Realignment surgery in adult spinal deformity

Diebo, Bassel G.; Shah, Neil V.; Stroud, Sarah; Paulino, Carl B.; Schwab, Frank J.; Lafage, Virginie

doi:10.1007/s00132-018-3536-5

Cited by 30 publications

(20 citation statements)

References 67 publications

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“…Moreover, spinal alignment is a unique anatomical feature, which allows the maintenance of a neutral upright posture with minimum energy expenditure [8]. Other researchers reported that older adults with spinal deformity have an impaired perception of upright vertical alignment that worsens with age-related impairment of proprioceptive and vibratory input from the lower extremities [9]. Correct posture allows one to retain a postural balance and limits movement in relation to the support plane, ensuring postural stability with minimum muscle involvement [10,11].…”

Section: Introductionmentioning

confidence: 99%

Postural Sway in Older Patients with Sagittal Imbalance and Young Adults during Local Vibratory Proprioceptive Stimulation

et al. 2021

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This study aimed to assess differences in somatosensory control strategies between older patients with sagittal imbalance and young adults during postural tasks. The center of pressure displacement in 27 older patients with sagittal imbalance and 27 young adults was determined upon standing blindfolded on a balance board. Vibratory stimulation at 56 to 100 Hz was applied bilaterally to the gastrocnemius and soleus muscles (GS) and lumbar multifidus to evaluate the contributions of proprioceptive signals to postural control. Data of older patients and young adults were compared using the Mann–Whitney U-test or independent sample t-tests. Compared with the young adults, the older patients were significantly more reliant on the GS (p < 0.005) for their postural control and showed a higher relative proprioceptive weighting ratio (RPW) (p = 0.038). The postural strategy adopted by the older patients depended on the level of proprioceptive stimulation applied to the GS, and the postural control strategy of the ankle correlated with RPW. Overall, this study identifies RPW as a novel measure of postural strategy in older patients with sagittal imbalance and provides an understanding of strategies used to maintain balance, which may assist in developing preventative measures to reduce the risk of falls.

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Section: Introductionmentioning

confidence: 99%

Postural Sway in Older Patients with Sagittal Imbalance and Young Adults during Local Vibratory Proprioceptive Stimulation

et al. 2021

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“…Second, the initial Cobb angle measurements were made from T1 to T10; this might not be consistent with the measurements made in the literature or clinically, which are typically from superior end plate of T1 or T4 to the inferior end plate of T9 or T12. 63,46 Third, for our data, the lumbar and cervical segments of the reference spine geometry in standing posture was obtained by normalization of a generic thoracolumbar model and not from imaging and hence is not fully subject specific. Fourth, the validation of estimated spine geometry is performed only on the thoracic spine due to limitations in availability of full spine data in all the postures of interest.…”

Section: Discussionmentioning

confidence: 99%

Estimation and assessment of sagittal spinal curvature and thoracic muscle morphometry in different postures

Zhang

Ashjaee

et al. 2021

Proc Inst Mech Eng H

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Spine models are typically developed from supine clinical imaging data, and hence clearly do not fully reflect postures that replicate subjects’ clinical symptoms. Our objectives were to develop a method to: (i) estimate the subject-specific sagittal curvature of the whole spine in different postures from limited imaging data, (ii) obtain muscle lines-of-action in different postures and analyze the effect of posture on muscle fascicle length, and (iii) correct for cosine between the magnetic resonance imaging (MRI) scan plane and dominant fiber line-of-action for muscle parameters (cross-sectional area (CSA) and position). The thoracic spines of six healthy volunteers were scanned in four postures (supine, standing, flexion, and sitting) in an upright MRI. Geometry of the sagittal spine was approximated with a circular spline. A pipeline was developed to estimate spine geometry in different postures and was validated. The lines-of-action for two muscles, erector spinae (ES) and transversospinalis (TS) were obtained for every posture and hence muscle fascicle lengths were computed. A correction factor based on published literature was then computed and applied to the muscle parameters. The maximum registration error between the estimated spine geometry and MRI data was small (average RMSE∼1.2%). The muscle fascicle length increased (up to 20%) in flexion when compared to erect postures. The correction factor reduced muscle parameters (∼5% for ES and ∼25% for TS) when compared to raw MRI data. The proposed pipeline is a preliminary step in subject-specific modeling. Direction cosines of muscles could be used while improving the inputs of spine models.

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“…Several risk factors of junctional kyphosis such as sagittal malalignment, 9 greater curvature correction, 9 , 10 , 11 , 12 and low bone mineral density, 11 , 13 have been reported in patients with adult spinal deformity, however, patients with LPTK were usually excluded due to specific pathogenesis. 10 , 14 , 15 The characteristics and risk factors of junctional kyphosis in patients with LPTK after long segmental instrumented fusion surgery are still unclear.…”

Section: Introductionmentioning

confidence: 99%

Junctional Kyphosis after Correction with Long Instrumentation for Late Posttraumatic Thoracolumbar Kyphosis: Characteristics and Risk Factors

Zhou

et al. 2023

Orthopaedic Surgery

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Objective Junctional kyphosis is a common complication after corrective long spinal fusion for adult spinal deformity. Whereas there is still a paucity of data on junctional kyphosis, specifically among late posttraumatic thoracolumbar kyphosis (LPTK) patients. Thus, the aim of this study was to investigate the characteristics and risk factors of junctional kyphosis in LPTK patients receiving long segmental instrumented fusion. Methods We retrospectively reviewed a cohort of LPTK patients who had received long segmental instrumented fusion (>4 segments) in our center between January 2012 and January 2019. Radiographic assessments included the sagittal alignment, pelvic parameters, bone quality on CT images, and measurements of the cross‐sectional area (CSA, cross‐sectional area of muscle‐vertebral body ratio × 100) and fat saturation fraction (FSF, cross‐sectional area of fat‐muscle body ratio × 100) of paraspinal muscles. Patients in this study were divided into those with junctional kyphosis or failure (Group J) and those without (Group NJ) during follow‐up. Group J included patients with junctional kyphosis (Group JK) and patients with junctional failure (Group JF). Results A total of 65 patients (16 males and 49 females, average age 56.5 ± 23.4 years) were enrolled in this study. After (32.7 ± 8.5) months follow‐up, 15 patients (23.1%) experienced junctional kyphosis, and four of them deteriorated into junctional failure. Eighty percent (12/15) of junctional kyphosis was identified within 6 months after surgery. In comparison with Group NJ, Group J were older (P = 0.026), longer fusion levels (P < 0.001), greater thoracic kyphosis (P = 0.01), greater global kyphosis (P = 0.023), lower bone quality (P < 0.001), less CSA (P = 0.005) and higher FSF (P <0.001) of paraspinal muscles. Preoperative global kyphosis more than 48.5° (P = 0.001, odds ratio 1.793) and FSF more than 48.4 (P = 0.010, odds ratio 2.916) were identified as independent risk factors of junctional kyphosis. Based on the statistical differences among Group NJ, Group JK and Group JF (P < 0.001), Group JF had lower bone quality than Group NJ (P < 0.001) and Group JK (P = 0.015). In terms of patient‐reported outcomes, patients in Group JF had worse outcomes in ODI and VAS scores, and PCS and MCS of SF‐36 than Group NJ and group JK Conclusion The prevalence of junctional kyphosis was 23.1% in LPTK patients after long segmental instrumented fusion. Preoperative hyperkyphosis and advanced fatty degeneration of paraspinal muscles were independent risk factors of junctional kyphosis. Patients with lower bone quality were more likely to develop junctional failure.

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Realignment surgery in adult spinal deformity

Cited by 30 publications

References 67 publications

Postural Sway in Older Patients with Sagittal Imbalance and Young Adults during Local Vibratory Proprioceptive Stimulation

Postural Sway in Older Patients with Sagittal Imbalance and Young Adults during Local Vibratory Proprioceptive Stimulation

Estimation and assessment of sagittal spinal curvature and thoracic muscle morphometry in different postures

Junctional Kyphosis after Correction with Long Instrumentation for Late Posttraumatic Thoracolumbar Kyphosis: Characteristics and Risk Factors

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