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

The value of radiographs obtained during forced traction under general anaesthesia in predicting flexibility in idiopathic scoliosis with Cobb angles exceeding 60 degree.

PubMed

Ibrahim, T; Gabbar, O A; El-Abed, K; Hutchinson, M J; Nelson, I W

2008-11-01

Our aim in this prospective radiological study was to determine whether the flexibility rate calculated from radiographs obtained during forced traction under general anaesthesia, was better than that of fulcrum-bending radiographs before corrective surgery in predicting the extent of the available correction in patients with idiopathic scoliosis. We evaluated 33 patients with a Cobb angle > 60 degrees on a standing posteroanterior radiograph, who had been treated by posterior correction. Pre-operative standing fulcrum-bending radiographs and those with forced-traction under general anaesthesia were obtained. Post-operative standing radiographs were taken after surgical correction. The mean forced-traction flexibility rate was 55% (SD 11.3) which was significantly higher than the mean fulcrum-bending flexibility rate of 32% (SD 16.1) (p < 0.001). We found no correlation between either the forced-traction or fulcrum-bending flexibility rates and the correction rate post-operatively (p = 0.24 and p = 0.44, respectively). Radiographs obtained during forced traction under general anaesthesia were better at predicting the flexibility of the curve than fulcrum-bending radiographs in curves with a Cobb angle > 60 degrees in the standing position and may identify those patients for whom supplementary anterior surgery can be avoided.

Annual changes in radiographic indices of the spine in cerebral palsy patients.

PubMed

Lee, Seung Yeol; Chung, Chin Youb; Lee, Kyoung Min; Kwon, Soon-Sun; Cho, Kyu-Jung; Park, Moon Seok

2016-03-01

We estimated the annual changes in radiographic indices of the spine in cerebral palsy (CP) patients and analyzed the factors that influence its progression rate. We included CP patients who had undergone whole-spine radiography more than twice and were followed for at least 1 year. The scoliosis Cobb angle, coronal balance, apical vertebral translation, apical rotation, and pelvic obliquity were measured on anteroposterior (AP) radiographs; thoracic kyphosis and lumbar lordosis angles, and sagittal balance was measured on lateral radiographs; and migration percentage was measured on AP hip radiographs to determine hip instability. For each gross motor function classification system (GMFCS) level, the Cobb angles, apical vertebral translation, coronal and sagittal balance, and pelvic obliquity were adjusted by multiple factors with a linear mixed model. A total of 184 patients (774 radiographs) were included in this study. There was no significant annual change in scoliosis Cobb, thoracic kyphosis, and lumbar lordosis angles in the GMFCS level I-II and III groups. In the GMFCS level IV-V group, there was an annual increase of 3.4° in the scoliosis Cobb angle (p = 0.020). The thoracic kyphosis angle increased by 2.2° (p = 0.018) annually in the GMFCS level IV-V group. Apical vertebral translation increased by 5.4 mm (p = 0.029) annually in the GMFCS level IV-V group. Progression of coronal and sagittal balance and pelvic obliquity with aging were not statistically significant. Sex, hip instability, hip surgery, and triradiate cartilage did not affect the progression of scoliosis and the balance of the spine and pelvis. The scoliosis Cobb angle, thoracic kyphosis angle, and apical vertebral translation in the GMFCS level IV-V CP patients progressed with age. These findings can predict radiographic progression of scoliosis in CP patients.

Correlation and Reliability of Cervical Sagittal Alignment Parameters between Lateral Cervical Radiograph and Lateral Whole-Body EOS Stereoradiograph.

PubMed

Singhatanadgige, Weerasak; Kang, Daniel G; Luksanapruksa, Panya; Peters, Colleen; Riew, K Daniel

2016-09-01

Retrospective analysis. To evaluate the correlation and reliability of cervical sagittal alignment parameters obtained from lateral cervical radiographs (XRs) compared with lateral whole-body stereoradiographs (SRs). We evaluated adults with cervical deformity using both lateral XRs and lateral SRs obtained within 1 week of each other between 2010 and 2014. XR and SR images were measured by two independent spine surgeons using the following sagittal alignment parameters: C2-C7 sagittal Cobb angle (SCA), C2-C7 sagittal vertical axis (SVA), C1-C7 translational distance (C1-7), T1 slope (T1-S), neck tilt (NT), and thoracic inlet angle (TIA). Pearson correlation and paired t test were used for statistical analysis, with intra- and interrater reliability analyzed using intraclass correlation coefficient (ICC). A total of 35 patients were included in the study. We found excellent intrarater reliability for all sagittal alignment parameters in both the XR and SR groups with ICC ranging from 0.799 to 0.994 for XR and 0.791 to 0.995 for SR. Interrater reliability was also excellent for all parameters except NT and TIA, which had fair reliability. We also found excellent correlations between XR and SR measurements for most sagittal alignment parameters; SCA, SVA, and C1-C7 had r > 0.90, and only NT had r < 0.70. There was a significant difference between groups, with SR having lower measurements compared with XR for both SVA (0.68 cm lower, p < 0.001) and C1-C7 (1.02 cm lower, p < 0.001). There were no differences between groups for SCA, T1-S, NT, and TIA. Whole-body stereoradiography appears to be a viable alternative for measuring cervical sagittal alignment parameters compared with standard radiography. XR and SR demonstrated excellent correlation for most sagittal alignment parameters except NT. However, SR had significantly lower average SVA and C1-C7 measurements than XR. The lower radiation exposure using single SR has to be weighed against its

Characteristics of pedicle screw loading. Effect of sagittal insertion angle on intrapedicular bending moments.

PubMed

Youssef, J A; McKinley, T O; Yerby, S A; McLain, R F

1999-06-01

A bending analysis of pedicle screws inserted into vertebral body analogues. Intravertebral and intrapedicular pedicle screw bending moments were studied as a function of sagittal insertion angle. To determine how the pedicle screw bending moment is affected by changes in the insertion angle. There is a significant incidence of failure when pedicle screws are used to instrument unstable spinal segments. Extrinsic factors that affect screw bending failure have been poorly characterized. Previous work has demonstrated that intrapedicular pedicle screw bending moments are significantly affected by the sagittal location and depth of pedicle screw placement. Pedicle screw transducers were inserted in analogue vertebrae at one of three orientations: 7 degrees cephalad (toward the superior endplate), 7 degrees caudal (toward the inferior endplate), or parallel to the superior endplate (control). An axial load was applied to the superior endplate of the vertebra, and screw bending moments were recorded directly from the transducers. Screws angled 7 degrees cephalad developed significantly greater mean intrapedicular bending moments compared with screws inserted caudal or control screws. There was no significant difference in bending moments realized within the vertebral body for the three screw positions. Angulating pedicle screws toward the superior endplate increased bending moments within the pedicle. If attention to optimal screw insertion technique can reduce bending moments and potential for screw failure without increasing morbidity, surgical risk, or operative time, then proper insertion technique takes on new importance.

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.

Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections.

PubMed

Kim, Han Jo; Bridwell, Keith H; Lenke, Lawrence G; Park, Moon Soo; Song, Kwang Sup; Piyaskulkaew, Chaiwat; Chuntarapas, Tapanut

2014-04-20

Case control study. To evaluate risk factors in patients in 3 groups: those without proximal junctional kyphosis (PJK) (N), with PJK but not requiring revision (P), and then those with PJK requiring revision surgery (S). It is becoming clear that some patients maintain stable PJK angles, whereas others progress and develop severe PJK necessitating revision surgery. A total of 206 patients at a single institution from 2002 to 2007 with adult scoliosis with 2-year minimum follow-up (average 3.5 yr) were analyzed. Inclusion criteria were age more than 18 years and primary fusions greater than 5 levels from any thoracic upper instrumented vertebra to any lower instrumented vertebrae. Revisions were excluded. Radiographical assessment included Cobb measurements in the coronal/sagittal plane and measurements of the PJK angle at postoperative time points: 1 to 2 months, 2 years, and final follow-up. PJK was defined as an angle greater than 10°. The prevalence of PJK was 34%. The average age in N was 49.9 vs. 51.3 years in P and 60.1 years in S. Sex, body mass index, and smoking status were not significantly different between groups. Fusions extending to the pelvis were 74%, 85%, and 91% of the cases in groups N, P, and S. Instrumentation type was significantly different between groups N and S, with a higher number of upper instrumented vertebra hooks in group N. Radiographical parameters demonstrated a higher postoperative lumbar lordosis and a larger sagittal balance change, with surgery in those with PJK requiring revision surgery. Scoliosis Research Society postoperative pain scores were inferior in group N vs. P and S, and Oswestry Disability Index scores were similar between all groups. Patients with PJK requiring revision were older, had higher postoperative lumbar lordosis, and larger sagittal balance corrections than patients without PJK. Based on these data, it seems as though older patients with large corrections in their lumbar lordosis and sagittal balance

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�

33 CFR 208.27 - Fort Cobb Dam and Reservoir, Pond (Cobb) Creek, Oklahoma.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., flows shall not exceed a 13.0-foot stage (1,300 cfs) on the USGS gage on Pond (Cobb) Creek near Fort Cobb, Oklahoma, river mile 5.0; a 19.0-foot stage (6,000 cfs) on the USGS gage on the Washita River...

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

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.

Response to Tom Cobb

ERIC Educational Resources Information Center

Nation, Paul

2016-01-01

In this article Paul Nation responds to Thomas Cobb's "Numbers or Numerology? A Response to Nation (2014) and McQuillan (2016)" (EJ1117024). Nation begins by clarifying his own position on vocabulary learning and goes on to highlight points made in Cobb's article with which he is in agreement, while drawing from his 2014 article,…

33 CFR 208.27 - Fort Cobb Dam and Reservoir, Pond (Cobb) Creek, Oklahoma.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Engineer showing the elevation of the reservoir level; number of river outlet works gates in operation with... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Fort Cobb Dam and Reservoir, Pond..., DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE FLOOD CONTROL REGULATIONS § 208.27 Fort Cobb Dam and Reservoir...

33 CFR 208.27 - Fort Cobb Dam and Reservoir, Pond (Cobb) Creek, Oklahoma.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Engineer showing the elevation of the reservoir level; number of river outlet works gates in operation with... 33 Navigation and Navigable Waters 3 2011-07-01 2011-07-01 false Fort Cobb Dam and Reservoir, Pond..., DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE FLOOD CONTROL REGULATIONS § 208.27 Fort Cobb Dam and Reservoir...

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.

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

Efficacy of nighttime brace in preventing progression of idiopathic scoliosis of less than 25°.

PubMed

Lateur, G; Grobost, P; Gerbelot, J; Eid, A; Griffet, J; Courvoisier, A

2017-04-01

The objective of the present study was to assess, at skeletal maturity, the efficacy of non-operative treatment by isolated nighttime brace in the prevention of progression of progressive idiopathic scoliosis of less than 25°. Isolated nighttime brace treatment is effective in the prevention of progression of mild progressive idiopathic scoliosis (Cobb<25°). A single-center retrospective study included 142 patients managed by nighttime brace for progressive idiopathic scoliosis with Cobb angle<25°, with assessment at skeletal maturity. Mean Cobb angle at start of treatment was 15.5° (range, 10-25°). Mean values for Cobb angle and sagittal parameters before treatment and at skeletal maturity were compared on Student t-test. Change in Cobb angle over time was also analyzed. Mean Cobb angle at skeletal maturity was 16.3°, showing significant increase over baseline (15.5°; P=0.04), although the difference was less than the uncertainty of measurement (±6°). In baseline Risser 0 or 1, mean change in Cobb angle at skeletal maturity (16.2°) was not significant (P=0.1). Cobb angle diminished in 26 cases (18%), increased in 24 (17%) and was unchanged in 92 (65%). The present study confirmed the efficacy of non-operative treatment by nighttime brace in mild progressive idiopathic scoliosis (<25°) in a large majority of cases. A nighttime brace thus seems to be an effective option for the treatment of adolescent scoliosis, ensuring a safe curve of around 20°. Level IV, retrospective study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Lumbar Spine Musculoskeletal Physiology and Biomechanics During Simulated Military Operations

DTIC Science & Technology

2015-06-01

decreases at a ll l eve l s except L1L2 when s i tting . Even anteri or/posteri or d i stri but i on o f l oad maintains whole lumbar lordosis as load...more forward. Data shown is mean ± STD. Figure 4. Cobb angle was measured in each position to assess lumbar lordosis . A.) Sagittal Cobb angle is...c C/)..C C) 0 () -(/) (!) !.... (!) .Q 0, !.... (!) ~Ŕ c- =<D ro-.....,e> :!:C O><( ro..c Cl)..c 0 () Lordosis Kyphosis endplate

Factors favoring regain of the lost vertical spinal height through posterior spinal fusion in adolescent idiopathic scoliosis.

PubMed

Shi, Benlong; Mao, Saihu; Xu, Leilei; Sun, Xu; Liu, Zhen; Zhu, Zezhang; Lam, Tsz Ping; Cheng, Jack Cy; Ng, Bobby; Qiu, Yong

2016-07-04

Height gain is a common beneficial consequence following correction surgery in adolescent idiopathic scoliosis (AIS), yet little is known concerning factors favoring regain of the lost vertical spinal height (SH) through posterior spinal fusion. A consecutive series of AIS patients from February 2013 to August 2015 were reviewed. Surgical changes in SH (ΔSH), as well as the multiple coronal and sagittal deformity parameters were measured and correlated. Factors associated with ΔSH were identified through Pearson correlation analysis and multivariate regression analysis. A total of 172 single curve and 104 double curve patients were reviewed. The ΔSH averaged 2.5 ± 0.9 cm in single curve group and 2.9 ± 1.0 cm in double curve group. The multivariate regression analysis revealed the following pre-operative variables contributed significantly to ΔSH: pre-op Cobb angle, pre-op TK (single curve group only), pre-op GK (double curve group only) and pre-op LL (double curve group only) (p < 0.05). Thus change in height (in cm) = 0.044 × (pre-op Cobb angle) + 0.012 × (pre-op TK) (Single curve, adjusted R(2) = 0.549) or 0.923 + 0.021 × (pre-op Cobb angle1) + 0.028 × (pre-op Cobb angle2) + 0.015 × (pre-op GK)-0.012 × (pre-op LL) (Double curve, adjusted R(2) = 0.563). Severer pre-operative coronal Cobb angle and greater sagittal curves were beneficial factors favoring more contribution to the surgical lengthening effect in vertical spinal height in AIS.

Central Sagittal Angle of the Sacrum as a New Risk Factor for Patients with Persistent Low Back Pain after Caesarean Section

PubMed Central

Kazdal, Hizir; Batcik, Osman Ersagun; Ozdemir, Bulent; Senturk, Senol; Yildirim, Murat; Kazancioglu, Leyla; Sen, Ahmet; Batcik, Sule; Balik, Mehmet Sabri

2017-01-01

Study Design Retrospective. Purpose This study investigated the possible association of persistent low back pain (LBP) with caesarean section (CS) under spinal anesthesia. Overview of Literature Many women suffer from LBP after CS, which is commonly performed under spinal anesthesia. However, this type of LBP is poorly understood, and there is poor consensus regarding increased risk after spinal anesthesia. Methods We examined two groups of patients who underwent cesarean delivery under spinal anesthesia. Group I included patients who presented to a neurosurgical clinic complaining of LBP for at least 6 months. Group II was a control group with patients without LBP. We analyzed clinical and sagittal angle parameters, including age, body mass index, parity, central sagittal angle of the sacrum (CSAS), and sacral slope (SS). Results Fifty-three patients participated in this study: 23 (43.1%) in Group I and 30 (56.9%) in Group II. Non-parametric Mann–Whitney U-tests showed that age, parity, and CSAS significantly differed between the two groups at 6 months. Conclusions Age, parity, and CSAS appear to be associated with increased risk for LBP after CS under spinal anesthesia. Future prospective studies on this subject may help validate our results. PMID:29093782

Quantification of shoulder and elbow passive moments in the sagittal plane as a function of adjacent angle fixations.

PubMed

Kodek, Timotej; Munih, Marko

2003-01-01

The goal of this study was an assessment of the shoulder and elbow joint passive moments in the sagittal plane for six healthy individuals. Either the shoulder or elbow joints were moved at a constant speed, very slowly throughout a large portion of their range by means of an industrial robot. During the whole process the arm was held fully passively, while the end point force data and the shoulder, elbow and wrist angle data were collected. The presented method unequivocally reveals a large passive moment adjacent angle dependency in the central angular range, where most everyday actions are performed. It is expected to prove useful in the future work when examining subjects with neuromuscular disorders. Their passive moments may show a fully different pattern than the ones obtained in this study.

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.

Reproducibility and repeatability of a new computerized software for sagittal spinopelvic and scoliosis curvature radiologic measurements: Keops(®).

PubMed

Maillot, C; Ferrero, E; Fort, D; Heyberger, C; Le Huec, J-C

2015-07-01

The purpose of this study was to evaluate the inter- and intra-observer variability of the computerized radiologic measurements using Keops(®) and to determine the bias between the software and the standard paper measurement. Four individuals measured all frontal and sagittal variables on the 30 X-rays randomly selected on two occasions (test and retest conditions). The Bland-Altman plot was used to determine the degree of agreement between the measurement on paper X-ray and the measurement using Keops(®) for all reviewers and for the two measures; the intraclass correlation coefficient (ICC) was calculated for each pair of analyses to assess interobserver reproducibility among the four reviewers for the same patient using either paper X-ray or Keops(®) measurement and finally, concordance correlation coefficient (rc) was calculated to assess intraobserver repeatability among the same reviewer for one patient between the two measure using the same method (paper or Keops(®)). The mean difference calculated between the two methods was minimal at -0, 4° ± 3.41° [-7.1; 6.4] for frontal measurement and 0.1° ± 3.52° [-6.7; 6.8] for sagittal measurement. Keops(®) has a better interobserver reproducibility than paper measurement for determination of the sagittal pelvic parameter (ICC = 0.9960 vs. 0.9931; p = 0.0001). It has a better intraobserver repeatability than paper for determination of Cobbs angle (rc = 0.9872 vs. 0.9808; p < 0.0001) and for pelvic parameter (rc = 0.9981 vs. 0.9953; p < 0.0001). We conclude that Keops(®) has no bias compared to the traditionally paper measurement, and moreover, the repeatability and the reproducibility of measurements with this method is much better than with similar standard radiologic measures done manually in both frontal and sagittal plane and that the use of this software can be recommended for clinical application. Diagnostic, level III.

Establishment of norms of the beta angle to assess the sagittal discrepancy for Nellore district population

PubMed Central

Prasad, Mandava; Reddy, Karnati Praveen Kumar; Talapaneni, Ashok Kumar; Chaitanya, Nellore; Bhaskar Reddy, Myla Vijay; Patil, Rajendra

2013-01-01

Background and Objectives: In orthodontic diagnosis and treatment planning, assessment of anteroposterior discrepancy is of importance to the orthodontist. Both angular and linear measurements have been incorporated into various cephalometric analyses to help the clinician diagnose anteroposterior discrepancies and establish the most appropriate treatment plan. Hence the present study is designed to establish the norms of Beta angle to assess the sagittal discrepancy for Nellore district population. Materials and Methods: The sample was screened from the old records of the Orthodontic department of Narayana Dental College and Hospital. One hundred and fifty pretreatment cephalometric radiographs (50 each of Class I, II, and III) were subdivided based on ANB, Wits appraisal, and Beta angle into skeletal Class I, II, III. The same cephalograms were again classified into skeletal Class I, II, and III based purely on Beta angle. Each group was again divided into 2 subgroups consisting of 25 male and 25 female subjects with a mean age limit between 15 and 45 years old. Results: The Newman-keuls post hoc test and ANOVA showed that the 3 groups were significantly different (P ≤ 0.001). The Newman-keuls post hoc test also found the groups to be significantly different. Conclusions: There was statistically significant difference for, the mean values and the standard deviation for Beta angle within the three skeletal patterns (Class I, Class II and Class III skeletal patterns). There was no statistically significant difference among the mean values of beta angle between Nellore district population and Caucasian norms and between male and female sex groups. PMID:24082742

Agreement between fiber optic and optoelectronic systems for quantifying sagittal plane spinal curvature in sitting.

PubMed

Cloud, Beth A; Zhao, Kristin D; Breighner, Ryan; Giambini, Hugo; An, Kai-Nan

2014-07-01

Spinal posture affects how individuals function from a manual wheelchair. There is a need to directly quantify spinal posture in this population to ultimately improve function. A fiber optic system, comprised of an attached series of sensors, is promising for measuring large regions of the spine in individuals sitting in a wheelchair. The purpose of this study was to determine the agreement between fiber optic and optoelectronic systems for measuring spinal curvature, and describe the range of sagittal plane spinal curvatures in natural sitting. Able-bodied adults (n = 26, 13 male) participated. Each participant assumed three sitting postures: natural, slouched (accentuated kyphosis), and extension (accentuated lordosis) sitting. Fiber optic (ShapeTape) and optoelectronic (Optotrak) systems were applied to the skin over spinous processes from S1 to C7 and used to measure sagittal plane spinal curvature. Regions of kyphosis and lordosis were identified. A Cobb angle-like method was used to quantify lordosis and kyphosis. Generalized linear model and Bland-Altman analyses were used to assess agreement. A strong correlation exists between curvature values obtained with Optotrak and ShapeTape (R(2) = 0.98). The mean difference between Optotrak and ShapeTape for kyphosis in natural, extension, and slouched postures was 4.30° (95% LOA: -3.43 to 12.04°), 3.64° (95% LOA: -1.07 to 8.36°), and 4.02° (95% LOA: -2.80 to 10.84°), respectively. The mean difference for lordosis, when present, in natural and extension postures was 2.86° (95% LOA: -1.18 to 6.90°) and 2.55° (95% LOA: -3.38 to 8.48°), respectively. In natural sitting, the mean ± SD of kyphosis values was 35.07 ± 6.75°. Lordosis was detected in 8/26 participants: 11.72 ± 7.32°. The fiber optic and optoelectronic systems demonstrate acceptable agreement for measuring sagittal plane thoracolumbar spinal curvature. Copyright © 2014 Elsevier B.V. All rights reserved.

Agreement between Fiber Optic and Optoelectronic Systems for Quantifying Sagittal Plane Spinal Curvature in Sitting

PubMed Central

Cloud, Beth A.; Zhao, Kristin D.; Breighner, Ryan; Giambini, Hugo; An, Kai-Nan

2014-01-01

Spinal posture affects how individuals function from a manual wheelchair. There is a need to directly quantify spinal posture in this population to ultimately improve function. A fiber optic system, comprised of an attached series of sensors, is promising for measuring large regions of the spine in individuals sitting in a wheelchair. The purpose of this study was to determine the agreement between fiber optic and optoelectronic systems for measuring spinal curvature, and describe the range of sagittal plane spinal curvatures in natural sitting. Able-bodied adults (n=26, 13 male) participated. Each participant assumed three sitting postures: natural, slouched (accentuated kyphosis), and extension (accentuated lordosis) sitting. Fiber optic (ShapeTape) and optoelectronic (Optotrak) systems were applied to the skin over spinous processes from S1 to C7 and used to measure sagittal plane spinal curvature. Regions of kyphosis and lordosis were identified. A Cobb angle-like method was used to quantify lordosis and kyphosis. Generalized linear model and Bland-Altman analyses were used to assess agreement. A strong correlation exists between curvature values obtained with Optotrak and ShapeTape (R2=0.98). The mean difference between Optotrak and ShapeTape for kyphosis in natural, extension, and slouched postures was 4.30° (95%LOA: −3.43-12.04°), 3.64° (95%LOA: −1.07-8.36°), and 4.02° (95%LOA: −2.80-10.84°), respectively. The mean difference for lordosis, when present, in natural and extension postures is 2.86° (95%LOA: −1.18-6.90°) and 2.55° (95%LOA: −3.38-8.48°), respectively. In natural sitting, the mean±SD of kyphosis values was 35.07± 6.75°. Lordosis was detected in 8/26 participants: 11.72±7.32°. The fiber optic and optoelectronic systems demonstrate acceptable agreement for measuring sagittal plane thoracolumbar spinal curvature. PMID:24909579

Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation?

PubMed

Chen, Zhonghui; Li, Song; Qiu, Yong; Zhu, Zezhang; Chen, Xi; Xu, Liang; Sun, Xu

2017-12-01

OBJECTIVE Although the vertical expandable prosthetic titanium rib (VEPTR) and growing rod instrumentation (GRI) encourage spinal growth via regular lengthening, they can create different results because of their different fixation patterns and mechanisms in correcting scoliosis. Previous studies have focused comparisons on coronal plane deformity with minimal attention to the sagittal profile. In this retrospective study, the authors aimed to compare the evolution of the sagittal spinal profile in early-onset scoliosis (EOS) treated with VEPTR versus GRI. METHODS The data for 11 patients with VEPTR and 22 with GRI were reviewed. All patients had more than 2 years' follow-up with more than 2 lengthening procedures. Radiographic measurements were performed before and after the index surgery and at the latest follow-up. The complications in both groups were recorded. RESULTS Patients in both groups had similar diagnoses, age at the index surgery, and number of lengthening procedures. The changes in the major coronal Cobb angle and T1-S1 spinal height were not significantly different between the 2 groups. Compared with the GRI group, the VEPTR group had less correction in thoracic kyphosis (23% ± 12% vs 44% ± 16%, p < 0.001) after the index surgery and experienced a greater correction loss in thoracic kyphosis (46% ± 18% vs 11% ± 8%, p < 0.001) at the latest follow-up. Although the increase in the proximal junctional angle was not significantly different (VEPTR: 7° ± 4° vs GRI: 8° ± 5°, p = 0.569), the incidence of proximal junctional kyphosis was relatively lower in the VEPTR group (VEPTR: 18.2% vs GRI: 22.7%). No significant changes in the spinopelvic parameters were observed, while the sagittal vertical axis showed a tendency toward a neutral position in both groups. The overall complication rate was higher in the VEPTR group than in the GRI group (72.7% vs 54.5%). CONCLUSIONS The VEPTR had coronal correction and spinal growth results similar to those

Posterior-only surgical correction of dystrophic scoliosis in 31 patients with neurofibromatosis Type 1 using the multiple anchor point method.

PubMed

Deng, Ang; Zhang, Hong-Qi; Tang, Ming-Xing; Liu, Shao-Hua; Wang, Yu-Xiang; Gao, Qi-Le

2017-01-01

OBJECTIVE The objective of this study was to evaluate the clinical efficacy of posterior-only surgical correction of dystrophic scoliosis in patients with neurofibromatosis Type 1 (NF1) using a multiple anchor point method (MAPM). METHODS From 2005 to 2014, 31 patients (mean age 13.5 years old, range 10-22 years old) suffering from dystrophic scoliosis associated with NF1 underwent posterior-only surgical correction using a MAPM. The apex of the deformity was thoracic (n = 25), thoracolumbar (n = 4), and lumbar (n = 2). The mean preoperative coronal Cobb angle was 69.1° (range 48.9°-91.4°). The mean Cobb angle on the side-bending radiograph of the convex side was 58.2° (range 40°-79.8°). The mean flexibility and apical vertebral rotation (AVR) were 15.6% (range 8.3%-28.2%) and 2.5° (range 2°-3°), respectively. The mean angle of sagittal kyphosis was 58.3° (range 34.1°-79.6°). RESULTS The mean follow-up period was 53 months (range 12-96 months). The mean postoperative coronal Cobb angle was 27.4° (range 16.3°-46.7°). Postoperatively, the mean AVR and angle of sagittal kyphosis were 1.2° (range 1°-2°) and 22.4° (range 4.2°-36.3°), respectively. All patients showed good correction of all indices postoperatively. The mean postoperative correction rate was 58.7% (range 46.3%-74.1%). At the final follow-up evaluation, the corrective loss rate of the Cobb angle was only 2.3%. Only 1 patient required revision surgery. No severe complications such as spinal cord, neural, or large vascular injury occurred during the operation. CONCLUSIONS Posterior-only surgical correction of dystrophic scoliosis in patients with NF1 using a MAPM could yield satisfactory clinical efficacy of correction and fusion.

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.

Inter- and intraobserver reliability of the vertebral, local and segmental kyphosis in 120 traumatic lumbar and thoracic burst fractures: evaluation in lateral X-rays and sagittal computed tomographies

PubMed Central

Brunner, Alexander; Gühring, Markus; Schmälzle, Traude; Weise, Kuno; Badke, Andreas

2009-01-01

Evaluation of the kyphosis angle in thoracic and lumbar burst fractures is often used to indicate surgical procedures. The kyphosis angle could be measured as vertebral, segmental and local kyphosis according to the method of Cobb. The vertebral, segmental and local kyphosis according to the method of Cobb were measured at 120 lateral X-rays and sagittal computed tomographies of 60 thoracic and 60 lumbar burst fractures by 3 independent observers on 2 separate occasions. Osteoporotic fractures were excluded. The intra- and interobserver reliability of these angles in X-ray and computed tomogram, using the intra class correlation coefficient (ICC) were evaluated. Highest reproducibility showed the segmental kyphosis followed by the vertebral kyphosis. For thoracic fractures segmental kyphosis shows in X-ray “excellent” inter- and intraobserver reliabilities (ICC 0.826, 0.802) and for lumbar fractures “good” to “excellent” inter- and intraobserver reliabilities (ICC = 0.790, 0.803). In computed tomography, the segmental kyphosis showed “excellent” inter- and intraobserver reliabilities (ICC = 0.824, 0.801) for thoracic and “excellent” inter- and intraobserver reliabilities (ICC = 0.874, 0.835) for the lumbar fractures. Regarding both diagnostic work ups (X-ray and computed tomography), significant differences were evaluated in interobserver reliabilities for vertebral kyphosis measured in lumbar fracture X-rays (p = 0.035) and interobserver reliabilities for local kyphosis, measured in thoracic fracture X-rays (p = 0.010). Regarding both fracture localizations (thoracic and lumbar fractures), significant differences could only be evaluated in interobserver reliabilities for the local kyphosis measured in computed tomographies (p = 0.045) and in intraobserver reliabilities for the vertebral kyphosis measured in X-rays (p = 0.024). “Good” to “excellent” inter- and intraobserver reliabilities for vertebral, segmental and local

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

[Effect of BMI and WHR on lumbar lordosis and sacrum slant angle in middle and elderly women].

PubMed

Guo, Jin-Ming; Zhang, Guo-Quan; Alimujiang

2008-01-01

To investigate the effect of body mass index (BMI) and waist hip ratio (WHR) on lumbar lordosis and sacrum slant angle in the patients with low back pain, and to discuss the theory of low back pain induced by obesity. The Roland Disability Questionnaire (RDQ) was answered by 98 middle and elderly women with low back pain, whose body height, body weight, waist circumference, and hip circumference were measured and used to calculate their MBI and WHR. According to BMI, all the cases were divided into normal, overweight and obesity groups. These cases were also divided into noncentral and central obesity groups according to WHR. The lateral X-ray films of the lumbar spine were studied by measuring LCI, Cobb angle, and SSA. The data of all groups were analyzed statistically. LCI, Cobb angle, SSA and RDQ scores in the overweight and obesity groups are significantly higher than those in the normal group. LCI, Cobb angle, SSA, and RDQ scores in the central obesity group are significantly higher than those in the noncentral obesity group. BMI exceeding 24 kg/m2 or WHR exceeding 0.85 may increase the measurements of Cobb angle, SSA and RDQ scores. Low back pain may occur because of overweight, obesity, or central obesity. The anatomy foundation of the increasing lumbar lordosis and sacrum slant angle may be the one of reasons of low back pain in obese person.

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.

Improving excellence in scoliosis rehabilitation: a controlled study of matched pairs.

PubMed

Weiss, H-R; Klein, R

2006-01-01

Physiotherapy programmes so far mainly address the lateral deformity of scoliosis, a few aim at the correction of rotation and only very few address the sagittal profile. Meanwhile, there is evidence that correction forces applied in the sagittal plane are also able to correct the scoliotic deformity in the coronal and frontal planes. So it should be possible to improve excellence in scoliosis rehabilitation by the implementation of exercises to correct the sagittal deformity in scoliosis patients. An exercise programme (physio-logic exercises) aiming at a physiologic sagittal profile was developed to add to the programme applied at the centre or to replace certain exercises or exercising positions. To test the hypothesis that physio-logic exercises improve the outcome of Scoliosis Intensive Rehabilitation (SIR), the following study design was chosen: Prospective controlled trial of pairs of patients with idiopathic scoliosis matched by sex, age, Cobb angle and curve pattern. There were 18 patients in the treatment group (SIR + physio-logic exercises) and 18 patients in the control group (SIR only), all in matched pairs. Average Cobb angle in the treatment group was 34.5 degrees (SD 7.8) Cobb angle in the control group was 31.6 degrees (SD 5.8). Age in the treatment group was at average 15.3 years (SD 1.1) and in the control group 14.7 years (SD 1.3). Thirteen of the 18 patients in either group had a brace. Outcome parameter: average lateral deviation (mm), average surface rotation ( degrees ) and maximum Kyphosis angle ( degrees ) as evaluated with the help of surface topography (Formetric-system). Lateral deviation (mm) decreased significantly after the performance of the physio-logic programme and highly significantly in the physio-logic ADL posture; however, it was not significant after completion of the whole rehabilitation programme (2.3 vs 0.3 mm in the controls). Surface rotation improved at average 1.2 degrees in the treatment group and 0.8 degrees in the

On the identity of Mononchus digiturus Cobb, 1893, Mononchus minor Cobb, 1893, Mononchus trionchus Thorne, 1924, Mononchus montanus Thorne, 1924, and Mononchus amphigonicus Thorne, 1924

USDA-ARS?s Scientific Manuscript database

Identities of five ancient known species of Mononchida, namely Mononchus digiturus Cobb, 1893, M. minor Cobb, 1893, M. trionchus Thorne, 1924, M. montanus Thorne, 1924, and M. amphigonicus Thorne, 1924 have been reassessed. These are redescribed and illustrated and their systematic positions and rel...

Investigation of the reproducibility and reliability of sagittal vertebral inclination measurements from MR images of the spine.

PubMed

Vrtovec, Tomaž; Pernuš, Franjo; Likar, Boštjan

2014-10-01

In this study, sagittal vertebral inclination (SVI) was systematically evaluated for 28 vertebrae (segments between T4 and L5) in magnetic resonance (MR) images of one normal and one scoliotic subject to compare the performance of manual and computerized measurements, and identify the most reproducible and reliable measurements. Manual measurements were performed by three observers, who identified on two occasions the distinctive anatomical landmarks required to evaluate SVI by six measurement methods, i.e. the superior tangents, inferior tangents, anterior tangents, posterior tangents, mid-endplate lines and mid-wall lines. Computerized measurements were performed by automatically evaluating SVI from the symmetry of vertebral anatomical structures in two-dimensional (2D) sagittal cross-sections and in three-dimensional (3D) volumetric images. The mid-wall lines and posterior tangents proved to be the manual measurements with the lowest intra-observer (standard deviation, SD, of 1.4° and 1.7°, respectively) and inter-observer variability (SD of 1.9° and 2.4°, respectively). The strongest inter-method agreement was found between the mid-wall lines and posterior tangents (SD of 2.0°). Computerized measurements in 2D and in 3D resulted in intra-observer (SD of 2.8° and 3.1°, respectively) and inter-observer variability (SD of 3.8° and 5.2°, respectively) that were comparable to those of the superior tangents (SD of 2.6° and 3.7°) and inferior tangents (SD of 3.2° and 4.5°), which represent standard Cobb angle measurements. It can be concluded that computerized measurements of SVI should be based on the inclination of vertebral body walls. Copyright © 2014 Elsevier Ltd. All rights reserved.

Automated quasi-3D spine curvature quantification and classification

NASA Astrophysics Data System (ADS)

Khilari, Rupal; Puchin, Juris; Okada, Kazunori

2018-02-01

Scoliosis is a highly prevalent spine deformity that has traditionally been diagnosed through measurement of the Cobb angle on radiographs. More recent technology such as the commercial EOS imaging system, although more accurate, also require manual intervention for selecting the extremes of the vertebrae forming the Cobb angle. This results in a high degree of inter and intra observer error in determining the extent of spine deformity. Our primary focus is to eliminate the need for manual intervention by robustly quantifying the curvature of the spine in three dimensions, making it consistent across multiple observers. Given the vertebrae centroids, the proposed Vertebrae Sequence Angle (VSA) estimation and segmentation algorithm finds the largest angle between consecutive pairs of centroids within multiple inflection points on the curve. To exploit existing clinical diagnostic standards, the algorithm uses a quasi-3-dimensional approach considering the curvature in the coronal and sagittal projection planes of the spine. Experiments were performed with manuallyannotated ground-truth classification of publicly available, centroid-annotated CT spine datasets. This was compared with the results obtained from manual Cobb and Centroid angle estimation methods. Using the VSA, we then automatically classify the occurrence and the severity of spine curvature based on Lenke's classification for idiopathic scoliosis. We observe that the results appear promising with a scoliotic angle lying within +/- 9° of the Cobb and Centroid angle, and vertebrae positions differing by at the most one position. Our system also resulted in perfect classification of scoliotic from healthy spines with our dataset with six cases.

Correction of flexible thoracic scoliosis below 65 degrees--a radiological comparison of anterior versus posterior segmental instrumentation applied to similar curves.

PubMed

Kotwicki, Tomasz; Dubousset, Jean; Padovani, Jean-Paul

2006-06-01

Direct comparison of the correction of scoliosis achieved by different surgical methods is usually limited by the heterogeneity of the patients analyzed (their age, curve pattern, curve magnitude, etc.). The hypothesis is that an analysis of comparable scoliotic curves treated by different implant systems could detect subtle differences in outcome. The objective of this study was therefore: (1) to measure the 3D radiological parameters of scoliotic deformity and to quantify their postoperative changes, and (2) to compare the radiographic results achieved with one anterior and one posterior instrumentation methods applied to similar curves but representing different mechanisms of correction. The clinical notes and radiographs of 46 patients operated on for adolescent idiopathic scoliosis were reviewed. The inclusion criteria consisted of: a single thoracic curve, right convex, a frontal Cobb angle minimum of 45 degrees and a maximum of 65 degrees , flexibility on a lateral bending test of more than 30%, and a Risser test value of between 1 and 4. The operative procedures were: Cotrel-Dubousset instrumentation (CDI) for 25 patients (the CD group) and correction by anterior instrumentation (Pouliquen plate) for 21 patients (the ANT group). Preoperative and postoperative long cassette standing antero-posterior and lateral radiographs were examined. The frontal and sagittal thoracic Cobb angle, apical vertebra transposition (AVT), apical vertebra rotation (AVR), lowest instrumented vertebra (LIV) tilt, C7 vertebra shift and rib cage shift (RCS) were all compared. A computed reconstruction was produced with Rachis-91 software. Vertebral axial rotation angle was evaluated throughout the spine. Postoperative assessment revealed a mean correction of the frontal Cobb angle of 37.0 degrees for the CD group and 41.0 degrees for the ANT group. The AVT operative correction was 45.8 and 42.7 mm, respectively, and AVR correction was 1.8 and 12.6 degrees , respectively. The

Adult's Degenerative Scoliosis: Midterm Results of Dynamic Stabilization without Fusion in Elderly Patients—Is It Effective?

PubMed Central

Di Silvestre, Mario; Lolli, Francesco; Greggi, Tiziana; Vommaro, Francesco; Baioni, Andrea

2013-01-01

Study Design. A retrospective study. Purpose. Posterolateral fusion with pedicle screw instrumentation used for degenerative lumbar scoliosis can lead to several complications. In elderly patients without sagittal imbalance, dynamic stabilization could represent an option to avoid these adverse events. Methods. 57 patients treated by dynamic stabilization without fusion were included. All patients had degenerative lumbar de novo scoliosis (average Cobb angle 17.2°), without sagittal imbalance, associated in 52 cases (91%) with vertebral canal stenosis and in 24 (42%) with degenerative spondylolisthesis. Nineteen patients (33%) had previously undergone lumbar spinal surgery. Results. At an average followup of 77 months, clinical results improved with statistical significance. Scoliosis Cobb angle was 17.2° (range, 12° to 38°) before surgery and 11.3° (range, 4° to 26°) at last follow-up. In the patients with associated spondylolisthesis, anterior vertebral translation was 19.5% (range, 12% to 27%) before surgery, 16.7% (range, 0% to 25%) after surgery, and 17.5% (range, 0% to 27%) at followup. Complications incidence was low (14%), and few patients required revision surgery (4%). Conclusions. In elderly patients with mild degenerative lumbar scoliosis without sagittal imbalance, pedicle screw-based dynamic stabilization is an effective option, with low complications incidence, granting curve stabilization during time and satisfying clinical results. PMID:23781342

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

Utility of multilevel lateral interbody fusion of the thoracolumbar coronal curve apex in adult deformity surgery in combination with open posterior instrumentation and L5-S1 interbody fusion: a case-matched evaluation of 32 patients.

PubMed

Theologis, Alexander A; Mundis, Gregory M; Nguyen, Stacie; Okonkwo, David O; Mummaneni, Praveen V; Smith, Justin S; Shaffrey, Christopher I; Fessler, Richard; Bess, Shay; Schwab, Frank; Diebo, Bassel G; Burton, Douglas; Hart, Robert; Deviren, Vedat; Ames, Christopher

2017-02-01

OBJECTIVE The aim of this study was to evaluate the utility of supplementing long thoracolumbar posterior instrumented fusion (posterior spinal fusion, PSF) with lateral interbody fusion (LIF) of the lumbar/thoracolumbar coronal curve apex in adult spinal deformity (ASD). METHODS Two multicenter databases were evaluated. Adults who had undergone multilevel LIF of the coronal curve apex in addition to PSF with L5-S1 interbody fusion (LS+Apex group) were matched by number of posterior levels fused with patients who had undergone PSF with L5-S1 interbody fusion without LIF (LS-Only group). All patients had at least 2 years of follow-up. Percutaneous PSF and 3-column osteotomy (3CO) were excluded. Demographics, perioperative details, radiographic spinal deformity measurements, and HRQoL data were analyzed. RESULTS Thirty-two patients were matched (LS+Apex: 16; LS: 16) (6 men, 26 women; mean age 63 ± 10 years). Overall, the average values for measures of deformity were as follows: Cobb angle > 40°, sagittal vertical axis (SVA) > 6 cm, pelvic tilt (PT) > 25°, and mismatch between pelvic incidence (PI) and lumbar lordosis (LL) > 15°. There were no significant intergroup differences in preoperative radiographic parameters, although patients in the LS+Apex group had greater Cobb angles and less LL. Patients in the LS+Apex group had significantly more anterior levels fused (4.6 vs 1), longer operative times (859 vs 379 minutes), and longer length of stay (12 vs 7.5 days) (all p < 0.01). For patients in the LS+Apex group, Cobb angle, pelvic tilt (PT), lumbar lordosis (LL), PI-LL (lumbopelvic mismatch), Oswestry Disability Index (ODI) scores, and visual analog scale (VAS) scores for back and leg pain improved significantly (p < 0.05). For patients in the LS-Only group, there were significant improvements in Cobb angle, ODI score, and VAS scores for back and leg pain. The LS+Apex group had better correction of Cobb angles (56% vs 33%, p = 0.02), SVA (43% vs 5%, p = 0

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.

Reliability of sagittal plane hip, knee, and ankle joint angles from a single frame of video data using the GAITRite camera system.

PubMed

Ross, Sandy A; Rice, Clinton; Von Behren, Kristyn; Meyer, April; Alexander, Rachel; Murfin, Scott

2015-01-01

The purpose of this study was to establish intra-rater, intra-session, and inter-rater, reliability of sagittal plane hip, knee, and ankle angles with and without reflective markers using the GAITRite walkway and single video camera between student physical therapists and an experienced physical therapist. This study included thirty-two healthy participants age 20-59, stratified by age and gender. Participants performed three successful walks with and without markers applied to anatomical landmarks. GAITRite software was used to digitize sagittal hip, knee, and ankle angles at two phases of gait: (1) initial contact; and (2) mid-stance. Intra-rater reliability was more consistent for the experienced physical therapist, regardless of joint or phase of gait. Intra-session reliability was variable, the experienced physical therapist showed moderate to high reliability (intra-class correlation coefficient (ICC) = 0.50-0.89) and the student physical therapist showed very poor to high reliability (ICC = 0.07-0.85). Inter-rater reliability was highest during mid-stance at the knee with markers (ICC = 0.86) and lowest during mid-stance at the hip without markers (ICC = 0.25). Reliability of a single camera system, especially at the knee joint shows promise. Depending on the specific type of reliability, error can be attributed to the testers (e.g. lack of digitization practice and marker placement), participants (e.g. loose fitting clothing) and camera systems (e.g. frame rate and resolution). However, until the camera technology can be upgraded to a higher frame rate and resolution, and the software can be linked to the GAITRite walkway, the clinical utility for pre/post measures is limited.

Mild angle early onset idiopathic scoliosis children avoid progression under FITS method (Functional Individual Therapy of Scoliosis).

PubMed

Białek, Marianna

2015-05-01

Physiotherapy for stabilization of idiopathic scoliosis angle in growing children remains controversial. Notably, little data on effectiveness of physiotherapy in children with Early Onset Idiopathic Scoliosis (EOIS) has been published.The aim of this study was to check results of FITS physiotherapy in a group of children with EOIS.The charts of the patients archived in a prospectively collected database were retrospectively reviewed. The inclusion criteria were:diagnosis of EOIS based on spine radiography, age below 10 years, both girls and boys, Cobb angle between 118 and 308, Risser zero, FITS therapy, no other treatment (bracing), and a follow-up at least 2 years from the initiation of the treatment. The criterion for curve progression were as follows: the Cobb angle increase of 68 or more, for curve stabilization; the Cobb angle was 58 comparing to the initial radiograph,for curve correction; and the Cobb angle decrease of 68 or more at the final follow-up radiograph.There were 41 children with EOIS, 36 girls and 5 boys, mean age 7.71.3 years (range 4 to 9 years) who started FITS therapy. The curve pattern was single thoracic (5 children), single thoracolumbar (22 children) or double thoracic/thoracolumbar (14 children), totally 55 structural curvatures. The minimum follow-up was 2 years after initiation of the FITS treatment, maximum was 16 years, mean 4.8 years). At follow-up the mean age was 12.53.4 years. Out of 41 children, 10 passed pubertal growth spurt at the final follow-up and 31 were still immature and continued FITS therapy. Out of 41 children, 27 improved, 13 were stable, and one progressed. Out of 55 structural curves, 32 improved, 22 were stable and one progressed. For the 55 structural curves, the Cobb angle significantly decreased from 18.085.48 at first assessment to 12.586.38 at last evaluation,p<0.0001, paired t-test. The angle of trunk rotation decreased significantly from 4.782.98 to 3.282.58 at last evaluation, p<0.0001,paired t

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

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.

Sagittal alignment of the cervical spine after neck injury.

PubMed

Beltsios, Michail; Savvidou, Olga; Mitsiokapa, Evanthia A; Mavrogenis, Andreas F; Kaspiris, Angelos; Efstathopoulos, Nikolaos; Papagelopoulos, Panayiotis J

2013-07-01

The normal sagittal alignment of the cervical spine is lordotic and is affected by the posture of the head and neck. The question of whether loss of cervical lordosis is the result of muscle spasm after injury or a normal variation, and the clinical significance of such changes in sagittal profile of the cervical spine has been an issue of several studies. The purpose of this paper is to study the incidence of normal cervical lordosis and its changes after neck injury compared to the healthy population. We studied the lateral radiographs of the cervical spine of 60 patients with neck injury compared to 100 patients without a neck injury. Lateral radiographs were obtained in the standing or sitting position, and the curvature of the cervical spine was measured using the angle formed between the inferior end plates of the C2 and C7 vertebrae. In the patients without neck injury, lordotic and straight cervical spine sagittal alignment was observed in 36.5% each, double curvature in 17%, and kyphotic in 10%. In the patients with neck injury, lordotic sagittal alignment was observed in 36%, straight in 34%, double curvature in 26% and kyphotic in 4%. No significant difference between the two groups regarding all types of sagittal alignment of the cervical spine was found (p > 0.100). The alterations in normal cervical lordosis in patients with neck injury must be considered coincidental. These alterations should not be associated with muscle spasm caused by neck pain.

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.

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.

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

Assessment of lumbosacral kyphosis in spondylolisthesis: a computer-assisted reliability study of six measurement techniques

PubMed Central

Glavas, Panagiotis; Mac-Thiong, Jean-Marc; Parent, Stefan; de Guise, Jacques A.

2008-01-01

Although recognized as an important aspect in the management of spondylolisthesis, there is no consensus on the most reliable and optimal measure of lumbosacral kyphosis (LSK). Using a custom computer software, four raters evaluated 60 standing lateral radiographs of the lumbosacral spine during two sessions at a 1-week interval. The sample size consisted of 20 normal, 20 low and 20 high grade spondylolisthetic subjects. Six parameters were included for analysis: Boxall’s slip angle, Dubousset’s lumbosacral angle (LSA), the Spinal Deformity Study Group’s (SDSG) LSA, dysplastic SDSG LSA, sagittal rotation (SR), kyphotic Cobb angle (k-Cobb). Intra- and inter-rater reliability for all parameters was assessed using intra-class correlation coefficients (ICC). Correlations between parameters and slip percentage were evaluated with Pearson coefficients. The intra-rater ICC’s for all the parameters ranged between 0.81 and 0.97 and the inter-rater ICC’s were between 0.74 and 0.98. All parameters except sagittal rotation showed a medium to large correlation with slip percentage. Dubousset’s LSA and the k-Cobb showed the largest correlations (r = −0.78 and r = −0.50, respectively). SR was associated with the weakest correlation (r = −0.10). All other parameters had medium correlations with percent slip (r = 0.31–0.43). All measurement techniques provided excellent inter- and intra-rater reliability. Dubousset’s LSA showed the strongest correlation with slip grade. This parameter can be used in the clinical setting with PACS software capabilities to assess LSK. A computer-assisted technique is recommended in order to increase the reliability of the measurement of LSK in spondylolisthesis. PMID:19015898

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.

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

Schroth Physiotherapeutic Scoliosis-Specific Exercises Added to the Standard of Care Lead to Better Cobb Angle Outcomes in Adolescents with Idiopathic Scoliosis - an Assessor and Statistician Blinded Randomized Controlled Trial.

PubMed

Schreiber, Sanja; Parent, Eric C; Khodayari Moez, Elham; Hedden, Douglas M; Hill, Douglas L; Moreau, Marc; Lou, Edmond; Watkins, Elise M; Southon, Sarah C

2016-01-01

The North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosis-specific exercises (PSSE) showed promise in several studies of suboptimal methodology. The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis. To determine the effect of a six-month Schroth PSSE intervention added to standard of care (Experimental group) on the Cobb angle compared to standard of care alone (Control group) in patients with AIS. Fifty patients with AIS aged 10-18 years, with curves of 10°-45° and Risser grade 0-5 were recruited from a single pediatric scoliosis clinic and randomized to the Experimental or Control group. Outcomes included the change in the Cobb angles of the Largest Curve and Sum of Curves from baseline to six months. The intervention consisted of a 30-45 minute daily home program and weekly supervised sessions. Intention-to-treat and per protocol linear mixed effects model analyses are reported. In the intention-to-treat analysis, after six months, the Schroth group had significantly smaller Largest Curve than controls (-3.5°, 95% CI -1.1° to -5.9°, p = 0.006). Likewise, the between-group difference in the square root of the Sum of Curves was -0.40°, (95% CI -0.03° to -0.8°, p = 0.046), suggesting that an average patient with 51.2° at baseline, will have a 49.3° Sum of Curves at six months in the Schroth group, and 55.1° in the control group with the difference between groups increasing with severity. Per protocol analyses produced similar, but larger differences: Largest Curve = -4.1° (95% CI -1.7° to -6.5°, p = 0.002) and [Formula: see text] (95% CI -0.8 to 0.2, p = 0.006). Schroth PSSE added to the standard of care were superior compared to standard of care alone for reducing the curve severity in patients with AIS. NCT01610908.

[Correlation analysis of preoperative T 1 slope in MRI and physiological curvature loss after expansive open-door laminoplasty].

PubMed

Cheng, Zhaojun; Peng, Bing; Zhang, Lilong; Cui, Zijian; Ren, Zhishuai; Zhang, Xueli

2018-01-01

To investigate whether preoperative T 1 slope (T 1 S) in MRI can predict the changes of cervical curvature after expansive open-door laminoplasty (EOLP) in patients with cervical spondylotic myelopathy, so as to make up for the shortcomings of difficult measurement in X-ray film. The clinical data of 36 patients with cervical spondylotic myelopathy who underwent EOLP were retrospectively analysed. There were 21 males and 15 females with an average age of 55.8 years (range, 37-73 years) and an average follow-up time of 14.3 months (range, 12-24 months). The preoperative X-ray films at dynamic position, CT, and MRI of cervical spine before operation, and the anteroposterior and lateral X-ray films at last follow-up were taken out to measure the following sagittal parameters. The parameters included C 2 -C 7 Cobb angle and C 2 -C 7 sagittal vertical axis (C 2 -C 7 SVA) in all patients before operation and at last follow-up; preoperative T 1 S were measured in MRI, and the patients were divided into larger T 1 S group (T 1 S>19°, group A) and small T 1 S group (T 1 S≤19°, group B) according to the median of T 1 S, and the preoperative T 1 S, C 2 -C 7 Cobb angle, C 2 -C 7 SVA, and the C 2 -C 7 Cobb angle and C 2 -C 7 SVA at last follow-up, difference in axial distance (the difference of C 2 -C 7 SVA before and after operation), postoperative curvature loss (the difference of C 2 -C 7 Cobb angle before and after operation), the number of patients whose curvature loss was more than 5° after operation, and the number of patients whose kyphosis changed (C 2 -C 7 Cobb angle was less than 0° after operation). The C 2 -C 7 Cobb angle at last follow-up was significantly decreased when compared with preoperative value ( t =8.000, P =0.000), but there was no significant difference in C 2 -C 7 SVA between pre- and post-operation ( t =-1.842, P =0.074). The preoperative T 1 S was (19.69±3.39)°; there were 17 cases in group A and 19 cases in group B with no significant

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

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

Schroth Physiotherapeutic Scoliosis-Specific Exercises Added to the Standard of Care Lead to Better Cobb Angle Outcomes in Adolescents with Idiopathic Scoliosis – an Assessor and Statistician Blinded Randomized Controlled Trial

PubMed Central

Parent, Eric C.; Khodayari Moez, Elham; Hedden, Douglas M.; Hill, Douglas L.; Moreau, Marc; Lou, Edmond; Watkins, Elise M.; Southon, Sarah C.

2016-01-01

Background The North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosis-specific exercises (PSSE) showed promise in several studies of suboptimal methodology. The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis. Objectives To determine the effect of a six-month Schroth PSSE intervention added to standard of care (Experimental group) on the Cobb angle compared to standard of care alone (Control group) in patients with AIS. Methods Fifty patients with AIS aged 10–18 years, with curves of 10°-45° and Risser grade 0–5 were recruited from a single pediatric scoliosis clinic and randomized to the Experimental or Control group. Outcomes included the change in the Cobb angles of the Largest Curve and Sum of Curves from baseline to six months. The intervention consisted of a 30–45 minute daily home program and weekly supervised sessions. Intention-to-treat and per protocol linear mixed effects model analyses are reported. Results In the intention-to-treat analysis, after six months, the Schroth group had significantly smaller Largest Curve than controls (-3.5°, 95% CI -1.1° to -5.9°, p = 0.006). Likewise, the between-group difference in the square root of the Sum of Curves was -0.40°, (95% CI -0.03° to -0.8°, p = 0.046), suggesting that an average patient with 51.2° at baseline, will have a 49.3° Sum of Curves at six months in the Schroth group, and 55.1° in the control group with the difference between groups increasing with severity. Per protocol analyses produced similar, but larger differences: Largest Curve = -4.1° (95% CI -1.7° to -6.5°, p = 0.002) and Sum of Curves=−0.5° (95% CI -0.8 to 0.2, p = 0.006). Conclusion Schroth PSSE added to the standard of care were superior compared to standard of care alone for reducing the

Reversal of childhood idiopathic scoliosis in an adult, without surgery: a case report and literature review

PubMed Central

2009-01-01

Background Some patients with mild or moderate thoracic scoliosis (Cobb angle <50-60 degrees) suffer disproportionate impairment of pulmonary function associated with deformities in the sagittal plane and reduced flexibility of the spine and chest cage. Long-term improvement in the clinical signs and symptoms of childhood onset scoliosis in an adult, without surgical intervention, has not been documented previously. Case presentation A diagnosis of thoracic scoliosis (Cobb angle 45 degrees) with pectus excavatum and thoracic hypokyphosis in a female patient (DOB 9/17/52) was made in June 1964. Immediate spinal fusion was strongly recommended, but the patient elected a daily home exercise program taught during a 6-week period of training by a physical therapist. This regime was carried out through 1992, with daily aerobic exercise added in 1974. The Cobb angle of the primary thoracic curvature remained unchanged. Ongoing clinical symptoms included dyspnea at rest and recurrent respiratory infections. A period of multimodal treatment with clinical monitoring and treatment by an osteopathic physician was initiated when the patient was 40 years old. This included deep tissue massage (1992-1996); outpatient psychological therapy (1992-1993); a daily home exercise program focused on mobilization of the chest wall (1992-2005); and manipulative medicine (1994-1995, 1999-2000). Progressive improvement in chest wall excursion, increased thoracic kyphosis, and resolution of long-standing respiratory symptoms occurred concomitant with a >10 degree decrease in Cobb angle magnitude of the primary thoracic curvature. Conclusion This report documents improved chest wall function and resolution of respiratory symptoms in response to nonsurgical approaches in an adult female, diagnosed at age eleven years with idiopathic scoliosis. PMID:20003501

Egg characteristics and hatch performance of Athens Canadian Random Bred 1955 meat-type chickens and 2013 Cobb 500 broilers.

PubMed

Collins, K E; McLendon, B L; Wilson, J L

2014-09-01

Athens Canadian Random Bred (ACRB) chickens, a 1955 meat-type control strain, were incubated with the 2013 Cobb 500 broiler to determine differences in egg composition, conductance values, incubation duration, hatch performance, and yolk utilization. Unincubated ACRB eggs had greater percentage solids than Cobb 500 eggs. The ACRB eggs had a greater solid portion as yolk, whereas the Cobb 500 devoted more solid percentage to albumen. Percentage shell was not different between the strains, but ACRB eggs had 2.7% greater percentage moisture loss after 18 d of incubation than Cobb 500 eggs. Conductance, conductance constant, and conductance standardized to a 100 g egg weight basis were all higher for ACRB eggs than Cobb 500 eggs at 12 and 18 d of incubation. The Cobb 500 chicks hatched 6 h earlier than ACRB chicks. The Cobb 500 incubation duration was 498 h, and the ACRB incubation duration was 504 h. There was no difference between the strains for percentage infertile eggs, embryonic mortality, hatchability, or salable chicks. The ACRB chicks hatched with a smaller dried residual yolk sac as a percentage of chick weight compared with the Cobb 500. Both strains had an average relative yolk-free chick weight of 61% of average initial egg weight. Thus the Cobb 500 eggs had decreased gas exchange across the eggshell, which may have contributed to the earlier hatch and decreased yolk utilization. Modern Cobb 500 broiler embryonic metabolism appears to have either become more dependent on albumen rather than yolk or has become more efficient with yolk reserves during development. Broiler hatch performance does not appear to have changed over the past 58 yr. © 2014 Poultry Science Association Inc.

Valine needs in starting and growing Cobb (500) broilers.

PubMed

Tavernari, F C; Lelis, G R; Vieira, R A; Rostagno, H S; Albino, L F T; Oliveira Neto, A R

2013-01-01

Two independent experiments were conducted with male Cobb × Cobb 500 broilers to determine the optimal valine-to-digestible-lysine ratio for broiler development. We conducted a randomized block experiment with 7 treatments, each with 8 replicates of 25 starter birds (8 to 21 d of age) and 20 finisher (30 to 43 d of age) birds. To prevent any excess of digestible lysine, 93% of the recommended level of digestible lysine was used to evaluate the valine-to-lysine ratio. The utilized levels of dietary digestible lysine were 10.7 and 9.40 g/kg for the starting and growing phases, respectively. A control diet with 100% of the recommended level of lysine and an adequate valine-to-lysine ratio was also used. The feed intake, weight gain, feed conversion ratio, and carcass parameters were evaluated. The treatments had no significant effect on the feed intakes or carcass parameters in the starter and finisher phases. However, during both of the studied phases, we observed a quadratic effect on weight gain and the feed conversion ratio. The broilers of both phases that were fed test diets with the lower valine-to-lysine (Val/Lys) ratio had poorer performance compared with those broilers fed control diets. However, when higher Val/Lys ratios were used for the starting and growing broilers that were fed test diets, the 2 groups had similar performance. During the starting phase, in broilers that were fed a higher Val/Lys ratio, weight gain, and the feed conversion ratio improved by 5.5% compared with broilers fed the basal diets. The broilers in the growing phase also had improved performance (by 7 to 8%) when the test diets had higher Val/Lys ratios. Based on the analysis of the starter phase data, we concluded that the optimal digestible Val/Lys ratio for Cobb × Cobb 500 broilers is 77%, whereas for birds in the finisher phase (30 to 43 d of age), a digestible Val/Lys ratio of 76% is suggested.

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

Right adolescent idiopathic thoracic curve (Lenke 1 A and B): does cost of instrumentation and implant density improve radiographic and cosmetic parameters?

PubMed

Yang, Scott; Jones-Quaidoo, Sean M; Eager, Matthew; Griffin, Justin W; Reddi, Vasantha; Novicoff, Wendy; Shilt, Jeffrey; Bersusky, Ernesto; Defino, Helton; Ouellet, Jean; Arlet, Vincent

2011-07-01

In adolescent idiopathic scoliosis (AIS) there has been a shift towards increasing the number of implants and pedicle screws, which has not been proven to improve cosmetic correction. To evaluate if increasing cost of instrumentation correlates with cosmetic correction using clinical photographs. 58 Lenke 1A and B cases from a multicenter AIS database with at least 3 months follow-up of clinical photographs were used for analysis. Cosmetic parameters on PA and forward bending photographs included angular measurements of trunk shift, shoulder balance, rib hump, and ratio measurements of waist line asymmetry. Pre-op and follow-up X-rays were measured for coronal and sagittal deformity parameters. Cost density was calculated by dividing the total cost of instrumentation by the number of vertebrae being fused. Linear regression and spearman's correlation were used to correlate cost density to X-ray and photo outcomes. Three independent observers verified radiographic and cosmetic parameters for inter/interobserver variability analysis. Average pre-op Cobb angle and instrumented correction were 54° (SD 12.5) and 59% (SD 25) respectively. The average number of vertebrae fused was 10 (SD 1.9). The total cost of spinal instrumentation ranged from $6,769 to $21,274 (Mean $12,662, SD $3,858). There was a weak positive and statistically significant correlation between Cobb angle correction and cost density (r = 0.33, p = 0.01), and no correlation between Cobb angle correction of the uninstrumented lumbar spine and cost density (r = 0.15, p = 0.26). There was no significant correlation between all sagittal X-ray measurements or any of the photo parameters and cost density. There was good to excellent inter/intraobserver variability of all photographic parameters based on the intraclass correlation coefficient (ICC 0.74-0.98). Our method used to measure cosmesis had good to excellent inter/intraobserver variability, and may be an effective tool to objectively assess cosmesis

4. COBBS CREEK BRIDGE. COLWYN, DELAWARE CO., PA. Sec. 1101, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

4. COBBS CREEK BRIDGE. COLWYN, DELAWARE CO., PA. Sec. 1101, MP 5.73 - Northeast Railroad Corridor, Amtrak route between Delaware-Pennsylvania & Pennsylvania-New Jersey state lines, Philadelphia, Philadelphia County, PA

Changing Sagittal-Plane Landing Styles to Modulate Impact and Tibiofemoral Force Magnitude and Directions Relative to the Tibia

PubMed Central

Shimokochi, Yohei; Ambegaonkar, Jatin P.; Meyer, Eric G.

2016-01-01

Context: Ground reaction force (GRF) and tibiofemoral force magnitudes and directions have been shown to affect anterior cruciate ligament loading during landing. However, the kinematic and kinetic factors modifying these 2 forces during landing are unknown. Objective: To clarify the intersegmental kinematic and kinetic links underlying the alteration of the GRF and tibiofemoral force vectors secondary to changes in the sagittal-plane body position during single-legged landing. Design: Crossover study. Setting: Laboratory. Patients or Other Participants: Twenty recreationally active participants (age = 23.4 ± 3.6 years, height = 171.0 ± 9.4 cm, mass = 73.3 ± 12.7 kg). Intervention(s): Participants performed single-legged landings using 3 landing styles: self-selected landing (SSL), body leaning forward and landing on the toes (LFL), and body upright with flat-footed landing (URL). Three-dimensional kinetics and kinematics were recorded. Main Outcome Measure(s): Sagittal-plane tibial inclination and knee-flexion angles, GRF magnitude and inclination angles relative to the tibia, and proximal tibial forces at peak tibial axial forces. Results: The URL resulted in less time to peak tibial axial forces, smaller knee-flexion angles, and greater magnitude and a more anteriorly inclined GRF vector relative to the tibia than did the SSL. These changes led to the greatest peak tibial axial and anterior shear forces in the URL among the 3 landing styles. Conversely, the LFL resulted in longer time to peak tibial axial forces, greater knee-flexion angles, and reduced magnitude and a more posteriorly inclined GRF vector relative to the tibia than the SSL. These changes in LFL resulted in the lowest peak tibial axial and largest posterior shear forces among the 3 landing styles. Conclusions: Sagittal-plane intersegmental kinematic and kinetic links strongly affected the magnitude and direction of GRF and tibiofemoral forces during the impact phase of single-legged landing

Spinal sagittal contour affecting falls: cut-off value of the lumbar spine for falls.

PubMed

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

2013-06-01

Spinal deformities reportedly affect postural instability or falls. To prevent falls in clinical settings, the determination of a cut-off angle of spinal sagittal contour associated with increase risk for falls would be useful for screening for high-risk fallers. The purpose of this study was to calculate the spinal sagittal contour angle associated with increased risk for falls during medical checkups in community dwelling elders. The subjects comprised 213 patients (57 men, 156 women) with a mean age of 70.1 years (range, 55-85 years). The upright and flexion/extension thoracic kyphosis and lumbar lordosis angles, and the spinal inclination were evaluated with SpinalMouse(®). Postural instability was evaluated by stabilometry, using the total track length (LNG), enveloped areas (ENV), and track lengths in the lateral and anteroposterior directions (X LNG and Y LNG, respectively). The back extensor strength (BES) was measured using a strain-gauge dynamometer. The relationships among the parameters were analyzed statistically. Age, lumbar lordosis, spinal inclination, LNG, X LNG, Y LNG, and BES were significantly associated with falls (P<0.05). Multivariate logistic regression analyses revealed that lumbar lordosis was the most significant factor (P<0.01). Univariate logistic regression analyses for falls about lumbar lordosis angles revealed that angles of 3° and less were significant for falls. The present findings suggest that increased age, spinal inclination, LNG, X LNG, Y LNG, and decreased BES and lumbar lordosis, are associated with falls. An angle of lumbar lordosis of 3° or less was associated with falls in these community-dwelling elders. Copyright © 2012 Elsevier B.V. All rights reserved.

Percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system: an analysis of 38 cases.

PubMed

Wang, Hong-wei; Li, Chang-qing; Zhou, Yue; Zhang, Zheng-feng; Wang, Jian; Chu, Tong-wei

2010-06-01

To prospectively evaluate the feasibility, safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system in the retrospective non-randomized case-control study. A total of 38 consecutive non-randomized patients with type A thoracolumbar fractures, which had been stabilized posteriorly from December 2006 to March 2009, were examined retrospectively more than 9 months after surgery. Twenty-one patients had been treated conventionally with open pedicle screw fixation (OPSF) and 17 patients received minimally invasive treatment with Sextant percutaneous pedicle screw fixation (SPPSF). As a method of evaluation, the incision size, the intraoperation and postoperative volume of blood loss, operation time, postoperative hospital stay, blood transfusion, the radiological assessment of the sagittal Cobb;s angle, vertebral body angle and vertebral body height were recorded and compared. All patients were followed up for 8-24 months (average 11.6 months). There were significant differences in the incision size, surgical blood loss, surgical draining loss, operation time, hospital stay after operation, blood transfusion, the proportion of antalgic supplement and postoperative incisional VAS between the two groups (P less than 0.05). Mean preoperative kyphotic deformity was 16.0 degree and improved by 9.3 degree after surgery in OPSF group, but 15.2 degree and 10.3 degree respectively in SPPSF group. Mean preoperative angle of the fractured vertebral body was 15.9 degree and improved by 7.9 degree after surgery in OPSF group, but 14.9 degree and 6.6 degree respectively in SPPSF group. Mean anterior vertebral body height (% of normal) was 67.3% before surgery and 95.8% after surgery, but 69.1% and 90.1% respectively in SPPSF group. Mean posterior vertebral body height (% of normal) was 93.3% before surgery and 99.5% after surgery, but 88.9% and 93.3% respectively in

11. Historic American Buildings Survey S. E. Cobbs, Photographer 1971 ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

11. Historic American Buildings Survey S. E. Cobbs, Photographer 1971 CENTRAL HALLWAY, SECOND FLOOR, SHOWING STAIRCASE COMING FROM FIRST FLOOR AND CONTINUING TO CUPOLA - Henry Tallman House, 982 High Street, Bath, Sagadahoc County, ME

Sagittal balance and idiopathic scoliosis: does final sagittal alignment influence outcomes, degeneration rate or failure rate?

PubMed

Ilharreborde, Brice

2018-02-01

In the last decade, spine surgeons have been impacted by the "sagittal plane analysis revolution". Significant correlations have been found in adult spinal deformity (ASD) between sagittal lumbo-pelvic parameters and functional outcomes, but most of them do not apply in adolescent idiopathic scoliosis (AIS). Meanwhile, instrumentation and reduction strategies have considerably evolved. This paper aims to describe the preoperative sagittal alignment in AIS, and to report literature evidence regarding the influence of postoperative sagittal balance on complication rates, low back pain incidence and disc degeneration. A bibliographic search in Medline and Google database from 1984 to May 2017 was performed. The keywords included 'adolescent idiopathic scoliosis', 'adult scoliosis', 'sagittal alignment', 'proximal junctional kyphosis', 'distal junctional kyphosis', 'outcomes', 'low back pain' and 'complication', used individually or in combination. Algorithms of sagittal balance analysis and treatment decision have been reported in ASD, but the clinical situation is very different in children. Sagittal alignment greatly varies in AIS among the various Lenke types. Most patients are clinically balanced before surgery, but the spinal harmony is altered, with overgrowth of the anterior column and global sagittal flattening (undersestimated in 2D). The exact role of pelvic incidence and whether or not patients also use pelvic compensation to maintain balance still require further clarification. The incidence of radiological junctional failures remains highly variable, depending on definitions, cohort size and follow-up. Preoperative hyperkyphosis seems to be a consistent and relevant risk factor. Current literature does not support the recent trend to save motion segments (selective fusion), and no significant association was found between the distal level of fusion and the incidence of low back pain. Postoperative sagittal alignment seems to be more important than LIV

Reliability of tunnel angle in ACL reconstruction: two-dimensional versus three-dimensional guide technique.

PubMed

Leiter, Jeff R S; de Korompay, Nevin; Macdonald, Lindsey; McRae, Sheila; Froese, Warren; Macdonald, Peter B

2011-08-01

To compare the reliability of tibial tunnel position and angle produced with a standard ACL guide (two-dimensional guide) or Howell 65° Guide (three-dimensional guide) in the coronal and sagittal planes. In the sagittal plane, the dependent variables were the angle of the tibial tunnel relative to the tibial plateau and the position of the tibial tunnel with respect to the most posterior aspect of the tibia. In the coronal plane, the dependent variables were the angle of the tunnel with respect to the medial joint line of the tibia and the medial and lateral placement of the tibial tunnel relative to the most medial aspect of the tibia. The position and angle of the tibial tunnel in the coronal and sagittal planes were determined from anteroposterior and lateral radiographs, respectively, taken 2-6 months postoperatively. The two-dimensional and three-dimensional guide groups included 28 and 24 sets of radiographs, respectively. Tibial tunnel position was identified, and tunnel angle measurements were completed. Multiple investigators measured the position and angle of the tunnel 3 times, at least 7 days apart. The angle of the tibial tunnel in the coronal plane using a two-dimensional guide (61.3 ± 4.8°) was more horizontal (P < 0.05) than tunnels drilled with a three-dimensional guide (64.7 ± 6.2°). The position of the tibial tunnel in the sagittal plane was more anterior (P < 0.05) in the two-dimensional (41.6 ± 2.5%) guide group compared to the three-dimensional guide group (43.3 ± 2.9%). The Howell Tibial Guide allows for reliable placement of the tibial tunnel in the coronal plane at an angle of 65°. Tibial tunnels were within the anatomical footprint of the ACL with either technique. Future studies should investigate the effects of tibial tunnel angle on knee function and patient quality of life. Case-control retrospective comparative study, Level III.

14. Charles Acey Cobb standing adjacent to the fish screen ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

14. Charles Acey Cobb standing adjacent to the fish screen he designed and installed in the Congdon Canal, facing southeast. Photo dates ca. late 1920's. - Congdon Canal, Fish Screen, Naches River, Yakima, Yakima County, WA

Three-dimensional action of Chêneau brace on thoracolumbar scoliosis.

PubMed

Kotwicki, Tomasz; Pietrzak, Szymon; Szulc, Andrzej

2002-01-01

We treated 18 girls for idiopathic thoracolumbar scoliosis with Chêneau brace. The apex of the curve was at Th12 or at L1 or at the disc Th12/L1. The initial Cobb angle varied from 21 to 42 degrees, mean 28. The follow up period was of 2 years and 6 months on the average. We noted the rib hump height on Adams' forward bending test. We measured Cobb angle, apical vertebra transposition and apical vertebra rotation (according to Perdriolle method) on antero-posterior standing radiograms before the treatment had started and at the moment of the best correction. We digitized antero-posterior and lateral standing radiograms with sonic digitizer GP-9 and we prepared computed reconstruction of the transversal plane of the spine with Hecquet and Graf's software RACHIS 91TM. The best clinical and radiological correction was achieved after 3 to 8 months of treatment (mean 5,5 months). We considered it as the fitting period and we analysed the correction achieved at that moment and at last follow-up. Cobb angle in brace ranged from 0 to 18 degrees, mean 9 degrees. The correction of apical vertebra transposition ranged from 51% to 100%, mean 80%. The correction of apical vertebra rotation ranged from 0% to 100%, mean 52%. The correction of rib hump ranged from 0 to 100%, mean 42%. Normal sagittal contour was established in 15 patients. important correction was present in each of the three planes.

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.

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.

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

Intravertebral deformation in idiopathic scoliosis: a transverse plane computer tomographic study.

PubMed

Kotwicki, Tomasz; Napiontek, Marek

2008-03-01

The scoliotic vertebrae are submitted to (1) the displacement in the 3-dimensional space and (2) the bone remodeling, which results in a 3-dimensional intrinsic vertebral deformation. Both phenomena are most expressed inside the apical zone of the curve and can be measured in a computer tomographic (CT) scan. A comparative study of CT thoracic scans in scoliotic and normal children was performed to provide a better description of the altered anatomy with respect to patomechanism of scoliosis. Twenty-three scoliotic girls, aged 14.3 +/- 2.1 years, a case of a right thoracic curve with a Cobb angle of 60.6 +/- 19.3 degrees, and 24 controls, free of spinal deformity, sex- and age-matched, underwent CT examination of the thorax at the level of Th8 to Th9 vertebra. The rotation angle of the apical vertebra and the sagittal to coronal rib cage diameters ratio were measured. The intravertebral deformation was assessed by measuring the angles between the axis of the whole vertebra and the axes of the spinous or transverse processes. The ratio of sagittal to coronal chest diameter was reduced in scoliosis patients (P < 0.001) and correlated with the Cobb angle. The angle between the axis of vertebra and the spinous process increased (P = 0.008), and its value was positively correlated with the rotation angle of the vertebra (r = 0.78, P < 0.05); however, the rotation was oriented clockwise, whereas the spinous process deviation was counterclockwise. The angle between the spinous and the transverse process revealed greater values on the concave side (P < 0.001), whereas the transverse processes were not deviated from the axis of vertebra (P = 0.469). A constant pattern, previously not described, of the alteration of morphology of the apical vertebra due to the intravertebral bone remodeling was identified. The intravertebral deformation accompanied the displacement of the vertebra with a linear correlation; however, the 2 phenomena were developing in the opposite directions

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

A portable system with sample rate of 250 Hz for characterization of knee and hip angles in the sagittal plane during gait

PubMed Central

2014-01-01

Background Gait analysis and research have been developed to obtain characteristics of movement patterns of people while walking. However, traditional measuring systems present different drawbacks that reduce their use and application. Among those drawbacks one can find: high price, low sampling frequency and limiting number of steps to be analyzed. Traditional measuring gait systems carry out their measurement at frequencies oscillating between 60 to 100 Hz. It can be argued about the need of higher sampling rates for gait measurements. However small displacements of the knee or hip for example, cannot be seen with low frequencies required a more detailed sampling and higher frequency sampling. Bearing this in mind, in this paper is presented a 250 Hz system based on accelerometers for gait measurement, and the particularities of knee and hip angles during gait are highlighted. Methods The system was designed with a PCI data acquisition card instrumented with an FPGA to achieve a rate sample of 250 Hz. The accelerometers were placed in thighs and legs to calculate the joint angles of hip and knee in the sagittal plane. The angles were estimated using the acceleration polygon method without integrating the acceleration and without filters. Results The gait of thirty healthy people of Mexican phenotype was analyzed over a flat floor free of obstacles. The results showed the gait phases and particularities associated with the walking style and people's laterality; the movement patterns were similar in the thirty persons. Based on the results, the particularities as the maximum amplitude in the angles and the shape in the movement patterns were related to the anthropometry and people phenotype. Conclusions The sampling frequency was essential to record 340 samples in single gait cycle and so registering the gait cycle with its particularities. In this work were recorded an average of 8 to 10 gait cycles, and the results showed variation regarding works carried out

A portable system with sample rate of 250 Hz for characterization of knee and hip angles in the sagittal plane during gait.

PubMed

Martínez-Solís, Fermín; Claudio-Sánchez, Abraham; Rodríguez-Lelis, José M; Vergara-Limon, Sergio; Olivares-Peregrino, Víctor; Vargas-Treviño, Marciano

2014-03-31

Gait analysis and research have been developed to obtain characteristics of movement patterns of people while walking. However, traditional measuring systems present different drawbacks that reduce their use and application. Among those drawbacks one can find: high price, low sampling frequency and limiting number of steps to be analyzed. Traditional measuring gait systems carry out their measurement at frequencies oscillating between 60 to 100 Hz. It can be argued about the need of higher sampling rates for gait measurements. However small displacements of the knee or hip for example, cannot be seen with low frequencies required a more detailed sampling and higher frequency sampling. Bearing this in mind, in this paper is presented a 250 Hz system based on accelerometers for gait measurement, and the particularities of knee and hip angles during gait are highlighted. The system was designed with a PCI data acquisition card instrumented with an FPGA to achieve a rate sample of 250 Hz. The accelerometers were placed in thighs and legs to calculate the joint angles of hip and knee in the sagittal plane. The angles were estimated using the acceleration polygon method without integrating the acceleration and without filters. The gait of thirty healthy people of Mexican phenotype was analyzed over a flat floor free of obstacles. The results showed the gait phases and particularities associated with the walking style and people's laterality; the movement patterns were similar in the thirty persons. Based on the results, the particularities as the maximum amplitude in the angles and the shape in the movement patterns were related to the anthropometry and people phenotype. The sampling frequency was essential to record 340 samples in single gait cycle and so registering the gait cycle with its particularities. In this work were recorded an average of 8 to 10 gait cycles, and the results showed variation regarding works carried out in biomechanics laboratories; this

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�

Comparison of Outcomes in 3 Surgical Approaches for Dystrophic Cervical Kyphosis in Patients with Neurofibromatosis 1.

PubMed

Lin, Tao; Shao, Wei; Zhang, Ke; Gao, Rui; Zhou, Xuhui

2018-03-01

To compare outcomes of anterior-only (AO), posterior-only (PO), and anteroposterior (AP) surgical approaches for treatment of dystrophic cervical kyphosis in patients with neurofibromatosis 1 (NF1). This retrospective observational study included 81 patients with dystrophic cervical kyphosis secondary to NF1. Length of kyphosis, duration of halo traction, Cobb angle, C2-7-sagittal vertical axis (SVA), T1 slope, Neck Disability Index score, and postoperative complications were evaluated before and, if possible, after each surgical approach. AP approach provided the best outcomes (average spinal Cobb angle was corrected from 61.2 ± 9.1° to 5.7 ± 3.2°, P < 0.05); there was no significant difference between AO and PO approaches (P > 0.05). With regard to cervical sagittal balance, AP approach had the most improvements of C2-7-SVA (mean C2-7-SVA was corrected from 3.2 ± 9.2 mm to 12.8 ± 2.6 mm, P < 0.05); the difference between AO and PO approaches was not significant (P > 0.05). T1 slope results were similar to C2-7-SVA. Neck Disability Index score of all patients improved significantly after surgery (P < 0.05); specifically, patients who had an AP approach constituted the largest portion of the satisfied patient group. Postoperative junctional kyphosis occurred in 11 patients (1 AP approach, 6 AO approach, 4 PO approach); these findings correlated with patients with ≤5 fused segments. AP approach surgery provided the best correction of dystrophic cervical kyphosis and sagittal balance for patients with NF1. Patients undergoing an AP approach were more satisfied with their outcomes. Junctional kyphosis can be prevented effectively using an AP approach in patients with >5 fused segments. Copyright © 2017 Elsevier Inc. All rights reserved.

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.

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

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

Subsphaerolaimus minor sp. n. and Micromicron cephalatum Cobb, 1920 (Nematoda) from the Yen River Estuary of Vietnam.

PubMed

Gagarin, Vladimir G; Nguyen, Vu Thanh

2015-08-03

Two nematode species found in Yen River Estuary of Vietnam are described and illustrated. Subsphaerolaimus minor sp. n. is similar to S. lamasus Gerlach, 1956, but differs from it in the shorter body, comparatively shorter pharynx and shorter cephalic setae. A pictorial key for determination of valid species in the genus Subsphaerolaimus Lorenzen, 1978 is given. Micromicron cephalatum Cobb, 1920 is redescribed and reillustrated based on numerous males and females. The genus Micromicron Cobb, 1920 is confirmed as a valid genus with type and only species, M. cephalatum Cobb, 1920.

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.

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

The posterior skeletal thorax: rib-vertebral angle and axial vertebral rotation asymmetries in adolescent idiopathic scoliosis.

PubMed

Burwell, R G; Aujla, R K; Freeman, B J C; Dangerfield, P H; Cole, A A; Kirby, A S; Polak, F J; Pratt, R K; Moulton, A

2008-01-01

The deformity of the ribcage in thoracic adolescent idiopathic scoliosis (AIS) is viewed by most as being secondary to the spinal deformity, though a few consider it primary or involved in curve aggravation. Those who consider it primary ascribe pathogenetic significance to rib-vertebra angle asymmetry. In thoracic AIS, supra-apical rib-vertebra angle differences (RVADs) are reported to be associated with the severity of the Cobb angle. In this paper we attempt to evaluate rib and spinal pathomechanisms in thoracic and thnoracolumbar AIS using spinal radiographs and real-time ultrasound. On the radiographs by costo-vertebral angle asymmetries (rib-vertebral angle differences RVADs, and rib-spinal angle differences RSADs), apical vertebral rotation (AV) and apical vertebral translation (AVT) were measured; and by ultrasound, spine-rib rotation differences (SRRDs) were estimated. RVADs are largest at two and three vertebral levels above the apex where they correlate significantly and positively with Cobb angle and AVT but not AVR. In right thoracic AIS, the cause(s) of the RVA asymmetries is unknown: it may result from trunk muscle imbalance, or from ribs adjusting passively within the constraint of the fourth column of the spine to increasing spinal curvature from whatever cause. Several possible mechanisms may drive axial vertebral rotation including, biplanar spinal asymmetry, relative anterior spinal overgrowth, dorsal shear forces in the presence of normal vertebral axial rotation, asymmetry of rib linear growth, trunk muscle imbalance causing rib-vertebra angle asymmetry weakening the spinal rotation-defending system of bipedal gait, and CNS mechanisms.

Conservation and sediment yield on the Fort Cobb reservoir watershed

USDA-ARS?s Scientific Manuscript database

Prior to about 1950, conservation practices on the Fort Cobb Reservoir watershed in West-Central Oklahoma were few and mostly demonstration type projects. Extensive soil conservation measures were implemented in the second half of the 20th century. Fortuitously, the U.S. Geological Survey collecte...

The correlation between calcaneal valgus angle and asymmetrical thoracic-lumbar rotation angles in patients with adolescent scoliosis.

PubMed

Park, Jaeyong; Lee, Sang Gil; Bae, Jongjin; Lee, Jung Chul

2015-12-01

[Purpose] This study aimed to provide a predictable evaluation method for the progression of scoliosis in adolescents based on quick and reliable measurements using the naked eye, such as the calcaneal valgus angle of the foot, which can be performed at public facilities such as schools. [Subjects and Methods] Idiopathic scoliosis patients with a Cobb's angle of 10° or more (96 females, 22 males) were included in this study. To identify relationships between factors, Pearson's product-moment correlation coefficient was computed. The degree of scoliosis was set as a dependent variable to predict thoracic and lumbar scoliosis using ankle angle and physique factors. Height, weight, and left and right calcaneal valgus angles were set as independent variables; thereafter, multiple regression analysis was performed. This study extracted variables at a significance level (α) of 0.05 by applying a stepwise method, and calculated a regression equation. [Results] Negative correlation (R=-0.266) was shown between lumbar lordosis and asymmetrical lumbar rotation angles. A correlation (R=0.281) was also demonstrated between left calcaneal valgus angles and asymmetrical thoracic rotation angles. [Conclusion] Prediction of scoliosis progress was revealed to be possible through ocular inspection of the calcaneus and Adams forward bending test and the use of a scoliometer.

[Effect analysis of anterior cervical operation for severe cervical kyphosis].

PubMed

Shen, X L; Wu, H Q; Hu, Z H; Liu, Y; Wang, X W; Chen, H J; Cao, P; Tian, Y; Yang, C; Yuan, W

2017-03-01

Objective: To determine the feasibility and safety of anterior cervical decompression and fusion in severe cervical kyphosis treatment. Methods: Totally 29 patients with severe cervical kyphosis(Cobb angle>50°) underwent anterior cervical decompression and fusion from June 2008 to May 2016 were studied retrospectively. There were 19 males and 10 females. The average age was 32.6 years ranging from 14 to 53 years. According to the etiology, 12 patients had iatrogenic deformity (11 had post-laminectomy cervical kyphosis, 1 had kyphosis due to anterior graft subsidence), 5 had neurofibromatosis, 4 had infective kyphosis, 8 had idiopathic cervical kyphosis. The curvature of cervical angle was measured by two-line Cobb method. The severity of cervical kyphosis was evaluated by kyphosis index (KI). Parameters including kyphosis levels, the apex of the kyphosis, C(2-7) sagittal vertical axis(SVA) and T(1) slope were also measured on lateral radiographs in the neutral position in each patient. The pre- and post-operative Japanese Orthopaedic Association(JOA) scores, visual analogue scale (VAS) of neek pain, neck disability index (NDI) and cervical alignment were compared. All patients were treated by skull traction. Motor evoked potential and somatosensory evoked potential were applied intraoperation as the spinal cord monitor. Results: Skull traction was performed for an average of 6.3 days. The mean vertebral number in kyphotic region was 4.7. The average operation time was 155 minutes and blood loss was 135 ml. The preoperative C(2-7)Cobb angle was 46.6°±18.1° in average. It was reduced to 11.4°±6.4° in average after operation. The Cobb angle of operation region was 72.9°±19.6° in average before operation. It was reduced to 11.2°±6.4° in average after operation. The kyphosis region correction rate was 84.6%. The mean preoperative C(2-7)SVA changed from (3.8±14.6) mm to (12.6±7.8) mm postoperatively. The mean preoperative T(1) slope changed from -10.6�

Pilot Jerrie Cobb Trains in the Multi-Axis Space Test Inertia Facility

NASA Image and Video Library

1960-04-21

Jerrie Cobb prepares to operate the Multi-Axis Space Test Inertia Facility (MASTIF) inside the Altitude Wind Tunnel at the National Aeronautics and Space Administration (NASA) Lewis Research Center. The MASTIF was a three-axis rig with a pilot’s chair mounted in the center to train Project Mercury pilots to bring a spinning spacecraft under control. An astronaut was secured in a foam couch in the center of the rig. The rig was then spun on three axes from 2 to 50 rotations per minute. The pilots were tested on each of the three axis individually, then all three simultaneously. The two controllers in Cobb’s hands activated the small nitrogen gas thrusters that were used to bring the MASTIF under control. A makeshift spacecraft control panel was set up in front of the trainee’s face. Cobb was one of several female pilots who underwent the skill and endurance testing that paralleled that of the Project Mercury astronauts. In 1961 Jerrie Cobb was the first female to pass all three phases of the Mercury Astronaut Program. NASA rules, however, stipulated that only military test pilots could become astronauts and there were no female military test pilots. The seven Mercury astronauts had taken their turns on the MASTIF in February and March 1960.

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

Porcine spine finite element model: a complementary tool to experimental scoliosis fusionless instrumentation.

PubMed

Hachem, Bahe; Aubin, Carl-Eric; Parent, Stefan

2017-06-01

Developing fusionless devices to treat pediatric scoliosis necessitates lengthy and expensive animal trials. The objective was to develop and validate a porcine spine numerical model as an alternative platform to assess fusionless devices. A parametric finite element model (FEM) of an osseoligamentous porcine spine and rib cage, including the epiphyseal growth plates, was developed. A follower-type load replicated physiological and gravitational loads. Vertebral growth and its modulation were programmed based on the Hueter-Volkmann principle, stipulating growth reduction/promotion due to increased compressive/tensile stresses. Scoliosis induction via a posterior tether and 5-level rib tethering, was simulated over 10 weeks along with its subsequent correction via a contralateral anterior custom tether (20 weeks). Scoliosis induction was also simulated using two experimentally tested compression-based fusionless implants (hemi- and rigid staples) over 12- and 8-weeks growth, respectively. Resulting simulated Cobb and sagittal angles, apical vertebral wedging, and left/right height alterations were compared to reported studies. Simulated induced Cobb and vertebral wedging were 48.4° and 7.6° and corrected to 21° and 5.4°, respectively, with the contralateral anterior tether. Apical rotation (15.6°) was corrected to 7.4°. With the hemi- and rigid staples, Cobb angle was 11.2° and 11.8°, respectively, with 3.7° and 2.0° vertebral wedging. Sagittal plane was within the published range. Convex/concave-side vertebral height difference was 3.1 mm with the induction posterior tether and reduced to 2.3 with the contralateral anterior tether, with 1.4 and 0.8 for the hemi- and rigid staples. The FEM represented growth-restraining effects and growth modulation with Cobb and vertebral wedging within 0.6° and 1.9° of experimental animal results, while it was within 5° for the two simulated staples. Ultimately, the model would serve as a time- and cost

[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.

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.

Fitting of full Cobb-Douglas and full VRTS cost frontiers by solving goal programming problem

NASA Astrophysics Data System (ADS)

Venkateswarlu, B.; Mahaboob, B.; Subbarami Reddy, C.; Madhusudhana Rao, B.

2017-11-01

The present research article first defines two popular production functions viz, Cobb-Douglas and VRTS production frontiers and their dual cost functions and then derives their cost limited maximal outputs. This paper tells us that the cost limited maximal output is cost efficient. Here the one side goal programming problem is proposed by which the full Cobb-Douglas cost frontier, full VRTS frontier can be fitted. This paper includes the framing of goal programming by which stochastic cost frontier and stochastic VRTS frontiers are fitted. Hasan et al. [1] used a parameter approach Stochastic Frontier Approach (SFA) to examine the technical efficiency of the Malaysian domestic banks listed in the Kuala Lumpur stock Exchange (KLSE) market over the period 2005-2010. AshkanHassani [2] exposed Cobb-Douglas Production Functions application in construction schedule crashing and project risk analysis related to the duration of construction projects. Nan Jiang [3] applied Stochastic Frontier analysis to a panel of New Zealand dairy forms in 1998/99-2006/2007.

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.

TREND ANALYSIS OF WATER QUALITY MONITORING DATA FOR COBB COUNTY, GEORGIA

EPA Science Inventory

The Cobb County Water Protection Division Water Quality Laboratory has conducted quarterly chemical monitoring from 1995-2005. Here we analyze these data for temporal trends in 20 Piedmont streams in the Chattahoochee and Etowah river basins. We found trends through time at mos...

TREND ANALYSIS OF WATER QUALITY MONITORING DATA FOR COBB COUNTY, GEORGIA

EPA Science Inventory

The Cobb County Water Protection Division Water Quality Laboratory has conducted quarterly chemical monitoring from 1995-2005. Here we analyze these data for temporal trends at 45 sites in 10 Piedmont streams in the Chattahoochee and Etowah river basins. The strongest overall tre...

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

Assessment of conservation practices in the Fort Cobb Reservoir watershed, southwestern Oklahoma

USGS Publications Warehouse

Becker, Carol J.

2011-01-01

The Fort Cobb Reservoir watershed encompasses about 813 square kilometers of rural farm land in Caddo, Custer, and Washita Counties in southwestern Oklahoma. The Fort Cobb Reservoir and six stream segments were identified on the Oklahoma 1998 303(d) list as not supporting designated beneficial uses because of impairment by nutrients, suspended solids, sedimentation, pesticides, and unknown toxicity. As a result, State and Federal agencies, in collaboration with conservation districts and landowners, started conservation efforts in 2001 to decrease erosion and transport of sediments and nutrients to the reservoir and improve water quality in tributaries. The U.S. Department of Agriculture selected the Fort Cobb Reservoir watershed in 2003 as 1 of 14 benchmark watersheds under the Conservation Effectiveness Assessment Project with the objective of quantifying the environmental benefits derived from agricultural conservation programs in reducing inflows of sediments and phosphorus to the reservoir. In November 2004, the Biologic, Geographic, Geologic, and Water Disciplines of the U.S. Geological Survey, in collaboration with the Agricultural Research Service, Grazinglands Research Laboratory in El Reno, Oklahoma, began an interdisciplinary investigation to produce an integrated publication to complement this program. This publication is a compilation of 10 report chapters describing land uses, soils, geology, climate, and water quality in streams and the reservoir through results of field and remote sensing investigations from 2004 to 2007. The investigations indicated that targeting best-management practices to small intermittent streams draining to the reservoir and to the Cobb Creek subwatershed may effectively augment efforts to improve eutrophic to hypereutrophic conditions that continue to affect the reservoir. The three major streams flowing into the reservoir contribute nutrients causing eutrophication, but minor streams draining cultivated fields near the

The association between athletic training time and the sagittal curvature of the immature spine.

PubMed

Wojtys, E M; Ashton-Miller, J A; Huston, L J; Moga, P J

2000-01-01

Strenuous physical activity is known to cause structural abnormalities in the immature vertebral body. Concern that exposure to years of intense athletic training may increase the risk for developing adolescent hyperkyphosis in certain sports, as well as the known association between hyperkyphosis and adult-onset back pain, led us to examine the association between cumulative hours of athletic training and the magnitude of the sagittal curvature of the immature spine. A sample of 2,270 children (407 girls and 1,863 boys) between 8 and 18 years of age were studied. An optical raster-stereographic method was used to measure the mid-sagittal curvatures of the surface of the back while the subject was in the upright standing position to quantify the angles of thoracic kyphosis and lumbar lordosis. These data were then correlated with self-reported hours of training measured by interview and questionnaire. The possible effects of age, sex, sport, and upper and lower body weight training were investigated. The results in these young athletes showed that larger angles of thoracic kyphosis and lumbar lordosis were associated with greater cumulative training time. Gymnasts showed the largest curves. Lack of sports participation, on the other hand, was associated with the smallest curves. Age and sex did not appear to affect the degree of curvature.

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

Diffuse idiopathic skeletal hyperostosis association with thoracic spine kyphosis: a cross-sectional study for the Health Aging and Body Composition Study.

PubMed

Nardo, Lorenzo; Lane, Nancy E; Parimi, Neeta; Cawthon, Peggy M; Fan, Bo; Shepherd, John; Cauley, Jane; Zucker-Levin, Audrey; Murphy, Rachel A; Katzman, Wendy B

2014-11-15

A descriptive study of the association between diffuse idiopathic skeletal hyperostosis (DISH) and kyphosis. To investigate the association of DISH with Cobb angle of kyphosis in a large cohort of older subjects from the Health Aging and Body Composition Study. DISH and thoracic kyphosis are well-defined radiographical findings in spines of older individuals. Characteristics of DISH (ossifications between vertebral segments) reflect changes of spine anatomy and physiology that may be associated with Cobb angle of kyphosis. Using data from 1172 subjects aged 70 to 79 years, we measured DISH and Cobb angle of kyphosis from computed tomographic lateral scout scans. Characteristics of participants with and without DISH were assessed using the χ² and t tests. Association between DISH and Cobb angle was analyzed using linear regression. Cobb angle and DISH relationship was assessed at different spine levels (thoracic and lumbar). DISH was identified on computed tomographic scout scan in 152 subjects with 101 cases in only the thoracic spine and 51 in both thoracic and lumbar spine segments. The mean Cobb angle of kyphosis in the analytic sample was 31.3° (standard deviation = 11.2). The presence of DISH was associated with a greater Cobb angle of 9.1° and 95% confidence interval (95% CI) (5.6-12.6) among African Americans and a Cobb angle of 2.9° and 95% CI (0.5-5.2) among Caucasians compared with those with no DISH. DISH in the thoracic spine alone was associated with a greater Cobb angle of 10.6° and 95% CI (6.5-14.7) in African Americans and a Cobb angle of 3.8° and 95% CI (1.0-6.5) in Caucasians compared with those with no DISH. DISH is associated with greater Cobb angle of kyphosis, especially when present in the thoracic spine alone. The association of DISH with Cobb angle is stronger within the African American population.

[Comparison of screw' inserting angle through the 11th and 12th rib anterior approaches for L1 burst fracture].

PubMed

Ma, Li-Tai; Liu, Hao; Li, Tao; Song, Yue-Ming; Pei, Fu-Xing; Liu, Li-Min; Gong, Quan; Zeng, Jian-Cheng; Feng, Gan-Jun; Zhou, Zhong-Jie

2012-12-01

To compare screw's inserting angle through the 11th and 12th rib in treating L1 burst fracture, explore effects on inserting screw and postoperative angle. From October 2007 to October 2010, 108 patients with L1 brust fracture treated through anterior approach were analyzed,including 68 males and 40 females, aged from 21 to 64 years (mean 38.22 years). All patients were divided into the 11th (A, 51 cases) and 12th (B, 57 cases) approach. The data of operation time,blood loss, duration of incision pain, JOA score, Oswestry score, VAS score, quality of life (SF-36), recovery of nervous function, coronal Cobb angle, included angle between screw and plate were observed. All patients were followed up for 9 to 37 months, mean 23 months. The operation time, blood loss, duration of incision pain, in group A were lower than group B (P<0.05), JOA score, Oswestry score, VAS score, SF-36, recovery of nervous function had no significant differences (P>0.05). There were no differences in Cobb angle before operation, but had significance after operation (P=0.000). There were statistically significance between two group in angle between screw and plate (P=0.000, P=0.003). The 11th rib approach for the treatment of L1 burst fracture has less effects on screw, less trauma and less angle between screw and plate.

[Evaluation of the resolving power of different angles in MPR images of 16DAS-MDCT].

PubMed

Kimura, Mikio; Usui, Junshi; Nozawa, Takeo

2007-03-20

In this study, we evaluated the resolving power of three-dimensional (3D) multiplanar reformation (MPR) images with various angles by using 16 data acquisition system multi detector row computed tomography (16DAS-MDCT) . We reconstructed the MPR images using data with a 0.75 mm slice thickness of the axial image in this examination. To evaluate resolving power, we used an original new phantom (RC phantom) that can be positioned at any slice angle in MPR images. We measured the modulation transfer function (MTF) by using the methods of measuring pre-sampling MTF, and used Fourier transform of image data of the square wave chart. The scan condition and image reconstruction condition that were adopted in this study correspond to the condition that we use for three-dimensional computed tomographic angiography (3D-CTA) examination of the head in our hospital. The MTF of MPR images showed minimum values at slice angles in parallel with the axial slice, and showed maximum values at the sagittal slice and coronal slice angles that are parallel to the Z-axis. With an oblique MPR image, MTF did not change with angle changes in the oblique sagittal slice plane, but in the oblique coronal slice plane, MTF increased as the tilt angle increased from the axial plane to the Z plane. As a result, we could evaluate the resolving power of a head 3D image by measuring the MTF of the axial image and sagittal image or the coronal image.

Comparison of different parameters for recording sagittal maxillo mandibular relation using natural head posture: A cephalometric study

PubMed Central

Singh, Ashish Kumar; Ganeshkar, Sanjay V.; Mehrotra, Praveen; Bhagchandani, Jitendra

2013-01-01

Background: Commonly used parameters for anteroposterior assessment of the jaw relationship includes several analyses such as ANB, NA-Pog, AB-NPog, Wits appraisal, Harvold's unit length difference, Beta angle. Considering the fact that there are several parameters (with different range and values) which account for sagittal relation, and still the published literature for comparisons and correlation of these measurements is scarce. Therefore, the objective of this study was to correlate these values in subjects of Indian origin. Materials and Methods: The sample consisted of fifty adult individuals (age group 18-26 years) with equal number of males and females. The selection criteria included subjects with no previous history of orthodontic and/or orthognathic surgical treatment; orthognathic facial profile; Angle's Class I molar relation; clinical Frankfort Mandibular plane angle FMA of 30±5° and no gross facial asymmetry. The cephalograms were taken in natural head position (NHP). Seven sagittal skeletal parameters were measured in the cephalograms and subjected to statistical evaluation with Wits reading on the true horizontal as reference. A correlation coefficient analysis was done to assess the significance of association between these variables. Results: ANB angle showed statistically significant correlation for the total sample, though the values were insignificant for the individual groups and therefore may not be very accurate. Wits appraisal was seen to have a significant correlation only in the female sample group. Conclusions: If cephalograms cannot be recorded in a NHP, then the best indicator for recording A-P skeletal dimension would be angle AB-NPog, followed by Harvold's unit length difference. However, considering biologic variability, more than one reading should necessarily be used to verify the same. PMID:24987638

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.

Treatment of Extreme Tuberculous Kyphosis Using Spinal Osteotomy and Halo-Pelvic Traction: A Case Report.

PubMed

Yu, Bin; Zhu, Ke; Zhao, Deng; Wang, Fei; Liang, Yijian

2016-02-01

A case report of treatment of extreme tuberculous kyphosis using spinal osteotomy and halopelvic traction. The aim of this study was to describe the process and outcome of treatment of a case with extreme tuberculous kyphosis using spine osteotomy and halo-pelvic traction. Spinal tuberculosis causes destruction, deformity, and paraplegia. Long-standing kyphosis may progress with growth in children, and produces respiratory insufficiency, and neurologic deficit. Surgery may help to prevent or reverse the neurological deterioration, while improving pulmonary function in cases with significant spinal deformity. Review of records and radiographs. A 24-year-old female with tuberculous angular kyphosis presented with bilateral lower extremities paresis and dyspnea. The vertebral bodies from T3 to T9 were severely destructed, with a Cobb's angle of 180°on radiographs. The total duration of distraction using halopelvic apparatus kept 10 months. During the duration of traction, the patient underwent a posterior release surgery because flexibility of the kyphosis was not sufficient. Pedicle subtraction osteotomy and pedicle screw fixation were performed to achieve final correction when the Cobb's angle decreased to about 80°. After the whole treatment of halopelvic traction and spine ostetomy, the patient's height increased nearly 30 cm, whereas the angular kyphosis was corrected to a Cobb's angle of 30°. The patient had no complication and neurological deterioration during the treatment. Correction angle and good sagittal balance were well maintained in the duration of 2 years' follow-up. The halo-pelvic apparatus produces high corrective forces applied over a long period, and it provides a slow and safe correction of deformity. In cases of extreme kyphotic deformity, halopelvic traction is an appropriate technique, while avoiding many serious complications from a rapid, one-stage correction. N/A.

Validity of a quantitative clinical measurement tool of trunk posture in idiopathic scoliosis.

PubMed

Fortin, Carole; Feldman, Debbie E; Cheriet, Farida; Labelle, Hubert

2010-09-01

Concurrent validity between postural indices obtained from digital photographs (two-dimensional [2D]), surface topography imaging (three-dimensional [3D]), and radiographs. To assess the validity of a quantitative clinical postural assessment tool of the trunk based on photographs (2D) as compared to a surface topography system (3D) as well as indices calculated from radiographs. To monitor progression of scoliosis or change in posture over time in young persons with idiopathic scoliosis (IS), noninvasive and nonionizing methods are recommended. In a clinical setting, posture can be quite easily assessed by calculating key postural indices from photographs. Quantitative postural indices of 70 subjects aged 10 to 20 years old with IS (Cobb angle, 15 degrees -60 degrees) were measured from photographs and from 3D trunk surface images taken in the standing position. Shoulder, scapula, trunk list, pelvis, scoliosis, and waist angles indices were calculated with specially designed software. Frontal and sagittal Cobb angles and trunk list were also calculated on radiographs. The Pearson correlation coefficients (r) was used to estimate concurrent validity of the 2D clinical postural tool of the trunk with indices extracted from the 3D system and with those obtained from radiographs. The correlation between 2D and 3D indices was good to excellent for shoulder, pelvis, trunk list, and thoracic scoliosis (0.81>r<0.97; P<0.01) but fair to moderate for thoracic kyphosis, lumbar lordosis, and thoracolumbar or lumbar scoliosis (0.30>r<0.56; P<0.05). The correlation between 2D and radiograph spinal indices was fair to good (-0.33 to -0.80 with Cobb angles and 0.76 for trunk list; P<0.05). This tool will facilitate clinical practice by monitoring trunk posture among persons with IS. Further, it may contribute to a reduction in the use of radiographs to monitor scoliosis progression.

Application of 3D Rapid Prototyping Technology in Posterior Corrective Surgery for Lenke 1 Adolescent Idiopathic Scoliosis Patients

PubMed Central

Yang, Mingyuan; Li, Chao; Li, Yanming; Zhao, Yingchuan; Wei, Xianzhao; Zhang, Guoyou; Fan, Jianping; Ni, Haijian; Chen, Ziqiang; Bai, Yushu; Li, Ming

2015-01-01

Abstract A retrospective study to evaluate the effectiveness of 3-dimensional rapid prototyping (3DRP) technology in corrective surgery for Lenke 1 adolescent idiopathic scoliosis (AIS) patients. 3DRP technology has been widely used in medical field; however, no study has been performed on the effectiveness of 3DRP technology in corrective surgery for Lenke 1 AIS patients. Lenke 1 AIS patients who were preparing to undergo posterior corrective surgery from a single center between January 2010 and January 2012 were included in this analysis. Patients were divided into 2 groups. In group A, 3-dimensional (3D) printing technology was used to create subject-specific spine models in the preoperative planning process. Group B underwent posterior corrective surgery as usual (by free hand without image guidance). Perioperative and postoperative clinical outcomes were compared between 2 groups, including operation time, perioperative blood loss, transfusion volume, postoperative hemoglobin (Hb), postoperative complications, and length of hospital stay. Radiological outcomes were also compared, including the assessment of screw placement, postoperative Cobb angle, coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis. Subgroup was also performed according to the preoperative Cobb angle: mean Cobb angle <50° and mean Cobb angle >50°. Besides, economic evaluation was also compared between 2 groups. A total of 126 patients were included in this study (group A, 50 and group B, 76). Group A had significantly shorter operation time, significantly less blood loss and transfusion volume, and higher postoperative Hb (all, P < 0.001). However, no significant differences were observed in complication rate, length of hospital stay, and postoperative radiological outcomes between 2 groups (all, P>0.05). There was also no significant difference in misplacement of screws in total populations (16.90% vs 18.82%, P = 0.305), whereas a low misplacement rate

Effects of myofascial release leg pull and sagittal plane isometric contract-relax techniques on passive straight-leg raise angle.

PubMed

Hanten, W P; Chandler, S D

1994-09-01

Experimental evidence does not currently exist to support the claims of clinical effectiveness for myofascial release techniques. This presents an obvious need to document the effects of myofascial release. The purpose of this study was to compare the effects of two techniques, sagittal plane isometric contract-relax and myofascial release leg pull for increasing hip flexion range of motion (ROM) as measured by the angle of passive straight-leg raise. Seventy-five nondisabled, female subjects 18-29 years of age were randomly assigned to contract-relax, leg pull, or control groups. Pretest hip flexion ROM was measured for each subject's right hip with a passive straight-leg raise test using a fluid-filled goniometer. Subjects in the treatment groups received either contract-relax or leg pull treatment applied to the right lower extremity; subjects in the control group remained supine quietly for 5 minutes. Following treatment, posttest straight-leg raise measurements were performed. A one-way analysis of variance followed by a Newman-Keuls post hoc comparison of mean gain scores showed that subjects receiving contract-relax treatment increased their ROM significantly more than those who received leg pull treatment, and the increase in ROM of subjects in both treatment groups was significantly higher than those of the control group. The results suggest that while both contract-relax and leg pull techniques can significantly increase hip flexion ROM in normal subjects, contract-relax treatment may be more effective and efficient than leg pull treatment.

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.

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.

Accuracy and reliability of coronal and sagittal spinal curvature data based on patient-specific three-dimensional models created by the EOS 2D/3D imaging system.

PubMed

Somoskeöy, Szabolcs; Tunyogi-Csapó, Miklós; Bogyó, Csaba; Illés, Tamás

2012-11-01

Three-dimensional (3D) deformations of the spine are predominantly characterized by two-dimensional (2D) angulation measurements in coronal and sagittal planes, using anteroposterior and lateral X-ray images. For coronal curves, a method originally described by Cobb and for sagittal curves a modified Cobb method are most widely used in practice, and these methods have been shown to exhibit good-to-excellent reliability and reproducibility, carried out either manually or by computer-based tools. Recently, an ultralow radiation dose-integrated radioimaging solution was introduced with special software for realistic 3D visualization and parametric characterization of the spinal column. Comparison of accuracy, correlation of measurement values, intraobserver and interrater reliability of methods by conventional manual 2D and sterEOS 3D measurements in a routine clinical setting. Retrospective nonrandomized study of diagnostic X-ray images created as part of a routine clinical protocol of eligible patients examined at our clinic during a 30-month period between July 2007 and December 2009. In total, 201 individuals (170 females, 31 males; mean age, 19.88 years) including 10 healthy athletes with normal spine and patients with adolescent idiopathic scoliosis (175 cases), adult degenerative scoliosis (11 cases), and Scheuermann hyperkyphosis (5 cases). Overall range of coronal curves was between 2.4° and 117.5°. Analysis of accuracy and reliability of measurements were carried out on a group of all patients and in subgroups based on coronal plane deviation: 0° to 10° (Group 1, n=36), 10° to 25° (Group 2, n=25), 25° to 50° (Group 3, n=69), 50° to 75° (Group 4, n=49), and more than 75° (Group 5, n=22). Coronal and sagittal curvature measurements were determined by three experienced examiners, using either traditional 2D methods or automatic measurements based on sterEOS 3D reconstructions. Manual measurements were performed three times, and sterEOS 3D

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.

Sagittal-Plane Knee Moment During Gait and Knee Cartilage Thickness.

PubMed

Schmitz, Randy J; Harrison, David; Wang, Hsin-Min; Shultz, Sandra J

2017-06-02

  Understanding the factors associated with thicker cartilage in a healthy population is important when developing strategies aimed at minimizing the cartilage thinning associated with knee osteoarthritis progression. Thicker articular cartilage is commonly thought to be healthier cartilage, but whether the sagittal-plane biomechanics important to gait are related to cartilage thickness is unknown.   To determine the relationship of a weight-bearing region of the medial femoral condyle's cartilage thickness to sagittal gait biomechanics in healthy individuals.   Descriptive laboratory study.   Laboratory.   Twenty-eight healthy participants (15 women: age = 21.1 ± 2.1 years, height = 1.63 ± 0.07 m, weight = 64.6 ± 9.9 kg; 13 men: age = 22.1 ± 2.9 years, height = 1.79 ± 0.05 m, weight = 75.2 ± 9.6 kg).   Tibiofemoral angle (°) was obtained via goniometric assessment, thickness of the medial femoral condyle cartilage (mm) was obtained via ultrasound imaging, and peak internal knee-extensor moment (% body weight · height) was measured during 10 trials of over-ground walking at a self-selected pace. We used linear regression to examine the extent to which peak internal knee-extensor moment predicted cartilage thickness after accounting for tibiofemoral angle and sex.   Sex and tibiofemoral angle (12.3° ± 3.2°) were entered in the initial step as control factors (R 2 = 0.01, P = .872). In the final step, internal knee-extensor moment (1.5% ± 1.3% body weight · height) was entered, which resulted in greater knee-extensor moment being related to greater cartilage thickness (2.0 ± 0.3 mm; R 2 Δ = 0.31, PΔ = .003).   Individuals who walked with a greater peak internal knee-extensor moment during gait had a cartilage structure that is generally considered beneficial in a healthy population. Our study offers promising findings that a potentially modifiable biomechanical factor is associated with cartilage status in a healthy population

Sagittal-Plane Knee Moment During Gait and Knee Cartilage Thickness

PubMed Central

Harrison, David; Wang, Hsin-Min; Shultz, Sandra J.

2017-01-01

Context:  Understanding the factors associated with thicker cartilage in a healthy population is important when developing strategies aimed at minimizing the cartilage thinning associated with knee osteoarthritis progression. Thicker articular cartilage is commonly thought to be healthier cartilage, but whether the sagittal-plane biomechanics important to gait are related to cartilage thickness is unknown. Objective:  To determine the relationship of a weight-bearing region of the medial femoral condyle's cartilage thickness to sagittal gait biomechanics in healthy individuals. Design:  Descriptive laboratory study. Setting:  Laboratory. Patients or Other Participants:  Twenty-eight healthy participants (15 women: age = 21.1 ± 2.1 years, height = 1.63 ± 0.07 m, weight = 64.6 ± 9.9 kg; 13 men: age = 22.1 ± 2.9 years, height = 1.79 ± 0.05 m, weight = 75.2 ± 9.6 kg). Main Outcome Measure(s):  Tibiofemoral angle (°) was obtained via goniometric assessment, thickness of the medial femoral condyle cartilage (mm) was obtained via ultrasound imaging, and peak internal knee-extensor moment (% body weight · height) was measured during 10 trials of over-ground walking at a self-selected pace. We used linear regression to examine the extent to which peak internal knee-extensor moment predicted cartilage thickness after accounting for tibiofemoral angle and sex. Results:  Sex and tibiofemoral angle (12.3° ± 3.2°) were entered in the initial step as control factors (R2 = 0.01, P = .872). In the final step, internal knee-extensor moment (1.5% ± 1.3% body weight · height) was entered, which resulted in greater knee-extensor moment being related to greater cartilage thickness (2.0 ± 0.3 mm; R2Δ = 0.31, PΔ = .003). Conclusion:  Individuals who walked with a greater peak internal knee-extensor moment during gait had a cartilage structure that is generally considered beneficial in a healthy population. Our study offers promising findings that a

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.

The contribution of two ears to the perception of vertical angle in sagittal planes.

PubMed

Morimoto, M

2001-04-01

Because the input signals to the left and right ears are not identical, it is important to clarify the role of these signals in the perception of the vertical angle of a sound source at any position in the upper hemisphere. To obtain basic findings on upper hemisphere localization, this paper investigates the contribution of each pinna to the perception of vertical angle. Tests measured localization of the vertical angle in five planes parallel to the median plane. In the localization tests, the pinna cavities of one or both ears were occluded. Results showed that pinna cavities of both the near and far ears play a role in determining the perceived vertical angle of a sound source in any plane, including the median plane. As a sound source shifts laterally away from the median plane, the contribution of the near ear increases and, conversely, that of the far ear decreases. For saggital planes at azimuths greater than 60 degrees from midline, the far ear no longer contributes measurably to the determination of vertical angle.

Male and female runners demonstrate different sagittal plane mechanics as a function of static hamstring flexibility.

PubMed

Williams, D S Blaise; Welch, Lee M

2015-01-01

Injuries to runners are common. However, there are many potential contributing factors to injury. While lack of flexibility alone is commonly related to injury, there are clear differences in hamstring flexibility between males and females. To compare the effect of static hamstring length on sagittal plane mechanics between male and female runners. Forty subjects (30.0±6.4 years) participated and were placed in one of 4 groups: flexible males (n=10), inflexible males (n=10), flexible females (n=10), and inflexible females (n=10). All subjects were free of injury at the time of data collection. Three-dimensional kinematics and kinetics were collected while subjects ran over ground across 2 force platforms. Sagittal plane joint angles and moments were calculated at the knee and hip and compared with a 2-way (sex X flexibility) ANOVA (α=0.05). Males exhibited greater peak knee extension moment than females (M=2.80±0.47, F=2.48±0.52 Nm/kg*m, p=0.05) and inflexible runners exhibited greater peak knee extension moment than flexible runners (In=2.83±0.56, Fl=2.44±0.51 Nm/kg*m, p=0.01). For hip flexion at initial contact, a significant interaction existed (p<0.05). Flexible females (36.7±7.4º) exhibited more hip flexion than inflexible females (27.9±4.6º, p<0.01) and flexible males (30.1±9.5º, p<0.05). No differences existed for knee angle at initial contact, peak knee angle, peak hip angle, or peak hip moment. Hamstring flexibility results in different mechanical profiles in males and females. Flexibility in the hamstrings may result in decreased moments via active or passive tension. These differences may have implications for performance and injury in flexible female runners.

Male and female runners demonstrate different sagittal plane mechanics as a function of static hamstring flexibility

PubMed Central

Williams III, D. S. Blaise; Welch, Lee M.

2015-01-01

ABSTRACT Background: Injuries to runners are common. However, there are many potential contributing factors to injury. While lack of flexibility alone is commonly related to injury, there are clear differences in hamstring flexibility between males and females. Objective: To compare the effect of static hamstring length on sagittal plane mechanics between male and female runners. Method: Forty subjects (30.0±6.4 years) participated and were placed in one of 4 groups: flexible males (n=10), inflexible males (n=10), flexible females (n=10), and inflexible females (n=10). All subjects were free of injury at the time of data collection. Three-dimensional kinematics and kinetics were collected while subjects ran over ground across 2 force platforms. Sagittal plane joint angles and moments were calculated at the knee and hip and compared with a 2-way (sex X flexibility) ANOVA (α=0.05). Results: Males exhibited greater peak knee extension moment than females (M=2.80±0.47, F=2.48±0.52 Nm/kg*m, p=0.05) and inflexible runners exhibited greater peak knee extension moment than flexible runners (In=2.83±0.56, Fl=2.44±0.51 Nm/kg*m, p=0.01). For hip flexion at initial contact, a significant interaction existed (p<0.05). Flexible females (36.7±7.4º) exhibited more hip flexion than inflexible females (27.9±4.6º, p<0.01) and flexible males (30.1±9.5º, p<0.05). No differences existed for knee angle at initial contact, peak knee angle, peak hip angle, or peak hip moment. Conclusion: Hamstring flexibility results in different mechanical profiles in males and females. Flexibility in the hamstrings may result in decreased moments via active or passive tension. These differences may have implications for performance and injury in flexible female runners. PMID:26537812

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

[Degenerative adult scoliosis].

PubMed

García-Ramos, C L; Obil-Chavarría, C A; Zárate-Kalfópulos, B; Rosales-Olivares, L M; Alpizar-Aguirre, A; Reyes-Sánchez, A A

2015-01-01

Adult scoliosis is a complex three-dimensional rotational deformity of the spine, resulting from the progressive degeneration of the vertebral elements in middle age, in a previously straight spine; a Cobb angle greater than 10° in the coronal plane, which also alters the sagittal and axial planes. It originates an asymmetrical degenerative disc and facet joint, creating asymmetrical loads and subsequently deformity. The main symptom is axial, radicular pain and neurological deficit. Conservative treatment includes drugs and physical therapy. The epidural injections and facet for selectively blocking nerve roots improves short-term pain. Surgical treatment is reserved for patients with intractable pain, radiculopathy and/ or neurological deficits. There is no consensus for surgical indications, however, it must have a clear understanding of the symptoms and clinical signs. The goal of surgery is to decompress neural elements with restoration, modification of the three-dimensional shape deformity and stabilize the coronal and sagittal balance.

[Adolescent scoliosis : From deformity to treatment].

PubMed

Schulze, A; Schrading, S; Betsch, M; Quack, V; Tingart, M

2015-11-01

Scoliosis affects up to 6 % of the population. The resulting spine deformity, the increasing risk of back pain, cosmetic aspects, pulmonary disorders if the Cobb angle is > 80°, and the progress of the deformity to > 50° after the end of growth indicate non-operative or operative therapy. In daily clinical practice, the classifications of scoliosis allow the therapy to be adapted. Classifications consider deformity, topography of the scoliosis, and the age at diagnosis. This publication gives an overview of the relevant and most common classifications in the treatment of adolescent scoliosis. For evaluation, the deformity measurement on the coronary radiographic projection of the total spine (Cobb angle) is relevant to therapy. The classification of topography, form, and the sagittal profile of the deformity of the spine are useful for preoperative planning of the fusion level. Classifications that take into account the age at the time of the diagnosis of scoliosis differentiate among early onset scoliosis (younger than 10 years of age), adolescent scoliosis (up to the end of growth), and adult scoliosis. Early onset scoliosis is subdivided by age and etiology. Therapy is derived from the classification of clinical and radiological findings. Classifications that take into account clinical and radiological parameters are essential components of modern scoliosis therapy.

Isola spinal instrumentation system for idiopathic scoliosis.

PubMed

Benli, I T; Akalin, S; Aydin, E; Baz, A; Citak, M; Kiş, M; Duman, E

2001-01-01

Since the definition of three-dimensional components of the scoliotic deformity, there have been important improvements in the surgical treatment of the problem. A derotation maneuver was proposed as a treatment option with CD instrumentation, but the reports of imbalance and decompensation with this system repopularized sublaminar wiring and translation as a corrective maneuver. Isola spinal instrumentation is one of the modern systems that utilizes vertebral translation instead of rod rotation. This study analyzes the results of 24 patients with idiopathic scoliosis who had been followed up for at least 2 years, and were surgically treated with titanium Isola Spinal Instrumentation in the Department of Orthopaedics and Traumatology, Ankara Social Security Hospital. Patients were grouped according to the King-Moe classification. Patients with type III, IV or V curves received only posterior instrumentation while this procedure followed anterior release and discectomy in the same session in patients with type I or II curves. A translation maneuver was utilized in the correction of scoliotic curves using the cantilever technique, either alone or supplemented by sublaminar wiring with Songer multifilament titanium cables. This study aimed to elucidate the effects of this technique in the frontal and sagittal plane curves and the trunk balance. The balance was analyzed clinically and radiologically by measurement of the lateral trunk shift (LT), shift of stable vertebra (SS), and shift of head (SH) in vertebral units (VU). The postoperative correction was significant in the frontal plane for all types of curves (p < 0.05). The postoperative correction was 80.9% +/- 9.5% in type III curves. Overall, the mean Cobb angle of the major curve value in the frontal plane was 66.9 degrees +/- 18.8 degrees, and it was corrected by 62.8% +/- 20.1%. The correction loss of Cobb angles in the frontal plane was 5.4 degrees +/- 5.5 degrees at the last follow-up visit. A normal

Does Andrews facial analysis predict esthetic sagittal maxillary position?

PubMed

Resnick, Cory M; Daniels, Kimberly M; Vlahos, Maryann

2018-04-01

Cephalometric analyses have limited utility in planning maxillary sagittal position for orthognathic surgery. In Six Elements of Orofacial Harmony, Andrews quantified maxillary position relative to forehead projection and angulation and proposed an ideal relationship. The purpose of this study was to investigate the ability of this technique to predict esthetic sagittal maxillary position. Survey study including a male and female with straight facial profiles, normal maxillary incisor angulations, and Angle's Class I. Maxillary position was modified on lateral photographs to create 5 images for each participant with incisor-goal anterior limit line (GALL) distances of -4, -2, 0, +2, and +4 mm. A series of health care professionals and laypeople were asked to rate each photo in order of attractiveness. A total of 100 complete responses were received. Incisor-GALL distances of +4 mm (41%) and +2 mm (40%) were most commonly considered "most esthetic" for the female volunteer (P < .001). For the male volunteer, there were 2 peak "most esthetic" responses: incisor-GALL distances of 0 mm (37%) and -4 mm (32%) (P < .001). Respondents considered maxillary incisor position 2 to 4 mm anterior to GALL most attractive in a woman and 0 to 4 mm posterior to GALL most esthetic in a man. Using these modified target distances, this analysis may be useful for orthognathic surgery planning. Copyright © 2018 Elsevier Inc. 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

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

Differences in standing and sitting postures of youth with idiopathic scoliosis from quantitative analysis of digital photographs.

PubMed

Fortin, Carole; Ehrmann Feldman, Debbie; Cheriet, Farida; Labelle, Hubert

2013-08-01

The objective of this study was to explore whether differences in standing and sitting postures of youth with idiopathic scoliosis could be detected from quantitative analysis of digital photographs. Standing and sitting postures of 50 participants aged 10-20-years-old with idiopathic scoliosis (Cobb angle: 15° to 60°) were assessed from digital photographs using a posture evaluation software program. Based on the XY coordinates of markers, 13 angular and linear posture indices were calculated in both positions. Paired t-tests were used to compare values of standing and sitting posture indices. Significant differences between standing and sitting positions (p < 0.05) were found for head protraction, shoulder elevation, scapula asymmetry, trunk list, scoliosis angle, waist angles, and frontal and sagittal plane pelvic tilt. Quantitative analysis of digital photographs is a clinically feasible method to measure standing and sitting postures among youth with scoliosis and to assist in decisions on therapeutic interventions.

Automated comprehensive Adolescent Idiopathic Scoliosis assessment using MVC-Net.

PubMed

Wu, Hongbo; Bailey, Chris; Rasoulinejad, Parham; Li, Shuo

2018-05-18

Automated quantitative estimation of spinal curvature is an important task for the ongoing evaluation and treatment planning of Adolescent Idiopathic Scoliosis (AIS). It solves the widely accepted disadvantage of manual Cobb angle measurement (time-consuming and unreliable) which is currently the gold standard for AIS assessment. Attempts have been made to improve the reliability of automated Cobb angle estimation. However, it is very challenging to achieve accurate and robust estimation of Cobb angles due to the need for correctly identifying all the required vertebrae in both Anterior-posterior (AP) and Lateral (LAT) view x-rays. The challenge is especially evident in LAT x-ray where occlusion of vertebrae by the ribcage occurs. We therefore propose a novel Multi-View Correlation Network (MVC-Net) architecture that can provide a fully automated end-to-end framework for spinal curvature estimation in multi-view (both AP and LAT) x-rays. The proposed MVC-Net uses our newly designed multi-view convolution layers to incorporate joint features of multi-view x-rays, which allows the network to mitigate the occlusion problem by utilizing the structural dependencies of the two views. The MVC-Net consists of three closely-linked components: (1) a series of X-modules for joint representation of spinal structure (2) a Spinal Landmark Estimator network for robust spinal landmark estimation, and (3) a Cobb Angle Estimator network for accurate Cobb Angles estimation. By utilizing an iterative multi-task training algorithm to train the Spinal Landmark Estimator and Cobb Angle Estimator in tandem, the MVC-Net leverages the multi-task relationship between landmark and angle estimation to reliably detect all the required vertebrae for accurate Cobb angles estimation. Experimental results on 526 x-ray images from 154 patients show an impressive 4.04° Circular Mean Absolute Error (CMAE) in AP Cobb angle and 4.07° CMAE in LAT Cobb angle estimation, which demonstrates the MVC

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.

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.

Modification of the sagittal split osteotomy of the mandibular ramus: mobilizing vertical osteotomy of the internal ramus segment.

PubMed

Ricard, Daniel; Ferri, Joël

2009-08-01

We describe a new surgical procedure to improve stability when counterclockwise rotation of the maxillomandibular complex and the occlusal plane is intended. This preliminary prospective study evaluated 10 patients (8 female patients and 2 male patients) who each underwent maxillomandibular surgical advancement with counterclockwise rotation of the occlusal plane. A mandibular counterclockwise rotation was done in all cases with bilateral ramus sagittal split osteotomy. After the split of the ramus had been completed, a vertical osteotomy was done distally to the second molar on the internal ramus segment. With the completion of this vertical osteotomy, the internal ramus segment became completely mobile. All osteotomies were stabilized with rigid internal fixation by use of plates with monocortical screws. Ten patients have been treated with the "mobilizing vertical osteotomy of the internal ramus segment." The mean reduction of the occlusal plane angle was 10.1 degrees , showing a substantial counterclockwise rotation of the maxillomandibular complex. All patients had significant improvement of their facial balance. After a 1-year follow-up period, all cases but 1 showed very good stability of their occlusion and occlusal plane angle. An 11.4% relapse of the forward movement of the mandible was noted. On the basis of this prospective study, we conclude that when performing a counterclockwise rotation of the maxillomandibular complex, the mobilizing vertical osteotomy of the internal ramus segment combined with the sagittal split osteotomy of the mandible potentially enhances the occlusal plane angle and occlusal stability after a 1-year period.

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 Study of Cobb Angular Velocity in Cervical Spine during Dynamic Extension-Flexion.

PubMed

Ren, Dong; Hu, Zhihao; Yuan, Wen

2016-04-01

A kinematic study of cervical spine. The aim of the study was to confirm the interesting manifestation observed in the dynamic images of the cervical spine movement from full-extension to full-flexion. To further explore the fine motion of total process of cervical spine movement with the new concept of Cobb angular velocity (CAV). Traditionally range of motion (ROM) is used to describe the cervical spine movement from extension to flexion. It is performed with only end position radiographs. However, these radiographs fail to explain how the elaborate movement happens. The dynamic images of the cervical spine movement from full-extension to full-flexion of 12 asymptomatic subjects were collected. After transforming these dynamic images to static lateral radiographs, we overlapped C7 cervical vertebrae of each subject and divided the total process of cervical spine movement into five equal partitions. Finally, CAV values from C2/3 to C6/7 were measured and analyzed. A broken line graph was created based on the data of CAV values. A simple motion process was observed in C2/3 and C3/4 segments. The motion processes of C4/5 and C5/6 segments exhibited a more complex track of "N" and "W" than the other segments. The peak CAV values of C4/5 and C5/6 were significantly greater than the other segments. From C2/3 to C6/7, the peak CAV value appeared in sequence. The intervertebral movements of cervical spine did not take a uniform motion form when the cervical spine moved from full-extension to full-flexion. From C2/3 to C6/7, the peak CAV value appeared in order. The C4/5 and C5/6 segments exhibited more complex kinematic characteristics in sagittal movement. This leads to C4/5 and C5/6 more vulnerable to injury and degeneration. We had a hypothesis that there was a positive correlation between injury/degeneration and complexity of intervertebral movement in the view of CAV. N/A.

Chronic low back pain after lumbosacral fracture due to sagittal and frontal vertebral imbalance.

PubMed

Boyoud-Garnier, L; Boudissa, M; Ruatti, S; Kerschbaumer, G; Grobost, P; Tonetti, J

2017-06-01

Over time, some patients with unilateral or bilateral lumbosacral injuries experience chronic low back pain. We studied the sagittal and frontal balance in a population with these injuries to determine whether mismatch in the pelvic and lumbar angles are associated with chronic low back pain. Patients with posterior pelvic ring fractures (Tile C1, C2, C3 and A3.3) that had healed were included. Foreign patients and those with an associated spinal or acetabular fracture or nonunion were excluded. The review consisted of subjective questionnaires, a clinical examination, and standing A/P and lateral stereoradiographic views. The pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), measured lumbar lordosis (LLm), T9 sagittal offset, leg discrepancy (LD) and lateral curvature (LC). The expected lumbar lordosis (LLe) was calculated using the formula LLe=PI+9°. We defined lumbopelvic mismatch (LPM) as the difference between LLm and LLe being equal or greater than 25% of LLe. Fifteen patients were reviewed after an average follow-up of 8.8 years [5.4-15]. There were four Tile C1, five Tile C2, five Tile C3 and one Tile A3.3 fracture. Ten of the 15 patients had low back pain. The mean angles were: LLm 49.6° and LLe 71.9° (P=0.002), PT 21.3°, SS 44.1°, PI 62.9° in patients with low back pain and LLm 57.4° and LLe 63.2° (P=0.55), PT 13°, SS 43.1°, PI 54.2° in those without. LPM was present in 9 patients, 8 of who had low back pain (P=0.02). Six patients, all of whom had low back pain, had a mean LC of 7.5° [4.5-23] (P=0.02). The mean LD was 0.77cm. The findings of this small study suggest that patients who experience low back pain after their posterior arch of the pelvic ring fracture has healed, have a lumbopelvic mismatch. Early treatment of these patients should aim to reestablish the anatomy of the pelvic base relative to the frontal and sagittal balance. IV. Copyright © 2017 Elsevier Masson SAS. 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.

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

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

Evaluation of Mandibular Anatomy Associated With Bad Splits in Sagittal Split Ramus Osteotomy of Mandible.

PubMed

Wang, Tongyue; Han, Jeong Joon; Oh, Hee-Kyun; Park, Hong-Ju; Jung, Seunggon; Park, Yeong-Joon; Kook, Min-Suk

2016-07-01

This study aimed to identify risk factors associated with bad splits during sagittal split ramus osteotomy by using three-dimensional computed tomography. This study included 8 bad splits and 47 normal patients without bad splits. Mandibular anatomic parameters related to osteotomy line were measured. These included anteroposterior width of the ramus at level of lingula, distance between external oblique ridge and lingula, distance between sigmoid notch and inferior border of mandible, mandibular angle, distance between inferior outer surface of mandibular canal and inferior border of mandible under distal root of second molar (MCEM), buccolingual thickness of the ramus at level of lingula, and buccolingual thickness of the area just distal to first molar (BTM1) and second molar (BTM2). The incidence of bad splits in 625 sagittal split osteotomies was 1.28%. Compared with normal group, bad split group exhibited significantly thinner BTM2 and shorter sigmoid notch and inferior border of mandible (P <0.05). However, for BTM1 and buccolingual thickness of the ramus at level of lingula, there was no statistical difference between the 2 groups. Mandibular angle, anteroposterior width of the ramus at level of lingula, external oblique ridge and lingula, and MCEM were not significantly different between the groups. This study suggests that patients with shorter ramus and low thickness of the buccolingual alveolar region distal to the second molar had a higher risk of bad splits. These anatomic data may help surgeons to choose the safest surgical techniques and best osteotomy sites.

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.

78 FR 60181 - Prevailing Rate Systems; Redefinition of the Clayton-Cobb-Fulton, Georgia, Nonappropriated Fund...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-01

... OFFICE OF PERSONNEL MANAGEMENT 5 CFR Part 532 RIN 3206-AM84 Prevailing Rate Systems; Redefinition of the Clayton-Cobb-Fulton, Georgia, Nonappropriated Fund Federal Wage System Wage Area AGENCY: U.S... Counties). The Federal Prevailing Rate Advisory Committee, the national labor-management committee...

Application of posterior pelvic tilt taping for the treatment of chronic low back pain with sacroiliac joint dysfunction and increased sacral horizontal angle.

PubMed

Lee, Jung-hoon; Yoo, Won-gyu

2012-11-01

Kinesio Taping (KT) is a therapeutic method used by physical therapists and athletic trainers in combination with other treatment techniques for various musculoskeletal and neuromuscular problems. However, no research has evaluated the effect of KT in patients with low back pain (LBP). The purpose of this case was to describe the application of posterior pelvic tilt taping (PPTT) with Kinesio tape as a treatment for chronic LBP and to reduce the anterior pelvic tilt angle. Case report. The patien was a 20-year-old female amateur swimmer with a Cobb's angle (L1-S1) of 68°, a sacral horizontal angle of 45°, and pain in both medial buttock areas and sacroiliac joints. We performed PPTT with Kinesio tape for 2 weeks (six times per week for an average of 9 h each time). The patient’s radiographs showed that the Cobb's angle (L1-S1) had decreased from 68° to 47° and that the sacral horizontal angle had decreased from 45° to 31°. Reductions in hypomobility or motion asymmetry, as assessed by the motion palpation test, and in pain, as measured by the pain-provocation tests, were observed. On palpation for both medial buttock areas in the prone position, the patient felt no pain. The patient experienced no pain or stiffness in the low back area while performing forward flexion in the standing position with knees fully extended when washing dishes in the sink. The case study demonstrated that PPTT intervention favourably affected the pelvic inclination and sacral horizontal angle, leading to beneficial effects on sacroiliac joint dysfunction (SIJD) and medial buttock pain. Additional research on the clinical effects of this taping procedure requires greater numbers of athletes with SIJD or LBP who have inappropriate anterior pelvic tilt angles and hyperlordosis.

Comparative analysis of hook, hybrid, and pedicle screw instrumentation in the posterior treatment of adolescent idiopathic scoliosis.

PubMed

Yilmaz, Guney; Borkhuu, Battugs; Dhawale, Arjun A; Oto, Murat; Littleton, Aaron G; Mason, Dan E; Gabos, Peter G; Shah, Suken A

2012-01-01

Spinal instrumentation in adolescent idiopathic scoliosis (AIS) aims to correct spinal deformity and maintain long-term spinal stability until bony healing is ensured. The purpose of this study was to compare the minimum 2-year postoperative radiographic and clinical results of posterior spine correction and fusion with all-hook instrumentation versus hybrid segmental instrumentation versus pedicle screw instrumentation for AIS from a single institution. A total of 105 patients with AIS who underwent a posterior spinal fusion with segmental pedicle screw (35), hook (35), or hybrid (35) instrumentation were sorted and matched according to the following criteria: similar age at surgery, identical Lenke curve types, curve magnitude, and Risser grade. Patients were evaluated before, immediately after, and at 2 years after surgery for radiographic parameters, complications, and outcome, as well as on the basis of the Scoliosis Research Society (SRS) questionnaire. The age and Risser grade, major curve Cobb angle, apical vertebral rotation (AVR), apical vertebral translation (AVT), lowest instrumented vertebral tilt, global coronal and sagittal balance, lumbar lordosis, and thoracic kyphosis were determined as part of preoperative evaluation. All 3 groups showed significant differences between the preoperative and postoperative major curve Cobb angle, lowest instrumented vertebral tilt, AVT, and AVR. At the latest follow-up, lumbar lordosis, thoracic kyphosis, and global coronal and sagittal balance remained similar among the 3 groups. Major curve Cobb angle, AVT, and AVR were significantly different--the hook group's measurements were significantly higher than the other groups, but there was no difference between the pedicle screw and hybrid groups. Major curve correction rate was significantly different among all groups (screw=71.9%±13.8%, hybrid=61.4%±16.6%, hook=48.1%±19.7%) (P<0.001). The pedicle screw group had the least amount of correction loss but there was

Biomechanical simulations of costo-vertebral and anterior vertebral body tethers for the fusionless treatment of pediatric scoliosis.

PubMed

Aubin, Carl-Éric; Clin, Julien; Rawlinson, Jeremy

2018-01-01

Compression-based fusionless tethers are an alternative to conventional surgical treatments of pediatric scoliosis. Anterior approaches place an anterior (ANT) tether on the anterolateral convexity of the deformed spine to modify growth. Posterior, or costo-vertebral (CV), approaches have not been assessed for biomechanical and corrective effectiveness. The objective was to biomechanically assess CV and ANT tethers using six patient-specific, finite element models of adolescent scoliotic patients (11.9 ± 0.7 years, Cobb 34° ± 10°). A validated algorithm simulated the growth and Hueter-Volkmann growth modulation over a period of 2 years with the CV and ANT tethers at two initial tensions (100, 200 N). The models without tethering also simulated deformity progression with Cobb angle increasing from 34° to 56°, axial rotation 11° to 13°, and kyphosis 28° to 32° (mean values). With the CV tether, the Cobb angle was reduced to 27° and 20° for tensions of 100 and 200 N, respectively, kyphosis to 21° and 19°, and no change in axial rotation. With the ANT tether, Cobb was reduced to 32° and 9° for 100 and 200 N, respectively, kyphosis unchanged, and axial rotation to 3° and 0°. While the CV tether mildly corrected the coronal curve over a 2-year growth period, it had sagittal lordosing effect, particularly with increasing initial axial rotation (>15°). The ANT tether achieved coronal correction, maintained kyphosis, and reduced the axial rotation, but over-correction was simulated at higher initial tensions. This biomechanical study captured the differences between a CV and ANT tether and indicated the variability arising from the patient-specific characteristics. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:254-264, 2018. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

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

Transverse plane of apical vertebra of structural thoracic curve: vertebra displacement versus vertebral deformation.

PubMed

Kotwicki, Tomasz; Napiontek, Marek; Nowakowski, Andrzej

2006-01-01

CT transversal scans of the trunk provided at the level of Th8 or Th9 (apical vertebra) of 23 patients with structural thoracic scoliosis were reviewed. The following parameters were studied: 1) alpha angle formed by the axis of vertebra and the axis of spinous process, 2) beta concave and beta convex angle between the spinous process and the left and right transverse process respectively, 3) gamma concave and gamma convex angle between the axis of vertebra and the left and right transverse process respectively, 4) rotation angle to the sagittal plane according to Aaro and Dahlborn, 5) Cobb angle. Values of measured parameters demonstrated a common pattern of intravertebral deformity: counter clockwise deviation of the spinous process (alpha angle 15,0 +/-8,5 degrees), beta concave (69,8 +/-8,5 degrees) significantly greater than beta convex (38,8 +/-8,5 degrees), gamma concave (54,3 +/-7,8 degrees) not different from gamma convex (56,0 +/-8,0 degrees). Strong linear positive correlation between alpha angle and Aaro-Dahlborn angle was observed (r=0,78, p<0,05). Changes in morphology of apical vertebra due to intravertebral bone remodelling followed the vertebral spatial displacement and there existed a linear correlation in between. The two processes develop in opposite directions.

Detection of progressive idiopathic scoliosis during growth using back surface topography: a prospective study of 100 patients.

PubMed

De Korvin, G; Randriaminahisoa, T; Cugy, E; Cheze, L; de Sèze, M

2014-12-01

The progression of adolescent idiopathic scoliosis is typically monitored via regular radiographic follow-up. The Cobb angle (as measured on whole-spine radiographs) is considered as the gold standard in scoliosis monitoring. To determine the sensitivity and specificity of back surface topography parameters, with a view to detecting changes in the Cobb angle. One hundred patients (mean age: 13.3) with Cobb angles greater than 10 degrees were included. Topographic parameters were measured in a standard position and in a position with hunched shoulders. Gibbosities and spinal curvatures were evaluated. An increase of more than 2 degrees in any one gibbosity or in the sum of the gibbosities (in either of the two examination positions) enabled the detection of a five-degree increase in the Cobb angle with a sensitivity of 86% and a specificity of 50%. If the present results are confirmed by other studies, analysis with back surface topography parameters may reduce the number of X-ray examinations required to detect increases in the Cobb angle. Copyright © 2014 Elsevier Masson SAS. 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.

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.

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.

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.

Effect of torso flexion on the lumbar torso extensor muscle sagittal plane moment arms.

PubMed

Jorgensen, Michael J; Marras, William S; Gupta, Purnendu; Waters, Thomas R

2003-01-01

Accurate anatomical inputs for biomechanical models are necessary for valid estimates of internal loading. The magnitude of the moment arm of the lumbar erector muscle group is known to vary as a function of such variables as gender. Anatomical evidence indicates that the moment arms decrease during torso flexion. However, moment arm estimates in biomechanical models that account for individual variability have been derived from imaging studies from supine postures. Quantify the sagittal plane moment arms of the lumbar erector muscle group as a function of torso flexion, and identify individual characteristics that are associated with the magnitude of the moment arms as a function of torso flexion. Utilization of a 0.3 Tesla Open magnetic resonance image (MRI) to image and quantify the moment arm of the right erector muscle group as a function of gender and torso flexion. Axial MRI images through and parallel to each of the lumbar intervertebral discs at four torso flexion angles were obtained from 12 male and 12 female subjects in a lateral recumbent posture. Multivariate analysis of variance was used to investigate the differences in the moment arms at different torso flexion angles, whereas hierarchical linear regression was used to investigate associations with individual anthropometric characteristics and spinal posture. The largest decrease in the lumbar erector muscle group moment arm from neutral to 45-degree flexion occurred at the L5-S1 level (9.7% and 8.9% for men and women, respectively). Measures of spinal curvature (L1-S1 lordosis), body mass and trunk characteristics (depth or circumference) were associated with the varying moment arm at most lumbar levels. The sagittal plane moment arms of the lumbar erector muscle mass decrease as the torso flexes forward. The change in moment arms as a function of torso flexion may have an impact on prediction of spinal loading in biomechanical models.

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.

Use of the smartphone for end vertebra selection in scoliosis.

PubMed

Pepe, Murad; Kocadal, Onur; Iyigun, Abdullah; Gunes, Zafer; Aksahin, Ertugrul; Aktekin, Cem Nuri

2017-03-01

The aim of our study was to develop a smartphone-aided end vertebra selection method and to investigate its effectiveness in Cobb angle measurement. Twenty-nine adolescent idiopathic scoliosis patients' pre-operative posteroanterior scoliosis radiographs were used for end vertebra selection and Cobb angle measurement by standard method and smartphone-aided method. Measurements were performed by 7 examiners. The intraclass correlation coefficient was used to analyze selection and measurement reliability. Summary statistics of variance calculations were used to provide 95% prediction limits for the error in Cobb angle measurements. A paired 2-tailed t test was used to analyze end vertebra selection differences. Mean absolute Cobb angle difference was 3.6° for the manual method and 1.9° for the smartphone-aided method. Both intraobserver and interobserver reliability were found excellent in manual and smartphone set for Cobb angle measurement. Both intraobserver and interobserver reliability were found excellent in manual and smartphone set for end vertebra selection. But reliability values of manual set were lower than smartphone. Two observers selected significantly different end vertebra in their repeated selections for manual method. Smartphone-aided method for end vertebra selection and Cobb angle measurement showed excellent reliability. We can expect a reduction in measurement error rates with the widespread use of this method in clinical practice. Level III, Diagnostic study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Association of spinal deformity and pelvic tilt with gait asymmetry in adolescent idiopathic scoliosis patients: Investigation of ground reaction force.

PubMed

Park, Yang Sun; Lim, Young Tae; Koh, Kyung; Kim, Jong Moon; Kwon, Hyun Joon; Yang, Ji Seung; Shim, Jae Kun

2016-07-01

Adolescent idiopathic scoliosis is a prevalent orthopedic problem in children ages 10 to 16years. Although genetic, physiological and biomechanical factors are considered to contribute to the onset and progression of adolescent idiopathic scoliosis, the underlying mechanisms are not yet clear. The purpose of this study was to investigate the association between spinal deformity and inter-leg ground reaction force asymmetry during walking in adolescent idiopathic scoliosis patients. Fourteen patients (3 males and 11 females) participated in this study. Maximum Cobb's angle, adjusted Cobb's angle, and pelvic tilt were calculated from X-ray images. Asymmetry indices between legs were also calculated from ground reaction force magnitude and time variables from their preferred speed walking. Pearson coefficients of correlation were used to investigate associations of asymmetry indices with angle variables. Asymmetry indices of ground reaction force magnitudes positively correlated with adjusted Cobb's angle and maximum Cobb's angle mainly during the peak of braking phase, average of braking phase, while asymmetry indices of ground reaction force time variables showed no significant correlation with adjusted or maximum Cobb's angle. In contrast, asymmetry indices of ground reaction force time variables positively correlated with pelvic tilt during stance phase. We concluded that the spinal deformity of adolescent idiopathic scoliosis patients estimated using the maximum and adjusted Cobb's angles is generally associated with greater asymmetry of ground reaction force magnitudes in walking, while the pelvic tilt is associated with the greater asymmetry of ground reaction force time variables. Copyright © 2016 Elsevier Ltd. All rights reserved.

Use of the scoliosis research society outcomes instrument to evaluate patient outcome in untreated idiopathic scoliosis patients in Japan: part II: relation between spinal deformity and patient outcomes.

PubMed

Watanabe, Kei; Hasegawa, Kazuhiro; Hirano, Toru; Uchiyama, Seiji; Endo, Naoto

2005-05-15

This study clarifies the relation between the results of the Scoliosis Research Society Outcomes Instrument (SRS-24) and radiographic parameters of back deformity in Japanese idiopathic scoliosis patients. To investigate the relation between magnitude of back deformity and results of the SRS-24 in untreated patients. In idiopathic scoliosis, it is necessary to clarify the relation between patient-perceived outcomes of the deformity and magnitude of back deformity before considering treatment. The relation between the magnitude of spinal deformity and outcomes of untreated patients, however, has not been fully investigated. Patients (n = 166) under 30 years of age with untreated scoliosis were evaluated. Radiologic examination included Cobb angle, rotation angle of apical vertebrae, and translation of C7 vertebra from the central sacral line (C7 translation) on the coronal plane. Patient evaluation using section 1 (15 questions) of the SRS-24 was compared with radiologic findings using Spearman's correlation coefficient by rank (rs). The average pain domain score was 27.0 +/- 2.2 points, general self-image 9.9 +/- 1.7 points, general function 12.7 +/- 1.1 points, and overall level of activity 14.9 +/- 0.6 points. In radiologic deformity, the average Cobb angle and rotation angle of the thoracic curve were 35.8 degrees +/- 12.1 degrees (range, 17 degrees-73 degrees) and 13.9 degrees +/- 8.2 degrees (range, 0 degrees-38 degrees), respectively. The average Cobb and rotation angle of the lumbar curve were 31.4 degrees +/- 9.3 degrees (range, 13 degrees-56 degrees) and 15.4 degrees +/- 9.7 degrees (range, 2 degrees-36 degrees), respectively. The mean C7 translation was 12.4 +/- 9.7 mm (range, 0-48 mm). Comparison between individual domains and radiologic measurements revealed that the total pain (rs = -0.33; P < 0.0001) and general self-image (rs = -0.25; P = 0.0024) domain scores had a significant inverse correlation with thoracic curve Cobb angle. Comparison between

Analysis of Sagittal Parameters in Patients Undergoing One- or Two-Level Closing Wedge Osteotomy for Correcting Thoracolumbar Kyphosis Secondary to Ankylosing Spondylitis.

PubMed

Hua, Wen-Bin; Zhang, Yu-Kun; Gao, Yong; Liu, Xian-Zhe; Yang, Shu-Hua; Wu, Xing-Huo; Wang, Jing; Yang, Cao

2017-07-15

Retrospective analysis of clinical records. To assess and compare the improvement in sagittal balance after one- or two-level closing wedge osteotomy for correcting thoracolumbar kyphosis secondary to ankylosing spondylitis (AS). Closing wedge osteotomy represents a common approach to correct kyphosis in AS. Although several reports have described the outcomes of one- or two-level closing wedge osteotomy in terms of sagittal parameters, data comparing the outcomes of these procedures are scarce. Between January 2010 and December 2014, 22 patients with AS underwent closing wedge osteotomy (one-level, 12 patients; two-level, 10 patients) for correcting thoracolumbar kyphosis (mean follow-up, 24.8 months; range, 12-60 months). Preoperative and postoperative chin-brow vertical angle, and the sagittal parameters of the vertebral osteotomy segment were documented and compared. Perioperative and postoperative complications were also recorded. The chin-brow vertical angle improved significantly, from 55.0° ± 27.3° to 4.7° ± 4.9° and from 38.2° ± 14.9° to 3.2° ± 5.4° in the one-level and two-level groups, respectively. The total correction (thoracic kyphosis and lumbar lordosis) was 32.8° ± 18.2° and 53.7° ± 9.4° in the one-level and two-level groups, respectively. No death, complete paralysis, or vascular complications occurred during the procedure, but cerebrospinal fluid leak was noted in one and two patients from the one-level and two-level groups, respectively. A distal pedicle screw adjacent to the osteotomy segment became loose during surgery in one patient (one-level group). Postoperatively, no transient neurological deficit, infection, delay union, or loosening or breaking of the internal fixation devices was observed. Osteotomy site fusion was achieved in all patients, and the Oswestry Disability Index scores improved significantly. Closing wedge osteotomy is effective and safe for correcting thoracolumbar kyphosis in

Accuracy of visual estimates of joint angle and angular velocity using criterion movements.

PubMed

Morrison, Craig S; Knudson, Duane; Clayburn, Colby; Haywood, Philip

2005-06-01

A descriptive study to document undergraduate physical education majors' (22.8 +/- 2.4 yr. old) estimates of sagittal plane elbow angle and angular velocity of elbow flexion visually was performed. 42 subjects rated videotape replays of 30 movements organized into three speeds of movement and two criterion elbow angles. Video images of the movements were analyzed with Peak Motus to measure actual values of elbow angles and peak angular velocity. Of the subjects 85.7% had speed ratings significantly correlated with true peak elbow angular velocity in all three angular velocity conditions. Few (16.7%) subjects' ratings of elbow angle correlated significantly with actual angles. Analysis of the subjects with good ratings showed the accuracy of visual ratings was significantly related to speed, with decreasing accuracy for slower speeds of movement. The use of criterion movements did not improve the small percentage of novice observers who could accurately estimate body angles during movement.

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

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

EFFECTS OF X-RAY BEAM ANGLE AND GEOMETRIC DISTORTION ON WIDTH OF EQUINE THORACOLUMBAR INTERSPINOUS SPACES USING RADIOGRAPHY AND COMPUTED TOMOGRAPHY-A CADAVERIC STUDY.

PubMed

Djernaes, Julie D; Nielsen, Jon V; Berg, Lise C

2017-03-01

The widths of spaces between the thoracolumbar processi spinosi (interspinous spaces) are frequently assessed using radiography in sports horses; however effects of varying X-ray beam angles and geometric distortion have not been previously described. The aim of this prospective, observational study was to determine whether X-ray beam angle has an effect on apparent widths of interspinous spaces. Thoracolumbar spine specimens were collected from six equine cadavers and left-right lateral radiographs and sagittal and dorsal reconstructed computed tomographic (CT) images were acquired. Sequential radiographs were acquired with each interspinous space in focus. Measurements were performed for each interspinous space in the focus position and up to eight angled positions as the interspinous space moved away from focus (±). Focus position measurements were compared to matching sagittal CT measurements. Effect of geometric distortion was evaluated by comparing the interspinous space in radiographs with sagittal and dorsal reconstructed CT images. A total of 49 interspinous spaces were sampled, yielding 274 measurements. X-ray beam angle significantly affected measured width of interspinous spaces in position +3 (P = 0.038). Changes in width did not follow a consistent pattern. Interspinous space widths in focus position were significantly smaller in radiographs compared to matching reconstructed CT images for backs diagnosed with kissing spine syndrome (P < 0.001). Geometric distortion markedly affected appearance of interspinous space width between planes. In conclusion, X-ray beam angle and geometric distortion influence radiographically measured widths of interspinous spaces in the equine thoracolumbar spine, and this should be taken into consideration when evaluating sport horses. © 2016 American College of Veterinary Radiology.

Two-stage vertebral column resection for severe and rigid scoliosis in patients with low body weight.

PubMed

Zhou, Chunguang; Liu, Limin; Song, Yueming; Liu, Hao; Li, Tao; Gong, Quan

2013-05-01

To date, there are no clinical series documenting the treatment of severe and rigid scoliosis in patients with low body weight. To optimize curve correction and minimize the risk of complications, we performed a two-stage vertebral column resection (VCR) with posterior pedicle screw instrumentation to treat patients with severe and rigid scoliosis and low body weight. The purposes of this study were to report the results of a two-staged VCR for patients with severe and rigid scoliosis and low body weight. This was a prospective, longitudinal, and descriptive study with a minimum follow-up of 2 years. Sixteen patients (nine women and seven men) with severe and rigid scoliosis and low body weight from the department of orthopedics, West China hospital, Sichuan University. Clinical analysis included rib hump and lumbar hump. Radiographic analysis consisted of Cobb angle measurements of coronal curves, apical vertebral translation, coronal balance, sagittal balance, thoracic kyphosis, and lumbar lordosis. All measurements were taken before surgery, after surgery, and in the final follow-up period. For evaluation of surgical effectiveness, comparative analysis of rib hump, lumbar hump, Cobb angle of coronal curves, apical vertebral translation, coronal balance, sagittal balance, thoracic kyphosis, and lumbar lordosis before operation, after operation, and at the most recent follow-up was done. The body weight of patients averaged 33.8 kg (range 27-40 kg). Mean operating time was 580.3 minutes, with a blood loss of 1,581.3 mL. The correction rates of rib hump and lumbar hump were 77% and 85%. Preoperative major curves ranged from 90° to 130° Cobb angle. Coronal plane correction of the major curve averaged 70.7%, with an average loss of correction of 1.8%. The apical vertebral translation of the major curve was corrected by 73.2%. The preoperative coronal imbalance of 0.6 cm (range 0-1.4 cm) was improved to 0.5 cm (range 0-1.4 cm) at the most recent follow-up. The

Scoliosis after pectus excavatum correction: does it improve or worsen?

PubMed

Chung, Jae Ho; Park, Hyung Joo; Kim, Kwang Taik

2017-07-01

Scoliosis is associated with pectus excavatum. However, the change in the degree of scoliosis after pectus excavatum correction has not been clarified. This study examined how the correction of pectus excavatum influences the status of pre-existing scoliosis. A total of 779 pectus excavatum patients operated between 2007 and 2011 using the pectus bar were retrospectively analysed. Preoperative severity and postoperative change of scoliosis in accordance with the severity of pectus excavatum were evaluated. Cobb angle, Haller index and sternal tilt degree were measured from pre- and postoperative whole-spine anteroposterior radiographs and chest computed tomography. Sixty-three (8%) patients had scoliosis (Cobb angle >10°). No significant correlation was noted between postoperative changes in Cobb angle, Haller index or sternal tilt angle. Preoperative severity of scoliosis showed a positive correlation with postoperative changes in Cobb angle ( r  = 0.527, P  < 0.001). In analyses between groups with mild and moderate scoliosis (Cobb angle <15° and >15°, respectively), the mean postoperative Cobb angle was decreased in mild scoliosis (-2.88°) but was increased in moderate scoliosis (3.86°; P  < 0.001). Regarding the 'improvement' and 'aggravation' of scoliosis after pectus correction, preoperative severity of scoliosis was the only significant factor in univariable and multivariable analysis. Pectus excavatum repair using a pectus bar may improve scoliosis, but when the preoperative Cobb angle exceeds 15°, scoliosis may be aggravated. Therefore, pectus excavatum with concomitant moderate scoliosis requires extra caution during repair. This preliminary result suggests further investigation into the effect of chest cage remodelling on spine dynamics. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. 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

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.

The analytic solution of the firm's cost-minimization problem with box constraints and the Cobb-Douglas model

NASA Astrophysics Data System (ADS)

Bayón, L.; Grau, J. M.; Ruiz, M. M.; Suárez, P. M.

2012-12-01

One of the most well-known problems in the field of Microeconomics is the Firm's Cost-Minimization Problem. In this paper we establish the analytical expression for the cost function using the Cobb-Douglas model and considering maximum constraints for the inputs. Moreover we prove that it belongs to the class C1.

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

Relationship between screw sagittal angle and stress on endplate of adjacent segments after anterior cervical corpectomy and fusion with internal fixation: a Chinese finite element study.

PubMed

Zhang, Yu; Tang, Yibo; Shen, Hongxing

2017-12-01

In order to reduce the incidence of adjacent segment disease (ASD), the current study was designed to establish Chinese finite element models of normal 3rd~7th cervical vertebrae (C3-C7) and anterior cervical corpectomy and fusion (ACCF) with internal fixation , and analyze the influence of screw sagittal angle (SSA) on stress on endplate of adjacent cervical segments. Mimics 8.1 and Abaqus/CAE 6.10 softwares were adopted to establish finite element models. For C4 superior endplate and C6 inferior endplate, their anterior areas had the maximum stress in anteflexion position, and their posterior areas had the maximum stress in posterior extension position. As SSA increased, the stress reduced. With an increase of 10° in SSA, the stress on anterior areas of C4 superior endplate and C6 inferior endplate reduced by 12.67% and 7.99% in anteflexion position, respectively. With an increase of 10° in SSA, the stress on posterior areas of C4 superior endplate and C6 inferior endplate reduced by 9.68% and 10.22% in posterior extension position, respectively. The current study established Chinese finite element models of normal C3-C7 and ACCF with internal fixation , and demonstrated that as SSA increased, the stress on endplate of adjacent cervical segments decreased. In clinical surgery, increased SSA is able to play important role in protecting the adjacent cervical segments and reducing the incidence of ASD.

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

Muscle complex saving posterior sagittal anorectoplasty.

PubMed

Zaiem, Maher; Zaiem, Feras

2017-05-01

Posterior sagittal anorectoplasty (PSARP) published by DeVries and Peña in 1982 had become the preferred surgical technique for the management of anorectal malformations (ARM). The original technique is based upon complete exposure of the anorectal region by means of a median sagittal incision that runs from the sacrum to the anal dimple, cutting through all muscle structures behind the rectum by dividing the levator muscle and the muscle complex. Then, the rectum is located in front of the levator and within the limits of the muscle complex. In this review, we described Muscle Complex Saving-Posterior Sagittal Anorectoplasty (MCS-PSARP), which is a less invasive technique that consists of keeping this funnel-shaped muscle complex completely intact and not divided, and pulling the rectum through this funnel, toward fixing the new anus to the skin. This technique aimed both to respect the lower part of the sphincter mechanism consisting of the muscle complex, and to avoid the disturbance of this important structure by dividing and resuturing it. We presented six cases of male patients who were born with anorectal malformation (ARM) and underwent MCS-PSARP. The surgical technique proved to be feasible to achieve the dissection of the rectal pouch and the division of the rectourethral fistula in all patients, by opening only the upper part of the sphincter mechanism, the levator muscle, and keeping the lower part consisting of intact muscle complex. The early results in our series are encouraging; however, long-term functional outcomes of these patients are awaited. The surgical tips were also discussed. This proposed approach in the management of anorectal malformation cases provides an opportunity to maximize preservation of the existing continence mechanisms. It preserves the muscle complex components of the levator muscle intact, allowing a better function of the continence mechanism. Copyright © 2016 Elsevier Inc. All rights reserved.

Biomechanical Comparison of 3 Ankle Braces With and Without Free Rotation in the Sagittal Plane

PubMed Central

Alfuth, Martin; Klein, Dieter; Koch, Raphael; Rosenbaum, Dieter

2014-01-01

Context: Various designs of braces including hinged and nonhinged models are used to provide external support of the ankle. Hinged ankle braces supposedly allow almost free dorsiflexion and plantar flexion of the foot in the sagittal plane. It is unclear, however, whether this additional degree of freedom affects the stabilizing effect of the brace in the other planes of motion. Objective: To investigate the dynamic and passive stabilizing effects of 3 ankle braces, 2 hinged models that provide free plantar flexion–dorsiflexion in the sagittal plane and 1 ankle brace without a hinge. Design: Crossover study. Setting: University Movement Analysis Laboratory. Patients or Other Participants: Seventeen healthy volunteers (5 women, 12 men; age = 25.4 ± 4.8 years; height = 180.3 ± 6.5 cm; body mass = 75.5 ± 10.4 kg). Intervention(s): We dynamically induced foot inversion on a tilting platform and passively induced foot movements in 6 directions via a custom-built apparatus in 3 brace conditions and a control condition (no brace). Main Outcome Measure(s): Maximum inversion was determined dynamically using an in-shoe electrogoniometer. Passively induced maximal joint angles were measured using a torque and angle sensor. We analyzed differences among the 4 ankle-brace conditions (3 braces, 1 control) for each of the dependent variables with Friedman and post hoc tests (P < .05). Results: Each ankle brace restricted dynamic foot-inversion movements on the tilting platform as compared with the control condition, whereas only the 2 hinged ankle braces differed from each other, with greater movement restriction caused by the Ankle X model. Passive foot inversion was reduced with all ankle braces. Passive plantar flexion was greater in the hinged models as compared with the nonhinged brace. Conclusions: All ankle braces showed stabilizing effects against dynamic and passive foot inversion. Differences between the hinged braces and the nonhinged brace did not appear to be

Synopsis of integrated science to support the assessment of conservation practices in the Fort Cobb reservoir watershed, southwestern Oklahoma

USDA-ARS?s Scientific Manuscript database

The Fort Cobb Reservoir in southwestern Oklahoma is an artificial impoundment constructed by the Bureau of Reclamation for water supplies, flood control, and recreation. Success of best-management practices in reducing inflows of sediments and phosphorus to the reservoir prompted the U.S. Departmen...

Magmatic effects of the Cobb hot spot on the Juan de Fuca Ridge

USGS Publications Warehouse

Chadwick, John; Perfit, M.; Ridley, I.; Jonasson, I.; Kamenov, G.; Chadwick, W.; Embley, R.; le, Roux P.; Smith, M.

2005-01-01

The interaction of the Juan de Fuca Ridge with the Cobb hot spot has had a considerable influence on the magmatism of the Axial Segment of the ridge, the second-order segment that overlies the hot spot. In addition to the construction of the large volcanic edifice of Axial Seamount, the Axial Segment has shallow bathymetry and a prevalence of constructional volcanic features along its 100-km length, suggesting that hot spot-derived magmas supplement and oversupply the ridge. Lavas are generally more primitive at Axial Seamount and more evolved in the Axial Segment rift zones, suggesting that fractional crystallization is enhanced with increasing distance from the hot spot because of a reduced magma supply and more rapid cooling. Although the Cobb hot spot is not an isotopically enriched plume, it produces lavas with some distinct geochemical characteristics relative to normal mid-ocean ridge basalt, such as enrichments in alkalis and highly incompatible trace elements, that can be used as tracers to identify the presence and prevalence of the hot spot influence along the ridge. These characteristics are most prominent at Axial Seamount and decline in gradients along the Axial Segment. The physical model that can best explain the geochemical observations is a scenario in which hot spot and mid-ocean ridge basalt (MORB) magmas mix to varying degrees, with the proportions controlled by the depth to the MORB source. Modeling of two-component mixing suggests that MORB is the dominant component in most Axial Segment basalts. Copyright 2005 by the American Geophysical Union.

Accuracy of a Radiological Evaluation Method for Thoracic and Lumbar Spinal Curvatures Using Spinous Processes.

PubMed

Marchetti, Bárbara V; Candotti, Cláudia T; Raupp, Eduardo G; Oliveira, Eduardo B C; Furlanetto, Tássia S; Loss, Jefferson F

The purpose of this study was to assess a radiographic method for spinal curvature evaluation in children, based on spinous processes, and identify its normality limits. The sample consisted of 90 radiographic examinations of the spines of children in the sagittal plane. Thoracic and lumbar curvatures were evaluated using angular (apex angle [AA]) and linear (sagittal arrow [SA]) measurements based on the spinous processes. The same curvatures were also evaluated using the Cobb angle (CA) method, which is considered the gold standard. For concurrent validity (AA vs CA), Pearson's product-moment correlation coefficient, root-mean-square error, Pitman- Morgan test, and Bland-Altman analysis were used. For reproducibility (AA, SA, and CA), the intraclass correlation coefficient, standard error of measurement, and minimal detectable change measurements were used. A significant correlation was found between CA and AA measurements, as was a low root-mean-square error. The mean difference between the measurements was 0° for thoracic and lumbar curvatures, and the mean standard deviations of the differences were ±5.9° and 6.9°, respectively. The intraclass correlation coefficients of AA and SA were similar to or higher than the gold standard (CA). The standard error of measurement and minimal detectable change of the AA were always lower than the CA. This study determined the concurrent validity, as well as intra- and interrater reproducibility, of the radiographic measurements of kyphosis and lordosis in children. Copyright © 2017. Published by Elsevier Inc.

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.

Measurement of sternal curvature angle on patients with pectus excavatum.

PubMed

Lee, Cory; Zavala-Garcia, Abraham; Teekappanavar, Neha; Lee, Catherine; Idowu, Olajire; Kim, Sunghoon

2017-01-01

Pectus excavatum (PE) is a chest deformity characterized by marked sternal depression. The objective of this study was to quantify the sternal curvature observed in patients diagnosed with PE using the sternal curvature angle (SCA). A retrospective review of lateral chest X-rays of patients with PE from 2006 to 2013 was performed. The SCA was measured in a manner similar to the method of Cobb's angle is used to measure spinal curvature. SCA and Haller index were calculated from the chest X-rays for all patients. Lateral chest X-rays of 202 PE and 196 normal control patients were analyzed. The mean SCA ± SD of PE patients was 40.56° ± 12.88° compared to 22.02° ± 7.65° for normal patients. The difference was statistically significant with a p value of <0.0001. No significant concordance between SCA and Haller index measurements in the PE group was found (Kendall τ = -0.00015, p value = 0.9975). The difference in sternal curvature as measured by the sternal curvature angle between the pectus excavatum and normal patients was statistically significant. Our data suggest that sternal depression evident in PE patients is not a simple linear depression of the sternum but due to curvature in the sternal body.

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

The characteristics of scoliosis in Prader-Willi syndrome (PWS): analysis of 58 scoliosis patients with PWS.

PubMed

Nakamura, Yutaka; Murakami, Nobuyuki; Iida, Takahiro; Ozeki, Satoru; Asano, Satoshi; Nohara, Yutaka; Nagai, Toshiro

2015-01-01

The purpose of this study was to compare the characteristics of scoliosis in Prader-Willi syndrome (PWS) patients versus idiopathic scoliosis (IS). We identified 193 PWS patients. Scoliosis was found in 58 PWS patients, 39 of whom were treated with GH. Fifty-five IS patients were consecutively selected from an outpatient clinic. We investigated 113 patients (58 PWS group, 55 IS group) followed for a minimum of 2 years. The mean age was 17.9 and 16.1 years, respectively. Deformity was measured using Lenke classification, Cobb angle, thoracic kyphosis at T2-5 and T5-12, lumbar lordosis at T12-S1, and sagittal alignment at the C7 plumb line. BMI was also recorded. According to the Lenke system, patients were classified as (PWS group/IS group): Type 1 (8/26), Type 2 (1/4), Type 3 (3/15), Type 4 (1/0), Type 5 (32/8), and Type 6 (13/2). The average Cobb angles were 32.6° in the PWS and 35.4° in the IS. No significant differences were found for the thoracic kyphosis (T2-5, T5-12), lumbar lordosis (T12-S1) or C7 plumb line between the two groups. BMI was increased in the PWS group not treated previously with GH as compared with the IS group and the PWS group with GH. Most PWS patients presented with lumbar or thoracolumbar curves (Type 5, 6), whereas IS patients typically had thoracic scoliosis (Type 1, 2, 3).

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.

'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.

Posterior Surgery for Adolescent Idiopathic Scoliosis With Pedicle Screws and Ultrahigh-Molecular Weight Polyethylene Tape: Achieving the Ideal Thoracic Kyphosis.

PubMed

Imagama, Shiro; Ito, Zenya; Wakao, Norimitsu; Ando, Kei; Hirano, Kenichi; Tauchi, Ryoji; Muramoto, Akio; Matsui, Hiroki; Matsumoto, Tomohiro; Sakai, Yoshihito; Katayama, Yoshito; Matsuyama, Yukihiro; Ishiguro, Naoki

2016-10-01

Prospective clinical case series. To describe our surgical procedure and results for posterior correction and fusion with a hybrid approach using pedicle screws, hooks, and ultrahigh-molecular weight polyethylene tape with direct vertebral rotation (DVR) (the PSTH-DVR procedure) for treatment of adolescent idiopathic scoliosis (AIS) with satisfactory correction in the coronal and sagittal planes. Introduction of segmental pedicle screws in posterior surgery for AIS has facilitated good correction and fusion. However, procedures using only pedicle screws have risks during screw insertion, higher costs, and decreased postoperative thoracic kyphosis. We have obtained good outcomes compared with segmental pedicle screw fixation in surgery for AIS using a relatively simple operative procedure (PSTH-DVR) that uses fewer pedicle screws. The subjects were 30 consecutive patients with AIS who underwent the PSTH-DVR procedure and were followed for a minimum of 2 years. Preoperative flexibility, preoperative and postoperative Cobb angles, correction rates, loss of correction, thoracic kyphotic angles (T5-T12), coronal balance, sagittal balance, and shoulder balance were measured on plain radiographs. Rib hump, operation time, estimated blood loss, spinal cord monitoring findings, complications, and scoliosis research society (SRS)-22 scores were also examined. The mean preoperative curve of 58.0 degrees (range, 40-96 degrees) was corrected to a mean of 9.9 degrees postoperatively, and the correction rate was 83.6%. Fusion was obtained in all patients without loss of correction. In 10 cases with preoperative kyphosis angles (T5-T12) <10 degrees, the preoperative mean of 5.8 degrees improved to 20.2 degrees at the final follow-up. Rib hump and coronal, sagittal and shoulder balances were also improved, and good SRS-22 scores were achieved at final follow-up. The correction of deformity with PSTH-DVR is equivalent to that of all-pedicle screw constructs. The procedure gives

[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

How Different Marker Sets Affect Joint Angles in Inverse Kinematics Framework.

PubMed

Mantovani, Giulia; Lamontagne, Mario

2017-04-01

The choice of marker set is a source of variability in motion analysis. Studies exist which assess the performance of marker sets when direct kinematics is used, but these results cannot be extrapolated to the inverse kinematic framework. Therefore, the purpose of this study was to examine the sensitivity of kinematic outcomes to inter-marker set variability in an inverse kinematic framework. The compared marker sets were plug-in-gait, University of Ottawa motion analysis model and a three-marker-cluster marker set. Walking trials of 12 participants were processed in opensim. The coefficient of multiple correlations was very good for sagittal (>0.99) and transverse (>0.92) plane angles, but worsened for the transverse plane (0.72). Absolute reliability indices are also provided for comparison among studies: minimum detectable change values ranged from 3 deg for the hip sagittal range of motion to 16.6 deg of the hip transverse range of motion. Ranges of motion of hip and knee abduction/adduction angles and hip and ankle rotations were significantly different among the three marker configurations (P < 0.001), with plug-in-gait producing larger ranges of motion. Although the same model was used for all the marker sets, the resulting minimum detectable changes were high and clinically relevant, which warns for caution when comparing studies that use different marker configurations, especially if they differ in the joint-defining markers.

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

Skeletal effects in Angle Class II/1 patients treated with the functional regulator type II : Cephalometric and tensor analysis.

PubMed

Schulz, Simone; Koos, Bernd; Duske, Kathrin; Stahl, Franka

2016-11-01

The purpose of this work was to employ both cephalometric and tensor analysis in characterizing the skeletal changes experienced by patients with Angle Class II/1 malocclusion during functional orthodontic treatment with the functional regulator type II. A total of 23 patients with Class II/1 malocclusion based on lateral cephalograms obtained before and after treatment with the functional regulator type II were analyzed. Another 23 patients with Angle Class II/1 malocclusion who had not undergone treatment were included as controls. Our cephalometric data attest to significant therapeutic effects of the functional regulator type II on the skeletal mandibular system, including significant advancement of the mandible, increases in effective mandibular length with enhancement of the chin profile, and reduction of growth-related bite deepening. No treatment-related effects were observed at the cranial-base and midface levels. In addition, tensor analysis revealed significant stimulation of mandibular growth in sagittal directions, without indications of growth effects on the maxilla. Its growth-pattern findings differed from those of cephalometric analysis by indicating that the appliance did promote horizontal development, which supports the functional orthodontic treatment effect in Angle Class II/1 cases. Tensor analysis yielded additional insights into sagittal and vertical growth changes not identifiable by strictly cephalometric means. The functional regulator type II was an effective treatment modality for Angle Class II/1 malocclusion and influenced the skeletal development of these patients in favorable ways.

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.

Gender differences of sagittal knee and ankle biomechanics during stair-to-ground descent transition.

PubMed

Hong, Yoon No Gregory; Shin, Choongsoo S

2015-12-01

Falls on stairs often result in severe injury and occur twice as frequently in women. However, gender differences in kinetics and kinematics during stair descent are unknown. Thus, this study aimed to determine whether gender differences of knee and ankle biomechanics exist in the sagittal plane during the stair-to-ground descending transition. It was hypothesized that 1) women would reveal higher ground-toe-trochanter angle and lower ground-toe length during stair-to-ground descent transition than men; and 2) women would reveal lower peak knee extension moment during stair-to-ground descent transition than men. Fifteen men and fifteen women were recruited and performed a stair descent activity. Kinetic and kinematic data were obtained using a force plate and motion capture system. The women performed the stair descent with a lower peak knee extension moment and a peak knee power at the early weight acceptance phase. The women also revealed a higher ground-toe-trochanter angle and a lower ground-toe length, which indicated a more forward position of the lower extremity relative to the toe contact point at both the initial contact and at the time of peak kinematic and kinetic events. This study found that knee and ankle kinematics and kinetics differed significantly between the genders due to differences in ground-toe-trochanter angle. Women have a different stair descending strategy that reduces the demand of the lower extremity muscle function, but this strategy seems to increase the risk of falls. Copyright © 2015 Elsevier Ltd. All rights reserved.

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.

‘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

Use of Vertical Expandable Prosthetic Titanium Rib (VEPTR) in the Treatment of Congenital Scoliosis Without Fused Ribs.

PubMed

Murphy, Robert F; Moisan, Alice; Kelly, Derek M; Warner, William C; Jones, Tamekia L; Sawyer, Jeffrey R

2016-06-01

Although the vertical expandable prosthetic titanium rib (VEPTR) has been shown to be useful in treating congenital scoliosis (CS) with fused ribs, no studies to date have specifically evaluated the efficacy of VEPTR in the treatment of CS without fused ribs. The purpose of this study was to determine the effectiveness of VEPTR in sagittal/coronal curve correction and spine growth and compare its complication rate to the use of VEPTR in other conditions and to other treatment methods used for CS. A multicenter database was queried for patients with CS without fused ribs treated with VEPTR. Anteroposterior (AP) and lateral radiographs were used to measure parameters at 3 timepoints (preoperative, immediate postoperative, and latest follow-up): coronal Cobb angle, sagittal kyphosis, and thoracic and lumbar spine heights. Clinical data included age, time to follow-up, and complications. Twenty-five patients (13 females, 12 males) were identified. The average age at implantation was 5.7 years, with an average follow-up of 50 months. Several parameters improved from preoperative to latest follow-up: coronal Cobb angle (69 to 54 degrees, P<0.0001), thoracic spine height (T1-T12) in the AP (13.3 to 15.9 cm, P<0.0001) and lateral (14.8 to 17.4 cm, P=0.0024) planes, and lumbar spine height (L1-S1) in the AP (8.8 to 11.4 cm, P<0.0001) and lateral (9.9 to 11.9 cm, P=0.0002) planes. Kyphosis increased over the study period (36 to 41 degrees, P=0.6). Fifteen patients (60%) had 41 complications (average 2.75; range, 1 to 12). Twenty-eight complications (68%) were device-related, and 13 (32%) were disease-related. The most common complications were infection, wound dehiscence, and device migration. Six complications (15%) altered the course of treatment. Thoracic spine height increased 79% of expected growth. VEPTR is an effective treatment for patients with CS without fused ribs, as evidenced by improved radiographic parameters and increased spinal height, with a complication

MRI signal distribution within the intervertebral disc as a biomarker of adolescent idiopathic scoliosis and spondylolisthesis.

PubMed

Gervais, Julien; Périé, Delphine; Parent, Stefan; Labelle, Hubert; Aubin, Carl-Eric

2012-12-03

Early stages of scoliosis and spondylolisthesis entail changes in the intervertebral disc (IVD) structure and biochemistry. The current clinical use of MR T2-weighted images is limited to visual inspection. Our hypothesis is that the distribution of the MRI signal intensity within the IVD in T2-weighted images depends on the spinal pathology and on its severity. Therefore, this study aims to develop the AMRSID (analysis of MR signal intensity distribution) method to analyze the 3D distribution of the MR signal intensity within the IVD and to evaluate their sensitivity to scoliosis and spondylolisthesis and their severities. This study was realized on 79 adolescents who underwent a MRI acquisition (sagittal T2-weighted images) before their orthopedic or surgical treatment. Five groups were considered: low severity scoliosis (Cobb angle ≤50°), high severity scoliosis (Cobb angles >50°), low severity spondylolisthesis (Meyerding grades I and II), high severity spondylolisthesis (Meyerding grades III, IV and V) and control. The distribution of the MRI signal intensity within the IVD was analyzed using the descriptive statistics of histograms normalized by either cerebrospinal fluid or bone signal intensity, weighted centers and volume ratios. Differences between pathology and severity groups were assessed using one- and two-way ANOVAs. There were significant (p < 0.05) variations of indices between scoliosis, spondylolithesis and control groups and between low and high severity groups. The cerebrospinal fluid normalization was able to detect differences between healthy and pathologic IVDs whereas the bone normalization, which reflects both bone and IVD health, detected more differences between the severities of these pathologies. This study proves for the first time that changes in the intervertebral disc, non visible to the naked eye on sagittal T2-weighted MR images of the spine, can be detected from specific indices describing the distribution of the MR

Effect of physical therapy scoliosis specific exercises using breathing pattern on adolescent idiopathic scoliosis.

PubMed

Yoon, Sungyoung; Rhee, Min-Hyung

2016-11-01

[Purpose] This study was performed to confirm physical therapy scoliosis specific exercises on adolescent idiopathic scoliosis patients. [Subject and Methods] A 15-year-old male middle school student with scoliosis. Cobb's angle, angle of rotation of the spine, and breathing pattern were measured before and after 8 weeks training. [Results] After 8 weeks training, Cobb's angle, angle of rotation of the spine, and breathing pattern were improved better. [Conclusion] These results indicate that physical therapy scoliosis specific exercises improves scoliosis curves and could provide an effective intervention and management of scoliosis.

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

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.

ROLE OF DIFFERENT HORMONES IN THE PATHOGENESIS AND SEVERITY OF ADOLESCENT IDIOPATHIC SCOLIOSIS

PubMed Central

SILVA, RICARDO TEIXEIRA E; FERNANDES, RENAN JOSE RODRIGUES; ONO, ALLAN HIROSHI DE ARAÚJO; MARCON, RAPHAEL MARTUS; CRISTANTE, ALEXANDRE FOGAÇA; BARROS, TARCISIO ELOY PESSOA DE

2017-01-01

ABSTRACT Objective: To evaluate the hormonal profile of patients with adolescent idiopathic scoliosis (AIS) and its relationship to the severity of the curvature and quality of life. Method: Patients with scoliosis (Cobb angle above 10°), of both genders, diagnosed after 10 years of age were included, excluding those who presented other condition that could lead to scoliosis. Serum levels of 25-hydroxyvitamin D (25-OHD), cortisol and gastrin were correlated with Cobb angle and quality of life, measured by the SRS-30 questionnaire. Results: The levels of 25-OHD decreased in 97% of patients. There was an inverse relationship between gastrin levels and quality of life (p = 0.016). Moreover, there was an inverse correlation between the value of Cobb angle and quality of life (p = 0.036). There were no changes in cortisol levels. There was no correlation between Cobb angle and any of the hormones measured. Conclusion: The patients had levels of 25-OHD diminished, strengthening the hypothesis of its involvement in the development of AIS. This study also suggests that increased gastrin levels may be associated with a worse quality of life in patients with AIS. Level of Evidence II, Diagnostic Study. PMID:28642644

Comparison of parameters characterizing lumbar lordosis in radiograph and photogrammetric examination of adults.

PubMed

Drzał-Grabiec, Justyna; Truszczyńska, Aleksandra; Tarnowski, Adam; Płaszewski, Maciej

2015-01-01

The purpose of this study was to test validity of photogrammetry compared with radiography as a method of measuring the Cobb angle and the size of anterior-posterior spine curvatures in adults. The study included 50 volunteers, 23 men and 27 women whose mean age was 52.6 years. The average weight of the subjects was 81.3 kg, average body height was 172.0 cm, and the average body mass index was 27.4. Based on radiologic examination, the length and depth of lumbar lordosis were determined and the size of the Cobb angle of lumbar scoliosis. After the radiologic examination, a photogrammetric test was performed for each subject with the projection moire phenomenon. The Pearson correlation found statistically significant associations concerning the length of lordosis (P < .001) and the Cobb angle (P < .001). Correlation of the depth of lordosis indicated a strong trend (P = .063). This study found that the moire method of photogrammetric measurement produced similar findings to radiographic measurements in determining size of the Cobb angle and the length of lumbar lordosis. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

A comparison of treatment effectiveness between the CAD/CAM method and the manual method for managing adolescent idiopathic scoliosis.

PubMed

Wong, M S; Cheng, J C Y; Lo, K H

2005-04-01

The treatment effectiveness of the CAD/CAM method and the manual method in managing adolescent idiopathic scoliosis (AIS) was compared. Forty subjects were recruited with twenty subjects for each method. The clinical parameters namely Cobb's angle and apical vertebral rotation were evaluated at the pre-brace and the immediate in-brace visits. The results demonstrated that orthotic treatments rendered by the CAD/CAM method and the conventional manual method were effective in providing initial control of Cobb's angle. Significant decreases (p < 0.05) were found between the pre-brace and immediate in-brace visits for both methods. The mean reductions of Cobb's angle were 12.8 degrees (41.9%) for the CAD/CAM method and 9.8 degrees (32.1%) for the manual method. An initial control of the apical vertebral rotation was not shown in this study. In the comparison between the CAD/CAM method and the manual method, no significant difference was found in the control of Cobb's angle and apical vertebral rotation. The current study demonstrated that the CAD/CAM method can provide similar result in the initial stage of treatment as compared with the manual method.

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.

Effect of Trunk Sagittal Attitude on Shoulder, Thorax and Pelvis Three-Dimensional Kinematics in Able-Bodied Subjects during Gait

PubMed Central

Leardini, Alberto; Berti, Lisa; Begon, Mickaël; Allard, Paul

2013-01-01

It has been shown that an original attitude in forward or backward inclination of the trunk is maintained at gait initiation and during locomotion, and that this affects lower limb loading patterns. However, no studies have shown the extent to which shoulder, thorax and pelvis three-dimensional kinematics are modified during gait due to this sagittal inclination attitude. Thirty young healthy volunteers were analyzed during level walking with video-based motion analysis. Reflecting markers were mounted on anatomical landmarks to form a two-marker shoulder line segment, and a four-marker thorax and pelvis segments. Absolute and relative spatial rotations were calculated, for a total of 11 degrees of freedom. The subjects were divided into two groups of 15 according to the median of mean thorax inclination angle over the gait cycle. Preliminary MANOVA analysis assessed whether gender was an independent variable. Then two-factor nested ANOVA was used to test the possible effect of thorax inclination on body segments, planes of motion and gait periods, separately. There was no significant difference in all anthropometric and spatio-temporal parameters between the two groups, except for subject mass. The three-dimensional kinematics of the thorax and pelvis were not affected by gender. Nested ANOVA revealed group effect in all segment rotations apart those at the pelvis, in the sagittal and frontal planes, and at the push-off. Attitudes in sagittal thorax inclination altered trunk segments kinematics during gait. Subjects with a backward thorax showed less thorax-to-pelvis motion, but more shoulder-to-thorax and thorax-to-laboratory motion, less motion in flexion/extension and in lateral bending, and also less motion during push-off. This contributes to the understanding of forward propulsion and sideways load transfer mechanisms, fundamental for the maintenance of balance and the risk of falling. PMID:24204763

Effect of trunk sagittal attitude on shoulder, thorax and pelvis three-dimensional kinematics in able-bodied subjects during gait.

PubMed

Leardini, Alberto; Berti, Lisa; Begon, Mickaël; Allard, Paul

2013-01-01

It has been shown that an original attitude in forward or backward inclination of the trunk is maintained at gait initiation and during locomotion, and that this affects lower limb loading patterns. However, no studies have shown the extent to which shoulder, thorax and pelvis three-dimensional kinematics are modified during gait due to this sagittal inclination attitude. Thirty young healthy volunteers were analyzed during level walking with video-based motion analysis. Reflecting markers were mounted on anatomical landmarks to form a two-marker shoulder line segment, and a four-marker thorax and pelvis segments. Absolute and relative spatial rotations were calculated, for a total of 11 degrees of freedom. The subjects were divided into two groups of 15 according to the median of mean thorax inclination angle over the gait cycle. Preliminary MANOVA analysis assessed whether gender was an independent variable. Then two-factor nested ANOVA was used to test the possible effect of thorax inclination on body segments, planes of motion and gait periods, separately. There was no significant difference in all anthropometric and spatio-temporal parameters between the two groups, except for subject mass. The three-dimensional kinematics of the thorax and pelvis were not affected by gender. Nested ANOVA revealed group effect in all segment rotations apart those at the pelvis, in the sagittal and frontal planes, and at the push-off. Attitudes in sagittal thorax inclination altered trunk segments kinematics during gait. Subjects with a backward thorax showed less thorax-to-pelvis motion, but more shoulder-to-thorax and thorax-to-laboratory motion, less motion in flexion/extension and in lateral bending, and also less motion during push-off. This contributes to the understanding of forward propulsion and sideways load transfer mechanisms, fundamental for the maintenance of balance and the risk of falling.

"Push-Through" Rod Passage Technique for the Improvement of Lumbar Lordosis and Sagittal Balance in Minimally Invasive Adult Degenerative Scoliosis Surgery.

PubMed

Haque, Raqeeb M; Uddin, Omar M; Ahmed, Yousef; El Ahmadieh, Tarek Y; Hashmi, Sohaib Z; Shah, Amir; Fessler, Richard G

2016-10-01

Traditional open surgical techniques for correction of adult degenerative scoliosis (ADS) are often associated with increased blood loss, postoperative pain, and complications. Minimally invasive (MIS) techniques have been utilized to address these issues; however, concerns regarding improving certain alignment parameters have been raised. A new "push-through" technique for MIS correction of ADS has been developed wherein a rod is bent before its placement into the screw heads and then contoured further to yield improved correction of radiographic parameters. Preoperative and postoperative radiographic measurements of 3 patients who underwent MIS correction of scoliosis using the "push-through" technique were compared with 22 prior patients who had received traditional MIS correction. All patients received staged correction of scoliosis. The first stage involved insertion of lateral lumbar interbodies. Standing x-rays were then evaluated for overall global balance. The second stage involved appropriate MIS facetectomies, facet fusions, posterior transforaminal interbodies at lower lumbar segments, and finally the placement of rods.TECHNIQUE OVERVIEW:: (1) A long rod composed of titanium is bent with a mild lordosis and passed through the extensions of the screw heads cephalad to caudad. (2) The rod is passed fully through the incision so it extrudes from the caudal end of the construct. At this point, further lordosis is bent into the rods. (3) The rod is then pulled back into the appropriate position. (4) The unnecessary cephalad rod is then cut to appropriate length with a circular saw. (5) Rod reducers are then sequentially lowered and tightened to achieve the desired correction. Mean age for all patients was 66.02 years. Preoperative coronal Cobb, sagittal vertical axis (SVA), and pelvic incidence (PI) were similar in all patients, whereas lumbar lordosis (LL) was smaller (15.27 vs. 29.85 degrees, P=0.00389) and pelvic tilt (PT) was larger (37.00 vs. 27

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.

A gait retraining system using augmented-reality to modify footprint parameters: Effects on lower-limb sagittal-plane kinematics.

PubMed

Bennour, Sami; Ulrich, Baptiste; Legrand, Thomas; Jolles, Brigitte M; Favre, Julien

2018-01-03

Improving lower-limb flexion/extension angles during walking is important for the treatment of numerous pathologies. Currently, these gait retraining procedures are mostly qualitative, often based on visual assessment and oral instructions. This study aimed to propose an alternative method combining motion capture and display of target footprints on the floor. The second objectives were to determine the error in footprint modifications and the effects of footprint modifications on lower-limb flexion/extension angles. An augmented-reality system made of an optoelectronic motion capture device and video projectors displaying target footprints on the floor was designed. 10 young healthy subjects performed a series of 27 trials, consisting of increased and decreased amplitudes in stride length, step width and foot progression angle. 11 standard features were used to describe and compare lower-limb flexion/extension angles among footprint modifications. Subjects became accustomed to walk on target footprints in less than 10 min, with mean (± SD) precision of 0.020 ± 0.002 m in stride length, 0.022 ± 0.006 m in step width, and 2.7 ± 0.6° in progression angle. Modifying stride length had significant effects on 3/3 hip, 2/4 knee and 4/4 ankle features. Similarly, step width and progression angle modifications affected 2/3 and 1/3 hip, 2/4 and 1/4 knee as well as 3/4 and 2/4 ankle features, respectively. In conclusion, this study introduced an augmented-reality method allowing healthy subjects to modify their footprint parameters rapidly and precisely. Walking with modified footprints changed lower-limb sagittal-plane kinematics. Further research is needed to design rehabilitation protocols for specific pathologies. Copyright © 2017 Elsevier Ltd. All rights reserved.

Prediction of Curve Progression in Idiopathic Scoliosis: Validation of the Sanders Skeletal Maturity Staging System.

PubMed

Sitoula, Prakash; Verma, Kushagra; Holmes, Laurens; Gabos, Peter G; Sanders, James O; Yorgova, Petya; Neiss, Geraldine; Rogers, Kenneth; Shah, Suken A

2015-07-01

Retrospective case series. This study aimed to validate the Sanders Skeletal Maturity Staging System and to assess its correlation to curve progression in idiopathic scoliosis. The Sanders Skeletal Maturity Staging System has been used to predict curve progression in idiopathic scoliosis. This study intended to validate that initial study with a larger sample size. We retrospectively reviewed 1100 consecutive patients with idiopathic scoliosis between 2005 and 2011. Girls aged 8 to 14 years (<2 yr postmenarche) and boys aged 10 to 16 years who had obtained at least 1 hand and spine radiograph on the same day for evaluation of skeletal age and scoliosis curve magnitude were followed to skeletal maturity (Risser stage 5 or fully capped Risser stage 4), curve progression to 50° or greater, or spinal fusion. Patients with nonidiopathic curves were excluded. There were 161 patients: 131 girls (12.3 ± 1.2 yr) and 30 boys (13.9 ± 1.1 yr). The distribution of patients within Sanders stage (SS) 1 through 7 was 7, 28, 41, 45, 7, 31, and 2 patients, respectively; modified Lenke curve types 1 to 6 were 26, 12, 63, 5, 38, and 17 patients, respectively. All patients in SS2 with initial Cobb angles of 25° or greater progressed, and patients in SS1 and SS3 with initial Cobb angles of 35° or greater progressed. Similarly, all patients with initial Cobb angles of 40° or greater progressed except those in SS7. Conversely, none of the patients with initial Cobb angles of 15° or less or those in SS5, SS6, and SS7 with initial Cobb angles of 30° or less progressed. Predictive progression of 67%, 50%, 43%, 27%, and 60% was observed for subgroups SS1/30°, SS2/20°, SS3/30°, SS4/30°, and SS6/35° respectively. This larger cohort shows a strong predictive correlation between SS and initial Cobb angle for probability of curve progression in idiopathic scoliosis. 3.

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.

Evaluation of postoperative residual spinal deformity and patient outcome in idiopathic scoliosis patients in Japan using the scoliosis research society outcomes instrument.

PubMed

Watanabe, Kei; Hasegawa, Kazuhiro; Hirano, Toru; Uchiyama, Seiji; Endo, Naoto

2007-03-01

This study clarifies the correlation between the components of the Scoliosis Research Society Outcomes Instrument (SRS-24) and the radiographic parameters after surgery in Japanese idiopathic scoliosis patients. To investigate the correlation between the magnitude of back deformity after scoliosis surgery and the components of the SRS-24. Patient outcomes for Japanese scoliosis patients using the SRS-24 have not been fully investigated. Idiopathic scoliosis patients (n = 81) who were treated with surgery and followed up for more than 2 years were evaluated. Radiographic examination included Cobb angle, rotation angle of apical vertebrae, and translation of the C7 vertebra from the center sacral line on the coronal plane. In addition, the score of one new question regarding postoperative scar was investigated and compared with that of the individual SRS-24 domains. A comparison of the SRS-24 and radiographic results revealed a significant inverse correlation between total pain and the postoperative correction of the rotation angle in the thoracic curve (rs = 0.27; P < 0.05). General self-image was inversely correlated with the Cobb angle (rs = -0.23; P < 0.05) and the rotation angle (rs = -0.30; P < 0.01) in the thoracic curve. Self-image after surgery was positively correlated with the correction degree of the thoracic Cobb angle (rs = 0.27; P < 0.05); 60% of patients had some concerns regarding postoperative scar, and the concerned patients demonstrated significantly lower scores in the pain and general self-image domains (P < 0.05) than the unconcerned patients did. Patients with a greater Cobb angle or rotation angle in the thoracic curve had a negative self-image. Self-image improved after surgery by greater correction of the thoracic Cobb angle. Thoracic scoliotic deformity with prominence should be substantially reduced by the surgical treatment to improve satisfaction rates and self-image regarding back appearance. Additionally, physicians should pay more

Trunk imbalance in adolescent idiopathic scoliosis.

PubMed

Fortin, Carole; Grunstein, Erin; Labelle, Hubert; Parent, Stefan; Ehrmann Feldman, Debbie

2016-06-01

Trunk imbalance (ie, frontal trunk shift measured with a plumb line from C7 to S1) is part of the clinical evaluation in adolescent idiopathic scoliosis (AIS), but its prevalence and relationship with scoliosis, back pain, and health-related factors are not well documented. The principal objectives are to document trunk imbalance prevalence and to explore the association between trunk imbalance and the following factors: Cobb angle, type of scoliosis, back pain, function, mental health, and self-image. The secondary objective is to determine back pain prevalence and the relationship between back pain and each of the following: Cobb angle, function, mental health, and self-image. This is a cross-sectional study in a scoliosis clinic of a tertiary university hospital center. The sample includes youth with AIS (N=55). The outcome measures were trunk imbalance prevalence and magnitude, and back pain prevalence and intensity using the Numeric Pain Rating Scale (NPRS) and the Scoliosis Research Society-22 (SRS-22) pain score, and the function, self-image, and mental health domains of the SRS-22. Trunk imbalance and back pain were assessed in 55 patients with AIS (Cobb angle: 10-60°). Patients completed the SRS-22 questionnaire and the NPRS. Correlations were done between trunk imbalance and scoliosis (Cobb angle, type of scoliosis), back pain (NPRS and SRS-22 pain score), and health-related factors using Pearson correlation coefficients (r) and logistic regression models. Trunk imbalance prevalence is 85% and back pain prevalence is 73%. We found fair to moderate significant positive correlation between trunk imbalance and Cobb angle (r=0.32-0.66, p<.05) but not with back pain, function, mental health, self-image, or type of scoliosis. Lower self-reported pain significantly correlated with lower Cobb angles (r=0.29, p=.03), higher function (r=0.55, p=.000), higher self-image (r=0.44, p=.001), and better mental health (r=0.48, p=.000). There was a trend for trunk

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

Analysis of the Pelvic Functional Orientation in the Sagittal Plane: A Radiographic Study With EOS 2D/3D Technology.

PubMed

Loppini, Mattia; Longo, Umile Giuseppe; Ragucci, Pasquala; Trenti, Nicoletta; Balzarini, Luca; Grappiolo, Guido

2017-03-01

We investigated the relationship between pelvic incidence (PI) with anterior pelvic plane angle (APPA), pelvic tilt (PT) angle, and sacral slope (SS) in standing and sitting positions to identify the best parameter expressing the pelvic functional orientation in the sagittal plane. We enrolled 109 consecutive patients (M:F = 43:66) eligible for a primary total hip arthroplasty (THA) with an average age of 63.4 years (15-85). EOS 2D/3D radiography was performed in standing and sitting positions before THA to evaluate the functional pelvic orientation. 3D images took into account the patient-specific sagittal balance measuring APPA, PT, SS, and PI. In standing position, functional parameters measured 5° ± 7.1 for APPA, 11° ± 8.3 for PT, 43° ± 8.5 for SS, and 53° ± 10.9 for PI. In sitting position, they were -18° ± 10.4 for APPA, 34° ± 11.8 for PT, 20° ± 12.6 for SS, and 54° ± 10.9 for PI. There was no significant difference between men and women in terms of the functional parameters in both positions. No relationship was found between APPA and PI in both positions. SS correlated with PI in standing (r = 0.66; P < .0001; R 2  = 0.44) and sitting (r = 0.51; P < .0001; R 2  = 0.26). PT correlated with PI in standing (r = 0.65; P < .0001; R 2  = 0.42) and sitting (r = 0.38; P < .0001; R 2  = 0.14). SS shows the highest correlation with functional pelvic tilt. The study suggests that adjustments in acetabular anteversion during primary THA should be based on SS. Copyright © 2016 Elsevier Inc. All rights reserved.

Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures compared with open technique.

PubMed

Paredes, Igor; Panero, Irene; Cepeda, Santiago; Castaño-Leon, Ana M; Jimenez-Roldan, Luis; Perez-Nuñez, Ángel; Alén, Jose A; Lagares, Alfonso

2018-06-14

This study aimed to compare the accuracy of screw placement between open pedicle screw fixation and percutaneous pedicle screw fixation (MIS) for the treatment of thoracolumbar spine fractures (TSF). Forty-nine patients with acute TSF who were treated with transpedicular screw fixation from January 2013 to December 2016 were retrospectively reviewed. The patients were divided into Open and MIS groups. Laminectomy was performed in either group if needed. The accuracy of the screw placement, the evolution of the Cobb sagital angle postoperatively and at 12-month follow up and the neurological status were recorded. AO type of fracture and TLICS score were also recorded. Mean age was 42 years old. Mean TLICS score was 6,29 and 5,96 for open and MIS groups respectively. Twenty five MIS and 24 open surgeries were performed, and 350 (175 in each group) screws were inserted (7,14 per patient). Twenty-four and 13 screws were considered ̈out ̈ in the open and MIS groups respectively (Odds ratio 1,98. 0,97-4,03 p=0,056). The Cobb sagittal angle went from 13,3o to 4,5o and from 14,9o to 8,2o in the Open and MIS groups respectively (both p<0,0001). Loss of correction at 12-month follow up was 3,2o and 4,2o for the open and MIS groups respectively. No neurological worsening was observed. For the treatment of acute thoracolumbar fractures, the MIS technique seems to achieve similar results to the open technique in relation to neurological improvement and deformity correction, while placing the screws more accurately.

Acute Effects of Hamstring Stretching on Sagittal Spinal Curvatures and Pelvic Tilt

PubMed Central

López-Miñarro, Pedro A.; Muyor, José M.; Belmonte, Felipe; Alacid, Fernando

2012-01-01

The aim of this study was to determine acute effects of hamstring stretching in thoracic and lumbar spinal curvatures and pelvic tilt. Fifty-five adults (29.24 ± 7.41 years) were recruited for this study. Subjects performed a hamstring stretching protocol consisting of four exercises. The session consisted of 3 sets of each exercise and subjects held the position for 20 seconds with a 30-second rest period between sets and exercises. Thoracic and lumbar spinal angles and pelvic tilt were measured with a SpinalMouse in relaxed standing, sit-and-reach test and Macrae & Wright position. Hamstring extensibility was determined by active straight leg raise test and sit-and-reach score. All measures were performed before and immediately after the hamstring stretching protocol. Active straight leg raise angle and sitand-reach score significantly improved immediately after the stretching protocol (p<0.001). Greater anterior pelvic tilt (p<0.001) and lumbar flexion (p<0.05) and a smaller thoracic kyphosis in the sit-and-reach (p<0.001) were found after the stretching protocol. However, stretching produced no significant change on spinal curvatures or pelvic tilt in standing and maximal trunk flexion with knees flexed. In conclusion, static stretching of the hamstring is associated to an immediate change in the sagittal spinal curvatures and pelvic position when performing trunk flexion with knees extended, so that allowing for greater lumbar flexion and anterior pelvic tilt and lower thoracic kyphosis. Hamstring stretching is recommended prior to sport activities involving trunk flexion with the knees straight. PMID:23486214

Sagittal endplate morphology of the lower lumbar spine.

PubMed

Lakshmanan, Palaniappan; Purushothaman, Balaji; Dvorak, Vlasta; Schratt, Walter; Thambiraj, Sathya; Boszczyk, Maximilian

2012-05-01

The sagittal profile of lumbar endplates is discrepant from current simplified disc replacement and fusion device design. Endplate concavity is symmetrical in the coronal plane but shows considerable variability in the sagittal plane, which may lead to implant-endplate mismatch. The aim of this investigation is to provide further analysis of the sagittal endplate morphology of the mid to lower lumbar spine study (L3–S1), thereby identifying the presence of common endplate shape patterns across these levels and providing morphological reference values complementing the findings of previous studies. Observational study. A total of 174 magnetic resonance imaging (MRI) scans of the adult lumbar spine from the digital archive of our centre, which met the inclusion criteria, were studied. Superior (SEP) and inferior (IEP) endplate shape was divided into flat (no concavity), oblong (homogeneous concavity) and ex-centric (inhomogeneous concavity). The concavity depth (ECD) and location of concavity apex (ECA) relative to endplate diameter of the vertebrae L3–S1 were determined. Flat endplates were only predominant at the sacrum SEP (84.5%). The L5 SEP was flat in 24.7% and all other endplates in less than 10%. The majority of endplates were concave with a clear trend of endplate shape becoming more ex-centric from L3 IEP (56.9% oblong vs. 37.4% ex-centric) to L5 IEP (4% oblong vs. 94.3% ex-centric). Ex-centric ECA were always found in the posterior half of the lumbar endplates. Both the oblong and ex-centric ECD was 2-3 mm on average with the IEP of a motion segment regularly possessing the greater depth. A sex- or age-related difference could not be found. The majority of lumbar endplates are concave, while the majority of sacral endplates are flat. An oblong and an ex-centric endplate shape can be distinguished, whereby the latter is more common at the lower lumbar levels. The apex of the concavity of ex-centric discs is located in the posterior half of the endplate

Effect of alignment changes on sagittal and coronal socket reaction moment interactions in transtibial prostheses.

PubMed

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

2013-04-26

Alignment is important for comfortable and stable gait of lower-limb prosthesis users. The magnitude of socket reaction moments in the multiple planes acting simultaneously upon the residual limb may be related to perception of comfort in individuals using prostheses through socket interface pressures. The aim of this study was to investigate the effect of prosthetic alignment changes on sagittal and coronal socket reaction moment interactions (moment-moment curves) and to characterize the curves in 11 individuals with transtibial amputation using novel moment-moment interaction parameters measured by plotting sagittal socket reaction moments versus coronal ones under various alignment conditions. A custom instrumented prosthesis alignment component was used to measure socket reaction moments during walking. Prosthetic alignment was tuned to a nominally aligned condition by a prosthetist, and from this position, angular (3° and 6° of flexion, extension, abduction or adduction of the socket) and translational (5mm and 10mm of anterior, posterior, medial or lateral translation of the socket) alignment changes were performed in either the sagittal or the coronal plane in a randomized manner. A total of 17 alignment conditions were tested. Coronal angulation and translation alignment changes demonstrated similar consistent changes in the moment-moment curves. Sagittal alignment changes demonstrated more complex changes compared to the coronal alignment changes. Effect of sagittal angulations and translations on the moment-moment curves was different during 2nd rocker (mid-stance) with extension malalignment appearing to cause medio-lateral instability. Presentation of coronal and sagittal socket reaction moment interactions may provide useful visual information for prosthetists to understand the biomechanical effects of malalignment of transtibial prostheses. Copyright © 2013 Elsevier Ltd. All rights reserved.

Sagittal and Vertical Craniofacial Growth Pattern and Timing of Circumpubertal Skeletal Maturation: A Multiple Regression Study

PubMed Central

Rosso, Luigi; Riatti, Riccardo

2016-01-01

The knowledge of the associations between the timing of skeletal maturation and craniofacial growth is of primary importance when planning a functional treatment for most of the skeletal malocclusions. This cross-sectional study was thus aimed at evaluating whether sagittal and vertical craniofacial growth has an association with the timing of circumpubertal skeletal maturation. A total of 320 subjects (160 females and 160 males) were included in the study (mean age, 12.3 ± 1.7 years; range, 7.6–16.7 years). These subjects were equally distributed in the circumpubertal cervical vertebral maturation (CVM) stages 2 to 5. Each CVM stage group also had equal number of females and males. Multiple regression models were run for each CVM stage group to assess the significance of the association of cephalometric parameters (ANB, SN/MP, and NSBa angles) with age of attainment of the corresponding CVM stage (in months). Significant associations were seen only for stage 3, where the SN/MP angle was negatively associated with age (β coefficient, −0.7). These results show that hyperdivergent and hypodivergent subjects may have an anticipated and delayed attainment of the pubertal CVM stage 3, respectively. However, such association remains of little entity and it would become clinically relevant only in extreme cases. PMID:27995136

Sagittal and Vertical Craniofacial Growth Pattern and Timing of Circumpubertal Skeletal Maturation: A Multiple Regression Study.

PubMed

Perinetti, Giuseppe; Rosso, Luigi; Riatti, Riccardo; Contardo, Luca

2016-01-01

The knowledge of the associations between the timing of skeletal maturation and craniofacial growth is of primary importance when planning a functional treatment for most of the skeletal malocclusions. This cross-sectional study was thus aimed at evaluating whether sagittal and vertical craniofacial growth has an association with the timing of circumpubertal skeletal maturation. A total of 320 subjects (160 females and 160 males) were included in the study (mean age, 12.3 ± 1.7 years; range, 7.6-16.7 years). These subjects were equally distributed in the circumpubertal cervical vertebral maturation (CVM) stages 2 to 5. Each CVM stage group also had equal number of females and males. Multiple regression models were run for each CVM stage group to assess the significance of the association of cephalometric parameters (ANB, SN/MP, and NSBa angles) with age of attainment of the corresponding CVM stage (in months). Significant associations were seen only for stage 3, where the SN/MP angle was negatively associated with age (β coefficient, -0.7). These results show that hyperdivergent and hypodivergent subjects may have an anticipated and delayed attainment of the pubertal CVM stage 3, respectively. However, such association remains of little entity and it would become clinically relevant only in extreme cases.

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.

Usefulness of Chest Radiographs for Scoliosis Screening: A Comparison with Thoraco-Lumbar Standing Radiographs

PubMed Central

Oh, Chang Hyun; Kim, Chan Gyu; Lee, Myoung Seok; Park, Hyeong-Chun; Park, Chong Oon

2012-01-01

Purpose The purposes of this study were to evaluate the usefulness and limitations of chest radiographs in scoliosis screening and to compare these results with those of thoraco-lumbar standing radiographs (TLSR). Materials and Methods During Korean conscription, 419 males were retrospectively examined using both chest radiographs and TLSR to confirm the scoliosis and Cobb angle at the Regional Military Manpower. We compared the types of spinal curves and Cobb angles as measured from different radiographs. Results In the pattern of spinal curves, the overall matching rate of chest radiographs using TLSR was about 58.2% (244 of 419 cases). Cobb angle differences between chest radiographs and TLSR with meaningful difference was observed in 156 cases (37.2%); a relatively high proportion (9.5%) of Cobb angle differences more than 10 degrees was also observed. The matching rate of both spinal curve types and Cobb angle accuracy between chest radiographs and TLSR was 27.9% (117 among 419 cases). Chest radiographs for scoliosis screening were observed with 93.94% of sensitivity and 61.67% of specificity in thoracic curves; however, less than 40% of sensitivity (38.27%, 20.00%, and 25.80%) and more than 95% of specificity (97.34%, 99.69%, and 98.45%) were observed in thoraco-lumbar, lumbar, and double major curves, respectively. Conclusion The accuracy of chest radiographs for scoliosis screening was low. The incidence of thoracic curve scoliosis was overestimated and lumbar curve scoliosis was easily missed by chest radiography. Scoliosis screening using chest radiography has limited values, nevertheless, it is useful method for detecting thoracic curve scoliosis. PMID:23074120

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

Reliability and accuracy analysis of a new semiautomatic radiographic measurement software in adult scoliosis.

PubMed

Aubin, Carl-Eric; Bellefleur, Christian; Joncas, Julie; de Lanauze, Dominic; Kadoury, Samuel; Blanke, Kathy; Parent, Stefan; Labelle, Hubert

2011-05-20

Radiographic software measurement analysis in adult scoliosis. To assess the accuracy as well as the intra- and interobserver reliability of measuring different indices on preoperative adult scoliosis radiographs using a novel measurement software that includes a calibration procedure and semiautomatic features to facilitate the measurement process. Scoliosis requires a careful radiographic evaluation to assess the deformity. Manual and computer radiographic process measures have been studied extensively to determine the reliability and reproducibility in adolescent idiopathic scoliosis. Most studies rely on comparing given measurements, which are repeated by the same user or by an expert user. A given measure with a small intra- or interobserver error might be deemed as good repeatability, but all measurements might not be truly accurate because the ground-truth value is often unknown. Thorough accuracy assessment of radiographic measures is necessary to assess scoliotic deformities, compare these measures at different stages or to permit valid multicenter studies. Thirty-four sets of adult scoliosis digital radiographs were measured two times by three independent observers using a novel radiographic measurement software that includes semiautomatic features to facilitate the measurement process. Twenty different measures taken from the Spinal Deformity Study Group radiographic measurement manual were performed on the coronal and sagittal images. Intra- and intermeasurer reliability for each measure was assessed. The accuracy of the measurement software was also assessed using a physical spine model in six different scoliotic configurations as a true reference. The majority of the measures demonstrated good to excellent intra- and intermeasurer reliability, except for sacral obliquity. The standard variation of all the measures was very small: ≤ 4.2° for Cobb angles, ≤ 4.2° for the kyphosis, ≤ 5.7° for the lordosis, ≤ 3.9° for the pelvic angles, and �

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

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.

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.

Proximal Junctional Kyphosis.

PubMed

Kim, Han Jo; Iyer, Sravisht

2016-05-01

Proximal junctional kyphosis (PJK) is a common complication following adult spinal deformity surgery. It is defined by two criteria: a proximal junctional sagittal Cobb angle (1) ≥ 10° and (2) at least 10° greater than the preoperative measurement. PJK is multifactorial in origin and likely stems from surgical, radiographic, and patient-related risk factors. The diagnosis of PJK represents a broad spectrum of disease ranging from asymptomatic patients with recurrence of deformity to those presenting with increased pain, functional deficit, and, in the most severe cases, neurologic deficits. Recent studies have demonstrated increased pain levels in select patients with PJK. In keeping with the broad spectrum of the disease, classification schemes are needed to better describe and stratify the severity of PJK. The most severe form is proximal junctional failure. A consensus on a uniform definition of proximal junctional failure is needed to allow for more systematic study of this phenomenon.

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

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

Effect of the sagittal ankle angle at initial contact on energy dissipation in the lower extremity joints during a single-leg landing.

PubMed

Lee, Jinkyu; Song, Yongnam; Shin, Choongsoo S

2018-05-01

During landing, the ankle angle at initial contact (IC) exhibits relatively wide individual variation compared to the knee and hip angles. However, little is known about the effect of different IC ankle angles on energy dissipation. The purpose of this study was to investigate the relationship between individual ankle angles at IC and energy dissipation in the lower extremity joints. Twenty-seven adults performed single-leg landings from a 0.3-m height. Kinetics and kinematics of the lower extremity joints were measured. The relationship between ankle angles at IC and negative work, range of motion, the time to peak ground reaction force, and peak loading rate were analyzed. The ankle angle at IC was positively correlated with ankle negative work (r = 0.80, R 2  = 0.64, p < 0.001) and the contribution of the ankle to total (ankle, knee and hip joint) negative work (r = 0.84, R 2  = 0.70, p < 0.001), but the ankle angle was negatively correlated with hip negative work (r = -0.46, R 2  = 0.21, p = 0.01) and the contribution of the hip to total negative work (r = -0.61, R 2  = 0.37, p < 0.001). The knee negative work and the contribution of the knee to total negative work were not correlated with the ankle angle at IC. The ankle angle at IC was positively correlated with total negative work (r = 0.50, R 2  = 0.25, p < 0.01) and negatively correlated with the peak loading rate (r = -0.76, R 2  = 0.57, p < 0.001). These results indicated that landing mechanics changed as the ankle angle at IC increased, such that the ankle energy dissipation increased and redistributed the energy dissipation in the ankle and hip joints. Further, these results suggest that increased ankle energy dissipation with a higher IC plantar flexion angle may be a potential landing technique for reducing the risk of injury to the anterior cruciate ligament and hip musculature. Copyright © 2018 Elsevier B.V. All rights reserved.

[Effectiveness of long segment fixation combined with vertebroplasty for severe osteoporotic thoracolumbar compressive fractures].

PubMed

Xu, Zixing; Xu, Weihong; Wang, Changsheng; Luo, Hongbin; Li, Guishuang; Chen, Rongsheng

2013-11-01

To study the effectiveness of long segment fixation combined with vertebroplasty (LSF-VP) for severe osteoporotic thoracolumbar compressive fractures with kyphosis deformity. Between March 2006 and May 2012, a retrospective analysis was made on the clinical data of 48 cases of severe osteoporotic thoracolumbar compressive fractures with more than 50% collapse of the anterior vertebral body or more than 400 of sagittal angulation, which were treated by LSF-VP in 27 cases (LSF-VP group) or percutaneous kyphoplasty (PKP) in 21 cases (PKP group). All patients suffered from single thoracolumbar vertebral compressive fracture at T11 to L2. There was no significant difference in gender, age, spinal segment, and T values of bone mineral density between 2 groups (P > 0.05). The effectiveness of the treatment was appraised by visual analogue scale (VAS), Cobb angle of thoracolumbar kyphosis, height of anterior/posterior vertebral body, and compressive ratio of vertebrae before and after operations. The LSF-VP group had longer operation time, hospitalization days, and more bone cement injection volume than the PKP group, showing significant differences (P < 0.05). Intraoperative blood loss in LSF-VP group ranged from 220 to 1,050 mL (mean, 517 mL). No pulmonaryor cerebral embolism or cerebrospinal fluid leakage was found in both groups. Asymptomatic bone cement leakage was found in 3 cases of LSF-VP group and 2 cases of PKP group. The patients were followed up for 16-78 months (mean, 41.1 months) in LSF-VP group, and 12-71 months (mean, 42.1 months) in PKP group. No fixation failure such as loosened or broken pedicle screw was found in LSF-VP group during the follow-up, and no re-fracture or adjacent vertebral body fracture was found. Two cases in PKP group at 39 and 56 months after operation respectively were found to have poor maintenance of vertebral height and loss of rectification (Cobb angle was more than 40 degrees) with recurrence of pain, which were treated by second

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.

Immediate responses to backpack carriage on postural angles in young adults: A crossover randomized self-controlled study with repeated measures.

PubMed

Abaraogu, Ukachukwu O; Ezenwankwo, Elochukwu F; Nwadilibe, Ijeoma B; Nwafor, Geoffrey C; Ugwuele, Bianca O; Uzoh, Pascal C; Ani, Ifunanya; Amarachineke, Kinsley; Atuma, Collins; Ewelunta, Obed

2017-01-01

Heavy backpacks have been associated with various postural changes and consequently musculoskeletal disorders. We evaluated the immediate responses of varying backpack loads on cranio-vertebral angle (CVA), sagittal shoulder angle (SSA) and trunk forward lean (TFL) of young adults between the ages of 18-25 years. This was a 3×3 cross over randomized controlled study with repeated measures among a convenience sample of young adults (n = 30; 50% male, 50% female). Each participant in a standing posture was assessed at four different loads: no backpack, carrying backpack of 5%, 10%, and 15% of body weight (BW). A sagittal photograph was taken of the area of the body corresponding to spinal angle during each of these test conditions to allow for later analysis of postural deviations. Comparisons of the mean deviations of the different postural angles from baseline and between test conditions were made using ANOVA at p≤0.05. Generally, there was a trend toward a decrease in the CVA and TFL with increasing backpack loads. Specifically, a significant decrease was seen for TFL at10% and 15% BW loads when compared with no load condition. In contrast, the decrease in CVA was only significant between no load condition and 15% body weight load. The SSA remained unchanged with backpack weight within 15% BW. Whereas the SSA of young adults may not be upset by an acute loading with a backpack within 15% of body weight, a 15% BW backpack led to more forward posture of the head on the neck. In addition, backpack load as low as 10% BW is enough to cause an immediate forward lean of the trunk.

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.

Correlation between Topographic Parameters Obtained by Back Surface Topography Based on Structured Light and Radiographic Variables in the Assessment of Back Morphology in Young Patients with Idiopathic Scoliosis.

PubMed

Pino-Almero, Laura; Mínguez-Rey, María Fe; Cibrián-Ortiz de Anda, Rosa María; Salvador-Palmer, María Rosario; Sentamans-Segarra, Salvador

2017-04-01

Optical cross-sectional study. To study the correlation between asymmetry of the back (measured by means of surface topography) and deformity of the spine (quantified by the Cobb angle). The Cobb angle is considered the gold standard in diagnosis and follow-up of scoliosis but does not correctly characterize the three-dimensional deformity of scoliosis. Furthermore, the exposure to ionizing radiation may cause harmful effects particularly during the growth stage, including breast cancer and other tumors. Patients aged 13.15±1.96 years (range, 7-17 years; n=88) with Cobb angle greater than 10° were evaluated with X-rays and our back surface topography method through three variables: axial plane (DHOPI), coronal plane (POTSI), and profile plane (PC). Pearson's correlation was applied to determine the correlation between topographic and radiographic variables. One-way analysis of variance and Bonferroni correction were used to compare groups with different grades of scoliosis. Significance was set at p <0.01 and, in some cases, at p <0.05. We detected a positive, statistically significant correlation between Cobb angle with DHOPI ( r =0.810) and POTSI ( r =0.629) and between PC variables with thoracic kyphosis angle ( r =0.453) and lordosis lumbar angle ( r =0.275). In addition, we found statistically significant differences for DHOPI and POTSI variables according to the grade of scoliosis. Although the back surface topography method cannot substitute for radiographs in the diagnosis of scoliosis, correlations between radiographic and topographic parameters suggest that it offers additional quantitative data that may complement radiologic study.

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.

Pedicle subtraction osteotomy and disc resection with cage placement in post-traumatic thoracolumbar kyphosis, a retrospective study.

PubMed

Hu, Wenhao; Wang, Bin; Run, Hongyu; Zhang, Xuesong; Wang, Yan

2016-10-12

It is estimated that upwards of 50,000 individuals suffer traumatic fracture of the spine each year, and the instability of the fractured vertebra and/or the local deformity results in pain and, if kyphosis increases, neurological impairment can occur. There is a significant controversy over the ideal management. The purpose of the study is to present clinical and radiographic results of pedicle subtraction osteotomy and disc resection with cage placement in correcting post-traumatic thoracolumbar kyphosis. From May 2010 to May 2013, 46 consecutive patients experiencing post-traumatic thoracolumbar kyphosis underwent the technique of one-stage pedicle subtraction osteotomy and disc resection with cage placement and long-segment fixation. Pelvic incidence (PI), pelvic tilt (PT), sagittal vertical axis (SVA), and sagittal Cobb angle were measured to evaluate the sagittal balance. Oswestry disability index (ODI), visual analog scale (VAS), and general complications were recorded. The average surgical time was 260 min (240-320 min). The mean intraoperative blood loss was 643 ml (400-1200 ml). The maximum correction angle was 58° with an average of 47°, and the SVA improved from +10.7 ± 3.5 cm (+7.2 to + 17.1 cm) to +4.1 ± 2.7 cm (+3.2 to + 7.6 cm) at final follow-up (p < 0.01). PT reduced from preoperative 27.2 ± 5.3° to postoperative 15.2 ± 4.7° (p < 0.01). The VAS changed from preoperative 7.8 ± 1.6 (5.0-9.0) to 3.2 ± 1.8 (2.0-5.0) (p < 0.01). Clinical symptoms and neurological function were significantly improved at the final follow-up. All patients completed follow-up of 41 months on average. Pedicle subtraction osteotomy and disc resection with cage placement and long-segment fixation are effective and safe methods to treat thoracolumbar post-traumatic kyphosis.

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.

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

Serial Casting for Infantile Idiopathic Scoliosis: Radiographic Outcomes and Factors Associated With Response to Treatment.

PubMed

Iorio, Justin; Orlando, Giuseppe; Diefenbach, Chris; Gaughan, John P; Samdani, Amer F; Pahys, Joshua M; Betz, Randal R; Cahill, Patrick J

Serial casting for early-onset scoliosis has been shown to improve curve deformity. Our goal was to define clinical and radiographic features that determine response to treatment. We retrospectively reviewed patients with idiopathic infantile scoliosis with a minimum of 2-year follow-up. Inclusion criteria were: progressive idiopathic infantile scoliosis and initial casting before 6 years of age. Two groups were analyzed and compared: group 1 (≥10-degree improvement in Cobb angle from baseline) and group 2 (no improvement). Twenty-one patients with an average Cobb angle of 48 degrees (range, 24 to 72 degrees) underwent initial casting at an average age of 2.1 years (range, 0.7 to 5.4 y). Average follow-up was 3.5 years (range, 2 to 6.9 y). Sex, age at initial casting, magnitude of spinal deformity, and curve flexibility (defined as change in Cobb angle from pretreatment to first in-cast radiograph) were not significantly different between groups (P>0.05). Group 1 had a significantly higher body mass index (BMI) than group 2 at the onset of treatment (17.6 vs. 14.8, P<0.05). Univariate analysis of demographic, radiographic, and treatment factors revealed that only BMI was predictive of Cobb improvement (P=0.04; odds ratio=2.38). Group 1 (n=15) had a significantly lower Cobb angle (21 vs. 56 degrees) and rib vertebral angle difference (13 vs. 25 degrees) compared with group 2 at latest follow-up (P<0.05). A significantly larger proportion of children who were casted at less than 1.8 years of age had a Cobb angle <20 degrees at latest follow-up (P=0.03). Group 2 maintained stable clinical and radiograph parameters from pretreatment to most recent follow-up. To maintain a homogeneous cohort, we excluded patients with syndromes and developmental delays. We believe that analyzing a homogeneous group provides more meaningful results than if we studied a heterogeneous sample. BMI was significantly associated with outcome such that for each unit increase in BMI, there is

Mini-open anterior instrumentation with diaphragm sparing for thoracolumbar idiopathic scoliosis: its technique and clinical results

PubMed Central

Zhu, Feng; Wang, Bin; Zhu, Zezhang; Yu, Yang; Sun, Xu; Ma, Weiwei

2010-01-01

The traditional method of thoracoabdominal retroperitoneal approach requires dissection of diaphragm which bears potential complications such as postoperatively weakened abdominal breathing and dysfunction of diaphragm. Mini-open anterior instrumentation with diaphragm sparing is designed to minimize the damage to diaphragm and improve cosmesis. This study compared the traditional anterior instrumentation and mini-open anterior instrumentation under the hypothesis that both results in similar surgical outcomes in treating thoracolumbar scoliosis. In Group A, 38 patients with an average age of 16.5 years underwent mini-open anterior instrumentation with diaphragm sparing. The average standing coronal Cobb angle was 56.4° in Group A. Thirty-eight patients with average age of 16.7 years in Group B received traditional open approach. The preoperative average Cobb angle was 55.8° in Group B. The average correction rate of coronal curve was 78% in group A while 75% in group B. No statistical difference between the two groups in terms of coronal curve correction, sagittal profile restoration and estimated blood loss was observed. The operation time was significantly higher in Group A than that in Group B. All patients in the two groups had good healing of incisions without neurological and instrumental complications during minimal 2 year follow-up. In Groups A and B, two patients suffered from pleural effusion, respectively. The wedging of the vertebral discs distal to the lowest fused level occurred in three and four patients in Group A and B, respectively. One case in group B was found to be suspicious pseudoarthrosis without loss of correction. Mini-open anterior instrumentation with diaphragm sparing could minimize the surgical invasion as well as achieve similar clinical outcomes compared with classical anterior approach. PMID:21181213

Revision extension to the pelvis versus primary spinopelvic instrumentation in adult deformity: comparison of clinical outcomes and complications.

PubMed

Fu, Kai-Ming G; Smith, Justin S; Burton, Douglas C; Kebaish, Khaled M; Shaffrey, Christopher I; Schwab, Frank; Lafage, Virginie; Arlet, Vincent; Hostin, Richard; Boachie, Oheneba; Akbarnia, Behrooz; Bess, Shay

2014-01-01

To evaluate the outcomes and complications of patients with adult spinal deformity treated in a primary versus revision fashion with long fusions to the sacropelvis. A retrospective review was performed of a multicenter consecutive series of patients with adult spinal deformity requiring fusion to the sacropelvis, either primarily or as revision, with minimum 2-year follow-up. Clinical (Scoliosis Research Society [SRS] 22 questionnaire) and radiographic parameters (including sagittal vertical axis [SVA], coronal Cobb angle, lumbar lordosis, and thoracic kyphosis) were compared between the groups. There were 63 patients who met inclusion criteria; mean patient age was 51.9 years, and mean follow-up was 43 months. Patients requiring primary fusion were older (58.0 years vs. 49.5 years, P=0.01) and at baseline had a lower SVA (2.1 cm vs. 6.8 cm, P=0.01) and greater thoracolumbar Cobb angle (51.2 degrees vs. 36.5 degrees, P=0.003). At last follow-up, patients undergoing primary fusion and patients undergoing revision treatment had similar SVA (2.9 cm vs. 1.8 cm, P=0.32) and lumbar lordosis (-42.3 degrees vs. -43.4 degrees, P=0.82); patients undergoing revision treatment had more favorable SRS 22 scores (3.65 vs. 3.14, P=0.005). There was no statistical difference in complication rates between the groups (44.4% vs. 35%, P=0.68). Patients requiring revision extension of instrumentation to the pelvis can be treated with the same expectation of radiographic and clinical success as patients treated primarily with fusion to the sacropelvis. The complication rate for the revision procedure is not insignificant and may be similar to a primary procedure that includes pelvic fixation. Copyright © 2014 Elsevier Inc. All rights reserved.

Computer-assisted design and finite element simulation of braces for the treatment of adolescent idiopathic scoliosis using a coronal plane radiograph and surface topography.

PubMed

Pea, Rany; Dansereau, Jean; Caouette, Christiane; Cobetto, Nikita; Aubin, Carl-Éric

2018-05-01

Orthopedic braces made by Computer-Aided Design and Manufacturing and numerical simulation were shown to improve spinal deformities correction in adolescent idiopathic scoliosis while using less material. Simulations with BraceSim (Rodin4D, Groupe Lagarrigue, Bordeaux, France) require a sagittal radiograph, not always available. The objective was to develop an innovative modeling method based on a single coronal radiograph and surface topography, and assess the effectiveness of braces designed with this approach. With a patient coronal radiograph and a surface topography, the developed method allowed the 3D reconstruction of the spine, rib cage and pelvis using geometric models from a database and a free form deformation technique. The resulting 3D reconstruction converted into a finite element model was used to design and simulate the correction of a brace. The developed method was tested with data from ten scoliosis cases. The simulated correction was compared to analogous simulations performed with a 3D reconstruction built using two radiographs and surface topography (validated gold standard reference). There was an average difference of 1.4°/1.7° for the thoracic/lumbar Cobb angle, and 2.6°/5.5° for the kyphosis/lordosis between the developed reconstruction method and the reference. The average difference of the simulated correction was 2.8°/2.4° for the thoracic/lumbar Cobb angles and 3.5°/5.4° the kyphosis/lordosis. This study showed the feasibility to design and simulate brace corrections based on a new modeling method with a single coronal radiograph and surface topography. This innovative method could be used to improve brace designs, at a lesser radiation dose for the patient. Copyright © 2018 Elsevier Ltd. All rights reserved.

Reliability and concurrent validity of postural asymmetry measurement in adolescent idiopathic scoliosis

PubMed Central

Prowse, Ashleigh; Aslaksen, Berit; Kierkegaard, Marie; Furness, James; Gerdhem, Paul; Abbott, Allan

2017-01-01

AIM To investigate the reliability and concurrent validity of the Baseline® Body Level/Scoliosis meter for adolescent idiopathic scoliosis postural assessment in three anatomical planes. METHODS This is an observational reliability and concurrent validity study of adolescent referrals to the Orthopaedic department for scoliosis screening at Karolinska University Hospital, Stockholm, Sweden between March-May 2012. A total of 31 adolescents with idiopathic scoliosis (13.6 ± 0.6 years old) of mild-moderate curvatures (25° ± 12°) were consecutively recruited. Measurement of cervical, thoracic and lumbar curvatures, pelvic and shoulder tilt, and axial thoracic rotation (ATR) were performed by two trained physiotherapists in one day. The intraclass correlation coefficient (ICC) was used to determine the inter-examiner reliability (ICC2,1) and the intra-rater reliability (ICC3,3) of the Baseline® Body Level/Scoliosis meter. Spearman’s correlation analyses were used to estimate concurrent validity between the Baseline® Body Level/Scoliosis meter and Gold Standard Cobb angles from radiographs and the Orthopaedic Systems Inc. Scoliometer. RESULTS There was excellent reliability between examiners for thoracic kyphosis (ICC2,1 = 0.94), ATR (ICC2,1 = 0.92) and lumbar lordosis (ICC2,1 = 0.79). There was adequate reliability between examiners for cervical lordosis (ICC2,1 = 0.51), however poor reliability for pelvic and shoulder tilt. Both devices were reproducible in the measurement of ATR when repeated by one examiner (ICC3,3 0.98-1.00). The device had a good correlation with the Scoliometer (rho = 0.78). When compared with Cobb angle from radiographs, there was a moderate correlation for ATR (rho = 0.627). CONCLUSION The Baseline® Body Level/Scoliosis meter provides reliable transverse and sagittal cervical, thoracic and lumbar measurements and valid transverse plan measurements of mild-moderate scoliosis deformity. PMID:28144582

Reliability and concurrent validity of postural asymmetry measurement in adolescent idiopathic scoliosis.

PubMed

Prowse, Ashleigh; Aslaksen, Berit; Kierkegaard, Marie; Furness, James; Gerdhem, Paul; Abbott, Allan

2017-01-18

To investigate the reliability and concurrent validity of the Baseline ® Body Level/Scoliosis meter for adolescent idiopathic scoliosis postural assessment in three anatomical planes. This is an observational reliability and concurrent validity study of adolescent referrals to the Orthopaedic department for scoliosis screening at Karolinska University Hospital, Stockholm, Sweden between March-May 2012. A total of 31 adolescents with idiopathic scoliosis (13.6 ± 0.6 years old) of mild-moderate curvatures (25° ± 12°) were consecutively recruited. Measurement of cervical, thoracic and lumbar curvatures, pelvic and shoulder tilt, and axial thoracic rotation (ATR) were performed by two trained physiotherapists in one day. The intraclass correlation coefficient (ICC) was used to determine the inter-examiner reliability (ICC2,1) and the intra-rater reliability (ICC3,3) of the Baseline ® Body Level/Scoliosis meter. Spearman's correlation analyses were used to estimate concurrent validity between the Baseline ® Body Level/Scoliosis meter and Gold Standard Cobb angles from radiographs and the Orthopaedic Systems Inc. Scoliometer. There was excellent reliability between examiners for thoracic kyphosis (ICC2,1 = 0.94), ATR (ICC2,1 = 0.92) and lumbar lordosis (ICC2,1 = 0.79). There was adequate reliability between examiners for cervical lordosis (ICC2,1 = 0.51), however poor reliability for pelvic and shoulder tilt. Both devices were reproducible in the measurement of ATR when repeated by one examiner (ICC3,3 0.98-1.00). The device had a good correlation with the Scoliometer (rho = 0.78). When compared with Cobb angle from radiographs, there was a moderate correlation for ATR (rho = 0.627). The Baseline ® Body Level/Scoliosis meter provides reliable transverse and sagittal cervical, thoracic and lumbar measurements and valid transverse plan measurements of mild-moderate scoliosis deformity.

Conservative treatment in Scheuermann's kyphosis: comparison between lateral curve and variation of the vertebral geometry.

PubMed

Aulisa, Angelo G; Falciglia, Francesco; Giordano, Marco; Mastantuoni, Giuseppe; Poscia, Andrea; Guzzanti, Vincenzo

2016-01-01

Conservative treatment in the Scheuermann's kyphosis obtain, during skeletal growth, remodelling of the deformed vertebras. In a previous paper on Scheuermann's kyphosis, we have studied the geometry variations of all vertebrae included in the curve, before and after the treatment. The purpose of this study was to confirm the effectiveness of conservative treatment in Scheuermann's kyphosis and was to evaluate and compare the variation of the vertebral geometry with the curve trend in Cobb degrees, before and after conservative treatment. From a consecutive series of patients, we selected 90 patients with thoracic Scheuermann's kyphosis, treated using anti-gravity brace: 59 male, 31 female. The mean age at the beginning of the treatment was 14 years. Radiographical measurements were performed on radiographs from a lateral projection, at the beginning (t1) and at the end of the treatment (t5). Vertebral geometry modifications at t1 and t5 were analysed according to the following parameters and evaluated by three independent observers: Anterior wedging angle (ALFA) of the apex vertebra and Posterior wall inclination (APOS) of the limiting lower vertebra. The curve was measured in Cobb degrees. The results from our study showed that of the 90 patients with a thoracic curve mean value of Cobb degrees was 57.8 ± 6.0 SD at t1 and 41.3 ± 5.6 SD at t5. The differences between t1(angle at baseline) and t5 (end of treatment) were calculated for Cobb, ALFA and APOS angle and were respectively -16.4 ± 4.5, -6.4 ± 1.4 and -2.7 ± 1.2; tested with paired t -test were significative ( p  < 0.01). The results of the regression analysis to test the relationship between the three measures for the kyphosis (Cobb degree, ALFA and APOS) showed that the best association was between Cobb t5 and ALFA t5 ( p  < 0.01) and Cobb t1 and APOS t1 ( p  < 0.01). No significative association was found between the difference between ALFA and APOS. We sustain that

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.

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.

The influence of heel height on sagittal plane knee kinematics during landing tasks in recreationally active and athletic collegiate females.

PubMed

Lindenberg, Kelly M; Carcia, Christopher R; Phelps, Amy L; Martin, Robroy L; Burrows, Anne M

2011-09-01

To determine if heel height alters sagittal plane knee kinematics when landing from a forward hop or drop landing. Knee angles close to extension during landing are theorized to increase ACL injury risk in female athletes. Fifty collegiate females performed two single-limb landing tasks while wearing heel lifts of three different sizes (0, 12 & 24 mm) attached to the bottom of a sneaker. Using an electrogoniometer, sagittal plane kinematics (initial contact [KA(IC)], peak flexion [KA(Peak)], and rate of excursion [RE]) were examined. Repeated measures ANOVAs were used to determine the influence of heel height on the dependent measures. Forward hop task- KA(IC) with 0 mm, 12 mm, and 24 mm lifts were 8.88±6.5, 9.38±5.8 and 11.28±7.0, respectively. Significant differences were noted between 0 and 24 mm lift (p<.001) and 12 and 24 mm lifts (p=.003), but not between the 0 and 12 mm conditions (p=.423). KA(Peak) with 0 mm, 12 mm, and 24 mm lifts were 47.08±10.9, 48.18±10.3 and 48.88±9.7, respectively. A significant difference was noted between 0 and 24 mm lift (p=.004), but not between the 0 and 12 mm or 12 and 24 mm conditions (p=.071 and p=.282, respectively). The RE decreased significantly from 2128/sec±52 with the 12 mm lift to 1958/sec±55 with the 24 mm lift (p=.004). RE did not differ from 0 to 12 or 0 to 24 mm lift conditions (p=.351 and p=.086, respectively). Jump-landing task- No significant differences were found in KA(IC) (p=.531), KA(Peak) (p=.741), or the RE (p=.190) between any of the heel lift conditions. The addition of a 24 mm heel lift to the bottom of a sneaker significantly alters sagittal plane knee kinematics upon landing from a unilateral forward hop but not from a drop jump.

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

Discrepancy in clinical versus radiological parameters describing deformity due to brace treatment for moderate idiopathic scoliosis.

PubMed

Kotwicki, Tomasz; Kinel, Edyta; Stryla, Wanda; Szulc, Andrzej

2007-12-03

The shape of the torso in patients with idiopathic scoliosis is considered to reflect the shape of the vertebral column, however the direct correlation between parameters describing clinical deformity and those characterizing radiological curvature was reported to be weak. It is not clear if the management proposed for scoliosis (physiotherapy, brace, surgery) affects equally the shape of the axial skeleton and the surface of the body. The aim of the study was to compare clinical deformity of (1) idiopathic scoliosis girls being under brace treatment for radiological curves of 25 to 40 degrees and (2) non treated scoliotic girls matched for age and Cobb angle. Cross-sectional study of 24 girls wearing the brace versus 26 girls without brace treatment, matched for age and Cobb angle. Patients wearing the brace for more than 6 months, when comparing to patients without brace, may present different external morphology of the trunk, in spite of having similar Cobb angle. Material. girls, idiopathic scoliosis, growing age (10-16 years), Cobb angle minimum 25 degrees , maximum 40 degrees . The braced group consisted of girls wearing a TLSO brace (Cheneau) for more than 6 months with minimum of 16 hours per day. The non-braced group consisted of girls first seen for their spinal deformity, previously not treated. The groups presented similar curve pattern. Methods. Scoliometer exam: angle of trunk rotation at three levels of the spine: upper thoracic, main thoracic, lumbar or thoracolumbar. The maximal angle was noted at each level and the sum of three levels was calculated. Posterior trunk symmetry index (POTSI) and Hump Sum were measured using surface topography. Cobb angle was 34.9 degrees +/- 4.8 degrees in braced and 32.7 degrees +/- 4.9 degrees in un-braced patients (difference not significant). The age was 14.1 +/- 1.6 years in braced patients and 13.1 +/- 1.9 years in un-braced group (p = 0.046). The value of angle of trunk rotation in the main curvature was 8

Estimation of the stress related to conservative scoliosis therapy: an analysis based on BSSQ questionnaires.

PubMed

Kotwicki, Tomasz; Kinel, Edyta; Stryła, Wanda; Szulc, Andrzej

2007-01-03

Adolescent girls treated with a brace for scoliosis are submitted to prolonged stress related to both the disease and the therapy. Currently proposed quality of life questionnaires are focused on the outcome of therapy. Bad Sobernheim Stress Questionnaire (BSSQ) enables monitoring of patients being under treatment with a brace or exercises. The aim of the study was to assess the stress level in conservatively managed scoliotic girls using BSSQ. 111 girls, aged 14.2 +/- 2.2 years, mean Cobb angle of the primary curve 42.8 degrees +/- 17.0 degrees and mean Bunnell angle of 11.4 degrees +/- 4.5 degrees were examined with two versions of BSSQ (Deformity and Brace). The analysis considered the type of treatment, curve location, correlation of the total score with age, Cobb angle and Bunnell rotation angle. The BSSQ Deformity revealed the median of 17 points in patients managed with exercises (from 4 to 24 points), 18 in patients managed with a brace (from 8 to 24 points) and 12 in patients before surgery (from 3 to 21 points). Braced patients who completed both questionnaires (n = 50) revealed significantly higher score with BSSQ Deformity (median = 18) comparing to BSSQ Brace (median = 9). There was a correlation between the total score of BSSQ Deformity and the Cobb angle (r = -0.34), Bunnell primary curve rotation (r = -0.34) and Bunnell sum of rotation (r = -0.33) but not with the age of patients. Scoliotic adolescents managed with exercises and brace suffered little stress from the deformity. The brace increased the level of stress over the stress induced by the deformity. The stress level correlated with clinical deformity (Bunnell angle), radiological deformity (Cobb angle) and the type of treatment (exercises, bracing, surgery). Bad Sobernheim Stress Questionnaires are simple and helpful in the management of girls treated conservatively for idiopathic scoliosis.

The Clinical Effectiveness of School Screening Programme for Idiopathic Scoliosis in Malaysia.

PubMed

Deepak, A S; Ong, J Y; Choon, Dsk; Lee, C K; Chiu, C K; Chan, Cyw; Kwan, M K

2017-03-01

There is no large population size study on school screening for scoliosis in Malaysia. This study is aimed to determine the prevalence rate and positive predictive value (PPV) of screening programme for adolescent idiopathic scoliosis. A total of 8966 voluntary school students aged 13-15 years old were recruited for scoliosis screening. Screening was done by measuring the angle of trunk rotation (ATR) on forward bending test (FBT) using a scoliometer. ATR of 5 degrees or more was considered positive. Positively screened students had standard radiographs done for measurement of the Cobb angle. Cobb angle of >10° was used to diagnose scoliosis. The percentage of radiological assessment referral, prevalence rate and PPV of scoliosis were then calculated. Percentage of radiological assessment referral (ATR >5°) was 4.2% (182/4381) for male and 5.0% (228/4585) for female. Only 38.0% of those with ATR >5° presented for further radiological assessment. The adjusted prevalence rate was 2.55% for Cobb angle >10°, 0.59% for >20° and 0.12% for >40°. The PPV is 55.8% for Cobb angle >10°, 12.8% for >20° and 2.6% for > 40°. This is the largest study of school scoliosis screening in Malaysia. The prevalence rate of scoliosis was 2.55%. The positive predictive value was 55.8%, which is adequate to suggest that the school scoliosis screening programme did play a role in early detection of scoliosis. However, a cost effectiveness analysis will be needed to firmly determine its efficacy.

Fracture patterns after bilateral sagittal split osteotomy of the mandibular ramus according to the Obwegeser/Dal Pont and Hunsuck/Epker modifications.

PubMed

Möhlhenrich, Stephan Christian; Kniha, Kristian; Peters, Florian; Ayoub, Nassim; Goloborodko, Evgeny; Hölzle, Frank; Fritz, Ulrike; Modabber, Ali

2017-05-01

The aim of this study was to compare the fracture patterns after sagittal split osteotomy according to Obwegeser/Dal Pont (ODP) and Hunsuck/Epker (HE), as well as to investigate the relationship between lateral bone cut ending or angle and the incidence of unfavorable/bad splits. Postoperative cone-beam computed tomograms of 124 splits according to ODP and 60 according to HE were analyzed. ODP led to 75.8% and HE led to 60% lingual fractures with mandibular foramen contact. Horizontal fractures were found in 9.7% and 6.7%, respectively, and unfavorable/bad splits were found in 11.3% and 10%, respectively. The lateral osteotomy angle was 106.22° (SD 12.03)° for bad splits and 106.6° (SD 13.12)° for favorable splits. Correlations were found between favorable fracture patterns and split modifications and between buccal ending of the lateral bone cut and bad splits (p < 0.001). No relationship was observed between split modifications (p = 0.792) or the osteotomy angle (p = 0.937) and the incidence of unfavorable/bad splits. Split modifications had no influence on the incidence of unfavorable/bad splits, but the buccal ending of the lateral bone cut did have an influence. More lingual fractures with mandibular foramen contact are expected with the ODP modification. The osteotomy angle did not differ between favorable and bad splits. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

The relation between knee flexion angle and anterior cruciate ligament femoral tunnel characteristics: a cadaveric study comparing a standard and a far anteromedial portal.

PubMed

Alavekios, Damon; Peterson, Alexander; Patton, John; McGarry, Michelle H; Lee, Thay Q

2014-11-01

The purpose of this study was to compare the anterior cruciate ligament (ACL) femoral tunnel characteristics between 2 common arthroscopic portals used for ACL reconstruction, a standard anteromedial portal and a far anteromedial portal. Seven cadaveric knees were used. A 1.25-mm Kirschner wire was drilled through the center of the ACL femoral footprint and through the distal femur from the standard anteromedial and far anteromedial portals at knee flexion angles of 100°, 120°, and 140°. No formal tunnels were drilled. Each tunnel exit point was marked with a colored pin. After all tunnels were created, the specimens were digitized with a MicroScribe device (Revware, Raleigh, NC) to measure the tunnel length; distance to the posterior femoral cortical wall (posterior cortical margin); and tunnel orientation in the sagittal, coronal, and axial planes. The standard anteromedial portal resulted in a longer tunnel length, a less horizontal tunnel in the coronal plane, and a greater posterior cortical margin compared with the far anteromedial portal at all knee flexion angles. For both portal locations, the tunnel length and posterior cortical margin increased, and the tunnel position became more horizontal in the coronal plane, more anterior in the sagittal plane, and less horizontal in the transverse plane as knee flexion increased. Portal position affects femoral tunnel characteristics, with results favoring the more laterally positioned standard anteromedial portal at all flexion angles. Increasing the knee flexion angle leads to a longer femoral tunnel length and posterior femoral cortical margin with either portal position. Understanding how portal positioning and knee flexion angle affect femoral tunnel orientation and characteristics may lead to improved surgical outcomes after ACL reconstruction. Published by Elsevier Inc.

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.

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.

Comparison of the trunk-pelvis and lower extremities sagittal plane inter-segmental coordination and variability during walking in persons with and without chronic low back pain.

PubMed

Ebrahimi, Samaneh; Kamali, Fahimeh; Razeghi, Mohsen; Haghpanah, Seyyed Arash

2017-04-01

Inter-segmental coordination can be influenced by chronic low back pain (CLBP). The sagittal plane lower extremities inter-segmental coordination pattern and variability, in conjunction with the pelvis and trunk, were assessed in subjects with and without non-specific CLBP during free-speed walking. Kinematic data were collected from 10 non-specific CLBP and 10 non-CLBP control volunteers while the subjects were walking at their preferred speed. Sagittal plane time-normalized segmental angles and velocities were used to calculate continuous relative phase for each data point. Mean absolute relative phase (MARP) and deviation phase (DP) were derived to quantify the trunk-pelvis and bilateral pelvis-thigh, thigh-shank and shank-foot coordination pattern and variability over the stance and swing phases of gait. Mann-Whitney U test was employed to compare the means of DP and MARP values between two groups (same side comparison). Statistical analysis revealed more in-phase/less variable trunk-pelvis coordination in the CLBP group (P<0.05). CLBP group demonstrated less variable right or left pelvis-thigh coordination pattern (P<0.05). Moreover, the left thigh-shank and left shank-foot MARP values in the CLBP group, were more in-phase than left MARP values in the non-CLBP control group during the swing phase (P<0.05). In conclusion, the sagittal plane lower extremities, pelvis and trunk coordination pattern and variability could be generally affected by CLBP during walking. These changes can be possible compensatory strategies of the motor control system which can be considered in the CLBP subjects. Copyright © 2017 Elsevier B.V. All rights reserved.

The Structure and Distribution of Benthic Communities on a Shallow Seamount (Cobb Seamount, Northeast Pacific Ocean)

PubMed Central

Curtis, Janelle M. R.; Clarke, M. Elizabeth

2016-01-01

Partially owing to their isolation and remote distribution, research on seamounts is still in its infancy, with few comprehensive datasets and empirical evidence supporting or refuting prevailing ecological paradigms. As anthropogenic activity in the high seas increases, so does the need for better understanding of seamount ecosystems and factors that influence the distribution of sensitive benthic communities. This study used quantitative community analyses to detail the structure, diversity, and distribution of benthic mega-epifauna communities on Cobb Seamount, a shallow seamount in the Northeast Pacific Ocean. Underwater vehicles were used to visually survey the benthos and seafloor in ~1600 images (~5 m2 in size) between 34 and 1154 m depth. The analyses of 74 taxa from 11 phyla resulted in the identification of nine communities. Each community was typified by taxa considered to provide biological structure and/or be a primary producer. The majority of the community-defining taxa were either cold-water corals, sponges, or algae. Communities were generally distributed as bands encircling the seamount, and depth was consistently shown to be the strongest environmental proxy of the community-structuring processes. The remaining variability in community structure was partially explained by substrate type, rugosity, and slope. The study used environmental metrics, derived from ship-based multibeam bathymetry, to model the distribution of communities on the seamount. This model was successfully applied to map the distribution of communities on a 220 km2 region of Cobb Seamount. The results of the study support the paradigms that seamounts are diversity 'hotspots', that the majority of seamount communities are at risk to disturbance from bottom fishing, and that seamounts are refugia for biota, while refuting the idea that seamounts have high endemism. PMID:27792782

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.

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.

[CORRELATION OF LUMBAR FACET JOINT DEGENERATION AND SPINE-PELVIC SAGITTAL BALANCE].

PubMed

Lo, Xin; Zhang, Bin; Liu, Yuan; Dai, Min

2015-08-01

To investigate the relationship between lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. A retrospective analysis was made the clinical data of 120 patients with lumbar degenerative disease, who accorded with the inclusion criteria between June and November 2014. There were 58 males and 62 females with an average age of 53 years (range, 24-77 years). The disease duration ranged from 3 to 96 months (mean, 6.6 months). Affected segments included L3,4 in 32 cases, L4,5 in 47 cases, and L5, S1 in 52 cases. The CT and X-ray films of the lumbar vertebrae were taken. The facet joint degeneration was graded based on the grading system of Pathria. The spine-pelvic sagittal balance parameters were measured, including lumbar lordosis (LL), upper lumbar lordosis (ULL), lower lumbar lordosis (LLL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). According to normal range of PI, the patients were divided into 3 groups: group A (PI was less than normal range), group B (PI was within normal range), and group C (PI was more than normal range). The facet joint degeneration was compared; according to the facet joint degeneration degree, the patients were divided into group N (mild degeneration group) and group M (serious degeneration group) to observe the relationship of lumbar facet joint degeneration of each segment and spine-pelvic sagittal balance parameters. At L4,5 and L5, S1, facet joint degeneration showed significant difference among groups A, B, and C (P < 0.05), more serious facet joint degeneration was observed in group C; no significant difference was found in facet joint degeneration at L3,4 (P > 0.05). There was no significant difference in the other spine-pelvic sagittal balance parameters between groups N and M at each segment (P > 0.05) except for PT (P < 0.05). PI of more than normal range may lead to or aggravate lumbar facet joint degeneration at L4,5 and L5, Si; PT and PI are significantly associated

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

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

Use of Postural Reconstruction® physiotherapy to treat an adolescent with asymmetric bilateral genu varum and idiopathic scoliosis.

PubMed

Destieux, C; Gaudreault, N; Isner-Horobeti, M E; Vautravers, P

2013-05-01

To document the effect of Postural Reconstruction® physiotherapy on two postural disorders commonly observed in adolescents: genu varum and idiopathic scoliosis. A case report on a 16-year-old boy suffering from knee pain and presenting with bilateral genu varum and mild scoliosis. At the initial evaluation (T0), the intercondylar space was 7 cm and the Cobb angles for the right lumbar curve and left thoracic curve were 18° and 13°, respectively. The boy was treated with Postural Reconstruction(®), a neuromuscular physiotherapy intervention using facilitation/inhibition techniques. The outcomes used to quantify the effect of 6 months (T1), 12 months (T2) and 26 months (T3) of treatment were pain levels, the intercondylar space, the lumbar gibbosity and the lumbar and thoracic Cobb angles. The knee pain disappeared rapidly. At T3, the intercondylar space had decreased by 4 cm, the lumbar gibbosity angle had decreased by 2° and the lumbar and thoracic Cobb angles had decreased by 8° and 7°, respectively. This non-invasive physiotherapy intervention appears to have considerable promise for the long-term correction of postural disorders. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Scoliosis convexity and organ anatomy are related.

PubMed

Schlösser, Tom P C; Semple, Tom; Carr, Siobhán B; Padley, Simon; Loebinger, Michael R; Hogg, Claire; Castelein, René M

2017-06-01

Primary ciliary dyskinesia (PCD) is a respiratory syndrome in which 'random' organ orientation can occur; with approximately 46% of patients developing situs inversus totalis at organogenesis. The aim of this study was to explore the relationship between organ anatomy and curve convexity by studying the prevalence and convexity of idiopathic scoliosis in PCD patients with and without situs inversus. Chest radiographs of PCD patients were systematically screened for existence of significant lateral spinal deviation using the Cobb angle. Positive values represented right-sided convexity. Curve convexity and Cobb angles were compared between PCD patients with situs inversus and normal anatomy. A total of 198 PCD patients were screened. The prevalence of scoliosis (Cobb >10°) and significant spinal asymmetry (Cobb 5-10°) was 8 and 23%, respectively. Curve convexity and Cobb angle were significantly different within both groups between situs inversus patients and patients with normal anatomy (P ≤ 0.009). Moreover, curve convexity correlated significantly with organ orientation (P < 0.001; ϕ = 0.882): In 16 PCD patients with scoliosis (8 situs inversus and 8 normal anatomy), except for one case, matching of curve convexity and orientation of organ anatomy was observed: convexity of the curve was opposite to organ orientation. This study supports our hypothesis on the correlation between organ anatomy and curve convexity in scoliosis: the convexity of the thoracic curve is predominantly to the right in PCD patients that were 'randomized' to normal organ anatomy and to the left in patients with situs inversus totalis.

No evidence hip joint angle modulates intrinsically produced stretch reflex in human hopping.

PubMed

Gibson, W; Campbell, A; Allison, G

2013-09-01

Motor output in activities such as walking and hopping is suggested to be mediated neurally by purported stretch reflex augmentation of muscle output. Reflex EMG activity during these tasks has been frequently investigated in the soleus muscle; with alterations in reflex amplitude being associated with changes in hip joint angle/phase of the gait cycle. Previous work has focussed on reflex activity induced by an artificial perturbation or by induction of H-reflexes. As such, it is currently unknown if stretch reflex activity induced intrinsically (as part of the task) is modulated by changes in hip joint angle. This study investigated whether hip joint angle modulated reflex EMG 'burst' activity during a hopping task performed on a custom-built partially reclined sleigh. Ten subjects participated; EMG and kinematic data (VICON motor capture system) was collected for each hop cycle. Participants completed 5 sets of 30s of self-paced hopping in (1) hip neutral and (2) hip 60° flexion conditions. There was no difference in EMG 'burst' activity or in sagittal plane kinematics (knee/ankle) in the hopping task between the two conditions. The results indicate that during a functional task such as hopping, changes in hip angle do not alter the stretch reflex-like activity associated with landing. Copyright © 2013 Elsevier B.V. All rights reserved.

Chest cage angle difference and rotation of main thoracic curve are independent risk factors of postoperative shoulder imbalance in surgically treated patients with adolescent idiopathic scoliosis.

PubMed

Yagi, Mitsuru; Takemitsu, Masakazu; Machida, Masafumi

2013-09-01

Retrospective case series of surgically treated adolescent patients with scoliosis. To assess the prevalence and independent risk factors for postoperative shoulder imbalance in surgically treated adolescent patients with idiopathic scoliosis. Despite recent reports that have identified risk factors for postoperative shoulder imbalance, the relative risks remain unclear. A retrospective review of 85 consecutive patients treated with thoracic fusion with a minimum 2-year follow-up (mean, 3.1 yr) was conducted to investigate the patient radiographical measurements and demographics. Shoulder height difference (SHD) was measured as the graded height difference of the soft tissue shadows. A SHD more than 2 cm indicated an unbalanced shoulder. Patient demographics and radiographical data were studied to determine risk factors for postoperative SHD. The potential risk factors included age, sex, Risser sign, Cobb angle, flexibility, and apical vertebral rotation (AVR) of the main curve, upper-instrumented vertebra level, SHD, and clavicle chest cage angle difference (CCAD). Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors for postoperative shoulder imbalance. Of the 85 patients, 21 patients presented postoperative shoulder imbalance. The univariate analysis indicated age, Risser sign, Cobb angle of the main curve, AVR of the main curve, and CCAD as risk factors, but the multivariate logistic regression analysis showed that only AVR of the main curve and CCAD were independent risk factors for postoperative shoulder imbalance (AVR, P = 0.04, odds ratio (OR): 3.54; CCAD, P = 0.01, OR: 5.10). Postoperative shoulder imbalance was observed in 25% of the surgically treated adolescent patients. The CCAD and AVR of the main thoracic curve were independent risk factors for postoperative shoulder imbalance in surgically treated patients with adolescent idiopathic scoliosis. The significant correlation between CCAD and

[Clinical outcomes of single-level lumbar spondylolisthesis by minimally invasive transforaminal lumbar interbody fusion with bilateral tubular channels].

PubMed

Zeng, Z L; Jia, L; Yu, Y; Xu, W; Hu, X; Zhan, X H; Jia, Y W; Wang, J J; Cheng, L M

2017-04-01

Objective: To evaluate the clinical effectiveness of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for single-level lumbar spondylolisthesis treatment with bilateral Spotlight tubular channels. Methods: A total of 21 patients with lumbar spondylolisthesis whom underwent MIS-TLIF via bilateral Spotlight tubular channels were retrospectively analyzed from October 2014 to November 2015. The 21 patients included 11 males and 10 females ranged from 35 to 82 years (average aged 60.7 years). In term of spondylolisthesis category, there were 18 cases of degenerative spondylolisthesis and 3 cases of isthmic spondylolisthesis. With respect to spondylolisthesis degree, 17 cases were grade Ⅰ° and 4 cases were grade Ⅱ°. Besides, 17 cases at L(4-5) and 4 cases at L(5)-S(1)were categorized by spondylolisthesis levels. Operation duration, blood loss, postoperative drainage and intraoperative exposure time were recorded, functional improvement was defined as an improvement in the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) was also employed at pre and post-operation (3 months and the last follow-up), to evaluate low back and leg pain. Furthermore, to evaluate the recovery of the intervertebral foramen and of lumbar sagittal curvature, average height of intervertebral space, Cobb angles of lumbar vertebrae and operative segments, spondylolisthesis index were measured. At the last follow-up, intervertebral fusion was assessed using Siepe evaluation criteria and the clinical outcome was assessed using the MacNab scale. Radiographic and functional outcomes were compared pre- and post-operation using the paired T test to determine the effectiveness of MIS-TLIF. Statistical significance was defined as P <0.05. Results: All patients underwent a successful MIS-TLIF surgery. The operation time (235.2±30.2) mins, intraoperative blood loss (238.1±130.3) ml, postoperative drainage (95.7±57.1) ml and intraoperative radiation exposure (47.1±8

A Novel Method to Measure the Tentorial Angle and the Implications on Surgeries of the Pineal Region.

PubMed

Syed, Hasan R; Jean, Walter C

2018-03-01

There is no standard way to define the angle of the tentorium. The current trend to use the Twining line to define this angle has significant pitfalls. The goal of the current study was to provide a new and accurate way to measure the tentorial angle and demonstrate its impact on surgeries of the pineal region. A new technique (n-angle) to measure the tentorial angle was introduced using the floor of the fourth ventricle and the torcula. Comparisons with older techniques were made to illustrate reliability. Midline sagittal MR images were used to measure the tentorial angle in 240 individuals to obtain population-based data. A cohort of 8 patients who underwent either the infratentorial or the transtentorial approach to the pineal or upper vermian region were examined in search of correlations between tentorial angle and surgical approach. The data in this study showed that the Twining line technique understates the tentorial angle in people with low-lying torcula. The n-angle is more reliable in reflecting the true steepness of the tentorium regardless of torcula position. On average, men have slightly steeper tentoriums. In the clinical cohort, all patients who underwent infratentorial surgery had tentorial angles <55°, whereas the majority of patients who underwent transtentorial surgeries had angles >67°. The n-angle provides a reliable and accurate way to describe the slope of the tentorium. The population-based average of 60° may be a useful measurement to influence the choice of surgical approach, either under or through the tentorium, to the pineal region. Copyright © 2017 Elsevier Inc. All rights reserved.

Management options of non-syndromic sagittal craniosynostosis.

PubMed

Lee, Bryan S; Hwang, Lee S; Doumit, Gaby D; Wooley, Joseph; Papay, Francis A; Luciano, Mark G; Recinos, Violette M

2017-05-01

There have been various effective surgical procedures for the treatment of non-syndromic sagittal craniosynostosis, but no definitive guidelines for management have been established. We conducted a study to elucidate the current state of practice and establish a warranted standard of care. An Internet-based study was sent to 180 pediatric neurosurgeons across the country and 102 craniofacial plastic surgeons in fourteen different countries, to collect data for primary indication for surgical management, preference for timing and choice of surgery, and pre-, peri-, and post-operative management options. The overall response rate from both groups was 32% (n=90/284). Skull deformity was the primary indication for surgical treatment in patients without signs of hydrocephalus for both neurosurgeons and craniofacial surgeons (80% and 63%, respectively). Open surgical management was most commonly performed at six months of age by neurosurgeons (46%) and also by craniofacial surgeons (35%). Open surgical approach was favored for patients younger than four months of age by neurosurgeons (50%), but endoscopic approach was favored by craniofacial surgeons (35%). When performing an open surgical intervention, most neurosurgeons preferred pi or reversed pi procedure (27%), whereas total cranial vault remodeling was the most commonly performed procedure by craniofacial surgeons (37%). The data demonstrated a discrepancy in the treatment options for non-syndromic sagittal craniosynostosis. By conducting/comparing a wide survey to collect consolidative data from both groups of pediatric neurosurgeons and craniofacial plastic surgeons, we can attempt to facilitate the establishment of standard of care. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

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.

Acute influence of restricted ankle dorsiflexion angle on knee joint mechanics during gait.

PubMed

Ota, S; Ueda, M; Aimoto, K; Suzuki, Y; Sigward, S M

2014-06-01

Restrictions in range of ankle dorsiflexion (DF) motion can persist following ankle injuries. Ankle DF is necessary during terminal stance of gait, and its restricted range may affect knee joint kinematics and kinetics. The purpose of this study was to investigate the acute influence of varied levels of restricted ankle DF on knee joint sagittal and frontal plane kinematics and kinetics during gait. Thirty healthy volunteers walked with a custom-designed ankle brace that restricted ankle DF. Kinematics and kinetics were collected using a 7-camera motion analysis system and two force plates. Ankle dorsiflexion was restricted in 10-degree increments, allowing for four conditions: Free, light (LR), moderate (MR) and severe restriction (SR). Knee angles and moments were measured during terminal stance. Real peak ankle DF for Free, LR, MR, and SR were 13.7±4.8°, 11.6±5.0°, 7.5±5.3°, and 4.2±7.2°, respectively. Peak knee extension angles under the same conditions were -6.7±6.7°, -5.4±6.4°, -2.5±7.5°, and 0.6±7.8°, respectively, and the peak knee varus moment was 0.48±0.17 Nm/kg, 0.47±0.17 Nm/kg, 0.53±0.20 Nm/kg, and 0.57±0.20 Nm/kg. The knee varus moment was significantly increased from MR condition with an 8-degree restriction in ankle DF. Knee joint kinematics and kinetics in the sagittal and frontal planes were affected by reduced ankle DF during terminal stance of gait. Differences were observed with restriction in ankle DF range of approximately 8°. level III. Copyright © 2014 Elsevier B.V. All rights reserved.

Installation Restoration Program. Phase 2. Confirmation/Quantification. Stage 1. Air Force Plant 6, Cobb County, Georgia. Volume 3.

DTIC Science & Technology

1986-08-09

WATER ASSESSMENT PROGRAM AIR FOsEa PLANT 6, L0CKED-GEOCIA CONPANY MARIETTA, GMO IA PROJECT NO. 611059 WELL 4W-22 WELL 4W-23 WELL MW-24 WELL 4W-25 Dace...PROGRAMo PHASE II--CONFIRMATION/QUANTIFICATION 0STAGE I Final Report for AIR FORCE PLANT 6, COBB COUNTY, GA. U.S. AIR FORCE OCCUPATIONAL AND ENVIRONMENTAL...Con uet on reverse 4 necessary arc .entir’y ay )lcx "UrCer) I;;EL_0 GROUP I SUB-GROuP Air Force Plant , Hazardous materialsI oilS’ DeB Ground water, S

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

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

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�

Discrepancy in clinical versus radiological parameters describing deformity due to brace treatment for moderate idiopathic scoliosis

PubMed Central

Kotwicki, Tomasz; Kinel, Edyta; Stryla, Wanda; Szulc, Andrzej

2007-01-01

Background The shape of the torso in patients with idiopathic scoliosis is considered to reflect the shape of the vertebral column, however the direct correlation between parameters describing clinical deformity and those characterizing radiological curvature was reported to be weak. It is not clear if the management proposed for scoliosis (physiotherapy, brace, surgery) affects equally the shape of the axial skeleton and the surface of the body. The aim of the study was to compare clinical deformity of (1) idiopathic scoliosis girls being under brace treatment for radiological curves of 25 to 40 degrees and (2) non treated scoliotic girls matched for age and Cobb angle. Methods Cross-sectional study of 24 girls wearing the brace versus 26 girls without brace treatment, matched for age and Cobb angle. Hypothesis: Patients wearing the brace for more than 6 months, when comparing to patients without brace, may present different external morphology of the trunk, in spite of having similar Cobb angle. Material. Inclusion criteria: girls, idiopathic scoliosis, growing age (10–16 years), Cobb angle minimum 25°, maximum 40°. The braced group consisted of girls wearing a TLSO brace (Cheneau) for more than 6 months with minimum of 16 hours per day. The non-braced group consisted of girls first seen for their spinal deformity, previously not treated. The groups presented similar curve pattern. Methods. Scoliometer exam: angle of trunk rotation at three levels of the spine: upper thoracic, main thoracic, lumbar or thoracolumbar. The maximal angle was noted at each level and the sum of three levels was calculated. Posterior trunk symmetry index (POTSI) and Hump Sum were measured using surface topography. Results Cobb angle was 34.9° ± 4.8° in braced and 32.7° ± 4.9° in un-braced patients (difference not significant). The age was 14.1 ± 1.6 years in braced patients and 13.1 ± 1.9 years in un-braced group (p = 0.046). The value of angle of trunk rotation in the main

Manipulative and rehabilitative therapy as a treatment of idiopathic scoliosis without psychological sequelae: a case report

PubMed Central

Villafañe, Jorge H.; Silva, Guillermo B.; Dughera, Andrea

2012-01-01

Objective The purpose of this case report is to describe management and outcomes of a patient with scoliosis. Clinical Features A 9-year-old female patient with a double curve pattern with Cobb angles of 18° and 24° (thoracic/thoracolumbar) compatible with scoliosis presented for physical therapy treatment. Intervention and Outcome Physiotherapy treatment with a combination of manipulative and rehabilitation techniques was used. After finishing the treatment, the patient had Cobb angles of 7° and 11°, an improvement of 55% and 54%, respectively. After 6 months, these effects were maintained, as the patient had Cobb angles of 11° and 11°. The clinical appearance of the patient improved after the course of care. The patient was evaluated for psychological outcomes by applying the following tests: Scoliosis Research Society 22, Bad Sobernheim Stress, and the Brace Questionnaire The patient had the maximum score in all tests at the conclusion of therapy. Conclusion The patient responded favorably to manipulative and rehabilitation techniques. At the end of care, the patient did not show psychological sequelae with selected outcome measures. PMID:23204954

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.

Accuracy of experimental mandibular osteotomy using the image-guided sagittal saw.

PubMed

Pietruski, P; Majak, M; Swiatek-Najwer, E; Popek, M; Szram, D; Zuk, M; Jaworowski, J

2016-06-01

The aim of this study was to perform an objective assessment of the accuracy of mandibular osteotomy simulations performed using an image-guided sagittal saw. A total of 16 image-guided mandibular osteotomies were performed on four prefabricated anatomical models according to the virtual plan. Postoperative computed tomography (CT) image data were fused with the preoperative CT scan allowing an objective comparison of the results of the osteotomy executed with the virtual plan. For each operation, the following parameters were analyzed and compared independently twice by two observers: resected bone volume, osteotomy trajectory angle, and marginal point positions. The mean target registration error was 0.95±0.19mm. For all osteotomies performed, the mean difference between the planned and actual bone resection volumes was 8.55±5.51%, the mean angular deviation between planned and actual osteotomy trajectory was 8.08±5.50°, and the mean difference between the preoperative and the postoperative marginal point positions was 2.63±1.27mm. In conclusion, despite the initial stages of the research, encouraging results were obtained. The current limitations of the navigated saw are discussed, as well as the improvements in technology that should increase its predictability and efficiency, making it a reliable method for improving the surgical outcomes of maxillofacial operations. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Surgical treatment of Lenke 1 thoracic adolescent idiopathic scoliosis with maintenance of kyphosis using the simultaneous double-rod rotation technique.

PubMed

Sudo, Hideki; Ito, Manabu; Abe, Yuichiro; Abumi, Kuniyoshi; Takahata, Masahiko; Nagahama, Ken; Hiratsuka, Shigeto; Kuroki, Kei; Iwasaki, Norimasa

2014-06-15

Retrospective analysis of a prospectively collected, consecutive, nonrandomized series of patients. To assess the surgical outcomes of the simultaneous double-rod rotation technique for treating Lenke 1 thoracic adolescent idiopathic scoliosis (AIS). With the increasing popularity of segmental pedicle screw spinal reconstruction for treating AIS, concerns regarding the limited ability to correct hypokyphosis have also increased. A consecutive series of 32 patients with Lenke 1 main thoracic AIS treated with the simultaneous double-rod rotation technique at our institution was included. Outcome measures included patient demographics, radiographical measurements, and Scoliosis Research Society questionnaire scores. All 32 patients were followed up for a minimum of 2 years (average, 3.6 yr). The average main thoracic Cobb angle correction rate and the correction loss at the final follow-up were 67.8% and 3.3°, respectively. The average preoperative thoracic kyphosis (T5-T12) was 11.9°, which improved significantly to 20.5° (P < 0.0001) at the final follow-up. An increase in thoracic kyphosis was significantly correlated with an increase in lumbar lordosis at the final follow-up (r = 0.42). The average preoperative vertebral rotation angle was 19.7°, which improved significantly after surgery to 14.9° (P = 0.0001). There was no correlation between change in thoracic kyphosis and change in apical vertebral rotation (r =-0.123). The average preoperative total Scoliosis Research Society questionnaire score was 3.0, which significantly improved to 4.4 (P < 0.0001) at the final follow-up. Throughout surgery and even after, there were no instrumentation failures, pseudarthrosis, infection of the surgical site, or clinically relevant neurovascular complications. The simultaneous double-rod rotation technique for treating Lenke 1 AIS provides significant sagittal correction of the main thoracic curve while maintaining sagittal profiles and correcting coronal and axial

Posterior Tibial Slope Angle Correlates With Peak Sagittal and Frontal Plane Knee Joint Loading During Robotic Simulations of Athletic Tasks.

PubMed

Bates, Nathaniel A; Nesbitt, Rebecca J; Shearn, Jason T; Myer, Gregory D; Hewett, Timothy E

2016-07-01

Tibial slope angle is a nonmodifiable risk factor for anterior cruciate ligament (ACL) injury. However, the mechanical role of varying tibial slopes during athletic tasks has yet to be clinically quantified. To examine the influence of posterior tibial slope on knee joint loading during controlled, in vitro simulation of the knee joint articulations during athletic tasks. Descriptive laboratory study. A 6 degree of freedom robotic manipulator positionally maneuvered cadaveric knee joints from 12 unique specimens with varying tibial slopes (range, -7.7° to 7.7°) through drop vertical jump and sidestep cutting tasks that were derived from 3-dimensional in vivo motion recordings. Internal knee joint torques and forces were recorded throughout simulation and were linearly correlated with tibial slope. The mean (±SD) posterior tibial slope angle was 2.2° ± 4.3° in the lateral compartment and 2.3° ± 3.3° in the medial compartment. For simulated drop vertical jumps, lateral compartment tibial slope angle expressed moderate, direct correlations with peak internally generated knee adduction (r = 0.60-0.65), flexion (r = 0.64-0.66), lateral (r = 0.57-0.69), and external rotation torques (r = 0.47-0.72) as well as inverse correlations with peak abduction (r = -0.42 to -0.61) and internal rotation torques (r = -0.39 to -0.79). Only frontal plane torques were correlated during sidestep cutting simulations. For simulated drop vertical jumps, medial compartment tibial slope angle expressed moderate, direct correlations with peak internally generated knee flexion torque (r = 0.64-0.69) and lateral knee force (r = 0.55-0.74) as well as inverse correlations with peak external torque (r = -0.34 to -0.67) and medial knee force (r = -0.58 to -0.59). These moderate correlations were also present during simulated sidestep cutting. The investigation supported the theory that increased posterior tibial slope would lead to greater magnitude knee joint moments, specifically

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.

Effects of mid-foot contact area ratio on lower body kinetics/kinematics in sagittal plane during stair descent in women.

PubMed

Lee, Jinkyu; Hong, Yoon No Gregory; Shin, Choongsoo S

2016-07-01

The mid-foot contact area relative to the total foot contact area can facilitate foot arch structure evaluation. A stair descent motion consistently provides initial fore-foot contact and utilizes the foot arch more actively for energy absorption. The purpose of this study was to compare ankle and knee joint angle, moment, and work in sagittal plane during stair descending between low and high Mid-Foot-Contact-Area (MFCA) ratio group. The twenty-two female subjects were tested and classified into two groups (high MFCA and low MFCA) using their static MFCA ratios. The ground reaction force (GRF) and kinematics of ankle and knee joints were measured while stair descending. During the period between initial contact and the first peak in vertical GRF (early absorption phase), ankle negative work for the low MFCA ratio group was 33% higher than that for the high MFCA ratio group (p<0.05). However, ankle negative work was not significantly different between the two groups during the period between initial contact and peak dorsiflexion angle (early absorption phase+late absorption phase). The peak ankle dorsiflexion angle was smaller in the low MFCA ratio group (p<0.05). Our results suggest that strategy of energy absorption at the ankle and foot differs depending upon foot arch types classified by MFCA. The low MFCA ratio group seemed to absorb more impact energy using strain in the planar fascia during early absorption phase, whereas the high MFCA ratio group absorbed more impact energy using increased dorsiflexion during late absorption phase. Copyright © 2016 Elsevier B.V. All rights reserved.

Sagittal plane bending moments acting on the lower leg during running.

PubMed

Haris Phuah, Affendi; Schache, Anthony G; Crossley, Kay M; Wrigley, Tim V; Creaby, Mark W

2010-02-01

Sagittal bending moments acting on the lower leg during running may play a role in tibial stress fracture development. The purpose of this study was to evaluate these moments at nine equidistant points along the length of the lower leg (10% point-90% point) during running. Kinematic and ground reaction force data were collected for 20 male runners, who each performed 10 running trials. Inverse dynamics and musculoskeletal modelling techniques were used to estimate sagittal bending moments due to reaction forces and muscle contraction. The muscle moment was typically positive during stance, except at the most proximal location (10% point) on the lower leg. The reaction moment was predominantly negative throughout stance and greater in magnitude than the muscle moment. Hence, the net sagittal bending moment acting on the lower leg was principally negative (indicating tensile loads on the posterior tibia). Peak moments typically occurred around mid-stance, and were greater in magnitude at the distal, compared with proximal, lower leg. For example, the peak reaction moment at the most distal point was -9.61+ or - 2.07%Bw.Ht., and -2.73 + or - 1.18%Bw.Ht. at the most proximal point. These data suggest that tensile loads on the posterior tibia are likely to be higher toward the distal end of the bone. This finding may explain the higher incidence of stress fracture in the distal aspect of the tibia, observed by some authors. Stress fracture susceptibility will also be influenced by bone strength and this should also be accounted for in future studies. Copyright 2009 Elsevier B.V. All rights reserved.

[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.

Detailed study of the Cobb offset of the Juan de Fuca ridge: evolution of a propagating rift

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

Johnson, H.P.; Karsten, J.L.; Delaney, J.R.

The Cobb Offset on the northern portion of the Juan de Fuca Ridge has been identified as the tip of a northward propagating rift (Hey and Wilson, 1982). Map compilations of magnetic and seismic data from four new cruises define the present locus of spreading and volcanism on the two ridge segments abutting the Offset and permit detailed modeling of the recent evolution within this transform zone. The axis of recent spreading on the southern ridge segment bends from the normal rdige trend (N20/sup 0/E) to a N-S trend, north of 47/sup 0/15'N. The spreading axis on the northern ridgemore » segment generally defines a N20/sup 0/E trend, except at the southern terminus, where the spreading center is offset slightly to the east. The two spreading centers overlap by about 33 km in the Offset vicinity, and there is evidence of recent volcanism on both segments. Present ridge axis morphology exhibits a transitional sequence from a symmetrical, axial high along the more 'normal' portions of each ridge segment to a grabenlike depression as the tip is approached. The magnetic anomaly patterns observed in the Cobb Offset vicinity are not consistent with the patterns predicted by models of continuous, northward propagation. The magnetic anomaly patterns of the Brunhes Epoch require an event of rapid northward propagation about 0.7 m.y. B.P., followed by a more gradual southward propagation in the middle Brunhes Epoch; most recently, the spreading center on the southern ridge has extended northward to its present configuration. Prior to the Brunhes Epoch, modeling of the magnetic anomaly patterns does not indicate a unique solution; however, net propagation has been northward. We present alternative models for the period beginning 1.7 m.y. B.P.« less

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.

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

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.

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.

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.

Correlation of Beta Angle with Antero-Posterior Dysplasia Indicators and FMA: An Institution Based Cephalometric Study.

PubMed

Singh, Gurinder; Verma, Sanjeev; Singh, Devinder Preet; Yadav, Sumit Kumar; Yadav, Achla Bharti

2016-11-01

Beta angle utilizes three skeletal landmarks - point A, point B, and point C (the apparent axis of the condyle). It is formed between A-B line and point A perpendicular to C-B line. Further this angle indicates the severity and the type of skeletal dysplasia in the sagittal dimension and it changes with the growth pattern of the patient. Hence, it is important to study the dependence of beta angle on the growth pattern. The present study was designed to evaluate the correlation of Beta angle with point A-Nasion-point B (ANB) angle, points A and B to palatal plane (App-Bpp), Wit's appraisal and Maxillary-Mandibular plane angle Bisector (MMB) and Frankfort-Mandibular plane Angle (FMA) in Skeletal Class I, Class II and Class III malocclusion groups. Pre-treatment lateral head cephalo-grams of 120 subjects in age group of 15-25 years were obtained. Three skeletal Class I, Class II and Class III malocclusion groups (40 each) were assorted on the basis of ANB, MMB, App-Bpp, Wit's appraisal and FMA. Analysis of variance (ANOVA) and mean differences were calculated to compare the study groups. Bivariate correlations among different parameters of these groups were obtained. Normal values of beta angle in skeletal Class I group, skeletal Class II group and skeletal Class III group was 31.33±3.25, 25.28±4.28 and 40.93±4.55 respectively. Overall beta angle showed a strong correlation with all parameters of anterio-posterior dysplasia indicators except FMA. Beta angle shows weak correlation with FMA and is not affected by growth pattern/jaw rotation. The normal values are in same range irrespective of the differences in craniofacial morphology.

Correlation of Beta Angle with Antero-Posterior Dysplasia Indicators and FMA: An Institution Based Cephalometric Study

PubMed Central

Singh, Gurinder; Verma, Sanjeev; Singh, Devinder Preet; Yadav, Achla Bharti

2016-01-01

Introduction Beta angle utilizes three skeletal landmarks – point A, point B, and point C (the apparent axis of the condyle). It is formed between A-B line and point A perpendicular to C-B line. Further this angle indicates the severity and the type of skeletal dysplasia in the sagittal dimension and it changes with the growth pattern of the patient. Hence, it is important to study the dependence of beta angle on the growth pattern. Aim The present study was designed to evaluate the correlation of Beta angle with point A–Nasion–point B (ANB) angle, points A and B to palatal plane (App-Bpp), Wit’s appraisal and Maxillary-Mandibular plane angle Bisector (MMB) and Frankfort-Mandibular plane Angle (FMA) in Skeletal Class I, Class II and Class III malocclusion groups. Materials and Methods Pre-treatment lateral head cephalo-grams of 120 subjects in age group of 15-25 years were obtained. Three skeletal Class I, Class II and Class III malocclusion groups (40 each) were assorted on the basis of ANB, MMB, App-Bpp, Wit’s appraisal and FMA. Analysis of variance (ANOVA) and mean differences were calculated to compare the study groups. Bivariate correlations among different parameters of these groups were obtained. Results Normal values of beta angle in skeletal Class I group, skeletal Class II group and skeletal Class III group was 31.33±3.25, 25.28±4.28 and 40.93±4.55 respectively. Overall beta angle showed a strong correlation with all parameters of anterio-posterior dysplasia indicators except FMA. Conclusion Beta angle shows weak correlation with FMA and is not affected by growth pattern/jaw rotation. The normal values are in same range irrespective of the differences in craniofacial morphology. PMID:28050509

Estimation of the stress related to conservative scoliosis therapy: an analysis based on BSSQ questionnaires

PubMed Central

Kotwicki, Tomasz; Kinel, Edyta; Stryła, Wanda; Szulc, Andrzej

2007-01-01

Background Adolescent girls treated with a brace for scoliosis are submitted to prolonged stress related to both the disease and the therapy. Currently proposed quality of life questionnaires are focused on the outcome of therapy. Bad Sobernheim Stress Questionnaire (BSSQ) enables monitoring of patients being under treatment with a brace or exercises. The aim of the study was to assess the stress level in conservatively managed scoliotic girls using BSSQ. Materials and methods 111 girls, aged 14,2 ± 2,2 years, mean Cobb angle of the primary curve 42,8° ± 17,0° and mean Bunnell angle of 11,4° ± 4,5° were examined with two versions of BSSQ (Deformity and Brace). The analysis considered the type of treatment, curve location, correlation of the total score with age, Cobb angle and Bunnell rotation angle. Results The BSSQ Deformity revealed the median of 17 points in patients managed with exercises (from 4 to 24 points), 18 in patients managed with a brace (from 8 to 24 points) and 12 in patients before surgery (from 3 to 21 points). Braced patients who completed both questionnaires (n = 50) revealed significantly higher score with BSSQ Deformity (median = 18) comparing to BSSQ Brace (median = 9). There was a correlation between the total score of BSSQ Deformity and the Cobb angle (r = -0,34), Bunnell primary curve rotation (r = -0,34) and Bunnell sum of rotation (r = -0,33) but not with the age of patients. Conclusion Scoliotic adolescents managed with exercises and brace suffered little stress from the deformity. The brace increased the level of stress over the stress induced by the deformity. The stress level correlated with clinical deformity (Bunnell angle), radiological deformity (Cobb angle) and the type of treatment (exercises, bracing, surgery). Bad Sobernheim Stress Questionnaires are simple and helpful in the management of girls treated conservatively for idiopathic scoliosis. PMID:17201928

Contact pressure in the facet joint during sagittal bending of the cadaveric cervical spine.

PubMed

Jaumard, Nicolas V; Bauman, Joel A; Weisshaar, Christine L; Guarino, Benjamin B; Welch, William C; Winkelstein, Beth A

2011-07-01

The facet joint contributes to the normal biomechanical function of the spine by transmitting loads and limiting motions via articular contact. However, little is known about the contact pressure response for this joint. Such information can provide a quantitative measure of the facet joint's local environment. The objective of this study was to measure facet pressure during physiologic bending in the cervical spine, using a joint capsule-sparing technique. Flexion and extension bending moments were applied to six human cadaveric cervical spines. Global motions (C2-T1) were defined using infra-red cameras to track markers on each vertebra. Contact pressure in the C5-C6 facet was also measured using a tip-mounted pressure transducer inserted into the joint space through a hole in the postero-inferior region of the C5 lateral mass. Facet contact pressure increased by 67.6 ± 26.9 kPa under a 2.4 Nm extension moment and decreased by 10.3 ± 9.7 kPa under a 2.7 Nm flexion moment. The mean rotation of the overall cervical specimen motion segments was 9.6 ± 0.8° and was 1.6 ± 0.7° for the C5-C6 joint, respectively, for extension. The change in pressure during extension was linearly related to both the change in moment (51.4 ± 42.6 kPa/Nm) and the change in C5-C6 angle (18.0 ± 108.9 kPa/deg). Contact pressure in the inferior region of the cervical facet joint increases during extension as the articular surfaces come in contact, and decreases in flexion as the joint opens, similar to reports in the lumbar spine despite the difference in facet orientation in those spinal regions. Joint contact pressure is linearly related to both sagittal moment and spinal rotation. Cartilage degeneration and the presence of meniscoids may account for the variation in the pressure profiles measured during physiologic sagittal bending. This study shows that cervical facet contact pressure can be directly measured with minimal disruption to the joint and is the first to provide local

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.

Quality of life and stress level in adolescents with idiopathic scoliosis subjected to conservative treatment.

PubMed

Kinel, Edyta; Kotwicki, Tomasz; Podolska, Anna; Białek, Marianna; Stryła, Wanda

2012-01-01

Quality of life (QoL) and stress level of adolescents with idiopathic scoliosis is under growing consideration by physicians, physiotherapists and other specialists (psychologist, nurses). The aim of the study was to evaluate the quality of life and stress level in adolescents with idiopathic scoliosis who are under brace treatment. It involved 45 adolescents, ages ranging between 10.0 and 15.0 years, all with Adolescent Idiopathic Scoliosis (AIS) with Cobb angle between 20-45 degrees. The adolescents were wearing the same kind of brace (Chêneau orthosis) for more than 3 months for at least 12h per day. Two questionnaires were used: the Brace Questionnaire (BrQ) and Bad Sobernheim Stress Questionnaire (BSSQ). The analysis considered the type of treatment, curve location, correlation of the total score with age, Cobb angle and Bunnell rotation angle. The age was 13.6 ± 1.3 years. Cobb angle was 31.7 ± 7.6 degrees. The mean score for BrQ was 78.1 ± 11.3 points. Adolescents revealed higher score with BSSQ Deformity (median = 15) comparing to BSSQ Brace (median = 12). Conservative treatment does not severely impact on the quality of life of scoliotic adolescents. The adolescents who were under brace treatment suffered moderate level of stress from the deformity.

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.

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.

[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.

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.

The Correlation between Insertion Depth of Prodisc-C Artificial Disc and Postoperative Kyphotic Deformity: Clinical Importance of Insertion Depth of Artificial Disc.

PubMed

Lee, Do-Youl; Kim, Se-Hoon; Suh, Jung-Keun; Cho, Tai-Hyoung; Chung, Yong-Gu

2012-09-01

This study was designed to investigate the correlation between insertion depth of artificial disc and postoperative kyphotic deformity after Prodisc-C total disc replacement surgery, and the range of artificial disc insertion depth which is effective in preventing postoperative whole cervical or segmental kyphotic deformity. A retrospective radiological analysis was performed in 50 patients who had undergone single level total disc replacement surgery. Records were reviewed to obtain demographic data. Preoperative and postoperative radiographs were assessed to determine C2-7 Cobb's angle and segmental angle and to investigate postoperative kyphotic deformity. A formula was introduced to calculate insertion depth of Prodisc-C artificial disc. Statistical analysis was performed to search the correlation between insertion depth of Prodisc-C artificial disc and postoperative kyphotic deformity, and to estimate insertion depth of Prodisc-C artificial disc to prevent postoperative kyphotic deformity. In this study no significant statistical correlation was observed between insertion depth of Prodisc-C artificial disc and postoperative kyphotic deformity regarding C2-7 Cobb's angle. Statistical correlation between insertion depth of Prodisc-C artificial disc and postoperative kyphotic deformity was observed regarding segmental angle (p<0.05). It failed to estimate proper insertion depth of Prodisc-C artificial disc effective in preventing postoperative kyphotic deformity. Postoperative segmental kyphotic deformity is associated with insertion depth of Prodisc-C artificial disc. Anterior located artificial disc leads to lordotic segmental angle and posterior located artificial disc leads to kyphotic segmental angle postoperatively. But C2-7 Cobb's angle is not affected by artificial disc location after the surgery.

Inter- and intraobserver reliability assessment of the axial trunk rotation: manual versus smartphone-aided measurement tools.

PubMed

Qiao, Jun; Xu, Leilei; Zhu, Zezhang; Zhu, Feng; Liu, Zhen; Qian, Bangping; Qiu, Yong

2014-10-11

Scoliogauge, has been developed for the measurement of ATR on iPhone smartphones. This study was to evaluate the reliability for the smartphone-aided ATR measurement method and to compare its reliability with that of the manual method. Sixty-four AIS patients with single thoracic or lumbar curve participated in this study. Of these patients, thirty-two patients had main thoracic scoliosis while other thirty-two had main thoracolumbar/lumbar scoliosis. Two spine surgeons performed the measurements with Scoliometer and Scoliogauge. The Scoliogauge measurements were conducted on an iPhone 4 smartphone. The intraclass correlation coefficient (ICC) 2-way mixed model on absolute agreement was used to analyze the reliability categorized according to regions: thoracic or lumbar, and Cobb angles: <20 degrees and >40 degrees. ICC < 0.40 is considered as poor, 0.40-0.59 as fair, 0.60-0.74 as good, and 0.75-1.00 as excellent. The overall intraobserver variability was 0.954 and the overall interobserver variability was 0.943 for the scoliometer set, whereas the intraobserver variability was 0.965 and interobserver variability was 0.964 for the scoliogauge set. Both the intraobserver and interobserver ICCs reached the excellent value in the 2 sets for both observers. The mean Cobb angle of thoracic curves in patients with main thoracic scoliosis was similar to that of lumbar curves in those with main thoracolumbar/lumbar scoliosis (35.7 degrees vs. 36.1 degrees). The intraobserver and interobserver reliability was similar between two groups (thoracic vs. lumbar) in the 2 sets. There were 21 patients having Cobb angles < 20 degrees, while 20 patients >40 degrees. The intraobserver and interobserver reliability was better in severe curve(>40 degrees) group. Smartphone-aided measurement for ATR showed excellent reliability, and the reliability of measurement with either scoliometer or scoliogauge could be influenced by Cobb angle that reliability was better for curves with

[Correlation analysis of cement leakage with volume ratio of intravertebral bone cement to vertebral body and vertebral body wall incompetence in percutaneous vertebroplasty for osteoporotic vertebral compression fractures].

PubMed

Liang, De; Ye, Linqiang; Jiang, Xiaobing; Huang, Weiquan; Yao, Zhensong; Tang, Yongchao; Zhang, Shuncong; Jin, Daxiang

2014-11-01

To investigate the risk factors of cement leakage in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). Between March 2011 and March 2012, 98 patients with single level OVCF were treated by PVP, and the clinical data were analyzed retrospectively. There were 13 males and 85 females, with a mean age of 77.2 years (range, 54-95 years). The mean disease duration was 43 days (range, 15-120 days), and the mean T score of bone mineral density (BMD) was -3.8 (range, -6.7- -2.5). Bilateral transpedicular approach was used in all the patients. The patients were divided into cement leakage group and no cement leakage group by occurrence of cement leakage based on postoperative CT. Single factor analysis was used to analyze the difference between 2 groups in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, preoperative vertebral body wall incompetence, cement volume, and volume ratio of intravertebral bone cement to vertebral body. All relevant factors were introduced to logistic regression analysis to analyze the risk factors of cement leakage. All procedures were performed successfully. The mean operation time was 40 minutes (range, 30-50 minutes), and the mean volume ratio of intravertebral bone cement to vertebral body was 24.88% (range, 7.84%-38.99%). Back pain was alleviated significantly in all the patients postoperatively. All patients were followed up with a mean time of 8 months (range, 6-12 months). Cement leakage occurred in 49 patients. Single factor analysis showed that there were significant differences in the volume ratio of intravertebral bone cement to vertebral body and preoperative vertebral body wall incompetence between 2 groups (P < 0.05), while no significant difference in T score of BMD, operative level, preoperative anterior compression degree of

[Tibiotalocalcaneal arthrodesis using a retrograde nail locked in the sagittal plane].

PubMed

Veselý, R; Procházka, V; Visna, P; Valentová, J; Savolt, J

2008-04-01

To evaluate our experience with the use of a retrograde nail locked in the sagittal plane for tibiotalocalcaneal arthrodesis indicated in severe post-traumatic arthritis of the ankle. Twenty patients, 16 men and four women at an average age of 58.7 years (range, 23 to 72) were evaluated. All patients had severe post-traumatic changes in the talocrural and talocalcaneal joints. Five patients also had an equinus deformity. In two patients arthrodesis followed the treatment of purulent arthritis of the talocrural joint. A local fasciocutaneous flap was used for soft tissue reconstruction in three patients. All patients were operated on using the standard surgical technique. METHODS With the patient in a supine position, reamed by hand with the use of a driving rod, a straight retrograde AAN Orthofix nail was inserted through the heel bone and talus into the distal tibia and locked in these bones in the sagittal plane. No complications such as injury to the neurovascular plexus or pseudoarthrosis were recorded. Four patients showed a reaction to the proximal locking screw on the proximal tibial surface, which was treated by earlier screw removal under topical anaesthesia. Due to infectious complications, the nail had to be removed prematurely in one patient. The average Foot Function Index was 12 points (range, 10 to 15) and the average ankle-hindfoot score was 67.6 points (range, 59 to 84). Thirteen patients (65 %) were not limited in their daily activities or recreational sports, six (30 %) experienced pain in sports but not daily activities and one patient (5 %) reported pain even when walking. All fusions healed in the correct position within 18 weeks. Tibiotalocalcaneal arthrodesis is not a frequent surgical procedure in either trauma surgery or orthopaedics. For this complicated procedure, rather than intramedullary nails, internal fixation with screws or plates or external fixation are preferred. The high rate of bony healing can be explained by maintenance of

Could CCI or FBCI Fully Eliminate the Impact of Curve Flexibility When Evaluating the Surgery Outcome for Thoracic Curve Idiopathic Scoliosis Patient? A Retrospective Study

PubMed Central

Ni, Haijian; Zhu, Xiaodong; Li, Ming

2015-01-01

Purpose To clarify if CCI or FBCI could fully eliminate the influence of curve flexibility on the coronal correction rate. Methods We reviewed medical record of all thoracic curve AIS cases undergoing posterior spinal fusion with all pedicle screw systems from June 2011 to July 2013. Radiographical data was collected and calculated. Student t test, Pearson correlation analysis and linear regression analysis were used to analyze the data. Results 60 were included in this study. The mean age was 14.7y (10-18y) with 10 males (17%) and 50 females (83%). The average Risser sign was 2.7. The mean thoracic Cobb angle before operation was 51.9°. The mean bending Cobb angle was 27.6° and the mean fulcrum bending Cobb angle was 17.4°. The mean Cobb angle at 2 week after surgery was 16.3°. The Pearson correlation coefficient r between CCI and BFR was -0.856(P<0.001), and between FBCI and FFR was -0.728 (P<0.001). A modified FBCI (M-FBCI) = (CR-0.513)/BFR or a modified CCI (M-CCI) = (CR-0.279)/FFR was generated by curve estimation has no significant correlation with FFR (r=-0.08, p=0.950) or with BFR (r=0.123, p=0.349). Conclusions Fulcrum-bending radiographs may better predict the outcome of AIS coronal correction than bending radiographs in thoracic curveAIS patients. Neither CCI nor FBCI can fully eliminate the impact of curve flexibility on the outcome of correction. A modified CCI or FBCI can better evaluating the corrective effects of different surgical techniques or instruments. PMID:25984945

Could CCI or FBCI Fully Eliminate the Impact of Curve Flexibility When Evaluating the Surgery Outcome for Thoracic Curve Idiopathic Scoliosis Patient? A Retrospective Study.

PubMed

Yang, Changwei; Sun, Xiaofei; Li, Chao; Ni, Haijian; Zhu, Xiaodong; Yang, Shichang; Li, Ming

2015-01-01

To clarify if CCI or FBCI could fully eliminate the influence of curve flexibility on the coronal correction rate. We reviewed medical record of all thoracic curve AIS cases undergoing posterior spinal fusion with all pedicle screw systems from June 2011 to July 2013. Radiographical data was collected and calculated. Student t test, Pearson correlation analysis and linear regression analysis were used to analyze the data. 60 were included in this study. The mean age was 14.7 y (10-18 y) with 10 males (17%) and 50 females (83%). The average Risser sign was 2.7. The mean thoracic Cobb angle before operation was 51.9°. The mean bending Cobb angle was 27.6° and the mean fulcrum bending Cobb angle was 17.4°. The mean Cobb angle at 2 week after surgery was 16.3°. The Pearson correlation coefficient r between CCI and BFR was -0.856(P<0.001), and between FBCI and FFR was -0.728 (P<0.001). A modified FBCI (M-FBCI) = (CR-0.513)/BFR or a modified CCI (M-CCI) = (CR-0.279)/FFR was generated by curve estimation has no significant correlation with FFR (r=-0.08, p=0.950) or with BFR (r=0.123, p=0.349). Fulcrum-bending radiographs may better predict the outcome of AIS coronal correction than bending radiographs in thoracic curveAIS patients. Neither CCI nor FBCI can fully eliminate the impact of curve flexibility on the outcome of correction. A modified CCI or FBCI can better evaluating the corrective effects of different surgical techniques or instruments.

Cervical spine alignment in the youth football athlete: recommendations for emergency transportation.

PubMed

Treme, Gehron; Diduch, David R; Hart, Jennifer; Romness, Mark J; Kwon, Michael S; Hart, Joseph M

2008-08-01

Substantial literature exists regarding recommendations for the on-field treatment and subsequent transportation of adult collision-sport athletes with a suspected injury to the cervical spine. To develop an evidence-based recommendation for transportation of suspected spine-injured youth football players. Descriptive laboratory study. Three lateral radiographs were obtained in supine to include the occiput to the cervical thoracic junction from 31 youth football players (8-14 years). Each child was imaged while wearing helmet and shoulder pads, without equipment, and with shoulder pads only. Two independent observers measured cervical spine angulation as Cobb angle from C1 to C7 and subaxial angulation from C2 to C7. We calculated intraclass correlation coefficients for intraobserver reliability analysis and compared Cobb and C2 to C7 angles between equipment conditions with t tests. Interobserver analysis showed excellent reliability among measurements. Cobb and subaxial angle measurements indicated significantly greater cervical lordosis while children wore shoulder pads only, compared with the other 2 conditions (no equipment and helmet and shoulder pads) (P Cobb or C2-C7 angles between fully equipped (helmet + shoulder pads) and no-equipment conditions (P >.05). Equipment removal for the youth football athlete with suspected cervical spine injury should abide by the "all or none" policy that has been widely accepted for adult athletes. Helmet and shoulder pads should be left in place during emergency transport of the suspected spine-injured youth athlete. Despite differences in head to torso size ratios between youth and adult players, helmet removal alone is not recommended for either during emergency transportation.

Adjacent-level arthroplasty following cervical fusion.

PubMed

Rajakumar, Deshpande V; Hari, Akshay; Krishna, Murali; Konar, Subhas; Sharma, Ankit

2017-02-01

OBJECTIVE Adjacent-level disc degeneration following cervical fusion has been well reported. This condition poses a major treatment dilemma when it becomes symptomatic. The potential application of cervical arthroplasty to preserve motion in the affected segment is not well documented, with few studies in the literature. The authors present their initial experience of analyzing clinical and radiological results in such patients who were treated with arthroplasty for new or persistent arm and/or neck symptoms related to neural compression due to adjacent-segment disease after anterior cervical discectomy and fusion (ACDF). METHODS During a 5-year period, 11 patients who had undergone ACDF anterior cervical discectomy and fusion (ACDF) and subsequently developed recurrent neck or arm pain related to adjacent-level cervical disc disease were treated with cervical arthroplasty at the authors' institution. A total of 15 devices were implanted (range of treated levels per patient: 1-3). Clinical evaluation was performed both before and after surgery, using a visual analog scale (VAS) for pain and the Neck Disability Index (NDI). Radiological outcomes were analyzed using pre- and postoperative flexion/extension lateral radiographs measuring Cobb angle (overall C2-7 sagittal alignment), functional spinal unit (FSU) angle, and range of motion (ROM). RESULTS There were no major perioperative complications or device-related failures. Statistically significant results, obtained in all cases, were reflected by an improvement in VAS scores for neck/arm pain and NDI scores for neck pain. Radiologically, statistically significant increases in the overall lordosis (as measured by Cobb angle) and ROM at the treated disc level were observed. Three patients were lost to follow-up within the first year after arthroplasty. In the remaining 8 cases, the duration of follow-up ranged from 1 to 3 years. None of these 8 patients required surgery for the same vertebral level during the follow

Medial Longitudinal Arch Angle Presents Significant Differences Between Foot Types: A Biplane Fluoroscopy Study.

PubMed

Balsdon, Megan E R; Bushey, Kristen M; Dombroski, Colin E; LeBel, Marie-Eve; Jenkyn, Thomas R

2016-10-01

The structure of the medial longitudinal arch (MLA) affects the foot's overall function and its ability to dissipate plantar pressure forces. Previous research on the MLA includes measuring the calcaneal-first metatarsal angle using a static sagittal plane radiograph, a dynamic height-to-length ratio using marker clusters with a multisegment foot model, and a contained angle using single point markers with a multisegment foot model. The objective of this study was to use biplane fluoroscopy to measure a contained MLA angle between foot types: pes planus (low arch), pes cavus (high arch), and normal arch. Fifteen participants completed the study, five from each foot type. Markerless fluoroscopic radiostereometric analysis (fRSA) was used with a three-dimensional model of the foot bones and manually matching those bones to a pair of two-dimensional radiographic images during midstance of gait. Statistically significant differences were found between barefoot arch angles of the normal and pes cavus foot types (p = 0.036), as well as between the pes cavus and pes planus foot types (p = 0.004). Dynamic walking also resulted in a statistically significant finding compared to the static standing trials (p = 0.014). These results support the classification of individuals following a physical assessment by a foot specialist for those with pes cavus and planus foot types. The differences between static and dynamic kinematic measurements were also supported using this novel method.

Surgical treatment of sagittal fracture of mandibular condyle using long-screw osteosynthesis.

PubMed

Luo, Shufang; Li, Bo; Long, Xing; Deng, Mohong; Cai, Hengxing; Cheng, Yong

2011-07-01

The retrospective study evaluated long-screw (bicortical screw) osteosynthesis used in the surgical treatment of sagittal fracture of the mandibular condyle and compared it with titanium plates and removal of the condylar fragment. Ninety-five patients with sagittal fracture of the mandibular condyle received open surgical treatment from 1997 to 2008. Among these patients, the condylar fragments were fixed with long screws in 56 cases (group A), were fixed with titanium plates in 12 cases (group B), and were completely removed in 24 cases (group C). Follow-up was carried out clinically and radiologically. The clinical features included limitation of mandibular mobility, occlusion disturbance, lateral deviation on mouth opening, joint pain, clicking, facial asymmetry, and patient's subjective evaluation. The radiologic parameters consisted of degree of bony resorption, bony change, change of osteosynthesis material, and shortening of mandibular ramus height. Anatomic reduction and functional restoration were obtained and no severe complication was detected in group A. However, 3 of 14 patients had severe osteoarthrosis and 2 of 14 patients had ankylosis in group B. In group C 3 of 24 patients had mandibular retrusion, 4 of 24 patients had front teeth open bite, 4 of 24 patients had severe osteoarthrosis, and 1 of 24 patients had ankylosis. The long-screw fixation group had a more favorable prognosis than the titanium plate group and the group in which removal of the condylar fragment was performed. The long-screw fixation technique might be suitable for use in the surgical treatment of sagittal fractures of the mandibular condyle. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Full fusion of proximal thoracic curve helps to prevent postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder.

PubMed

Jiang, Jun; Qian, Bang-Ping; Qiu, Yong; Wang, Bin; Yu, Yang; Zhu, Ze-Zhang

2017-08-23

To date, no study had reported the phenomenon of deteriorated postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients. The purpose of this study is to evaluate the cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder treated by either full fusion or partial/non fusion of the proximal thoracic curve. A total of 30 Lenke type 2 AIS patients with preoperative right-elevated shoulder underwent posterior spinal instrumentation from 2009 to 2011 were included in this study. All the subjects were divided into 2 groups according to the selection of upper instrumented vertebra. There were 14 cases proximally fused to T1 or T2 (Group A) and 16 cases proximally fused to T3 or below (Group B). Both standing anteroposterior and sagittal X-ray films of the spine obtained preoperatively, one week after the operation, and at a minimum of two-year follow-up were analyzed with respect to the following parameters: cervical tilt, T1 tilt, proximal thoracic Cobb angle, main thoracic Cobb angle, apical vertebral translation of proximal thoracic curve, apical vertebral translation of main thoracic curve, radiographic shoulder height, cervical lordosis, proximal thoracic kyphosis and main thoracic kyphosis. Most (83.3%) of the patients in these two groups gained satisfactory shoulder balance after surgery. However, the cervical tilt significantly improved in group A (p < 0.001) but deteriorated in group B (p < 0.001). In group A, the decrease of cervical tilt significantly positively correlated with that of T1 tilt (p < 0.001). In group B, the increase of cervical tilt significantly positively correlated with both the increase of T1 tilt (p < 0.001) and the increase of apical vertebral translation of proximal thoracic curve (p < 0.05). Lenke type 2 AIS patients with right-elevated shoulder gain improved shoulder but deteriorated cervical tilt after partial/non fusion of proximal thoracic curve. Full

Development of synthetic simulators for endoscope-assisted repair of metopic and sagittal craniosynostosis.

PubMed

Eastwood, Kyle W; Bodani, Vivek P; Haji, Faizal A; Looi, Thomas; Naguib, Hani E; Drake, James M

2018-06-01

OBJECTIVE Endoscope-assisted repair of craniosynostosis is a safe and efficacious alternative to open techniques. However, this procedure is challenging to learn, and there is significant variation in both its execution and outcomes. Surgical simulators may allow trainees to learn and practice this procedure prior to operating on an actual patient. The purpose of this study was to develop a realistic, relatively inexpensive simulator for endoscope-assisted repair of metopic and sagittal craniosynostosis and to evaluate the models' fidelity and teaching content. METHODS Two separate, 3D-printed, plastic powder-based replica skulls exhibiting metopic (age 1 month) and sagittal (age 2 months) craniosynostosis were developed. These models were made into consumable skull "cartridges" that insert into a reusable base resembling an infant's head. Each cartridge consists of a multilayer scalp (skin, subcutaneous fat, galea, and periosteum); cranial bones with accurate landmarks; and the dura mater. Data related to model construction, use, and cost were collected. Eleven novice surgeons (residents), 9 experienced surgeons (fellows), and 5 expert surgeons (attendings) performed a simulated metopic and sagittal craniosynostosis repair using a neuroendoscope, high-speed drill, rongeurs, lighted retractors, and suction/irrigation. All participants completed a 13-item questionnaire (using 5-point Likert scales) to rate the realism and utility of the models for teaching endoscope-assisted strip suturectomy. RESULTS The simulators are compact, robust, and relatively inexpensive. They can be rapidly reset for repeated use and contain a minimal amount of consumable material while providing a realistic simulation experience. More than 80% of participants agreed or strongly agreed that the models' anatomical features, including surface anatomy, subgaleal and subperiosteal tissue planes, anterior fontanelle, and epidural spaces, were realistic and contained appropriate detail. More

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.

Clinical validation of coronal and sagittal spinal curve measurements based on three-dimensional vertebra vector parameters.

PubMed

Somoskeöy, Szabolcs; Tunyogi-Csapó, Miklós; Bogyó, Csaba; Illés, Tamás

2012-10-01

� (Group 4; n=49), and above 75° (Group 5; n=22). All study subjects were examined by EOS 2D imaging, resulting in anteroposterior (AP) and lateral (LAT) full spine, orthogonal digital X-ray images, in standing position. Conventional coronal and sagittal curvature measurements including sagittal L5 vertebra wedges were determined by 3 experienced examiners, using traditional Cobb methods on EOS 2D AP and LAT images. Vertebra vector-based measurements were performed as published earlier, based on computer-assisted calculations of corresponding spinal curvature. Vertebra vectors were generated by dedicated software from sterEOS 3D spine models reconstructed from EOS 2D images by the same three examiners. Manual measurements were performed by each examiner, thrice for sterEOS 3D reconstructions and twice for vertebra vector-based measurements. Means comparison t test, Pearson bivariate correlation analysis, reliability analysis by intraclass correlation coefficients for intraobserver reproducibility and interrater reliability were performed using SPSS v16.0 software. In comparison with manual 2D methods, only small and nonsignificant differences were detectable in vertebra vector-based curvature data for coronal curves and thoracic kyphosis, whereas the found difference in L1-L5 lordosis values was shown to be strongly related to the magnitude of corresponding L5 wedge. Intraobserver reliability was excellent for both methods, and interrater reproducibility was consistently higher for vertebra vector-based methods that was also found to be unaffected by the magnitude of coronal curves or sagittal plane deviations. Vertebra vector-based angulation measurements could fully substitute conventional manual 2D measurements, with similar accuracy and higher intraobserver reliability and interrater reproducibility. Vertebra vectors represent a truly 3D solution for clear and comprehensible 3D visualization of spinal deformities while preserving crucial parametric information for

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.

Three-dimensional ultrasound imaging and measurement of nasal bone length, prenasal thickness and frontomaxillary facial angle in normal second- and third-trimester fetuses.

PubMed

Vos, F I; De Jong-Pleij, E A P; Ribbert, L S M; Tromp, E; Bilardo, C M

2012-06-01

To assess the feasibility of nasal bone length (NBL), prenasal thickness (PT) and frontomaxillary facial (FMF) angle measurements performed on the same three-dimensional (3D) multiplanar-corrected profile view in healthy second- and third-trimester fetuses, to create reference ranges and to review published measurement techniques. 3D volumes of 219 healthy second- and third-trimester fetuses were retrospectively analyzed. The quality of images and measurability of the markers were assessed with 5-point and 3-point scoring systems, respectively. Measurements of NBL (with care to exclude the frontal bone), PT and FMF were obtained in the exact mid-sagittal plane. Reference ranges were constructed based on measurements from images with high-quality (4 or 5 points) and high measurability (2 or 3 points) scores and compared with those in the most relevant published literature. A high-quality score was assigned to 111 images. Among these, a high measurability score was significantly more often achieved for NBL (98.2%) and PT (97.3%) than for the FMF angle (26.1%) (P < 0.001). Both NBL (NBL = - 6.927 + (0.83 × GA) - (0.01 × GA(2))) and PT (PT = (0.212 × GA) - 0.873) (where GA = gestational age) showed growth with gestation, with less pronounced growth for NBL after 28 weeks. Our reference range for the NBL showed a systematically smaller length than those in other two-dimensional (2D) ultrasound-based publications. The FMF angle measurements that we obtained did not show a significant change with GA. NBL and PT are easily measured using 3D ultrasound whereas FMF angle measurement is more challenging. When it is measured in the exact mid-sagittal plane and care is taken to exclude the frontal bone, measurements of the NBL are systematically smaller than those in previous 2D ultrasound-based publications. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

Specific exercises reduce brace prescription in adolescent idiopathic scoliosis: a prospective controlled cohort study with worst-case analysis.

PubMed

Negrini, Stefano; Zaina, Fabio; Romano, Michele; Negrini, Alessandra; Parzini, Silvana

2008-06-01

To compare the effect of Scientific Exercises Approach to Scoliosis (SEAS) exercises with "usual care" rehabilitation programmes in terms of the avoidance of brace prescription and prevention of curve progression in adolescent idiopathic scoliosis. Prospective controlled cohort observational study. Seventy-four consecutive outpatients with adolescent idiopathic scoliosis, mean 15 degrees (standard deviation 6) Cobb angle, 12.4 (standard deviation 2.2) years old, at risk of bracing who had not been treated previously. Thirty-five patients were included in the SEAS exercises group and 39 in the usual physiotherapy group. The primary outcome included the number of braced patients, Cobb angle and the angle of trunk rotation. There were 6.1% braced patients in the SEAS exercises group vs 25.0% in the usual physiotherapy group. Failures of treatment in the worst-case analysis were 11.5% and 30.8%, respectively. In both cases the differences were statistically significant. Cobb angle improved in the SEAS exercises group, but worsened in the usual physiotherapy group. In the SEAS exercises group, 23.5% of patients improved and 11.8% worsened, while in the usual physiotherapy group 11.1% improved and 13.9% worsened. These data confirm the effectiveness of exercises in patients with scoliosis who are at high risk of progression. Compared with non-adapted exercises, a specific and personalized treatment (SEAS) appears to be more effective.

Sagittal focusing Laue monochromator

DOEpatents

Zhong,; Zhong, Hanson [Stony Brook, NY; Jonathan, Hastings [Wading River, NY; Jerome, Kao [Stanford, CA; Chi-Chang, Lenhard [Setauket, NY; Anthony, Siddons [Medford, NY; David Peter, Zhong [Cutchogue, NY; Hui, [Coram, NY

2009-03-24

An x-ray focusing device generally includes a slide pivotable about a pivot point defined at a forward end thereof, a rail unit fixed with respect to the pivotable slide, a forward crystal for focusing x-rays disposed at the forward end of the pivotable slide and a rearward crystal for focusing x-rays movably coupled to the pivotable slide and the fixed rail unit at a distance rearward from the forward crystal. The forward and rearward crystals define reciprocal angles of incidence with respect to the pivot point, wherein pivoting of the slide about the pivot point changes the incidence angles of the forward and rearward crystals while simultaneously changing the distance between the forward and rearward crystals.

Role of Clavicle Chest Cage Angle Difference in Predicting Postoperative Shoulder Balance in Lenke 5C Adolescent Idiopathic Scoliosis Patients after Selective Posterior Fusion.

PubMed

Liu, Zhen; Hu, Zong-Shan; Qiu, Yong; Zhang, Zhen; Zhao, Zhi-Hui; Han, Xiao; Zhu, Ze-Zhang

2017-02-01

To evaluate the role of preoperative clavicle chest cage angle difference (CCAD) on postoperative radiographic shoulder imbalance, patient's satisfaction and surgeon's fulfillment in Lenke 5 adolescent idiopathic scoliosis (AIS). CCAD, as a novel radiographic parameter, has proven to be a reliable predictor for postoperative shoulder imbalance in Lenke 1 AIS patients. However, the value of CCAD in predicting shoulder balance has never been evaluated in Lenke 5 AIS patients. A total of 42 Lenke 5C AIS patients aged from 10 to 18 years old with a minimum 2-year follow-up were enrolled for evaluation. All patients underwent selective posterior spinal instrumentation and fusion using the all segmental pedicle screw technique by the same surgical team. The fusion levels were determined according to the Lenke criteria. Shoulder height difference (SHD) and CCAD were measured on anteroposterior (AP) standing radiographs. The patients' satisfaction and the surgeons' fulfillment were evaluated using a questionnaire. A receiver operative characteristic curve analysis was performed to explore the threshold values of preoperative CCAD in the prediction of the final follow-up radiographic shoulder imbalance, patients' satisfaction and surgeons' fulfillment. The average preoperative Cobb angle of the main curve was 46.8° ± 4.8°, and the average immediate postoperative Cobb angle was 13.3° ± 2.6°, representing an average surgical correction rate of 75.6% ± 8.5%. The average follow-up time was 29.2 months. At the last follow-up, the value of preoperative CCAD was significantly higher in patients with unbalanced shoulders (SHD ≥ 10 mm). At the final follow-up, 66.7% (28/42) of the patients were satisfied with their appearance, while 33.3% (14/42) of the patients were not satisfied with their appearance. At the final follow-up, 61.9% (26/42) of the surgeons were fulfilled with their operation, while 38.1% (16/42) of the surgeons were not. For patients' satisfaction and

Comparison between two pedicle screw augmentation instrumentations in adult degenerative scoliosis with osteoporosis.

PubMed

Xie, Yang; Fu, Qiang; Chen, Zi-qiang; Shi, Zhi-cai; Zhu, Xiao-dong; Wang, Chuan-feng; Li, Ming

2011-12-21

The operative treatment of adult degenerative scoliosis combined with osteoporosis increase following the epidemiological development. Studies have confirmed that screws in osteoporotic spines have significant lower-screw strength with more frequent screw movements within the vertebra than normal spines. Screws augmented with polymethylmethacrylate (PMMA) or with autogenous bone can offer more powerful corrective force and significant advantages. A retrospective analysis was conducted on 31 consecutive patients with degenerative lumbar scoliosis combined with osteoporosis who had surgery from December 2000. All had a minimum of 2-year follow-up. All patients had posterior approach surgery. 14 of them were fixed with pedicle screw by augmentation with polymethylmethacrylate (PMMA) and the other 17 patients with autogenous bone. Age, sex and whether smoking were similar between the two groups. Surgical time, blood loss, blood transfusion, medical cost, post surgery ICU time, hospital day, length of oral pain medicines taken, Pre-and postoperative Oswestry disability index questionnaire and surgical revision were documented and compared. Preoperative, postoperative and final follow up Cobb angle, sagittal lumbar curve, correction rate, and Follow up Cobb loss were also compared. No significant differences were found between the autogenous bone group and polymethylmethacrylate group with regards to all the targets above except for length of oral pain medicines taken and surgery cost. 2 patients were seen leakage during operation, but there is neither damage of nerve nor symptom after operation. No revision was needed. Both augmentation pedicle screw with polymethylmethacrylate (PMMA) and autogenous bone treating degenerative lumbar scoliosis combined with osteoporosis can achieve a good surgical result. Less oral pain medicines taken are the potential benefits of polymethylmethacrylate augmentation, but that is at the cost of more medical spending.

Expansive open-door laminoplasty versus laminectomy and instrumented fusion for cases with cervical ossification of the posterior longitudinal ligament and straight lordosis.

PubMed

Liu, Xiaowei; Chen, Yu; Yang, Haisong; Li, Tiefeng; Xu, Bin; Chen, Deyu

2017-04-01

To identify whether expansive open-door laminoplasty (Lam) is more appropriate than laminectomy and instrumented fusion (LIF) for cases with ossification of the posterior longitudinal ligament (OPLL) and straight cervical lordosis. A total of 67 cases were included and divided into Group Lam (n = 32) and Group LIF (n = 35), and the mean follow-up periods were 38 and 42 months, respectively. The cervical lordosis was elevated by C2-7 Cobb angle and cervical sagittal balance by C2-C7 sagittal vertical axis (SVA). Japanese Orthopedic Association (JOA), neurological recovery rate (RR) being calculated by the JOA, visual analog scale (VAS) and neck disability index (NDI) were used to assess clinical outcomes. Differences in general data between two groups were not significant. Total blood loss and operation duration in Group Lam were both significantly less than that in the Group LIF. By the final follow-up, the cervical lordosis significantly decreased in Group Lam and increased in Group LIF, the SVA significantly increased in Group Lam and kept unchanged in Group LIF, and the JOA, VAS, NDI significantly improved in both groups. Although there was no significant difference in RR between the two groups, cases in Group Lam had significantly larger incidence of postoperative kyphosis and kyphotic change rate, and less VAS, NDI and incidence of axial pain than cases in Group LIF. When compared with the LIF, the Lam is recommended for cases with OPLL and straight cervical lordosis when taking comparable neurological recovery, less axial pain and better neck function improvement into consideration.

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.

A model of cerebrocerebello-spinomuscular interaction in the sagittal control of human walking.

PubMed

Jo, Sungho; Massaquoi, Steve G

2007-03-01

A computationally developed model of human upright balance control (Jo and Massaquoi on Biol cybern 91:188-202, 2004) has been enhanced to describe biped walking in the sagittal plane. The model incorporates (a) non-linear muscle mechanics having activation level -dependent impedance, (b) scheduled cerebrocerebellar interaction for control of center of mass position and trunk pitch angle, (c) rectangular pulse-like feedforward commands from a brainstem/ spinal pattern generator, and (d) segmental reflex modulation of muscular synergies to refine inter-joint coordination. The model can stand when muscles around the ankle are coactivated. When trigger signals activate, the model transitions from standing still to walking at 1.5 m/s. Simulated natural walking displays none of seven pathological gait features. The model can simulate different walking speeds by tuning the amplitude and frequency in spinal pattern generator. The walking is stable against forward and backward pushes of up to 70 and 75 N, respectively, and with sudden changes in trunk mass of up to 18%. The sensitivity of the model to changes in neural parameters and the predicted behavioral results of simulated neural system lesions are examined. The deficit gait simulations may be useful to support the functional and anatomical correspondences of the model. The model demonstrates that basic human-like walking can be achieved by a hierarchical structure of stabilized-long loop feedback and synergy-mediated feedforward controls. In particular, internal models of body dynamics are not required.

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.

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.

Focused Molding Using Adhesive Pads in Mehta Casting for Early-Onset Scoliosis.

PubMed

Abraham, Roby; Sponseller, Paul D

2014-11-01

Prospective clinical series. To determine the effect of adhesive pads placed over the apex of scoliosis curves on curve correction 1) after the first cast and 2) after the final cast. Early-onset scoliosis is often effectively managed by serial casting. Properly localizing the apex of the molds with the cast in place is challenging. The authors explored the effectiveness of a novel technique: incorporation of adhesive pads placed over the major curve apex before Mehta casting. The 27 patients who received body casts (2000-2013) were divided into 2 groups: those without and with apical adhesive pads (5-6 layers of pads placed on the major curve's apex during casting): non-pad (NP) group (n = 12) and pad (P) group (n = 15), respectively. Groups were compared regarding the percentage of Cobb angle change from the first cast and curve correction to a Cobb angle of <25° with Student t and chi-square tests (significance was p < .05). The mean percentage of major first-cast curve correction was 39% ± 18% and 56% ± 17% in the NP and P groups, respectively. Of the 26 patients out of a cast, 11 (42%) had a Cobb angle of <25°: 3 (25%) and 8 (57%) in the NP and P groups, respectively. The mean differences between the 2 groups in percentage of major curve correction and this Cobb angle correction were significant: p = .023 and .005, respectively. Adhesive pads placed over major curve(s) during Mehta casting were effective in increasing the amount of major curve correction from the first cast for idiopathic early-onset scoliosis and in decreasing curves to <25° at final follow-up. Copyright © 2014 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Scoliosis in osteogenesis imperfecta caused by COL1A1/COL1A2 mutations - genotype-phenotype correlations and effect of bisphosphonate treatment.

PubMed

Sato, Atsuko; Ouellet, Jean; Muneta, Takeshi; Glorieux, Francis H; Rauch, Frank

2016-05-01

Bisphosphonates are widely used to treat children with osteogenesis imperfecta (OI), a bone fragility disorder that is most often caused by mutations in COL1A1 or COL1A2. However, it is unclear whether this treatment decreases the risk of developing scoliosis. We retrospectively evaluated spine radiographs and charts of 437 patients (227 female) with OI caused by mutations in COL1A1 or COL1A2 and compared the relationship between scoliosis, genotype and bisphosphonate treatment history. At the last follow-up (mean age 11.9 [SD: 5.9] years), 242 (55%) patients had scoliosis. The prevalence of scoliosis was highest in OI type III (89%), followed by OI type IV (61%) and OI type I (36%). Moderate to severe scoliosis (Cobb angle ≥25°) was rare in individuals with COL1A1 haploinsufficiency mutations but was present in about two fifth of patients with triple helical glycine substitutions or C-propeptide mutations. During the first 2 to 4years of bisphosphonate therapy, patients with OI type III had lower Cobb angle progression rates than before bisphosphonate treatment, whereas in OI types I and IV bisphosphonate treatment was not associated with a change in Cobb angle progression rates. At skeletal maturity, the prevalence of scoliosis (Cobb angle >10°) was similar in patients who had started bisphosphonate treatment early in life (before 5.0years of age) and in patients who had started therapy later (after the age of 10.0years) or had never received bisphosphonate therapy. Bisphosphonate treatment decreased progression rate of scoliosis in OI type III but there was no evidence of a positive effect on scoliosis in OI types I and IV. The prevalence of scoliosis at maturity was not influenced by the bisphosphonate treatment history in any OI type. Copyright © 2016 Elsevier Inc. All rights reserved.

Sensitivity of MRI parameters within intervertebral discs to the severity of adolescent idiopathic scoliosis.

PubMed

Huber, Maxime; Gilbert, Guillaume; Roy, Julien; Parent, Stefan; Labelle, Hubert; Périé, Delphine

2016-11-01

To measure magnetic resonance imaging (MRI) parameters including relaxation times (T 1 ρ, T 2 ), magnetization transfer (MT) and diffusion parameters (mean diffusivity [MD], fractional anisotropy [FA]) of intervertebral discs in adolescents with idiopathic scoliosis, and to investigate the sensitivity of these MR parameters to the severity of the spine deformities. Thirteen patients with adolescent idiopathic scoliosis and three control volunteers with no history of spine disease underwent an MRI acquisition at 3T including the mapping of T 1 ρ, T 2 , MT, MD, and FA. The apical zone included all discs within the scoliotic curve while the control zone was composed of other discs. The severity was analyzed through low (<32°) versus high (>40°) Cobb angles. One-way analysis of variance (ANOVA) and agglomerative hierarchical clustering (AHC) were performed. Significant differences were found between the apical zone and the control zone for T 2 (P = 0.047), and between low and high Cobb angles for T 2 (P = 0.014) and MT (P = 0.002). AHC showed two distinct clusters, one with mainly low Cobb angles and one with mainly high Cobb angles, for the MRI parameters measured within the apical zone, with an accuracy of 0.9 and a Matthews correlation coefficient (MCC) of 0.8. Within the control zone, the AHC showed no clear classification (accuracy of 0.6 and MCC of 0.2). We successfully performed an in vivo multiparametric MRI investigation of young patients with adolescent idiopathic scoliosis. The MRI parameters measured within the intervertebral discs were found to be sensitive to intervertebral disc degeneration occurring with scoliosis and to the severity of scoliosis. J. Magn. Reson. Imaging 2016;44:1123-1131. © 2016 International Society for Magnetic Resonance in Medicine.

Comparison between zero-profile spacer and plate with cage in the treatment of single level cervical spondylosis.

PubMed

Lan, Tao; Lin, Jian-Ze; Hu, Shi-Yu; Yang, Xin-Jian; Chen, Yang

2018-01-01

Retrospective study of 68 patients of symptomatic cervical spondylosis who were treated by anterior cervical discectomy and fusion (ACDF). The purpose of this study was to compare the clinical and radiological outcomes of patients with single level cervical spondylosis using either zero-profile spacer (group A) or anterior cervical plate and cage (group B). Clinical and radiological data of 68 patients undergoing ACDF from C3-C7 were collected retrospectively. There were 35 patients with a mean age of 54.05 years who received treatment by zero-profile implant. A total of 33 patients with a mean age of 52.09 years underwent fusion by traditional plate with cage. Group A and group B were followed up for an average of 23.68 months and 24.39 months, respectively. Age, blood loss, and operation time were assessed. The clinical outcomes were evaluated by JOA and VAS score before and after surgery. In addition, incidence of dysphagia was recorded. The Cobb angle (from C2 to C7) change was measured on the lateral cervical spine radiographs. There was no significant difference in terms of operation time and blood loss between two groups. The postoperative JOA significantly increased and the VAS decreased correspondently in both groups. The postoperative Cobb angle increased and showed statistical difference compared with preoperative Cobb angle in both groups. There was no significant difference between group A and group B in achieving clinical symptoms and radiograph improvement according to postoperative JOA, VAS and Cobb angle comparison. The incidence of postoperative dysphagia was lower in the group A than group B. Our study suggests that the application of zero-p spacer can achieve similar clinical and radiological improvement compared with traditional plate and cage. Meanwhile, zero-p is superior to plate and cage with a lower incidence of postoperative dysphagia.

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.

Sagittal back motion of college football athletes and nonathletes.

PubMed

Strong, L R; Titlow, L

1997-08-01

The study was designed as an ex post facto study using volunteers. To compare sagittal back motion of male college athletes with that of nonathletes and to compare data from both groups with normative data. Few studies have evaluated athletic demands on the spine. Much of the information on athletic demands comes from electromyographic studies, flexibility comparisons, and lift task studies. Although these studies provide a basis for back testing and evaluation, they do not present direct evidence of athletic low back performance. Fifteen male college football athletes and 15 male college nonathletes volunteered for testing using the IsoStation B-200 BSCAN 2.0 protocol (Isotechnologies, Inc., Hillsborough, NC). Measures were recorded for range of motion, isometric flexion and extension, and moderate and high dynamic flexion and extension. Data were analyzed using multivariate analysis of variance. The results of Hotelling's multivariate test were significant. Univariate follow-up analysis showed that athletes had significantly better isometric flexion, isometric extension, moderate dynamic flexion, high dynamic flexion, and high dynamic extension. Athletic data were compared with the BSCAN population data at the 50th and 80th percentile. Athletes were significantly better (P < 0.007) for all variables at the 50th percentile and for all dynamic variables at the 80th percentile. Within the limitations of the study, college football athletes had better sagittal back motion strength and speed as tested with the B-200 than nonathletes. Population data for the B-200 were representative for nonathletes but nonrepresentative for football players.

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

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

Does the sagittal alignment of the cervical spine have an impact on disk degeneration? Minimum 10-year follow-up of asymptomatic volunteers

PubMed Central

Okada, Eijiro; Ichihara, Daisuke; Chiba, Kazuhiro; Toyama, Yoshiaki; Fujiwara, Hirokazu; Momoshima, Suketaka; Nishiwaki, Yuji; Hashimoto, Takeshi; Ogawa, Jun; Watanabe, Masahiko; Takahata, Takeshi

2009-01-01

There have been few studies that investigated and clarified the relationships between progression of degenerative changes and sagittal alignment of the cervical spine. The objective of the study was to longitudinally evaluate the relationships among progression of degenerative changes of the cervical spine with age, the development of clinical symptoms and sagittal alignment of the cervical spine in healthy subjects. Out of 497 symptom-free volunteers who underwent MRI and plain radiography of the cervical spine between 1994 and 1996, 113 subjects (45 males and 68 females) who responded to our contacts were enrolled. All subjects underwent another MRI at an average of 11.3 years after the initial study. Their mean age at the time of the initial imaging was 36.6 ± 14.5 years (11–65 years). The items evaluated on MRI were (1) decrease in signal intensity of the intervertebral disks, (2) posterior disk protrusion, and (3) disk space narrowing. Each item was evaluated using a numerical grading system. The subjects were divided into four groups according to the age and sagittal alignment of the cervical spine, i.e., subjects under or over the age of 40 years, and subjects with the lordosis or non-lordosis type of sagittal alignment of the cervical spine. During the 10-year period, progression of decrease in signal intensity of the disk, posterior disk protrusion, and disk space narrowing were recognized in 64.6, 65.5, and 28.3% of the subjects, respectively. Progression of posterior disk protrusion was significantly more frequent in subjects over 40 years of age with non-lordosis type of sagittal alignment. Logistic regression analysis revealed that stiff shoulder was closely correlated with females (P = 0.001), and that numbness of the upper extremity was closely correlated with age (P = 0.030) and male (P = 0.038). However, no significant correlation between the sagittal alignment of the cervical spine and clinical symptoms was detected. Sagittal

Fetal frontomaxillary facial angle between 11 and 13 + 6 weeks of gestation in a Brazilian population: influence of different races.

PubMed

Panigassi, Ana Paula Nascimento; Araujo Júnior, Edward; Nardozza, Luciano Marcondes Machado; Moron, Antonio Fernandes; Pares, David Baptista da Silva

2013-07-01

To evaluate the influence of different races over the measurement of the frontomaxillary facial angle between 11 and 13 + 6 weeks of pregnancy in a Brazilian population. A cross-sectional study was conducted with 332 healthy pregnant women, with a crown-rump length (CRL) between 47 and 84 mm. Such measurements were taken abdominally, using the mid-sagittal plane, and the angle was measured by tracing a line over the palate and a line from the anterosuperior maxillary angle all the way to the external part of the forehead. As for the reference intervals, a simple linear regression between the frontomaxillary facial angle and the CRL was used, as well as Pearson's correlation coefficient (r). To evaluate the difference between races, a variance analysis was used (ANOVA). To calculate reproducibility, the intraclass correlation coefficient (ICC) was used. The means for the fetal frontomaxillary facial angle in white, black and mixed races were 81.8 ± 6.6; 82.2 ± 6.1 and 81.4 ± 6.2 mm, respectively. There was no statistical difference between races (p = 0.713). A decreasing correlation between the frontomaxillary facial angle and the CRL was observed for the black (r = -0.450) and mixed (r = -0.212) races. Excellent intraobserver reproducibility was observed, as well as a satisfactory interobserver reproducibility, with ICC of 0.858 and 0.605, respectively. There were no significative statistical differences in the measurement of the fetal frontomaxillary facial angle between 11 and 13 + 6 weeks of pregnancy in the different races in a Brazilian population.

[Application of surface electromyography in the treatment of adolescent idiopathic scoliosis with traditional spinal balanced therapy].

PubMed

Du, Hong-Gen; Ye, Shu-Liang; Xu, Jin-Yuan; Jiang, Zhong; Song, Hong-Quan; Yu, Ji-Wei

2013-11-01

To evaluate the values of surface electromyography (sEMG) in the treatment of adolescent idiophathic scoliosis (AIS) with non-surgical therapy. From October 2011 to May 2012, the data of 33 patients with AIS underwent traditional spinal balanced therapy were analyzed. There were 14 males and 19 females with an average age of (15.40 +/- 3.01) years,ranging in Cobb angle from 13 degrees to 40 degrees, course of disease more than 3 months. X-rays showed 21 cases were type C and 9 cases were type S. Preoperative and postoperative 6 months, Cobb angle, the ratio of averaged electromyography paramete (AEMG), security of treatment were observed. Thirty cases (90.9%) accomplished the treatment and detection. No harmful effects to vital sign was found and no fracture, dislocation, apopsychia, infection of pin hole was found. There was positive correlation between the ratio of AEMG and Cobb angle (P = 0.003). The ratio of AEMG decreased after treatment,and indicated the improvement of myosthenic otherness. sEMG can be used as a objective examination in evaluating difference of muscle electricity activity on both concaved and convex sides for patients of AIS, so it is a qualified objective examination for effectiveness evaluation and assessment aggravation risk, and has great value in clinic.

Scoliosis in Patients with Severe Cerebral Palsy: Three Different Courses in Adolescents.

PubMed

Oda, Yoshiaki; Takigawa, Tomoyuki; Sugimoto, Yoshihisa; Tanaka, Masato; Akazawa, Hirofumi; Ozaki, Toshifumi

2017-04-01

Patients with cerebral palsy (CP) frequently present with scoliosis; however, the pattern of curve progression is difficult to predict. We aimed to clarify the natural course of the progression of scoliosis and to identify scoliosis predictors. This was a retrospective, single-center, observational study. Total of 92 CP patients from Asahikawasou Ryouiku Iryou Center in Okayama, Japan were retrospectively analyzed. Cobb angle, presence of hip dislocation and pelvic obliquity, and Gross Motor Function Classification System (GMFCS) were investigated. Severe CP was defined as GMFCS level IV or V. The mean observation period was 10.7 years. Thirtyfour severe CP patients presented with scoliosis and were divided into 3 groups based on their clinical courses: severe, moderate and mild. The mean Cobb angles at the final follow-up were 129°, 53°, and 13° in the severe, moderate, and mild groups, respectively. The average progressions from 18 to 25 years were 2.7°/year, 0.7°/year, and 0.1°/year in the severe, moderate, and mild curve groups, respectively. We observed the natural course of scoliosis and identified 3 courses based on the Cobb angle at 15 and 18 years of age. This method of classification may help clinicians predict the patients' disease progression.

Patient evaluation in idiopathic scoliosis: Radiographic assessment, trunk deformity and back asymmetry.

PubMed

Rigo, Manuel

2011-01-01

Progressive adolescent idiopathic scoliosis (AIS) produces specific signs and symptoms, including trunk and spinal deformity and imbalance, impairment of breathing function, pain, progression during adult life, and psychological problems, as a whole resulting in an alteration of the health-related quality of life. A scoliosis-specific rehabilitation program attempts to prevent, improve, or minimize these signs and symptoms by using exercises and braces as the main tools in the rehabilitation treatment. Patient evaluation is an essential point in the decision-making process and determines the selection of the specific exercises and the specifications of the brace design. However, this article is not addressed to scoliosis management. In this present article, a complete definition and discussion of radiological aspects, such as the Cobb angle, axial rotation, curve pattern classifications, and sagittal configuration, follow a short description of the three-dimensional nature of AIS. The relationship between AIS and growth is also discussed. There is also a section dedicated to the assessment of trunk deformity and back asymmetry. Other important clinical aspects, such as pain and disability, changes in other regions of the body, muscular balance, breathing function, and health-related quality of life, are not discussed in this present article.

Significance of peak height velocity as a predictive factor for curve progression in patients with idiopathic scoliosis

PubMed Central

2015-01-01

Background Much attention has been paid to peak height velocity (PHV) as a possible predictor of curve progression in patients with idiopathic scoliosis (IS). The aim of this study was to analyze the relationship between the magnitude of the Cobb angle at PHV and scoliosis progression, defined as having surgery prior to skeletal maturity in female patients with IS. Methods A retrospective review identified 56 skeletally immature female IS patients who were followed until maturity. The mean age and the mean pubertal status at the initial visit were 10 years and 24 months before menarche respectively, with a follow-up period of 5 years. They were divided into two groups: non-surgery group (NS) and surgery group (S), depending on their treatment method in use at the final follow-up visit. Surgery group was defined as an ultimately having surgery due to Cobb angle greater than 45 degrees prior to skeletal maturity regardless of conservative management. Height measurements were recorded at each visit; height velocity was calculated as the height change, in cm, divided by the time interval, in years. The PHV, chronological age at PHV (APHV), height at PHV (HPHV), and final height (FH) were determined for each group. In patients with Cobb angle greater than 30 degrees, the corrected height was calculated by Kono formula and corrected height velocity values were provided. The sensitivity, specificity, and area under the curve (AUC) of the receiver-operating -characteristic (ROC) analysis were calculated to predict spinal curve progression for various Cobb-angle cutoff values at PHV. Results The corrected PHV had a mean value of 8.5 and 8.9 cm/year in the NS-group and S-group, respectively. The APHV was 11.9 and 11 years, the corrected HPHV was 152.9, and 149.3 cm, and the corrected FH was 159.9 and 159.3 cm, respectively. When a Cobb angle of 31.5 degrees was at PHV, ROC analysis revealed 78% sensitivity, 82% specificity, and an AUC of 0.93, acceptable values for curve

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.

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

[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.

Selective activation of the latissimus dorsi and the inferior fibers of trapezius at various shoulder angles during isometric pull-down exertion.

PubMed

Park, Se-yeon; Yoo, Won-gyu

2013-12-01

The aim of this study was to determine the effect of isometric pull down exercise on muscle activity with shoulder elevation angles of 60°, 90°, and 120° and sagittal, scapular, and frontal movement planes, by electromyography (EMG) of the latissimus dorsi, inferior fibers of trapezius, and latissimus dorsi/inferior fibers of trapezius activity ratio. Fourteen men performed nine conditions of isometric pull down exercise (three conditions of shoulder elevation × three conditions of movement planes). Surface EMG was used to collect data from the latissimus dorsi and inferior fibers of trapezius during exercise. Two-way repeated analysis of variance with two within-subject factors (shoulder elevation angles and planes of movement) was used to determine the significance of the latissimus dorsi and inferior fibers of trapezius activity and latissimus dorsi/inferior fibers of trapezius activity ratio. The latissimus dorsi activity and ratio between the latissimus dorsi and the inferior fibers of trapezius were significantly decreased as shoulder elevation angle increased from 60° to 120°. The inferior fibers of trapezius activity was significantly increased with shoulder elevation angle. The EMG activity and the ratios were not affected by changes in movement planes. This study suggests that selective activation of the latissimus dorsi is accomplished with a low shoulder elevation angle, while the inferior fibers of the trapezius are activated with high shoulder elevation angles. Copyright © 2013 Elsevier Ltd. All rights reserved.

Changes in pennation with joint angle and muscle torque: in vivo measurements in human brachialis muscle.

PubMed Central

Herbert, R D; Gandevia, S C

1995-01-01

1. Estimates of pennation in human muscles are usually obtained from cadavers. In this study, pennation of human brachialis was measured in vivo using sonography. Effects of static and dynamic changes in elbow angle and torque were investigated. 2. Pennation was measured in eight subjects using an 80 mm, 5 MHz, linear-array ultrasound transducer to generate sagittal images of the brachialis during maximal and submaximal isometric contractions at various elbow angles. It was shown that estimates of pennation were reproducible, representative of measurements made throughout the belly of the muscle and not distorted by compression of the muscle with the transducer or rotation of the muscle out of the plane of the transducer. 3. Mean resting pennation was 9.0 +/- 2.0 deg (S.D., range 6.5-12.9 deg). When the muscle was relaxed there was no effect of elbow angle on pennation. However, during a maximal isometric contraction (MVC), with the elbow flexed to 90 deg, pennation increased non-linearly with elbow torque to between 22 and 30 deg (mean 24.7 +/- 2.4 deg). The effect of increasing torque was small when the elbow was fully extended. The relationship between elbow angle, elbow torque and brachialis pennation suggests that the relaxed brachialis muscle is slack over much of its physiological range of lengths. 4. There was no hysteresis in the relationship between torque and pennation during slow isometric contractions (0.2 MVC s-1), and the relationship between elbow angle and pennation was similar during slow shortening and lengthening contractions. 5. Two consequences follow from these findings. Firstly, intramuscular mechanics are complex and simple planar models of muscles underestimate the increases in pennation which occur during muscle contraction. Second, spindle afferents from relaxed muscles may not encode joint angle over the full range of movement. Images Figure 2 PMID:7602542

Examining the Perceptions of Gwinnett and Cobb County Georgia Principals to Determine the Strategies Needed to Improve Performance and Graduation Rates of African-American Males in Metropolitan U.S. Schools

ERIC Educational Resources Information Center

Henderson, Darren L.

2012-01-01

The purpose of this study was to examine the perceptions of high school administrators in Gwinnett and Cobb Counties, Georgia that have successfully narrowed the achievement gap for high school African-American males as to: (a) why the achievement gap continues to occur in other metropolitan high schools in the United States; (b) what successful…

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.

The therapeutic characteristics of serial casting on congenital scoliosis: a comparison with non-congenital cases from a single-center experience.

PubMed

Cao, Jun; Zhang, Xue-Jun; Sun, Ning; Sun, Lin; Guo, Dong; Qi, Xin-Yu; Bai, Yun-Song; Sun, Bao-Sheng

2017-04-04

The therapeutic efficacy of serial casting on idiopathic scoliosis has been gradually documented. However, literatures on serial casting for congenital scoliosis (CS) remain extremely rare. This paper aimed to compare the treatment outcomes of serial casting between CS and non-CS patients to comprehensively evaluate the therapeutic characteristics of serial casting on CS patients. A total of 23 early-onset scoliosis cases were included and divided into congenital scoliosis (CS, n = 8) and non-congenital group (non-CS, n = 15). Therapeutic outcomes including the major curve Cobb angle, thoracic kyphosis angle, lumbar lodosis angle, and thoracic spine growing rate were compared between groups at precast, after the first cast, and at the latest follow-up, respectively. All patients received the first cast at the age of 3.25 ± 1.20 years and 5.70 ± 1.18 times of cast corrections. The average casting time was 17.17 ± 3.38 months, and the mean follow-up time was 23.91 ± 12.28 months. Both CS and non-CS groups had significant decrease in Cobb angle after the first cast and at the latest follow-up (all P < 0.05). Cobb angle was significantly lower in non-CS group than in CS group at both time points (all P < 0.01). The correction rate of Cobb angle was significantly higher in non-CS group than in CS group (around 50 vs. 20%, both P < 0.01). The mean thoracic growth rate was significantly lower in CS group than in non-CS group (0.72 ± 0.20 vs. 1.42 ± 0.22 cm/year, P < 0.001). At the latest follow-up, there are 2 cases receiving growing rod surgery, 8 cases wearing a brace, and 13 cases continuing serial casting. Although the therapeutic efficacy of casting on CS patients is not as good as that on non-CS patients, casting is still an efficient treatment option for CS patients to delay the need for initial surgery.

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

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

Reliability analysis for radiographic measures of lumbar lordosis in adult scoliosis: a case–control study comparing 6 methods

PubMed Central

Hong, Jae Young; Modi, Hitesh N.; Hur, Chang Yong; Song, Hae Ryong; Park, Jong Hoon

2010-01-01

Several methods are used to measure lumbar lordosis. In adult scoliosis patients, the measurement is difficult due to degenerative changes in the vertebral endplate as well as the coronal and sagittal deformity. We did the observational study with three examiners to determine the reliability of six methods for measuring the global lumbar lordosis in adult scoliosis patients. Ninety lateral lumbar radiographs were collected for the study. The radiographs were divided into normal (Cobb < 10°), low-grade (Cobb 10°–19°), high-grade (Cobb  ≥ 20°) group to determine the reliability of Cobb L1–S1, Cobb L1–L5, centroid, posterior tangent L1–S1, posterior tangent L1–L5 and TRALL method in adult scoliosis. The 90 lateral radiographs were measured twice by each of the three examiners using the six measurement methods. The data was analyzed to determine the inter- and intra-observer reliability. In general, for the six radiographic methods, the inter- and intra-class correlation coefficients (ICCs) were all ≥0.82. A comparison of the ICCs and 95% CI for the inter- and intra-observer reliability between the groups with varying degrees of scoliosis showed that, the reliability of the lordosis measurement decreased with increasing severity of scoliosis. In Cobb L1–S1, centroid and posterior tangent L1–S1 methods, the ICCs were relatively lower in the high-grade scoliosis group (≥0.60). And, the mean absolute difference (MAD) in these methods was high in the high-grade scoliosis group (≤7.17°). However, in the Cobb L1–L5 and posterior tangent L1–L5 method, the ICCs were ≥0.86 in all groups. And, in the TRALL method, the ICCs were ≥0.76 in all groups. In addition, in the Cobb L1–L5 and posterior tangent L1–L5 method, the MAD was ≤3.63°. And, in the TRALL method, the MAD was ≤3.84° in all groups. We concluded that the Cobb L1–L5 and the posterior tangent L1–L5 methods are reliable methods for measuring the global lumbar lordosis

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.

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.

Climate change and observed climate trends in the fort cobb experimental watershed.

PubMed

Garbrecht, J D; Zhang, X C; Steiner, J L

2014-07-01

Recurring droughts in the Southern Great Plains of the United States are stressing the landscape, increasing uncertainty and risk in agricultural production, and impeding optimal agronomic management of crop, pasture, and grazing systems. The distinct possibility that the severity of recent droughts may be related to a greenhouse-gas induced climate change introduces new challenges for water resources managers because the intensification of droughts could represent a permanent feature of the future climate. Climate records of the Fort Cobb watershed in central Oklahoma were analyzed to determine if recent decade-long trends in precipitation and air temperature were consistent with climate change projections for central Oklahoma. The historical precipitation record did not reveal any compelling evidence that the recent 20-yr-long decline in precipitation was related to climate change. Also, precipitation projections by global circulation models (GCMs) displayed a flat pattern through the end of the 21st century. Neither observed nor projected precipitation displayed a multidecadal monotonic rising or declining trend consistent with an ongoing warming climate. The recent trend in observed annual precipitation was probably a decade-scale variation not directly related to the warming climate. On the other hand, the observed monotonic warming trend of 0.34°C decade that started around 1978 is consistent with GCM projections of increasing temperature for central Oklahoma. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

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

Long-term outcomes of anterior spinal fusion for treating thoracic adolescent idiopathic scoliosis curves: average 15-year follow-up analysis.

PubMed

Sudo, Hideki; Ito, Manabu; Kaneda, Kiyoshi; Shono, Yasuhiro; Takahata, Masahiko; Abumi, Kuniyoshi

2013-05-01

Retrospective review. To assess the long-term outcomes of anterior spinal fusion (ASF) for treating thoracic adolescent idiopathic scoliosis (AIS). Although ASF is reported to provide good coronal and sagittal correction of the main thoracic (MT) AIS curves, the long-term outcomes of ASF is unknown. A consecutive series of 25 patients with Lenke 1 MT AIS were included. Outcome measures comprised radiographical measurements, pulmonary function, and Scoliosis Research Society outcome instrument (SRS-30) scores (preoperative SRS-30 scores were not documented). Postoperative surgical revisions and complications were recorded. Twenty-five patients were followed-up for 12 to 18 years (average, 15.2 yr). The average MT Cobb angle correction rate and the correction loss at the final follow-up were 56.7% and 9.2°, respectively. The average preoperative instrumented level of kyphosis was 8.3°, which significantly improved to 18.6° (P = 0.0003) at the final follow-up. The average percent-predicted forced vital capacity and forced expiratory volume in 1 second were significantly decreased during long-term follow-up measurements (73% and 69%; P = 0.0004 and 0.0016, respectively). However, no patient had complaints related to pulmonary function. The average total SRS-30 score was 4.0. Implant breakage was not observed. All patients, except 1 who required revision surgery, demonstrated solid fusion. Late instrumentation-related bronchial problems were observed in 1 patient who required implant removal and bronchial tube repair, 13 years after the initial surgery. Overall radiographical findings and patient outcome measures of ASF for Lenke 1 MT AIS were satisfactory at an average follow-up of 15 years. ASF provides significant sagittal correction of the main thoracic curve with long-term maintenance of sagittal profiles. Percent-predicted values of forced vital capacity and forced expiratory volume in 1 second were decreased in this cohort; however, no patient had complaints

Three-Dimensional Vertebral Wedging in Mild and Moderate Adolescent Idiopathic Scoliosis

PubMed Central

Scherrer, Sophie-Anne; Begon, Mickaël; Leardini, Alberto; Coillard, Christine; Rivard, Charles-Hilaire; Allard, Paul

2013-01-01

Background Vertebral wedging is associated with spinal deformity progression in adolescent idiopathic scoliosis. Reporting frontal and sagittal wedging separately could be misleading since these are projected values of a single three-dimensional deformation of the vertebral body. The objectives of this study were to determine if three-dimensional vertebral body wedging is present in mild scoliosis and if there are a preferential vertebral level, position and plane of deformation with increasing scoliotic severity. Methodology Twenty-seven adolescent idiopathic scoliotic girls with mild to moderate Cobb angles (10° to 50°) participated in this study. All subjects had at least one set of bi-planar radiographs taken with the EOS® X-ray imaging system prior to any treatment. Subjects were divided into two groups, separating the mild (under 20°) from the moderate (20° and over) spinal scoliotic deformities. Wedging was calculated in three different geometric planes with respect to the smallest edge of the vertebral body. Results Factorial analyses of variance revealed a main effect for the scoliosis severity but no main effect of vertebral Levels (apex and each of the three vertebrae above and below it) (F = 1.78, p = 0.101). Main effects of vertebral Positions (apex and above or below it) (F = 4.20, p = 0.015) and wedging Planes (F = 34.36, p<0.001) were also noted. Post-hoc analysis demonstrated a greater wedging in the inferior group of vertebrae (3.6°) than the superior group (2.9°, p = 0.019) and a significantly greater wedging (p≤0.03) along the sagittal plane (4.3°). Conclusions Vertebral wedging was present in mild scoliosis and increased as the scoliosis progressed. The greater wedging of the inferior group of vertebrae could be important in estimating the most distal vertebral segment to be restrained by bracing or to be fused in surgery. Largest vertebral body wedging values obtained in the sagittal plane support the claim

Validity of a smartphone protractor to measure sagittal parameters in adult spinal deformity.

PubMed

Kunkle, William Aaron; Madden, Michael; Potts, Shannon; Fogelson, Jeremy; Hershman, Stuart

2017-10-01

Smartphones have become an integral tool in the daily life of health-care professionals (Franko 2011). Their ease of use and wide availability often make smartphones the first tool surgeons use to perform measurements. This technique has been validated for certain orthopedic pathologies (Shaw 2012; Quek 2014; Milanese 2014; Milani 2014), but never to assess sagittal parameters in adult spinal deformity (ASD). This study was designed to assess the validity, reproducibility, precision, and efficiency of using a smartphone protractor application to measure sagittal parameters commonly measured in ASD assessment and surgical planning. This study aimed to (1) determine the validity of smartphone protractor applications, (2) determine the intra- and interobserver reliability of smartphone protractor applications when used to measure sagittal parameters in ASD, (3) determine the efficiency of using a smartphone protractor application to measure sagittal parameters, and (4) elucidate whether a physician's level of experience impacts the reliability or validity of using a smartphone protractor application to measure sagittal parameters in ASD. An experimental validation study was carried out. Thirty standard 36″ standing lateral radiographs were examined. Three separate measurements were performed using a marker and protractor; then at a separate time point, three separate measurements were performed using a smartphone protractor application for all 30 radiographs. The first 10 radiographs were then re-measured two more times, for a total of three measurements from both the smartphone protractor and marker and protractor. The parameters included lumbar lordosis, pelvic incidence, and pelvic tilt. Three raters performed all measurements-a junior level orthopedic resident, a senior level orthopedic resident, and a fellowship-trained spinal deformity surgeon. All data, including the time to perform the measurements, were recorded, and statistical analysis was performed to

Optimal sagittal motion axis for trunk extension and flexion tests in chronic low back trouble.

PubMed

Rantanen, P; Nykvist, F

2000-11-01

To find the optimal height for sagittal motion axis for trunk strength test in chronic low back trouble. Cross-sectional study. The strength of trunk muscles of low back pain patients is decreased. The measured strength depends on the height of the sagittal motion axis but the differences between patients and controls are not known. 114 (67 female) patients with chronic low back trouble are classified according to Quebec Task Force, 50 (31 female) patients with rheumatic disorder, but without low back trouble, and 33 (22 female) healthy controls, no appreciable physical differences but clear differences in Oswestry score. Isometric trunk extension-flexion test with different heights for the pelvic fulcrum. Force decreased in extension, increased in flexion, and torque increased both in flexion and extension in every group (P<0.001) as the fulcrum was moved caudally. The male controls were stronger than patients with low back trouble (P<0.01). The female controls were stronger only if the fulcrum was set at the hip joint level (P<0.05). There were no differences between patients with rheumatic disorder and low back trouble, except in extension if the fulcrum was at the hip joint level (P<0.02). The rotation axis in trunk extension-flexion strength test should be set at the level of the hip joint. Trunk muscle weakness is a common sign of different rheumatic disorders. Proper setting of sagittal motion axis and concomitant measurement of trunk and hip extensor or flexor muscles increases the specificity of the strength test for low back trouble.

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

Three-dimensional sampling perfection with application-optimised contrasts using a different flip angle evolutions sequence for routine imaging of the spine: preliminary experience.

PubMed

Tins, B; Cassar-Pullicino, V; Haddaway, M; Nachtrab, U

2012-08-01

The bulk of spinal imaging is still performed with conventional two-dimensional sequences. This study assesses the suitability of three-dimensional sampling perfection with application-optimised contrasts using a different flip angle evolutions (SPACE) sequence for routine spinal imaging. 62 MRI examinations of the spine were evaluated by 2 examiners in consensus for the depiction of anatomy and presence of artefact. We noted pathologies that might be missed using the SPACE sequence only or the SPACE and a sagittal T(1) weighted sequence. The reference standards were sagittal and axial T(1) weighted and T(2) weighted sequences. At a later date the evaluation was repeated by one of the original examiners and an additional examiner. There was good agreement of the single evaluations and consensus evaluation for the conventional sequences: κ>0.8, confidence interval (CI)>0.6-1.0. For the SPACE sequence, depiction of anatomy was very good for 84% of cases, with high interobserver agreement, but there was poor interobserver agreement for other cases. For artefact assessment of SPACE, κ=0.92, CI=0.92-1.0. The SPACE sequence was superior to conventional sequences for depiction of anatomy and artefact resistance. The SPACE sequence occasionally missed bone marrow oedema. In conjunction with sagittal T(1) weighted sequences, no abnormality was missed. The isotropic SPACE sequence was superior to conventional sequences in imaging difficult anatomy such as in scoliosis and spondylolysis. The SPACE sequence allows excellent assessment of anatomy owing to high spatial resolution and resistance to artefact. The sensitivity for bone marrow abnormalities is limited.

Is circumferential minimally invasive surgery effective in the treatment of moderate adult idiopathic scoliosis?

PubMed

Anand, Neel; Baron, Eli M; Khandehroo, Babak

2014-06-01

74 (p = 0.026). Mean Cobb angle and sagittal vertical axis decreased from 42° and 51 mm preoperatively to 16° and 27 mm postoperatively (both p < 0.001). An 88% fusion rate was confirmed on CT scan. Perioperative complications occurred in 11 of the 50 patients (22%), with delayed complications needing further surgery in 10 more patients at last followup. cMIS provides for good clinical and radiographic outcomes for moderate (30°-75°) adult idiopathic scoliosis. Patients undergoing cMIS should be carefully selected to avoid fixed, rigid deformities and a preoperative sagittal vertical axis of greater than 10 cm; surgeons should consider alternative techniques in those patients. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Assessment of spring cranioplasty biomechanics in sagittal craniosynostosis patients.

PubMed

Borghi, Alessandro; Schievano, Silvia; Rodriguez Florez, Naiara; McNicholas, Roisin; Rodgers, Will; Ponniah, Allan; James, Greg; Hayward, Richard; Dunaway, David; Jeelani, N U Owase

2017-11-01

OBJECTIVE Scaphocephaly secondary to sagittal craniosynostosis has been treated in recent years with spring-assisted cranioplasty, an innovative approach that leverages the use of metallic spring distractors to reshape the patient skull. In this study, a population of patients who had undergone spring cranioplasty for the correction of scaphocephaly at the Great Ormond Street Hospital for Children was retrospectively analyzed to systematically assess spring biomechanical performance and kinematics in relation to spring model, patient age, and outcomes over time. METHODS Data from 60 patients (49 males, mean age at surgery 5.2 ± 0.9 months) who had received 2 springs for the treatment of isolated sagittal craniosynostosis were analyzed. The opening distance of the springs at the time of insertion and removal was retrieved from the surgical notes and, during the implantation period, from planar radiographs obtained at 1 day postoperatively and at the 3-week follow-up. The force exerted by the spring to the patient skull at each time point was derived after mechanical testing of each spring model-3 devices with the same geometry but different wire thicknesses. Changes in the cephalic index between preoperatively and the 3-week follow-up were recorded. RESULTS Stiffer springs were implanted in older patients (p < 0.05) to achieve the same opening on-table as in younger patients, but this entailed significantly different-higher-forces exerted on the skull when combinations of stiffer springs were used (p < 0.001). After initial force differences between spring models, however, the devices all plateaued. Indeed, regardless of patient age or spring model, after 10 days from insertion, all the devices were open. CONCLUSIONS Results in this study provide biomechanical insights into spring-assisted cranioplasty and could help to improve spring design and follow-up strategy in the future.

Comparison between two pedicle screw augmentation instrumentations in adult degenerative scoliosis with osteoporosis

PubMed Central

2011-01-01

Background The operative treatment of adult degenerative scoliosis combined with osteoporosis increase following the epidemiological development. Studies have confirmed that screws in osteoporotic spines have significant lower-screw strength with more frequent screw movements within the vertebra than normal spines. Screws augmented with Polymethylmethacrylate (PMMA) or with autogenous bone can offer more powerful corrective force and significant advantages. Methods A retrospective analysis was conducted on 31 consecutive patients with degenerative lumbar scoliosis combined with osteoporosis who had surgery from December 2000. All had a minimum of 2-year follow-up. All patients had posterior approach surgery. 14 of them were fixed with pedicle screw by augmentation with Polymethylmethacrylate (PMMA) and the other 17 patients with autogenous bone. Age, sex and whether smoking were similar between the two groups. Surgical time, blood loss, blood transfusion, medical cost, post surgery ICU time, hospital day, length of oral pain medicines taken, Pre-and postoperative Oswestry disability index questionnaire and surgical revision were documented and compared. Preoperative, postoperative and final follow up Cobb angle, sagittal lumbar curve, correction rate, and Follow up Cobb loss were also compared. Results No significant differences were found between the autogenous bone group and Polymethylmethacrylate group with regards to all the targets above except for length of oral pain medicines taken and surgery cost. 2 patients were seen leakage during operation, but there is neither damage of nerve nor symptom after operation. No revision was needed. Conclusion Both augmentation pedicle screw with Polymethylmethacrylate (PMMA) and autogenous bone treating degenerative lumbar scoliosis combined with osteoporosis can achieve a good surgical result. Less oral pain medicines taken are the potential benefits of Polymethylmethacrylate augmentation, but that is at the cost of more

[Non-operative treatment for severe forms of infantile idiopathic scoliosis].

PubMed

Trobisch, P D; Samdani, A; O'Neil, C; Betz, R; Cahill, P

2012-02-01

Infantile idiopathic scoliosis (IIS) is a rare orthopaedic condition. Braces and casts are popular options in the treatment of IIS but there is a paucity of studies commenting on the outcome of non-operative treatment. The purpose of this study was to analyse failure and success after non-operative treatment for severe forms of IIS. We retrospectively reviewed the data of all children who had been treated for IIS between 2003 and 2009 at a single institution. After calculating the failure and success rates, we additionally performed a risk factor analysis for patients who failed non-operative treatment. Chi (2) and T tests were used for statistical analysis with significance set at p < 0.05. 25 children with an average age of 11 months and an Cobb angle of 46 degrees at presentation were analysed. Seven (28 %) patients were considered as having failed non-operative treatment after an average follow-up of 28 months. The pretreatment Cobb angle was identified as single significant risk factor for failure (55 versus 42) while neither age, gender, nor RVAD seem to influence the outcome. In children who were considered as successfully treated, the Cobb angle decreased from 42 to 18 degrees. Non-operative treatment for IIS is successful in 3 out of 4 patients. © Georg Thieme Verlag KG Stuttgart · New York.

The role of hyperthyroidism as the predisposing factor for superior sagittal sinus thrombosis.

PubMed

Hwang, Jong-Uk; Kwon, Ki-Young; Hur, Jin-Woo; Lee, Jong-Won; Lee, Hyun-Koo

2012-09-01

Superior sagittal sinus thrombosis (SSST) is an uncommon cause of stroke, whose symptoms and clinical course are highly variable. It is frequently associated with a variety of hypercoagulable states. Coagulation abnormalities are commonly seen in patients with hyperthyroidism. To the best of our knowledge, there are few reports on the association between hyperthyroidism and cerebral venous thrombosis. We report on a 31-year-old male patient with a six-year history of hyperthyroidism who developed seizure and mental deterioration. Findings on brain computed tomography (CT) showed multiple hemorrhages in the subcortical area of both middle frontal gyrus and cerebral digital subtraction angiography (DSA) showed irregular intra-luminal filling defects of the superior sagittal sinus. These findings were consistent with hemorrhagic transformation of SSST. Findings on clinical laboratory tests were consistent with hyperthyroidism. In addition, our patient also showed high activity of factors IX and XI. The patient received treatment with oral anticoagulant and prophylthiouracil. His symptoms showed complete improvement. A follow-up cerebral angiography four weeks after treatment showed a recanalization of the SSS. In conclusion, findings of our case indicate that hypercoagulability may contribute to development of SSST in a patient with hyperthyroidism.

Morphologic and biomechanical comparison of spinous processes and ligaments from scoliotic and kyphotic patients.

PubMed

Beaubien, Brian P; Freeman, Andrew L; Buttermann, Glenn R

2016-01-25

The spinous processes and supraspinous and interspinous ligaments (SSL and ISL, respectively) limit flexion and may relate to spinal curvature. Spinous process angles and mechanical properties of explanted human thoracic posterior SSL/ISL complexes were compared for scoliosis (n=14) vs. kyphosis (n=8) patients. The median thoracic coronal Cobb angle for scoliosis patients was 48°, and sagittal angles for kyphosis patients was 78°. Spinous processes were gripped and four strain steps of 4% were applied and held. Percent relaxation was calculated over each step, equilibrium load data were fit to an exponential equation, and a Kelvin model was fit to the load from all four curves. Failure testing was also performed. Median ligament complex dimensions from scoliosis and kyphosis patients were, respectively: ISL width=16.5mm and 16.0mm; SSL width=4.3mm and 3.8mm; ISL+SSL area=17.2mm and 25.7mm; these differences were not significant. Significant differences did exist in terms of spinous process angle vs. spine axis (47° for scoliosis and 32° for kyphosis) and SSL thickness (2.1mm for scoliosis and 3.0mm for kyphosis). Fourth-step median relaxation was 42% for scoliosis and 49% for kyphosis. Median linear region stiffness was 42N/mm for scoliosis and 51N/mm for kyphosis. Median failure load was 191N for scoliotic and 175N for kyphotic ligaments. Differences in loading, relaxation, viscoelastic and failure parameters were not statistically significant, except for a trend for greater initial rate of relaxation (T1) for scoliosis ligaments. However, we found significant morphological differences related to the spinous processes, which suggests a need for future biomechanical studies related to the musculoskeletal aspects of spinal alignment and posture. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

Assessment of Soft Tissue Changes by Cephalometry and Two-Dimensional Photogrammetry in Bilateral Sagittal Split Ramus Osteotomy Cases

PubMed Central

Martin, Alice

2011-01-01

ABSTRACT Objectives We aimed to compare the standard methods of cephalometry and two-dimensional photogrammetry, to evaluate the reliability and accuracy of both methods. Material and Methods Twenty-six patients (mean age 25.5, standard deviation (SD) 5.2 years) with Class II relationship and 23 patients with Class III relationship (mean age 26.4, SD 4.7 years) who had undergone bilateral sagittal split ramus osteotomy were selected, with a median follow-up of 8 months between pre- and postsurgical evaluation. Pre- and postsurgical cephalograms and lateral photograms were traced and changes were recorded. Results Pre- and postsurgical measurements of hard tissue angles and distances revealed higher correlations with cephalometrically performed soft tissue measurements of facial convexity (Class II: N-PG, r = - 0.50, P = 0.047; Class III: ANB, r = 0.73, P = 0.005; NaPg , r = 0.71, P = 0.007;) and labiomental angle (Class II: SNB, r = 0.72, P = 0.002; ANB, r = - 0.72, P = 0.002; N-B, r = - 0.68, P = 0.004; ANS-Gn, r = 0.71, P = 0.002; Class III: ANS-Gn, r = 0.65, P = 0.043) compared with two-dimensional photogrammetry. However, two-dimensional photogrammetry revealed higher correlation between lower lip length and cephalometrically assessed angular hard tissue changes (Class II: SNB, r = 0.98, P = 0.007; N-B, r = 0.89, P = 0.037; N-Pg, r = 0.90, P = 0.033; Class III: SNB, r = - 0.54, P = 0.060; NAPg, r = - 0.65, P = 0.041; N-Pg, r = 0.58, P = 0.039). Conclusions Our findings suggest that cephalometry and two-dimensional photogrammetry offer the possibility to complement one another. PMID:24421994

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.

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

Cost of treating sagittal synostosis in the first year of life.

PubMed

Abbott, Megan M; Rogers, Gary F; Proctor, Mark R; Busa, Kathleen; Meara, John G

2012-01-01

Endoscopically assisted suturectomy (EAS) has been reported to reduce the morbidity and cost of treating sagittal synostosis when compared with traditional open cranial vault remodeling (CVR) procedures. Whereas the former claim is well substantiated and intuitive, the latter has not been validated by rigorous cost analysis. Patient medical records and financial database reports were culled retrospectively to determine the total cost associated with both EAS and CVR during 1 year of care. Recorded cost data included physician and hospital services, orthotic equipment and fittings, and indirect patient cost. Ten patients treated with CVR were compared with 10 patients who underwent EAS. The CVR patients incurred greater costs in nearly all categories studied, including overall 1-year costs, physician services, hospital services, supplies/equipment, medications/intravenous fluids, and laboratory and blood bank services. Postoperative costs were greater in the EAS group, primarily because of the cost associated with orthotic services and indirect patient costs for travel and lost work. However, overall indirect patient costs for the whole year did not differ between the groups. One-year median costs were $55,121 for CVR and $23,377 for EAS. Early clinical results were similar for the 2 groups. Cranial vault remodeling was more costly in the first year of treatment than EAS, although indirect patient costs were similar. The favorable cost of EAS compared with CVR provides further justification to consider this procedure as first-line treatment of sagittal synostosis in young infants.

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

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.

Characterization and Predictive Value of Segmental Curve Flexibility in Adolescent Idiopathic Scoliosis Patients.

PubMed

Yao, Guanfeng; Cheung, Jason P Y; Shigematsu, Hideki; Ohrt-Nissen, Søren; Cheung, Kenneth M C; Luk, Keith D K; Samartzis, Dino

2017-11-01

A prospective radiographic analysis of adolescent idiopathic scoliosis (AIS) patients managed with alternate-level pedicle screw fixation was performed. The objective of this study was to characterize segmental curve flexibility and to determine its predictive value in curve correction in AIS patients. Little is known regarding the distinct segmental curve characteristics and their ability to predict curve correction in patients with AIS. The segmental Cobb angle was measured on posteroanterior standing radiographs and on fulcrum bending radiographs. Radiographs were analyzed preoperatively and at 2 years postoperatively and the curve was divided into upper, mid, and lower segments based on predefined criteria. The segmental flexibility and the segmental fulcrum bending correction index (FBCI) were calculated. Eighty patients were included with mean age of 15 years. Preoperative mean segmental Cobb angles were 18, 31, and 17 degrees in the upper, mid, and lower segments, respectively. Segmental bending Cobb angles were 6, 13, and 4 degrees, respectively, corresponding to segmental flexibilities of 50%, 47%, and 83% in the upper, mid, and lower segments, respectively (P < 0.001). At 2-year follow up, the mean segmental FBCI were 155%, 131%, and 100% in the upper, mid, and lower segments, respectively (P < 0.001), which suggested that the lower segment of the curve was more flexible than the other segments and that higher correction was noted in the upper segments. A significant, positive correlation was noted between the segmental bending Cobb angle and the segmental FBCI (P < 0.05), whereby the strength of the correlation varied based on the curve segment. This is the first study to demonstrate the segmental variations in curve flexibility using the fulcrum bending radiograph in AIS patients. Curve flexibility is not uniform throughout the curve and different segments exhibit greater flexibility/correctibility than others. Segmental flexibility should

Influence of growth hormone treatment on radiographic indices of the spine: propensity-matched analysis.

PubMed

Yun, Yeo-Hon; Kwon, Soon-Sun; Koh, Youngdo; Kim, Dong-Jun; Ahn, Jonghyun; Lee, Seung Yeol

2017-09-06

We performed this study to investigate the influence of recombinant human growth hormone (rhGH) therapy on radiographic indices of the spine using propensity-matched analysis. Patients with idiopathic short stature who had undergone both growth hormone therapy and whole-spine radiographs more than twice prior to 15 years of age were included in the patient group. Other patients who had undergone whole-spine radiographs more than twice prior to the same age during regular checkups for idiopathic scoliosis formed the control group. Propensity-matched analysis was performed to reduce the selection bias. The scoliosis Cobb angle, coronal balance, apical vertebral translation, apical rotation, and pelvic obliquity were measured from the radiographs taken at the periodic follow-ups. The rate of progression of the measurements was adjusted by multiple factors using a linear mixed model with sex as the fixed effect and age and each subject as the random effects. Using a propensity-matched analysis, 48 patients were finally included in both groups. The scoliosis Cobb angle increased by 1.0° (p < 0.001) per year in the patient group, whereas there was no significant annual change in the control group (p = 0.496). Female patients showed a greater scoliosis Cobb angle (1.8°, p = 0.039) compared with male patients. There was no significant difference between the patient and control groups in coronal balance (p = 0.264). Apical vertebral translation per year was increased by 1.2 mm (p < 0.001) in the patient group and 0.5 mm in the control group (p = 0.003). Radiographic examination revealed that growth hormone therapy for idiopathic short stature affected the progression of the scoliosis Cobb angle and apical vertebral translation on the coronal plane. Physicians should be aware that annual follow-up is required to evaluate the change in the curvature of the spine in patients undergoing rhGH treatment.

Assessing kyphosis with SpineScan: another attempt to reduce our dependence on radiography.

PubMed

Finestone, Aharon S; Marcus, Gil; Anekstein, Yoram; Mirovsky, Yigal; Agar, Gabriel

2013-08-01

Kyphosis management is mainly conservative, with annual examinations to assess angular progression. This includes physical examination and usually long spine X-rays, notorious for ionizing radiation. Several nonradiological instruments have been devised for this, but none have become popular. SpineScan, a programmed digital inclinometer, has been proved effective for screening kyphoscoliosis. The aim of this study was to assess the accuracy of SpineScan in monitoring kyphosis. Prospective, observational, diagnostic accuracy study. Twenty-eight subjects examined for kyphosis, with recent full-length lateral spine X-rays. Each subject was examined by two examiners. The technique involved the subject standing with arms flexed to 90° and then sliding the SpineScan from just below C7 to L2. Maximum X-ray kyphotic Cobb angle was compared with the SpineScan result. The study was institutional review board approved, and all patients signed an informed consent. The mean Cobb angle of the 28 subjects on radiography was 51° ± 15°. The mean SpineScan angle of all trials of all examiners was 54° ± 12°. The difference between the two measurements was significantly different from zero (3.2° ± 9.4°, p<.0001) and not normally distributed. The difference was significantly affected by the Cobb angle, examiner, and interaction between Cobb and examiner (statistical significance for all p<.0001). Ninety-five percent confidence intervals for all examiners ranged between -16° and 22° and for separate examiners between -25° and 32°, far above the 5° preplanned error level. The results demonstrated that there is significant error in monitoring kyphosis with SpineScan. Even for a more modest indication including replacing radiography with SpineScan on alternate visits, the measurement was not accurate enough. Future research is necessary to find a nonradiographic method of kyphosis follow-up, possibly using a digitalized modification of one of the described instruments

The sagittal stem alignment and the stem version clearly influence the impingement-free range of motion in total hip arthroplasty: a computer model-based analysis.

PubMed

Müller, Michael; Duda, Georg; Perka, Carsten; Tohtz, Stephan

2016-03-01

The component alignment in total hip arthroplasty influences the impingement-free range of motion (ROM). While substantiated data is available for the cup positioning, little is known about the stem alignment. Especially stem rotation and the sagittal alignment influence the position of the cone in relation to the edge of the socket and thus the impingement-free functioning. Hence, the question arises as to what influence do these parameters have on the impingement-free ROM? With the help of a computer model the influence of the sagittal stem alignment and rotation on the impingement-free ROM were investigated. The computer model was based on the CT dataset of a patient with a non-cemented THA. In the model the stem version was set at 10°/0°/-10° and the sagittal alignment at 5°/0°/-5°, which resulted in nine alternative stem positions. For each position, the maximum impingement-free ROM was investigated. Both stem version and sagittal stem alignment have a relevant influence on the impingement-free ROM. In particular, flexion and extension as well as internal and external rotation capability present evident differences. In the position intervals of 10° sagittal stem alignment and 20° stem version a difference was found of about 80° in the flexion and 50° in the extension capability. Likewise, differences were evidenced of up to 72° in the internal and up to 36° in the external rotation. The sagittal stem alignment and the stem torsion have a relevant influence on the impingement-free ROM. To clarify the causes of an impingement or accompanying problems, both parameters should be examined and, if possible, a combined assessment of these factors should be made.

Fort Cobb Reservoir Watershed, Oklahoma and Thika River Watershed, Kenya Twinning Pilot Project

NASA Astrophysics Data System (ADS)

Moriasi, D.; Steiner, J.; Arnold, J.; Allen, P.; Dunbar, J.; Shisanya, C.; Gathenya, J.; Nyaoro, J.; Sang, J.

2007-12-01

The Fort Cobb Reservoir Watershed (FCRW) (830 km2) is a watershed within the HELP Washita Basin, located in Caddo and Washita Counties, OK. It is also a benchmark watershed under USDA's Conservation Effects Assessment Project, a national project to quantify environmental effects of USDA and other conservation programs. Population in south-western Oklahoma, in which FCRW is located, is sparse and decreasing. Agricultural focuses on commodity production (beef, wheat, and row crops) with high costs and low margins. Surface and groundwater resources supply public, domestic, and irrigation water. Fort Cobb Reservoir and contributing stream segments are listed on the Oklahoma 303(d) list as not meeting water quality standards based on sedimentation, trophic level of the lake associated with phosphorus loads, and nitrogen in some stream segments in some seasons. Preliminary results from a rapid geomorphic assessment results indicated that unstable stream channels dominate the stream networks and make a significant but unknown contribution to suspended-sediment loadings. Impairment of the lake for municipal water supply, recreation, and fish and wildlife are important factors in local economies. The Thika River Watershed (TRW) (867 km2) is located in central Kenya. Population in TRW is high and increasing, which has led to a poor land-population ratio with population densities ranging from 250 people/km2 to over 500 people/km2. The poor land-population ratio has resulted in land sub-division, fragmentation, over- cultivation, overgrazing, and deforestation which have serious implications on soil erosion, which poses a threat to both agricultural production and downstream reservoirs. Agricultural focuses mainly on subsistence and some cash crops (dairy cattle, corn, beans, coffee, floriculture and pineapple) farming. Surface and groundwater resources supply domestic, public, and hydroelectric power generation water. Thika River supplies 80% of the water for the city of

Brain structure in sagittal craniosynostosis

NASA Astrophysics Data System (ADS)

Paniagua, Beatriz; Kim, Sunghyung; Moustapha, Mahmoud; Styner, Martin; Cody-Hazlett, Heather; Gimple-Smith, Rachel; Rumple, Ashley; Piven, Joseph; Gilmore, John; Skolnick, Gary; Patel, Kamlesh

2017-03-01

Craniosynostosis, the premature fusion of one or more cranial sutures, leads to grossly abnormal head shapes and pressure elevations within the brain caused by these deformities. To date, accepted treatments for craniosynostosis involve improving surgical skull shape aesthetics. However, the relationship between improved head shape and brain structure after surgery has not been yet established. Typically, clinical standard care involves the collection of diagnostic medical computed tomography (CT) imaging to evaluate the fused sutures and plan the surgical treatment. CT is known to provide very good reconstructions of the hard tissues in the skull but it fails to acquire good soft brain tissue contrast. This study intends to use magnetic resonance imaging to evaluate brain structure in a small dataset of sagittal craniosynostosis patients and thus quantify the effects of surgical intervention in overall brain structure. Very importantly, these effects are to be contrasted with normative shape, volume and brain structure databases. The work presented here wants to address gaps in clinical knowledge in craniosynostosis focusing on understanding the changes in brain volume and shape secondary to surgery, and compare those with normally developing children. This initial pilot study has the potential to add significant quality to the surgical care of a vulnerable patient population in whom we currently have limited understanding of brain developmental outcomes.

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.

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.

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.

Anterior cervical corpectomy for cervical spondylotic myelopathy: Reconstruction with expandable cylindrical cage versus iliac crest autograft. A retrospective study.

PubMed

Perrini, Paolo; Gambacciani, Carlo; Martini, Carlotta; Montemurro, Nicola; Lepori, Paolo

2015-12-01

To compare retrospectively the clinical and radiographic outcomes between cervical reconstruction with expandable cylindrical cage (ECC) and iliac crest autograft after one- or two-level anterior cervical corpectomy for spondylotic myelopathy. Forty-two patients underwent cervical reconstruction with either iliac crest autograft and plating (20 patients) or ECC and plating (22 patients). The average clinical and radiological follow-up period was 77.54 ± 44.28 months (range 14-155 months). The authors compared clinical parameters (Nurick Myelopathy Grade, modified Japanese Orthopedic Association (mJOA) scores), perioperative parameters (hospital stays, complications) and radiological parameters (Cobb's angles of the fused segments and C2-C7 segments, cervical subsidence, fusion rate). Fusion was assessed on flexion-extension X-ray films. No significant differences between the two groups were found in demographics, neurological presentation, preoperative sagittal alignment, clinical improvement and length of hospitalization. Patients of the autograft group experienced more postoperative complications, although the difference between the two treatment groups was not statistically significant (15 versus 4.5%, p=0.232). The fusion rate was 100% in both groups. The average lordotic increase of the segmental angle was significantly greater in the ECC group (p<0.05). Other radiological parameters were not significantly different in the two groups. Cervical reconstruction either with iliac crest autograft and plating or ECC and plating provides good clinical results and similar fusion rates after one- or two-level corpectomy for spondylotic myelopathy. However, the use of ECC obviates donor site complications and provides a more significant increase of lordosis in segmental angle. Copyright © 2015 Elsevier B.V. All rights reserved.

The wits appraisal using three reference planes and its interaction with the ANB angle among a sub-set of Nigerians".

PubMed

Ifesanya, J U; Adeyemi, A T; Otuyemi, O D

2014-09-01

Conjoint analysis of orthodontic patients using the Subspinale (A-point) Nasion-Supramentale (B point) (ANB) angle and the Wits appraisal is popular in many practices. This study aimed to present reference values for the Wits appraisal among Nigerians using three horizontal reference planes namely the bisected occlusal plane (BOP), the functional occlusal plane (FOP) and the maxillomandibular angle bisector (MM° bisector) plane. It also assessed the relationship of the Wits appraisal with the ANB angle and its interaction with clinical measures of sagittal skeletal relations among subjects with malocclusion. One hundred participants with normal occlusion and 120 with malocclusion were recruited in the study. Cephalometric radiographs were taken for all participants. Each radiograph was manually traced on a 0.003 matted cellulose acetate tracing paper using a sharpened 2H pencil. The Wits appraisal and ANB angle were determined. Data was analyzed using SPSS version 19. The mean age was 20.7 ± 4.9 years for those with normal occlusion and 18.8 ± 6.5 years in the malocclusion group. There were 91 (41.4%) males and 129 (58.6%) females. Mean values for the Wits appraisal using the BOP as reference, was--1.27 ± 2.91mm, with the FOP, it was -3.54 ± 3.24mm, while with the MM° bisector plane, it was--.75? ± .94mm. The ANB angle showed highest correlation with the MM'°bisector plane Wits value(P< 0 .001). CCONCLUSION: hen the clinical and angular cephalometric findings are at variance, the ANB angle is best moderated by the MM'° isector plane Wits appraisal.

Relationship Between the Lateral Center-Edge Angle and 3-Dimensional Acetabular Coverage.

PubMed

Wylie, James D; Kapron, Ashley L; Peters, Christopher L; Aoki, Stephen K; Maak, Travis G

2017-04-01

The lateral center-edge angle (LCEA) is an important measurement in understanding acetabular morphology and has had multiple interpretations. Misunderstanding of the LCEA and its relationship with acetabular 3-dimensional (3D) morphology may result in misdiagnosis and poor outcomes. To determine the discrepancy between bone-edge and sourcil-edge LCEA measurements on anteroposterior (AP) radiographs and to determine the 3D anatomic location of the sourcil-edge and bone-edge LCEA measurements. Cohort study (diagnosis); Level of evidence, 2. The LCEA was measured on radiographs to both the sourcil-edge and bone-edge on AP images of 60 symptomatic hips. On computed tomography (CT), coronal slices producing an LCEA matching the magnitude of each AP LCEA were identified. These coronal slices were mapped to a sagittal image of the acetabulum, which was divided into a standard clockface (3 = anterior, 12 = superior). We identified clockface locations corresponding to the AP sourcil-edge and bone-edge LCEA measurements. Paired t tests identified differences in magnitude and location of the bone and sourcil LCEAs. Limits of agreement were calculated for the differences between measures. Intraclass correlation coefficients (ICCs) assessed inter- and intraobserver repeatability. On the AP radiographs, the bone-edge LCEA was a mean 4.7° (95% CI, -4.0° to 13.3°) greater than the sourcil-edge LCEA ( P < .001). On CT, the sagittal clockface location of the sourcil-edge LCEA was more anterior compared with the sagittal clockface location of the maximum bone-edge LCEA (1:03 ± 0:42 vs 12:06 ± 0:30, respectively; P < .001). In hips with a difference >5° between sourcil-edge and bone-edge measurements, the coronal CT slice corresponding to the sourcil-edge LCEA was significantly more anterior (1:26 ± 0:35) than the CT slice corresponding to the bone-edge LCEA (11:46 ± 0:29; P < .001). This significant difference was similar in location but less pronounced in hips with a

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

Ground-water quality, levels, and flow direction near Fort Cobb Reservoir, Caddo County, Oklahoma, 1998-2000

USGS Publications Warehouse

Becker, Carol J.

2001-01-01

Fort Cobb Reservoir in northwest Caddo County Oklahoma is managed by the Bureau of Reclamation for water supply, recreation, flood control, and wildlife. Excessive amounts of nitrogen in the watershed have the potential to cause long-term eutrophication of the reservoir and increase already elevated concentrations of nitrogen in the Rush Springs aquifer. The U.S. Geological Survey in cooperation with the Bureau of Reclamation studied ground water in the area surrounding a swine feeding operation located less than 2 miles upgradient from Fort Cobb Reservoir in Caddo County, Oklahoma. Objectives of the study were to (1) determine if the operation was contributing nitrogen to the ground water and (2) measure changes in ground-water levels and determine the local ground-water flow direction in the area surrounding the swine feeding operation. Nitrate concentrations (28.1 and 31.5 milligrams per liter) were largest in two ground-water samples from a well upgradient of the wastewater lagoon. Nitrate concentrations ranged from 4.30 to 8.20 milligrams per liter in samples from downgradient wells. Traces of ammonia and nitrite were detected in a downgradient well, but not in upgradient wells. d15N values indicate atmospheric nitrogen, synthetic fertilizer, or plants were the predominate sources of nitrate in ground water from the downgradient wells. The d15N values in these samples are depleted in nitrogen-15, indicating that animal waste was not a significant contributor of nitrate. Manganese concentrations (1,150 and 965 micrograms per liter) in samples from a downgradient well were substantially larger than concentrations in samples from other wells, exceeding the secondary drinking-water standard of 50 micrograms per liter. Larger concentrations of bicarbonate, magnesium, fluoride, and iron and a higher pH were also measured in water from a downgradient well. Ground-water levels in an observation well were higher from April to mid-July and lower during the late summer

Subjective evaluation of treatment outcomes of instrumentation with pedicle screws or hybrid constructs in Lenke Type 1 and 2 adolescent idiopathic scoliosis: what happens when judges are blinded to the instrumentation?

PubMed Central

Ouellet, Jean Albert; Shilt, Jeffrey; Shen, Francis H.; Wood, Kirkham; Chan, Donald; Hicks, John; Bersusky, Ernesto; Reddi, Vasantha

2009-01-01

Superiority of pedicle screws over hybrid/hook instrumentation or vice versa in the treatment of Lenke Type 1 and 2 adolescent idiopathic scoliosis (AIS) remains unresolved for moderate curves. Our objective was therefore to compare the assessment of pedicle screw and hybrid/hooks instrumentation with special attention to cosmesis and uninstrumented spine using novel assessment methods. We carried out a retrospective study of radiographs and clinical photos of 40 cases of thoracic AIS between 40° and 70° of Cobb angle Lenke Type 1 and 2, treated with either pedicle screws or hybrid/hooks. The cases were subjectively assessed by four spine surgeons (SRS Travelling Fellows) for radiographic and operative cosmetic result, shoulder balance, trunk shift, rib hump, and waist asymmetry. Instrumentation in the radiographs was obscured with only the non-instrumented part visible, and the surgeons were asked to guess the instrumentation being used. Eighty photographs of patients before and after surgery were assessed for cosmesis by ten non-medical judges for overall cosmetic score, shoulder balance, waist asymmetry, and shoulder blade prominence. Objective assessment of radiographs and clinical photos was performed for Cobb angle of instrumented and non-instrumented spine, global coronal and sagittal balance, number of unfused vertebrae, disc angulation, tilt of last instrumented vertebra, shoulder balance, waist asymmetry, rib prominence, and percent correction. SRS-24 questionnaire was used to measure health-related quality of life in patients. Subjective assessments by surgeons and non-medical judges showed no significant difference by instrumentation (P ≥ 0.05) for all variables. Out of the 160 guesses by surgeons of the cases with instrumentation blocked in the radiographs, they were unable to guess the instrumentation in 92% of the cases. Objective assessment of all variables and SRS-24 scores of all five domains showed no significant difference by

[The clinical features and surgical treatment strategies of cervical kyphosis].

PubMed

Fang, Jia-hu; Jia, Lian-shun; Zhou, Xu-hui; Song, Li-jun; Cai, Wei-hua; Li, Xiang

2010-10-15

To analyze the clinical characteristics and the surgical treatment strategy of cervical kyphosis. From March 2006 to October 2009, 31 cases of cervical kyphosis were treated. According to the clinical features and imaging findings, different treatment methods were used. There were 9 patients in operation group, including 4 male and 5 female patients, aged from 17 to 72 years (average age of 35 years). Among them, 5 cases were idiopathic kyphosis and 4 cases were caused by laminectomy or other reasons. There were 22 patients in conservative treatment group, including 11 male and 11 female patients, aged from 14 to 40 years (average age of 29 years), who were all idiopathic cervical kyphosis. Before and 1 week after operation, clinical assessment were taken for the patients in operation group using Spinal Cord Injuries Classification Standard of American Spinal Injury Association (AISA). During the periodic review, the anteroposterior, normal sagittal films of cervical spine were taken. At 1 week and every 6 months after operation, MRI films were also taken. These films were studied to evaluate the effects of the operations. In the conservative group, assessment of treatment results by studying anteroposterior and normal lateral views of cervical spine were were taken every month. The clinical characteristics and the surgical treatment strategies of these patients were analyzed. In operation group, 9 cases were followed up for 6 to 18 months, all patients did not failed in internal fixation and fusion. AISA neurological score and neurological function significantly improved. Three days after operation the average Cobb angle was -1.29 ° (preoperative 54.24 °). In conservative group, the average Cobb angle was -5.41 ° (before treatment 11.20 °) 4 months after the treatment. The symptoms of neck shoulder and back pain disappeared, and all patients were followed up for 3 to 24 months, with no recurrence of symptoms. In the early period of cervical kyphosis, adopt

3D correction of AIS in braces designed using CAD/CAM and FEM: a randomized controlled trial.

PubMed

Cobetto, Nikita; Aubin, Carl-Éric; Parent, Stefan; Barchi, Soraya; Turgeon, Isabelle; Labelle, Hubert

2017-01-01

Recent studies showed that finite element model (FEM) combined to CAD/CAM improves the design of braces for the conservative treatment of adolescent idiopathic scoliosis (AIS), using 2D measurements from in-brace radiographs. We aim to assess the immediate effectiveness on curve correction in all three planes of braces designed using CAD/CAM and numerical simulation compared to braces designed with CAD/CAM only. SRS standardized criteria for bracing were followed to recruit 48 AIS patients who were randomized into two groups. For both groups, 3D reconstructions of the spine and patient's torso, respectively built from bi-planar radiographs and surface topography, were obtained and braces were designed using the CAD/CAM approach. For the test group, 3D reconstructions of the spine and patient's torso were additionally used to generate a personalized FEM to simulate and iteratively improve the brace design with the objective of curve correction maximization in three planes and brace material minimization. For the control group (CtrlBraces), average Cobb angle prior to bracing was 29° (thoracic, T) and 25° (lumbar, L) with the planes of maximal curvature (PMC) respectively oriented at 63° and 57° on average with respect to the sagittal plane. Average apical axial rotation prior to bracing was 7° (T) and 9° (L). For the test group (FEMBraces), initial Cobb angles were 33° (T) and 28° (L) with the PMC at 68° (T) and 56° (L) and average apical axial rotation prior to bracing at 9° (T and L). On average, FEMBraces were 50% thinner and had 20% less covering surface than CtrlBraces while reducing T and L curves by 47 and 48%, respectively, compared to 25 and 26% for CtrlBraces. FEMBraces corrected apical axial rotation by 46% compared to 30% for CtrlBraces. The combination of numerical simulation and CAD/CAM approach allowed designing more efficient braces in all three planes, with the advantages of being lighter than standard CAD/CAM braces. Bracing in AIS may

Three-dimensional sampling perfection with application-optimised contrasts using a different flip angle evolutions sequence for routine imaging of the spine: preliminary experience

PubMed Central

Tins, B; Cassar-Pullicino, V; Haddaway, M; Nachtrab, U

2012-01-01

Objectives The bulk of spinal imaging is still performed with conventional two-dimensional sequences. This study assesses the suitability of three-dimensional sampling perfection with application-optimised contrasts using a different flip angle evolutions (SPACE) sequence for routine spinal imaging. Methods 62 MRI examinations of the spine were evaluated by 2 examiners in consensus for the depiction of anatomy and presence of artefact. We noted pathologies that might be missed using the SPACE sequence only or the SPACE and a sagittal T1 weighted sequence. The reference standards were sagittal and axial T1 weighted and T2 weighted sequences. At a later date the evaluation was repeated by one of the original examiners and an additional examiner. Results There was good agreement of the single evaluations and consensus evaluation for the conventional sequences: κ>0.8, confidence interval (CI)>0.6–1.0. For the SPACE sequence, depiction of anatomy was very good for 84% of cases, with high interobserver agreement, but there was poor interobserver agreement for other cases. For artefact assessment of SPACE, κ=0.92, CI=0.92–1.0. The SPACE sequence was superior to conventional sequences for depiction of anatomy and artefact resistance. The SPACE sequence occasionally missed bone marrow oedema. In conjunction with sagittal T1 weighted sequences, no abnormality was missed. The isotropic SPACE sequence was superior to conventional sequences in imaging difficult anatomy such as in scoliosis and spondylolysis. Conclusion The SPACE sequence allows excellent assessment of anatomy owing to high spatial resolution and resistance to artefact. The sensitivity for bone marrow abnormalities is limited. PMID:22374284

[Application of temporomandibular joint dics reduction in the operation of condylar sagittal fracture].

PubMed

Wenli, Zeng; Wuchao, Zhou; Jingkun, Zhang; Yisen, Shao; Weihong, Xi

2017-10-01

To explore the selection of temporomandibular joint (TMJ) disc reduction and fixation methods in condylar sagittal fracture surgery. A total of 36 patients with condylar fractures were chosen. The follow-up period was more 6 months. All 36 cases of condylar sagittal fracture were fixed with long screw. In the operation, the displaced joint disc was repositioned and fixed. The fixed method included direct suture (22 cases) and anchorage (14 cases). Clinical followups were performed before surgery and 1 month, 3 months, 6 months and 1 year after surgery. Clinicians recorded data related to the Fricton craniomandibular index (CMI) and evaluated the postoperative joint function during followup before surgery and 6 months after surgery. In both groups, function of TMJ significantly improved after surgery. The CMI decreased from 0.213±0.162 and 0.273±0.154 to 0.059±0.072 and 0.064±0.068 (P<0.05), respectively. No statistical difference was observed between the two groups in palpation index (PI), dysfunction index (DI) and CMI (P>0.05) before or after surgery. Both methods could effectively improve the dysfunction of the TMJ caused by trauma. The selection of joint disc reduction and fixation methods is based on the displacement and damage degree of the joint disc.

Radiographic analysis of the correlation between ossification of the nuchal ligament and sagittal alignment and segmental stability of the cervical spine in patients with cervical spondylotic myelopathy.

PubMed

Ying, Jinwei; Teng, Honglin; Qian, Yunfan; Hu, Yingying; Wen, Tianyong; Ruan, Dike; Zhu, Minyu

2018-01-01

Background Ossification of the nuchal ligament (ONL) caused by chronic injury to the nuchal ligament (NL) is very common in instability-related cervical disorders. Purpose To determine possible correlations between ONL, sagittal alignment, and segmental stability of the cervical spine. Material and Methods Seventy-three patients with cervical spondylotic myelopathy (CSM) and ONL (ONL group) and 118 patients with CSM only (control group) were recruited. Radiographic data included the characteristics of ONL, sagittal alignment and segmental stability, and ossification of the posterior longitudinal ligament (OPLL). We performed comparisons in terms of radiographic parameters between the ONL and control groups. The correlations between ONL size, cervical sagittal alignment, and segmental stability were analyzed. Multivariate logistic regression was used to identify the independent risk factors of the development of ONL. Results C2-C7 sagittal vertical axis (SVA), T1 slope (T1S), T1S minus cervical lordosis (T1S-CL) on the lateral plain, angular displacement (AD), and horizontal displacement (HD) on the dynamic radiograph increased significantly in the ONL group compared with the control group. The size of ONL significantly correlated with C2-C7 SVA, T1S, AD, and HD. The incidence of ONL was higher in patients with OPLL and segmental instability. Cervical instability, sagittal malalignment, and OPLL were independent predictors of the development of ONL through multivariate analysis. Conclusion Patients with ONL are more likely to have abnormal sagittal alignment and instability of the cervical spine. Thus, increased awareness and appreciation of this often-overlooked radiographic finding is warranted during diagnosis and treatment of instability-related cervical pathologies and injuries.

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.

Lower extremity sagittal joint moment production during split-belt treadmill walking

PubMed Central

Roemmich, Ryan T.; Stegemöller, Elizabeth L.; Hass, Chris J.

2012-01-01

The split-belt treadmill (SBT) has recently been used to rehabilitate locomotor asymmetries in clinical populations. However, the joint mechanics produced while walking on a SBT are not well-understood. The purpose of this study was to investigate the lower extremity sagittal joint moments produced by each limb during SBT walking and provide insight as to how these joint moment patterns may be useful in rehabilitating unilateral gait deficits. Thirteen healthy young volunteers walked on the SBT with the belts tied and in a “SPLIT” session in which one belt moved twice as fast as the other. Sagittal lower extremity joint moment and ground reaction force impulses were then calculated over the braking and propulsive phases of the gait cycle. Paired t-tests were performed to analyze magnitude differences between conditions (i.e. the fast and slow limbs during SPLIT vs. the same limb during tied-belt walking) and between the fast and slow limbs during SPLIT. During the SPLIT session, the fast limb produced higher ground reaction force and ankle moment impulses during the propulsive and braking phases, and lower knee moment impulses during the propulsive phase when compared to the slow limb. The knee moment impulse was also significantly higher during braking in the slow limb than in the fast limb. The mechanics of each limb during the SPLIT session also differed from the mechanics observed when the belt speeds were tied. Based on these findings, we suggest that each belt may have intrinsic value in rehabilitating specific unilateral locomotor deficits. PMID:22985473

Leg stiffness, valgus knee motion, and Q-angle are associated with hypertrophic soft patella tendon and idiopathic knee pain in adolescent basketball players.

PubMed

Satkunskiene, Danguole; Mickevicius, Mantas; Snieckus, Audrius; Kamandulis, Sigitas

2017-01-01

Knee pain without knee degenerative symptoms is a common phenomenon among young basketball players. The aim of this study was to identify factors predisposing young basketball players to suffer from knee pain. The study involved 20 male adolescent (14-15 years) basketball players who were divided into two equal groups based on knee pain symptoms. Legs torque was tested on an isokinetic dynamometer. The length, elongation and the cross-sectional area (CSA) of the patellar tendon were measured with ultrasonography. Quadriceps angle (Q-angle), knee valgus motion, and joint angular displacement in the sagittal plane were analyzed using video recording during countermovement jump. Ground reaction force was measured using a force platform. Knee pain (KP) participants had a significantly lower Q-angle (P=0.045) and lower maximum varus knee angle (P=0.035), and a greater knee inside displacement (P=0.039) during squat phase. In the KP group, the CSA at the top of the tendon was significantly greater than in the middle (P=0.006) and at the bottom (P=0.039). Absolute tendon stiffness (P=0.013) and Young's modulus (P=0.034) were significantly lower in the KP group compared with controls. Leg stiffness during landing was significantly greater in the control group (P=0.015). Leg stiffness, valgus knee motion, and Q-angle are associated with hypertrophic soft patella tendon and idiopathic knee pain in adolescent basketball players.

Stabilization with the Dynamic Cervical Implant: a novel treatment approach following cervical discectomy and decompression.

PubMed

Matgé, Guy; Berthold, Christophe; Gunness, Vimal Raj Nitish; Hana, Ardian; Hertel, Frank

2015-03-01

Although cervical total disc replacement (TDR) has shown equivalence or superiority to anterior cervical discectomy and fusion (ACDF), potential problems include nonphysiological motion (hypermobility), accelerated degeneration of the facet joints, particulate wear, and compromise of the mechanical integrity of the endplate during device fixation. Dynamic cervical stabilization is a novel motion-preserving concept that facilitates controlled, limited flexion and extension, but prevents axial rotation and lateral bending, thereby reducing motion across the facet joints. Shock absorption of the Dynamic Cervical Implant (DCI) device is intended to protect adjacent levels from accelerated degeneration. The authors conducted a prospective evaluation of 53 consecutive patients who underwent DCI stabilization for the treatment of 1-level (n = 42), 2-level (n = 9), and 3-level (n = 2) cervical disc disease with radiculopathy or myelopathy. Forty-seven patients (89%) completed all clinical and radiographic outcomes at a minimum of 24 months. Clinical outcomes consisted of Neck Disability Index (NDI) and visual analog scale (VAS) scores, neurological function at baseline and at latest follow-up, as well as patient satisfaction. Flexion-extension radiography was evaluated for device motion, implant migration, subsidence, and heterotopic ossification. Cervical sagittal alignment (Cobb angle), functional spinal unit (FSU) angle, and range of motion (ROM) at index and adjacent levels were evaluated with WEB 1000 software. The NDI score, VAS neck and arm pain scores, and neurological deficits were significantly reduced at each postoperative time point compared with baseline (p < 0.0001). At 24 months postoperatively, 91% of patients were very satisfied and 9% somewhat satisfied, while 89% would definitely and 11% would probably elect to have the same surgery again. In 47 patients with 58 operated levels, the radiographic assessment showed good motion (5°-12°) of the device in

Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance.

PubMed

Yang, Benson P; Ondra, Stephen L; Chen, Larry A; Jung, Hee Soo; Koski, Tyler R; Salehi, Sean A

2006-07-01

The authors conducted a study to evaluate the radiographically documented and functional outcomes obtained in patients who underwent pedicle subtraction osteotomy (PSO). They also compared outcomes after classification of cases into thoracic and lumbar PSO subgroups. The authors analyzed data obtained in 35 consecutive PSO-treated patients with sagittal imbalance. One surgeon performed all surgeries. The minimal follow-up period was 2 years. Events during the perioperative course and complications were noted. Standing long-film radiographs of the spine were obtained and measurements were made preoperatively, immediately postoperatively, and at most recent follow-up examination. The modified Prolo Scale and the 22-item Scoliosis Research Society (SRS-22) Outcomes Questionnaire were administered. Early complications after PSO included neurological injury, wound-related problems, and nosocomial infections. Late complications were limited to pseudarthrosis and attendant instrumentation failure. Early and late complication rates ranged from 10 to 30% for both thoracic and lumbar PSO cohorts. Lumbar PSO was associated with improvements in local, segmental, and global measures of sagittal balance, whereas thoracic PSO was only associated with local improvement. Most patients rated their functional status as fair to good according to the modified Prolo Scale and reported, according to the SRS-22 Outcomes Questionnaire, that they were satisfied with the overall treatment of their back condition. The ability to perform a PSO at both lumbar and thoracic levels is a powerful asset for the spine surgeon treating spinal deformity. In the present study radiographic and clinical outcomes were superior when PSO was used to treat lumbar deformity rather than thoracic deformity because of several anatomical and technical obstacles that hindered the thoracic procedure. Nevertheless, the thoracic PSO proved a useful addition with which to produce regional improvement in sagittal

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.

Skull fracture with effacement of the superior sagittal sinus following drone impact: a case report.

PubMed

Chung, Lawrance K; Cheung, Yuri; Lagman, Carlito; Au Yong, Nicholas; McBride, Duncan Q; Yang, Isaac

2017-09-01

The popularity of unmanned aerial vehicles, or drones, raises safety concerns as they become increasingly common for commercial, personal, and recreational use. Collisions between drones and people may result in serious injuries. A 13-year-old male presented with a comminuted depressed skull fracture causing effacement of the superior sagittal sinus secondary to a racing drone impact. The patient experienced a brief loss of consciousness and reported lower extremity numbness and weakness after the accident. Imaging studies revealed bone fragments crossing the superior sagittal sinus with a short, focal segment of blood flow interruption. Neurosurgical intervention was deferred given the patient's improving neurological deficits, and the patient was treated conservatively. He was discharged home in stable condition. Drones may represent a hazard when operated inappropriately due to their capacity to fly at high speeds and altitudes. Impacts from drones can carry enough force to cause skull fractures and significant head injuries. The rising popularity of drones likely translates to an increased incidence of drone-related injuries. Thus, clinicians should be aware of this growing trend.

Clinical outcomes, radiologic kinematics, and effects on sagittal balance of the 6 df LP-ESP lumbar disc prosthesis.

PubMed

Lazennec, Jean-Yves; Even, Julien; Skalli, Wafa; Rakover, Jean-Patrick; Brusson, Adrien; Rousseau, Marc-Antoine

2014-09-01

Surgical treatment of degenerative disc disease remains a controversial subject. Lumbar fusion has been associated with a potential risk of segmental junctional disease and sagittal balance misalignment. Motion preservation devices have been developed as an alternative to fusion. The LP-ESP disc is a one-piece deformable device achieving 6 df, including shock absorption and elastic return. This is the first clinical report on its use. To assess clinical outcomes and radiologic kinematics in the first 2 years after implantation. Prospective cohort of patients with LP-ESP total disc replacement (TDR) at the lumbar spine. Forty-six consecutive patients. Clinical outcomes were the visual analog scale (VAS) for pain, the Oswestry disability index (ODI), and the GHQ28 (General Health Questionnaire) psychological score. Radiologic data were the range of motion (ROM), sagittal balance parameters, and mean center of rotation (MCR). Patients had single-level TDR at L4-L5 or L5-S1. Outcomes were prospectively recorded for 2 years (before and at 3, 6, 12, and 24 months after surgery). The SpineView software was used for computed analysis of the radiographic data. Paired t tests were used for statistical comparisons. No intraoperative complication occurred. All clinical scores improved significantly at 24 months: the back pain VAS scores by a mean of 4.1 points and the ODI by 33 points. The average ROM of the instrumented level was 5.4°±4.8° at 2 years and more than 2° for 76% of prostheses. The MCR was in a physiological area in 73% of cases. The sagittal balance (pelvic tilt, sacral slope, and segmental lordosis) did not change significantly at any point of the follow-up. Results from the 2-year follow-up indicate that LP-ESP prosthesis recreates lumbar spine function similar to that of the healthy disc in terms of ROM, quality of movement, effect on sagittal balance, and absence of modification in the kinematics of the upper adjacent level. Copyright © 2014 Elsevier Inc

[VALUE OF SMART PHONE Scoliometer SOFTWARE IN OBTAINING OPTIMAL LUMBAR LORDOSIS DURING L4-S1 FUSION SURGERY].

PubMed

Yu, Weibo; Liang, De; Ye, Linqiang; Jiang, Xiaobing; Yao, Zhensong; Tang, Jingjing; Tang, Yongchao

2015-10-01

To investigate the value of smart phone Scoliometer software in obtaining optimal lumbar lordosis (LL) during L4-S1 fusion surgery. Between November 2014 and February 2015, 20 patients scheduled for L4-S1 fusion surgery were prospectively enrolled the study. There were 8 males and 12 females, aged 41-65 years (mean, 52.3 years). The disease duration ranged from 6 months to 6 years (mean, 3.4 years). Before operation, the pelvic incidence (PI) and Cobb angle of L4-S1 (CobbL4-S1) were measured on lateral X-ray film of lumbosacral spine by PACS system; and the ideal CobbL4-S1 was then calculated according to previously published methods [(PI+9 degrees) x 70%]. Subsequently, intraoperative CobbL4-S1 was monitored by the Scoliometer software and was defined as optimal while it was less than 5 degrees difference compared with ideal CobbL4-S1. Finally, the CobbL4-S1 was measured by the PACS system after operation and the consistency was compared between Scoliometer software and PACS system to evaluate the accuracy of this software. In addition, value of this method in obtaining optimal LL was validated by comparing the difference between ideal CobbL4-S1 and preoperative one with that between ideal CobbL4-S1 and postoperative one. The CobbL4-S1 was (36.17 ± 1.53)degrees for ideal one, (22.57 ± 5.50)degrees for preoperative one, (32.25 ± 1.46)degrees for intraoperative one measured by Scoliometer software, and (34.43 ± 1.72)degrees for postoperative one, respectively. The observed intraclass correlation coefficient (ICC) was excellent [ICC = 0.96, 95% confidence interval (0.93, 0.97)] and the mean absolute difference (MAD) was low (MAD = 1.23) between Scoliometer software and PACS system. The deviation between ideal CobbL4-S1 and postoperative CobbL4-S1 was (2.31 ± 0.23)degrees, which was significantly lower than the deviation between ideal CobbL4-S1 and preoperative CobbL4-S1 (13.60 ± 1.85)degrees (t = 6.065, P = 0.001). Scoliometer software can help surgeon obtain

A DYNAMIC VALGUS INDEX THAT COMBINES HIP AND KNEE ANGLES: ASSESSMENT OF UTILITY IN FEMALES WITH PATELLOFEMORAL PAIN.

PubMed

Scholtes, Sara A; Salsich, Gretchen B

2017-06-01

Two=dimensional motion analysis of lower=extremity movement typically focuses on the knee frontal plane projection angle, which considers the position of the femur and the tibia. A measure that includes the pelvis may provide a more comprehensive and accurate indicator of lower=extremity movement. Hypothesis/Purpose: The purpose of the study was to describe the utility of a two=dimensional dynamic valgus index (DVI) in females with patellofemoral pain. The hypothesis was that the DVI would be more reliable and valid than the knee frontal plane projection angle, be greater in females with patellofemoral pain during a single=limb squat than in females without patellofemoral pain, and decrease in females with patellofemoral pain following instruction. Study Design: Controlled Laboratory Study. Data were captured while participants performed single limb squats under two conditions: usual and corrected. Two=dimensional hip and knee angles and a DVI that combined the hip and knee angles were calculated. Three=dimensional sagittal, frontal, and transverse plane angles of the hip and knee and a DVI combining the frontal and transverse plane angles were calculated. The two=dimensional DVI demonstrated moderate reliability (ICC=0.74). The correlation between the two=dimensional and three=dimensional DVI's was 0.635 (p<0001). Females with patellofemoral pain demonstrated a greater two=dimensional DVI (31.14 °±13.36 °) than females without patellofemoral pain (18.30 °±14.97 °; p=0.010). Females with patellofemoral pain demonstrated a decreased DVI in the corrected (19.04 °±13.70 °) versus usual (31.14 °±13.36 °) condition (p=0.001). The DVI is a reliable and valid measure that may provide a more comprehensive assessment of lower=extremity movement patterns than the knee frontal plane projection angle in individuals with lower=extremity musculoskeletal pain problems. 2b.

The Significance of the Angle between Superior Mesenteric Artery and Aorta in Spontaneous Isolated Superior Mesenteric Artery Dissection.

PubMed

Wu, Zhongyin; Yi, Jie; Xu, Huanming; Guo, Wei; Wang, Lijun; Chen, Duanduan; Xiong, Jiang

2017-11-01

The aim of this study is to assess the significance of the angle between superior mesenteric artery (SMA) and distal aorta in spontaneous isolated superior mesenteric artery dissection (SISMAD) by clinical and biomechanical analyses. Thirty-seven patients with SISMAD (1 asymptomatic) and 148 controls (1:4 matched for age [mean 50.2 years], gender [92% male], and body mass index, and being ruled out for arterial disease) underwent aortic computed tomography angiography. SMA-distal aorta angle, measured on sagittal plane, was compared along with baseline characteristics (body mass index, smoking history, and comorbidities) between groups, and assessed as tool to evaluate SISMAD risk after stratification into 4 angle-interval categories. Flow analysis and fluid-structure interaction study were conducted based on patient-specific models with ultrasound-measured boundary conditions to further reveal the flow pattern and loading distribution in the 4 angle-interval categories. SISMAD patients versus controls had larger mean SMA-distal aorta angle (73 ± 19.8° vs. 50 ± 18.81°, P < 0.001), and more frequently smoking history (62% vs. 40%, P = 0.02) and hypertension (59% vs. 34%, P < 0.001), all multivariate predictors of no SISMAD (odds ratio 0.946 [95% confidence interval 0.927-0.966]; 0.415 [0.198-0.87]; and 0.252 [0.117-0.544], respectively). Odds ratio for SISMAD increased with increasing SMA-distal aorta angle (1, 10, 57, and 73 for <50°, 50-69°, 70-90°, and >90°, respectively; P < 0.05 for >70°). In silico study confirmed that larger angle is associated with higher stress in the arterial wall and higher oscillatory shear index in the vessel lumen at the SMA superior convex, where dissection commonly occurs. Besides smoking history and hypertension, SISMAD was positively associated with a morphological parameter, the SMA-distal aorta angle. This might be due to the greater wall stress and oscillatory stress index in the arterial convex with a

Utilization of ring-shaped bone allograft for surgical treatment of adolescent post-tubercular kyphosis: A retrospective study.

PubMed

Yin, Xiang; Liu, Peng; Liu, Yao-Yao; Fan, Wei-Li; Liu, Bai-Yi; Zhao, Jian-Hua

2017-06-01

This study aimed to investigate the mid-term outcome of ring-shaped bone allografts in the surgical treatment of adolescent post-tubercular kyphosis secondary to spinal tuberculosis.The records of adolescent patients diagnosed with spinal tuberculosis who received treatment in our department between 2009 and 2013 were retrospectively reviewed. The anterior approach was used in cases of cervical kyphosis and the posterior approach was used in cases of thoracic and lumbar kyphosis. During the surgery, the ring-shaped bone was used as a structural bone graft associated with the cancellous bone filing in the center portion of the ring shape. Cobb's angle, signs of spinal infusion on computed tomography, and complications were followed up.A total of 25 patients were included in our study. Among them, 3 involved the cervical region, 5 involved the thoracic region, 8 involved the thoracolumbar region, and 9 involved the lumbar region. The preoperative kyphosis deformity was a mean 65° Cobb's angle (40°-97°) compared to the postoperative 14° Cobb's angle (10°-21°) for an average correction of 51°. All wounds healed well without graft rejection. All patients achieved bone fusion 3 months postoperative for a 100% fusion rate.Our results show that the ring-shaped allograft bone is an effective option for the treatment of adolescent kyphosis. The ring-shaped allograft bone demonstrated satisfactory mechanical strength and vertebral fusion without mid-term metallic toxicity.

Utilization of ring-shaped bone allograft for surgical treatment of adolescent post-tubercular kyphosis

PubMed Central

Yin, Xiang; Liu, Peng; Liu, Yao-yao; Fan, Wei-Li; Liu, Bai-yi; Zhao, Jian-Hua

2017-01-01

Abstract This study aimed to investigate the mid-term outcome of ring-shaped bone allografts in the surgical treatment of adolescent post-tubercular kyphosis secondary to spinal tuberculosis. The records of adolescent patients diagnosed with spinal tuberculosis who received treatment in our department between 2009 and 2013 were retrospectively reviewed. The anterior approach was used in cases of cervical kyphosis and the posterior approach was used in cases of thoracic and lumbar kyphosis. During the surgery, the ring-shaped bone was used as a structural bone graft associated with the cancellous bone filing in the center portion of the ring shape. Cobb's angle, signs of spinal infusion on computed tomography, and complications were followed up. A total of 25 patients were included in our study. Among them, 3 involved the cervical region, 5 involved the thoracic region, 8 involved the thoracolumbar region, and 9 involved the lumbar region. The preoperative kyphosis deformity was a mean 65° Cobb's angle (40°–97°) compared to the postoperative 14° Cobb's angle (10°–21°) for an average correction of 51°. All wounds healed well without graft rejection. All patients achieved bone fusion 3 months postoperative for a 100% fusion rate. Our results show that the ring-shaped allograft bone is an effective option for the treatment of adolescent kyphosis. The ring-shaped allograft bone demonstrated satisfactory mechanical strength and vertebral fusion without mid-term metallic toxicity. PMID:28614236

Effect of a Traditional Chinese Medicine combined therapy on adolescent idiopathic scoliosis: a randomized controlled trial.

PubMed

Wei, Hui; Xu, Jinyuan; Jiang, Zhong; Ye, Shuliang; Song, Hongquan; Ning, Xitao; Huang, Huanmin; Chen, Wei; Pei, Jianwei; Jiang, Nengyi; Chen, Shao; Du, Honggen

2015-10-01

To evaluate the effectiveness of a combined Traditional Chinese Medicine (TCM) therapy versus conventional treatment on adolescent idiopathic scoliosis. One hundred twenty outpatients with mild and moderate adolescent idiopathic scoliosis were randomly divided into a TCM group (TCMG) and a brace group (CG). TCMG patients underwent Daoyin, Tuina, and acupotomology therapies. CG patients were treated with a Milwaukee brace. Each patient's Cobb angle was measured after 12 and 24 months of treatment, and pulmonary function was determined after 12 months of treatment. Average electromyogram (AEMG) ratio of the surface electromyogram was measured after 6 and 12 months of treatment and followed-up after 18 and 24 months. The Cobb angle significantly decreased in both groups after 12 months of treatment compared with before treatment (P< 0.05). The percentages of original Cobb angle in TCMG and CG were 51.4% and 47.8% (P > 0.05) after 12 months and 62.5% and 34.7% (P < 0.05) after 24 months, respectively. Pulmonary function significantly improved after 12 months in TCMG (P < 0.05) but significantly decreased in CG (P < 0.05). The AEMG ratio was significantly lower (P < 0.01) and tended to remain at 1 after stopping treatment in TCMG, but increased in CG (P < 0.05). TCM combined therapy can prevent the progression of scoliosis. The AEMG ratio is a promising index that could replace radiography in the evaluation of treatment effect and progression in scoliosis.

Hard and Soft Tissue Changes Following Maxillary Distraction Osteogenesis and Mandibular Setback with Bilateral Sagittal Split Osteotomy.

PubMed

Bawane, Shilpa S; Andrade, Neelam N

2016-12-01

(1) To highlight the role of intraoral submerged device in distraction osteogenesis (DO) of patients requiring two jaw surgeries for the correction of severe developmental maxillary hypoplasia (MH) and mandibular prognathism (MP) (2) To analyse the hard and soft tissue changes following maxillary DO and mandibular setback with bilateral sagittal split osteotomy (BSSO) in patients with severe MH and MP requiring two jaw surgeries. During the period Jan 2004 to Dec 2006, five patients with severe developmental MH along with MP were treated. In 1st stage maxillary distraction was done. Distraction started on 6th postoperative day, 1 mm distraction was carried out for 10-15 days on either side. Serial radiographs were taken immediate postoperative period for baseline comparison, post-distraction and at the end of distraction. After a period of 3-4 months of distraction 2nd stage was done. In 2nd stage, mandibular setback was done with BSSO and distractors were removed under general anesthesia. Radiographs were taken immediately and at 4 months post-operatively. Cephalometric tracings were carried out preoperatively, post DO and finally after mandibular setback with BSSO. The mean horizontal movement of maxilla was 11.4 mm at ANS and 9.6 mm at A point. Upper incisor edge was advanced by 8.8 mms. SNA increased by 8.4° and SNB decreased by 4.6°. Nasal projection advanced by 4°. Nasolabial angle normalized in all patients, mean change achieved was 10.8°. Upper lip moved forward by 5.4 mm. Lower lip moved backward by 5.4 mm. Mandible positioned backward by 4 mm at B point. No vertical change occurred in the position of A, ANS and upper incisor edges. Mean increase in skeletal angle of convexity was 26.4°. Concave profile was significantly changed to convex in all patients. Maxillary DO and mandibular setback with BSSO was associated with improved facial balance and esthetics.

[Evaluation of three methods for constructing craniofacial mid-sagittal plane based on the cone beam computed tomography].

PubMed

Wang, S W; Li, M; Yang, H F; Zhao, Y J; Wang, Y; Liu, Y

2016-04-18

To compare the accuracyof interactive closet point (ICP) algorithm, Procrustes analysis (PA) algorithm,and a landmark-independent method to construct the mid-sagittal plane (MSP) of the cone beam computed tomography.To provide theoretical basis for establishing coordinate systemof CBCT images and symmetric analysis. Ten patients were selected and scanned by CBCT before orthodontic treatment.The scan data was imported into Mimics 10.0 to reconstructthree dimensional skulls.And the MSP of each skull was generated by ICP algorithm, PA algorithm and landmark-independent method. MSP extracted by ICP algorithm or PA algorithm involvedthree steps. First, the 3D skull processing was performed by reverse engineering software geomagic studio 2012 to obtain the mirror skull. Then, the original and its mirror skull was registered separately by ICP algorithm in geomagic studio 2012 and PA algorithm in NX Imageware 11.0. Finally, the registered data were united into new data to calculate the MSP of the originaldata in geomagic studio 2012. The mid-sagittal plane was determined by SELLA (S), nasion (N), basion (Ba) as traditional landmark-dependent methodconducted in software InVivoDental 5.0. The distance from 9 pairs of symmetric anatomical marked points to three sagittal plane were measured and calculated to compare the differences of the absolute value. The one-way ANOVA test was used to analyze the variable differences among the 3 MSPs. The pairwise comparison was performed with LSD method. MSPs calculated by the three methods were available for clinic analysis, which could be concluded from the front view.However, there was significant differences among the distances from the 9 pairs of symmetric anatomical marked points to the MSPs (F=10.932,P=0.001).LSD test showed there was no significant difference between the ICP algorithm and landmark-independent method (P=0.11), while there was significant difference between the PA algorithm and landmark-independent methods (P=0

Skeletal and dental changes in the sagittal, vertical, and transverse dimensions after rapid palatal expansion.

PubMed

Chung, Chun-Hsi; Font, Blanca

2004-11-01

The purpose of this study was to examine the maxillary and mandibular responses to rapid palatal expansion (RPE) in all 3 dimensions. Twenty children (average age, 11.7 years) who required RPE treatment were included in this study. Pre- (T1) and post-RPE (T2) lateral and posteroanterior (PA) cephalograms and study models were taken for all patients. For each patient, lateral and PA cephalograms at T1 and T2 were traced, and the sagittal, vertical, and transverse measurements were made. In addition, on the pre- and postexpansion models, the widths between the first premolars, the first molars, and the two acrylic halves of the Haas-type expander were measured. Results showed that from T1 to T2, the mean SNA increased 0.35 degrees (P < .05) and ANB increased 1.00 degrees (P < .05). Both the ANS and PNS moved downward (1.30 mm and 1.43 mm, respectively, P < .05), and the mandibular plane angle (MP-SN) increased 1.72 degrees (P < .05). The maxillary and mandibular incisors did not change significantly after RPE. After RPE, the mean increase of maxillary interpremolar width, maxillary intermolar width, maxillary width (J-J), nasal width, and interorbital width were found to be 110.7%, 104.5%, 30.1%, 23.1%, and 3.3% of the screw expansion, respectively. After RPE treatment in children, the maxilla displaced slightly forward and downward (P < .05); the mandible rotated downward and backward, and the anterior facial height increased significantly (P < .05); and the widths of the maxilla and nasal cavity increased significantly (P < .05).

The effects of whole-vault cranioplasty versus strip craniectomy on long-term neuropsychological outcomes in sagittal craniosynostosis.

PubMed

Hashim, Peter W; Patel, Anup; Yang, Jenny F; Travieso, Roberto; Terner, Jordan; Losee, Joseph E; Pollack, Ian; Jane, John; Jane, John; Kanev, Paul; Mayes, Linda; Duncan, Charles; Bridgett, David J; Persing, John A

2014-09-01

The optimal type of surgical management for isolated sagittal synostosis remains a source of significant debate. There is a paucity of data regarding possible differences in long-term neuropsychological outcomes following treatment with whole-vault cranioplasty or endoscopic strip craniectomy. This study provides the first comparative analysis examining the effects of the two techniques related to long-term intellectual functioning. A total of 70 patients were enrolled in this multicenter study, 29 of whom had previously undergone endoscopic strip craniectomy and 41 of whom had previously undergone whole-vault cranioplasty. All patients completed a battery of neurodevelopmental tests (Beery-Buktenica Developmental Test of Visual-Motor Integration, Wechsler Abbreviated Scale of Intelligence, and Wechsler Fundamentals) to evaluate various domains of neuropsychological function. In a group comparison of those treated before 6 months of age, whole-vault patients obtained higher scores relative to endoscopic strip craniectomy patients on visuomotor integration, full-scale intelligence quotient, verbal intelligence quotient, word reading, and reading comprehension (p < 0.05 for all). When compared against strip craniectomy performed before 3 months of age, the whole-vault group still showed significantly higher scores in verbal intelligence quotient, reading comprehension, and word reading (p < 0.05 for all). The type of surgical intervention for isolated sagittal synostosis impacts long-term neuropsychological outcomes. Patients undergoing early whole-vault cranioplasty attained higher intelligence quotient and achievement scores relative to those undergoing strip craniectomy. Surgical management with whole-vault cranioplasty performed before 6 months of age provides the most favorable long-term intellectual outcomes in patients with isolated sagittal synostosis. Therapeutic, II.

Effects of Exercise on Spinal Deformities and Quality of Life in Patients with Adolescent Idiopathic Scoliosis

PubMed Central

Anwer, Shahnawaz; Alghadir, Ahmad; Abu Shaphe, Md.; Anwar, Dilshad

2015-01-01

Objectives. This systematic review was conducted to examine the effects of exercise on spinal deformities and quality of life in patients with adolescent idiopathic scoliosis (AIS). Data Sources. Electronic databases, including PubMed, CINAHL, Embase, Scopus, Cochrane Register of Controlled Trials, PEDro, and Web of Science, were searched for research articles published from the earliest available dates up to May 31, 2015, using the key words “exercise,” “postural correction,” “posture,” “postural curve,” “Cobb's angle,” “quality of life,” and “spinal deformities,” combined with the Medical Subject Heading “scoliosis.” Study Selection. This systematic review was restricted to randomized and nonrandomized controlled trials on AIS published in English language. The quality of selected studies was assessed by the PEDro scale, the Cochrane Collaboration's tool, and the Grading of Recommendations Assessment, Development, and Evaluation System (GRADE). Data Extraction. Descriptive data were collected from each study. The outcome measures of interest were Cobb angle, trunk rotation, thoracic kyphosis, lumbar kyphosis, vertebral rotation, and quality of life. Data Synthesis. A total of 30 studies were assessed for eligibility. Six of the 9 selected studies reached high methodological quality on the PEDro scale. Meta-analysis revealed moderate-quality evidence that exercise interventions reduce the Cobb angle, angle of trunk rotation, thoracic kyphosis, and lumbar lordosis and low-quality evidence that exercise interventions reduce average lateral deviation. Meta-analysis revealed moderate-quality evidence that exercise interventions improve the quality of life. Conclusions. A supervised exercise program was superior to controls in reducing spinal deformities and improving the quality of life in patients with AIS. PMID:26583083

Short-term effect (ATR, Kasperczyk's Scale, chest's mobility) of using of physiotherapy method in the treatment of AIS - pilot study.

PubMed

Blicharska, I; Brzek, A; Durmala, J

2012-01-01

The assessment of influence physiotherapy (DoboMed) to the chest's mobility and the morphology of the ribcage and the posture in short-term intensive physiotherapy in the Department of Rehabilitation. Forty five girls with AIS (mean age- 14.9y.; Cobb angle-range 11-40 degree) were examined. The physiotherapy was been continued for 3 weeks. The angle of trunk rotation (ATR) (Bunnell scoliometer), the posture's morphology (Kasperczyk's Scale) and the chest's mobility index were estimated twice- before and after therapy. After therapy values of ATR decreased by 2°, the chest mobility index increased by 1.3 and total point obtained in the Kasperczyk's Scale has decreased by 1.9 point- which indicates the improvement body posture. All differences are statistically significantly. Also, reported correlations between Cobb angle and ATR and the sum of the points obtained by Kapserczyk's Scale in first exam. Using of physiotherapeutic method in the treatment of AIS provides to the functionally improvement of the chest's mobility, the angle of trunk rotation and the posture in the short time. A used measurement's tools were practical for PT in everyday's work.

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

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.

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

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

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.

Economic impact due to Cimanuk river flood disaster in Garut district using Cobb-Douglas analysis with least square method

NASA Astrophysics Data System (ADS)

Bestari, T. A. S.; Supian, S.; Purwani, S.

2018-03-01

Cimanuk River, Garut District, West Java which have upper course in Papandayan Mountain have an important purpose in dialy living of Garut people as a water source. But in 2016 flash flood in this river was hitted and there was 26 peple dead and 23 peole gone. Flash flood which hitted last year make the settlement almost align with the ground, soaking school and hospital. BPLHD Jawa Barat saw this condition as a disaster which coused by distroyed upper course of Cimanuk River. Flash Flood which happened on the 2016 had ever made economic sector paralized. Least square method selected to analyze economic condition in residents affected post disaster, after the mathematical equations was determined by Cobb Douglas Method. By searching proportion value of the damage, and the result expected became a view to the stakeholder to know which sector that become a worse and be able to make a priority in development

Bilateral lambdoid and sagittal synostosis (BLSS): a unique craniosynostosis syndrome or predictable craniofacial phenotype?

PubMed

Hing, Anne V; Click, Eleanor S; Holder, Ursula; Seto, Marianne L; Vessey, Kyle; Gruss, Joseph; Hopper, Richard; Cunningham, Michael L

2009-05-01

Multisutural craniosynostosis that includes bilateral lambdoid and sagittal synostosis (BLSS) results in a very characteristic head shape with frontal bossing, turribrachycephaly, biparietal narrowing, occipital concavity, and inferior displacement of the ears. This entity has been reported both in the genetics literature as craniofacial dyssynostosis and in the surgical literature as "Mercedes Benz" syndrome. Craniofacial dyssynostosis was first described in 1976 by Dr. Neuhauser when he presented a series of seven patients with synostosis of the sagittal and lambdoid sutures, short stature, and developmental delay. Over the past 30 years nine additional patients with craniofacial dyssynostosis have been reported in the literature adding to the growing evidence for a distinct craniosynostosis syndrome. The term "Mercedes Benz" syndrome was coined by Moore et al. in 1998 due to the characteristic appearance of the fused sutures on three-dimensional CT imaging. In contrast to the aforementioned reported cases of craniofacial dyssynostosis, all three patients had normal development. Recently, there have been several case reports of patients with BLSS and distinct chromosomal anomalies. These findings suggest that BLSS is a heterogeneous disorder perhaps with syndromic, chromosomal, and isolated forms. In this manuscript we will present the largest series of patients with BLSS and review clinical, CT, and molecular findings.

Hybrid Method of Transvertebral Foraminotomy Combined with Anterior Cervical Decompression and Fusion for Multilevel Cervical Disease.

PubMed

Yamamoto, Yu; Hara, Masahito; Nishimura, Yusuke; Haimoto, Shoichi; Wakabayashi, Toshihiko

2018-03-15

Transvertebral foraminotomy (TVF) combined with anterior cervical decompression and fusion (ACDF) can be used to treat multilevel cervical spondylotic myelopathy and radiculopathy; however, the radiological outcomes and effectiveness of this hybrid procedure are unknown. We retrospectively assessed 22 consecutive patients treated with combined TVF and ACDF between January 2007 and May 2016. The Japanese Orthopedic Association (JOA) score and Odom's criteria were analyzed. Radiological assessment included the C2-7 sagittal Cobb angle (CA) and range of motion (ROM). The tilting angle (TA), TA ROM, and disc height (DH) of segments adjacent to the ACDF were also measured. Adjacent segment degeneration, which includes disc degeneration, was evaluated. The mean postoperative follow-up was 41.7 months. All surgeries were performed at two adjacent segments, with ACDF and TVF of the upper and lower segments, respectively. The JOA scores significantly improved. There were no significant differences in the C2-7 CA, C2-7 ROM, TA, and TA ROM, but there was a statistically significant decrease in DH of the lower adjacent segment to ACDF. Progression of disc degeneration was identified in two patients, with no progression in the criterion of adjacent segment degeneration over the follow-up. The TVF combined with ACDF produced excellent clinical results and maintained spinal alignment, albeit with a reduction in DH. TVF was safely performed at the lower segment adjacent to the ACDF, although this might result in earlier degeneration. In conclusion, this hybrid method is less invasive and beneficial for reduction of the number of fused levels.