sutures is described in three patients. The external cranial ridging associated with fusion of these sutures produces a characteristic triradiate, or "Mercedes Benz," appearance to the posterior skull. Locally marked growth restriction is evident in the posterior fossa with compensatory secondary expansion of the anterior fossa manifesting a degree of frontal bossing which mimics bicoronal synostosis. Although this appearance could lead to inadvertent surgery in the frontal region, attention to the occipital region with wide early suture excision and vault shaping is indicated.

Models and Analogues for the Evaluation of Human Biodynamic Response, Performance and Protection

DTIC Science & Technology

1979-06-01

but in a point situated more ventrally . Nid-sagittal sacral curvature, length-width proportions and the height of the mid-sagittal curvature are...principal moments of che new ellipsoid are then calculated. I* , ioV- cm2 275 a:.s 1.981Iola - 82.99 225 175 125 75- 50 75 100 12S , S5 O75 Ix.,, to...along and three angulations about the three axes of the coordinate system. The complete descrip- tion of the behavior of a FSU can be obtained by

Femoral articular shape and geometry. A three-dimensional computerized analysis of the knee.

PubMed

Siu, D; Rudan, J; Wevers, H W; Griffiths, P

1996-02-01

An average, three-dimensional anatomic shape and geometry of the distal femur were generated from x-ray computed tomography data of five fresh asymptomatic cadaver knees using AutoCAD (AutoDesk, Sausalito, CA), a computer-aided design and drafting software. Each femur model was graphically repositioned to a standardized orientation using a series of alignment templates and scaled to a nominal size of 85 mm in mediolateral and 73 mm in anteroposterior dimensions. An average generic shape of the distal femur was synthesized by combining these pseudosolid models and reslicing the composite structure at different elevations using clipping and smoothing techniques in interactive computer graphics. The resulting distal femoral geometry was imported into a computer-aided manufacturing system, and anatomic prototypes of the distal femur were produced. Quantitative geometric analyses of the generic femur in the coronal and transverse planes revealed definite condylar camber (3 degrees-6 degrees) and toe-in (8 degrees-10 degrees) with an oblique patellofemoral groove (15 degrees) with respect to the mechanical axis of the femur. In the sagittal plane, each condyle could be approximated by three concatenated circular arcs (anterior, distal, and posterior) with slope continuity and a single arc for the patellofemoral groove. The results of this study may have important implications in future femoral prosthesis design and clinical applications.

Measurement accuracy of a stressed contact lens during its relaxation period

NASA Astrophysics Data System (ADS)

Compertore, David C.; Ignatovich, Filipp V.

2018-02-01

We examine the dioptric power and transmitted wavefront of a contact lens as it releases its handling stresses. Handling stresses are introduced as part of the contact lens loading process and are common across all contact lens measurement procedures and systems. The latest advances in vision correction require tighter quality control during the manufacturing of the contact lenses. The optical power of contact lenses is one of the critical characteristics for users. Power measurements are conducted in the hydrated state, where the lens is resting inside a solution-filled glass cuvette. In a typical approach, the contact lens must be subject to long settling times prior to any measurements. Alternatively, multiple measurements must be averaged. Apart from potential operator dependency of such approach, it is extremely time-consuming, and therefore it precludes higher rates of testing. Comprehensive knowledge about the settling process can be obtained by monitoring multiple parameters of the lens simultaneously. We have developed a system that combines co-aligned a Shack-Hartmann transmitted wavefront sensor and a time-domain low coherence interferometer to measure several optical and physical parameters (power, cylinder power, aberrations, center thickness, sagittal depth, and diameter) simultaneously. We monitor these parameters during the stress relaxation period and show correlations that can be used by manufacturers to devise methods for improved quality control procedures.

A comparison of the posture between young female handball players and non-training peers.

PubMed

Grabara, Małgorzata

2014-01-01

To evaluate and compare the posture in young female handball players and a group of non-training peers. 125 handball players and 135 non-training individuals as a control group. All the subjects were aged 12-15. Measurements of basic somatic parameters (body height and mass, BMI, fat mass and total body water) were taken with an electronic balance 'Tanita'. The posture was evaluated using the moiré method. We analysed the shape of the spine in the sagittal plane and the position of the spine, pelvis and shoulder girdle in terms of symmetry. In 13-year-old handball players there was a smaller inclination of the thoracolumbar segment and a greater forward tilt of the torso. Among the training 15-year-olds, the inclination of the lower back, the sum of angles of anteroposterior curvatures and the angle of lumbar lordosis were smaller than in their non-training peers. Moreover, a correct pelvic alignment in the frontal plane, and pelvis and scapulas asymmetries in the transverse plane were more common in handball players. The formation of anteroposterior curvatures of the spine diversified some of the age groups of training and non-training young females. Handball training can affect the quality of posture.

Anatomical Calibration through Post-Processing of Standard Motion Tests Data.

PubMed

Kong, Weisheng; Sessa, Salvatore; Zecca, Massimiliano; Takanishi, Atsuo

2016-11-28

The inertial measurement unit is popularly used as a wearable and flexible tool for human motion tracking. Sensor-to-body alignment, or anatomical calibration (AC), is fundamental to improve accuracy and reliability. Current AC methods either require extra movements or are limited to specific joints. In this research, the authors propose a novel method to achieve AC from standard motion tests (such as walking, or sit-to-stand), and compare the results with the AC obtained from specially designed movements. The proposed method uses the limited acceleration range on medial-lateral direction, and applies principal component analysis to estimate the sagittal plane, while the vertical direction is estimated from acceleration during quiet stance. The results show a good correlation between the two sets of IMUs placed on frontal/back and lateral sides of head, trunk and lower limbs. Moreover, repeatability and convergence were verified. The AC obtained from sit-to-stand and walking achieved similar results as the movements specifically designed for upper and lower body AC, respectively, except for the feet. Therefore, the experiments without AC performed can be recovered through post-processing on the walking and sit-to-stand data. Moreover, extra movements for AC can be avoided during the experiment and instead achieved through the proposed method.

Unstable upper and middle thoracic fractures. Preliminary experience with a posterior transpedicular correction-fixation technique.

PubMed

Payer, M

2005-06-01

A number of conservative and operative approaches have been described for the treatment of unstable traumatic upper and middle thoracic fractures. The advantage of surgical correction and fixation/fusion lies in its potential to restore sagittal and coronal alignment, thereby indirectly decompressing the spinal cord. A consecutive series of 8 patients with unstable traumatic upper and middle thoracic fractures is reviewed. In all patients, polyaxial pedicle screws were inserted bilaterally into the two levels above and below the fracture. Rods that were less contoured ("undercontoured") than the regional hyperkyphosis at the injured level, were anchored to the caudal four screws. The cranial four screws, with the vertebrae to which they were inserted, were then progressively pulled posteriorly onto the undercontoured rods with rod reducers, thus correcting the hyperkyphosis and anterolisthesis. The mean follow-up was 15 months. The mean regional kyphosis was 23 degrees preoperatively, 17 degrees postoperatively and 18 degrees at follow-up. The mean anterolisthesis was 8 mm preoperatively, 1 mm postoperatively and 1 mm at follow-up. No hardware failure occurred. Five patients with complete spinal cord injury at presentation made no neurological recovery, two patients with incomplete spinal cord injury initially (ASIA B), recovered substantially (to ASIA D), and the patients who were neurologically intact at presentation remained so.

Gaze and viewing angle influence visual stabilization of upright posture

PubMed Central

Ustinova, KI; Perkins, J

2011-01-01

Focusing gaze on a target helps stabilize upright posture. We investigated how this visual stabilization can be affected by observing a target presented under different gaze and viewing angles. In a series of 10-second trials, participants (N = 20, 29.3 ± 9 years of age) stood on a force plate and fixed their gaze on a figure presented on a screen at a distance of 1 m. The figure changed position (gaze angle: eye level (0°), 25° up or down), vertical body orientation (viewing angle: at eye level but rotated 25° as if leaning toward or away from the participant), or both (gaze and viewing angle: 25° up or down with the rotation equivalent of a natural visual perspective). Amplitude of participants’ sagittal displacement, surface area, and angular position of the center of gravity (COG) were compared. Results showed decreased COG velocity and amplitude for up and down gaze angles. Changes in viewing angles resulted in altered body alignment and increased amplitude of COG displacement. No significant changes in postural stability were observed when both gaze and viewing angles were altered. Results suggest that both the gaze angle and viewing perspective may be essential variables of the visuomotor system modulating postural responses. PMID:22398978

Intra-observer reproducibility and interobserver reliability of the radiographic parameters in the Spinal Deformity Study Group's AIS Radiographic Measurement Manual.

PubMed

Dang, Natasha Radhika; Moreau, Marc J; Hill, Douglas L; Mahood, James K; Raso, James

2005-05-01

Retrospective cross-sectional assessment of the reproducibility and reliability of radiographic parameters. To measure the intra-examiner and interexaminer reproducibility and reliability of salient radiographic features. The management and treatment of adolescent idiopathic scoliosis (AIS) depends on accurate and reproducible radiographic measurements of the deformity. Ten sets of radiographs were randomly selected from a sample of patients with AIS, with initial curves between 20 degrees and 45 degrees. Fourteen measures of the deformity were measured from posteroanterior and lateral radiographs by 2 examiners, and were repeated 5 times at intervals of 3-5 days. Intra-examiner and interexaminer differences were examined. The parameters include measures of curve size, spinal imbalance, sagittal kyphosis and alignment, maximum apical vertebral rotation, T1 tilt, spondylolysis/spondylolisthesis, and skeletal age. Intra-examiner reproducibility was generally excellent for parameters measured from the posteroanterior radiographs but only fair to good for parameters from the lateral radiographs, in which some landmarks were not clearly visible. Of the 13 parameters observed, 7 had excellent interobserver reliability. The measurements from the lateral radiograph were less reproducible and reliable and, thus, may not add value to the assessment of AIS. Taking additional measures encourages a systematic and comprehensive assessment of spinal radiographs.

Knee Kinematics is Altered Post-Fatigue While Performing a Crossover Task

PubMed Central

Cortes, Nelson; Greska, Eric; Ambegaonkar, Jatin P.; Kollock, Roger O.; Caswell, Shane V.; Onate, James A.

2013-01-01

Purpose To examine the effect of a sequential fatigue protocol on lower extremity biomechanics during a crossover cutting task in female soccer players. Methods Eighteen female collegiate soccer players alternated between a fatigue protocol and two consecutive unanticipated crossover trials until fatigue was reached. Lower extremity biomechanics were evaluated during the crossover using a 3D motion capture system and two force plates. Repeated measures ANOVAs analyzed differences between three sequential stages of fatigue (pre, 50%, 100%) for each dependent variable (α=0.05). Results Knee flexion angles at initial contact (IC) for pre- (−32±9°) and 50% (−29±11°) were significantly higher than at 100% fatigue (−22±9°) (p<0.001 and p=0.015, respectively). Knee adduction angles at IC for pre- (9±5°) and 50% (8±4°) were significantly higher (p=0.006 and p=0.049, respectively) than at 100% fatigue (6±4°). Conclusions Fatigue altered sagittal and frontal knee kinematics after 50% fatigue whereupon participants had diminished knee control at initial contact. Interventions should attempt to reduce the negative effects of fatigue on lower extremity biomechanics by promotion appropriate frontal plane alignment, and increased knee flexion during fatigue status. PMID:24045915

Orthodontic-surgical retreatment of facial asymmetry with occlusal cant and severe root resorption: A 3-year follow-up.

PubMed

Lisboa, Cinthia de Oliveira; Borges, Marlon Sampaio; Medeiros, Paulo José D'Albuquerque; Motta, Alexandre Trindade; Mucha, José Nelson

2017-08-01

Our objective was to report the orthodontic and surgical retreatment of a patient who had undergone a prolonged orthodontic treatment with extractions, but who had unsatisfactory results and persistent side effects. The man, aged 25 years 3 months, sought treatment with major complaints of facial and smile asymmetries. The clinical examination showed a mandibular deviation to the right and a maxillary occlusal cant. A Class II Division 1 subdivision right was observed. Radiographic examination showed extensive root resorptions in the maxillary second premolars and absence of the 4 first premolars. The maxillary midline was deflected 2 mm to the left, and the mandibular midline was shifted 5 mm to the right. Aligning and leveling were performed with orthodontic fixed appliances, with a standard edgewise system (0.022 × 0.028 in), followed by LeFort I maxillary impaction and bilateral sagittal split osteotomy with asymmetrical advancement. Retreatment showed outstanding results that remained stable after 3 years of follow-up. Root resorption in the second premolars did not seem to increase. Orthodontic-surgical intervention is the main choice for correcting esthetic and functional problems in facial asymmetry, particularly in cases of retreatment. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Pregnancy-associated osteoporosis with eight fractures in the vertebral column treated with kyphoplasty and bracing: a case report.

PubMed

Bonacker, J; Janousek, M; Kröber, M

2014-02-01

Pregnancy-associated osteoporosis is a rare condition, which imposes multiple symptoms in the musculoskeletal system. Common complaints announced by patients are severe pain in the lower back, hips and the joints of the lower extremities with a reduced and less mobility status in general. Most of the patients' problems occur in the last trimester of pregnancy or postpartum and are often not diagnosed as side effects of osteoporosis but as problems associated with pregnancy. Although vertebral fractures are rare complications of pregnancy-associated osteoporosis, they should be always considered in women presenting with an acute pain syndrome in peripregnancy period. This case presents a 40-year-old primagravid woman who developed pain in hips and severe pain in the lower back causing an immobilization diagnosed with a pregnancy-associated osteoporosis with eight compression fractures in the thoracic and lumbar spine. Because of sagittal imbalance of the spine, she was treated with kyphoplasty at the four lumbar fractures and with bracing for the upper, thoracic ones, additional to the conservative anti-osteoporotic therapy. The authors discuss pregnancy-associated osteoporosis and its clinical presentation, as well as the indications of kyphoplasty, spinal alignment and the risk of single conservative treatment.

Influence of medial parapatellar nail insertion on alignment in proximal tibia fractures--special consideration of the fracture level.

PubMed

Weninger, Patrick; Tschabitscher, Manfred; Traxler, Hannes; Pfafl, Veronika; Hertz, Harald

2010-04-01

Although a lateral starting point for tibial nailing is recommended to avoid valgus misalignment, higher rates of intra-articular damage were described compared with a medial parapatellar approach. The aim of this anatomic study was to evaluate the fracture level allowing for a safe medial nail entry point without misalignment or dislocation of fragments. Thirty-two fresh-frozen cadaver lower extremities were used to create 1-cm osteotomies at four different levels (n = 8) from 2 cm to 8 cm below the tibial tuberosity. Nine-millimeter unreamed solid titanium tibial nails (Connex, I.T.S. Spectromed, Lassnitzhohe, Austria) were inserted from a medial parapatellar incision. Misalignment (degree) and dislocation of the distal fragment were measured in the frontal and sagittal plane. A medial parapatellar approach for tibial nail insertion mainly caused valgus and anterior bow misalignment and ventral and medial fragment displacement. Mean misalignment and fragment displacement did not exceed 0.5 degree if the osteotomy was performed 8 cm to 9 cm below the tibial tuberosity. According to the results of this study, a medial parapatellar approach can be performed without misalignment and fragment dislocation in proximal tibia fractures extending 8 cm or more below the tibial tuberosity.

An in vivo comparison study in goats for a novel motion-preserving cervical joint system

PubMed Central

Qin, Jie; Zhao, Chenguang; Wang, Dong; Zhao, Bo; Dong, Jun; Li, Haopeng; Sang, Rongxia; Wang, Shuang; Fu, Jiao; Kong, Rangrang

2017-01-01

Cervical degenerative disease is one of the most common spinal disorders worldwide, especially in older people. Anterior cervical corpectomy and fusion (ACCF) is a useful method for the surgical treatment of multi-level cervical degenerative disease. Anterior cervical disc replacement (ACDR) is considered as an alternative surgical method. However, both methods have drawbacks, particularly the neck motion decrease observed after arthrodesis, and arthroplasty should only be performed on patients presenting with cervical disc disease but without any vertebral body disease. Therefore, we designed a non-fusion cervical joint system, namely an artificial cervical vertebra and intervertebral complex (ACVC), to provide a novel treatment for multi-level cervical degenerative disease. To enhance the long-term stability of ACVC, we applied a hydroxyapatite (HA) biocoating on the surface of the artificial joint. Thirty-two goats were randomly divided into four groups: a sham control group, an ACVC group, an ACVC-HA group, and an ACCF group (titanium and plate fixation group). We performed the prosthesis implantation in our previously established goat model. We compared the clinical, radiological, biomechanical, and histological outcomes among these four different groups for 24 weeks post surgery. The goats successfully tolerated the entire experimental procedure. The kinematics data for the ACVC and ACVC-HA groups were similar. The range of motion (ROM) in adjacent level increased after ACCF but was not altered after ACVC or ACVC-HA implantation. Compared with the control group, no significant difference was found in ROM and neutral zone (NZ) in flexion-extension or lateral bending for the ACVC and ACVC-HA groups, whereas the ROM and NZ in rotation were significantly greater. Compared with the ACCF group, the ROM and NZ significantly increased in all directions. Overall, stiffness was significantly decreased in the ACVC and ACVC-HA groups compared with the control group and the ACCF group. Similar results were found after a fatigue test of 5,000 repetitions of axial rotation. The histological results showed more new bone formation and better bone implant contact in the ACVC-HA group than the ACVC group. Goat is an excellent animal model for cervical spine biomechanical study. Compared with the intact state and the ACCF group, ACVC could provide immediate stability and preserve segmental movement after discectomy and corpectomy. Besides, HA biocoating provide a better bone ingrowth, which is essential for long-term stability. In conclusion, ACVC-HA brings new insight to treat cervical degenerative disease. PMID:28582418