Age-related variations in global spinal alignment and sagittal balance in asymptomatic Japanese adults

Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Tanaka, Hidekazu; Ito, Yutaka; Kawabata, Shinji; Kuroiwa, Toshihiko

doi:10.1080/01616412.2017.1296654

Cited by 56 publications

(34 citation statements)

References 15 publications

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“…Much more cases possessed a PI < 45°, but less with PI > 60° than Caucasian population 8,9 . It was comparable to Asian population according to previous reports 3,4 . Thus, the cohort was strati ed into 4 groups rather than 3 groups, according to PI value: very low PI group (PI < 30°), low PI group (PI = 30°-45°), moderate PI group (45°-60°), and high PI group (PI > 60°).…”

Section: Discussionsupporting

confidence: 89%

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Lumbar Lordosis Morphology Correlates to Erector Spinae Muscularity in Asymptomatic Asian Adults

Wang

Sun

2020

Preprint

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Background It is still blank on the relationship between lumbar lordosis morphology and paraspinal muscle in asymptomatic Asian adults. The study aims to investigate the relationships. Methods 87 asymptomatic adults aged between 18 and 45 years old were enrolled in the retrospective study. Lumbar lordosis morphology, consisting of total lumbar lordosis (LL), proximal lumbar lordosis (PLL), distal lumbar lordosis (DLL), lumbar lordosis apex (LLA) and inflexion point (IP), was evaluated, as well as pelvic incidence (PI) and muscularity of erector spinae (ES) and multifidus (MF). Pearson correlation was performed to analyze the relationship between each other parameter. Cases were stratified according to pelvic incidence (very low < 30°, low 30°-45°, moderate 45°-60°, and high > 60°), comparison between groups was performed by univariance analysis. Results PLL revealed a correlation with LLA (r = 0.603, p = 0.002) and inflexion point (r = 0.536, p = 0.004), but did not DLL with LL apex (r = 0.204, p = 0.058) or inflexion point (r = 0.210, p = 0.051). PI revealed a greater correlation with PLL (r=-0.673, p < 0.001) than with DLL (r=-0.237, p = 0.045). Linear stepwise regression analysis also exhibited the correlation between PI and PLL (R2 = 0.452, PLL = 16.2–0.61*PI, p < 0.001). ES muscularity correlated with LL apex (r=-0.279, p = 0.014) and inflexion point (r=-0.227, p = 0.047). Stratification by PI demonstrated PLL increased across groups (p < 0.001), but DLL was comparable between low and moderate PI group (p = 0.329). Conclusion Lumbar lordosis morphology correlates to erector spinae muscularity. Proximal lumbar lordosis has a bigger correlation with pelvic incidence than the distal lumbar lordosis. The results are helpful for restoring a rational lumbar lordosis shape in long fusion surgery.

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Section: Discussionsupporting

confidence: 89%

“…Sagittal spinal alignment and lumbar lordosis shape varies across individuals [1][2][3][4][5] . It has been a research hot spot nowadays, since Roussouly classi cation of normal spinal sagittal pro le [6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

Lumbar Lordosis Morphology Correlates to Erector Spinae Muscularity in Asymptomatic Asian Adults

Wang

Sun

2020

Preprint

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“…Third, this study was based on radiologic data of Koreans. Comparative studies are needed to apply the change in the segmental thoracic curve to other races [24][25][26]. Finally, we enrolled a relatively small sample size; therefore, the four segments could not be subdivided.…”

Section: Discussionmentioning

confidence: 99%

Changes in Thoracic Kyphosis and Thoracolumbar Kyphosis in Asymptomatic Korean Male Subjects Aged >50 Years: Do They Progress Above T5, T10, T12, or L2?

et al. 2020

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Study Design: Retrospective analysis of prospectively collected data.Purpose: To evaluate the natural progression of segmental kyphosis in thoracic and thoracolumbar spine with advancing age.Overview of Literature: To our knowledge, the evolution of segmental thoracic kyphosis (TK) in individuals aged >50 years has not been reported.Methods: Total 179 normal, asymptomatic Korean men were divided in to three groups (6th, 7th, and 8th decade) according to their age. Standard sagittal spinopelvic parameters, including TK and thoracolumbar kyphosis, were measured and subdivided into the following four segments: A (C7 upper end plate [UEP]–T5 UEP), B (T5 UEP–T10 UEP), C (T10 UEP–T12 lower end plate [LEP]), and D (T12 LEP–L2 LEP). These segments of the three study groups were analyzed.Results: In segment B, the segmental kyphosis of group 3 (20.2°±8.0°) showed a statistically larger value than that of group 1 (15.6°±6.8°) and group 2 (16.7°±8.8°) (p=0.017). In segment C, the segmental kyphosis of group 2 (12.9°±6.5°) and group 3 (12.2°±7.1°) showed statistically larger values than that of group 1 (9.5°±6.2°) (p=0.016). The A and D segments of the three groups were not significantly different.Conclusions: Increased TK was observed in the middle (segment B) and lower (segment C) thoracic segments in normal asymptomatic male subjects with age. The results from the natural progression of segmental kyphosis with age would provide baseline reference data to help surgeons choose the optimal point of the upper instrumented vertebra level for preventing proximal junctional kyphosis.

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“…3). Yokoyama und Kollegen konnten dabei der lumbosakralen Lordose mit dem L1-Slope als zentralen Parameter eine besondere kompensatorische Rolle zuordnen [6]. Da diese Kompensationsmechanismen grundsätzlich mit muskulärer Anstrengung verbunden sind, führt eine schnelle Ermüdung, insbesondere bei muskelschwachen älteren Patienten, oft zum klassischen Symptomenkomplex mit Schmerzen im Bereich der lumbalen, lumbosakralen oder iliosakralen Region und damit einhergehender Einschränkung der autonomen Gehstrecke.…”

Section: Klinische Relevanzunclassified

Die Veränderung des sagittalen Profils im Alter und dessen therapeutische Relevanz

Tschöke

2018

Die Wirbelsäule

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ZusammenfassungDie steigende Zahl der komplexen Wirbelsäulendeformitäten im Alter stellt eine neue therapeutische Herausforderung dar. Hierbei wird dem komplexen Zusammenspiel der spinopelvinen Kompensationsmechanismen eine besondere Bedeutung zugeschrieben. Obwohl die Analyse der globalen sagittalen Balance wesentlich zum Verständnis dieser Mechanismen beigetragen hat, wird die vereinfachte algebraische Darstellung und Definition des „normalen“ Sagittalprofils dem älteren Patienten mit multiplen degenerativen Veränderungen des Bewegungsapparates nicht gerecht. Vielmehr ist beim älteren Patienten eine durch die unzureichende Flexibilität der benachbarten Strukturen limitierte „Komfort-Balance“ funktionell nicht zwingend nachteilig. Dennoch sollte das therapeutische Ziel immer die Wiederherstellung einer harmonischen Lastverteilung an der Wirbelsäule sein. Bei älteren Patienten mit einer symptomatisch dekompensierten sagittalen Imbalance, bleibt die rein konservative Therapie meist ohne Erfolg. In diesen Fällen sollte immer die strukturell zugrunde liegende Pathologie im Sinne der Profilkorrektur adressiert werden. Die Wahl der operativen Technik, Länge des Konstrukts und dessen Verankerungspunkte müssen dabei die individuellen Möglichkeiten, Risiken und Bedürfnisse des älteren Patienten berücksichtigen, um eine iatrogene Invalidisierung und komplikationsbedingte Sekundäreingriffe zu vermeiden. Mit stetig steigender Lebenserwartung unserer Bevölkerung werden wir uns dem wachsenden Anspruch, auch im hohen Alter aktiv bleiben zu können, stellen müssen. Dies setzt ein ganzheitliches Verständnis der patienteneigenen Leistungsfähigkeit sowie eine realistische Einschätzung des zu erzielenden Ergebnisses und das Beherrschen aller operativer Korrekturtechniken voraus.

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Age-related variations in global spinal alignment and sagittal balance in asymptomatic Japanese adults

Abstract: PI; pelvic incidence; SS; sacral slope; PT; pelvic tilt; LL; lumbar lordosis; C7SVA; C7 sagittal vertical axis; SSA; spinosacral angle; TK; thoracic kyphosis; C2-C7SVA; C2-C7 sagittal vertical axis; C2-C7A; C2-C7 Angle; TIA; thoracic inlet angle; NT; neck tilt.

Cited by 56 publications

References 15 publications

Lumbar Lordosis Morphology Correlates to Erector Spinae Muscularity in Asymptomatic Asian Adults

Lumbar Lordosis Morphology Correlates to Erector Spinae Muscularity in Asymptomatic Asian Adults

Changes in Thoracic Kyphosis and Thoracolumbar Kyphosis in Asymptomatic Korean Male Subjects Aged >50 Years: Do They Progress Above T5, T10, T12, or L2?

Die Veränderung des sagittalen Profils im Alter und dessen therapeutische Relevanz

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Age-related variations in global spinal alignment and sagittal balance in asymptomatic Japanese adults

Abstract: PI; pelvic incidence; SS; sacral slope; PT; pelvic tilt; LL; lumbar lordosis; C7SVA; C7 sagittal vertical axis; SSA; spinosacral angle; TK; thoracic kyphosis; C2-C7SVA; C2-C7 sagittal vertical axis; C2-C7A; C2-C7 Angle; TIA; thoracic inlet angle; NT; neck tilt.

Cited by 56 publications

References 15 publications

Lumbar Lordosis Morphology Correlates to Erector Spinae Muscularity in Asymptomatic Asian Adults

Lumbar Lordosis Morphology Correlates to Erector Spinae Muscularity in Asymptomatic Asian Adults

Changes in Thoracic Kyphosis and Thoracolumbar Kyphosis in Asymptomatic Korean Male Subjects Aged &gt;50 Years: Do They Progress Above T5, T10, T12, or L2?

Die Veränderung des sagittalen Profils im Alter und dessen therapeutische Relevanz

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Changes in Thoracic Kyphosis and Thoracolumbar Kyphosis in Asymptomatic Korean Male Subjects Aged >50 Years: Do They Progress Above T5, T10, T12, or L2?