Relationships between radiographic parameters and spinopelvic muscles in adult spinal deformity patients

Ferrero, Emmanuelle; Skalli, Wafa; Lafage, Virginie; Maillot, Cédric; Carlier, Robert; Feydy, A.; Felter, Adrien; Khalifé, Marc; Guigui, P.

doi:10.1007/s00586-019-06243-3

Cited by 25 publications

(31 citation statements)

References 33 publications

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“…Our findings are supported by previous investigations demonstrating relationships between alignment and FI of the lumbar PVM [9,10,15]. Lee et al compared eleven patients with lumbar flatback (average LL 11.6°) to ten volunteers, finding a significantly higher amount of FI throughout the lumbar PVM and psoas [10], leading the authors to conclude that muscular imbalance is likely related to the pathogenesis of the condition.…”

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

“…While the posterior vertebral musculature (PVM) is a key component of stabilization [9], its role in the pathogenesis of degenerative spine disease is unknown. Abnormal PVM has been demonstrated in patients with a variety of conditions, including low back pain, degenerative disc disease, and lumbar radiculopathy, and patients with degenerative lumbar scoliosis; investigators have shown asymmetry between musculature on opposite sides of the curve [8][9][10][11]. Muscular changes have also been demonstrated in regional sagittal deformities [8,10,[12][13][14], and relationships between fatty degeneration of lumbar PVM and increased global sagittal malalignment have previously been demonstrated [15].…”

Section: Introductionmentioning

confidence: 99%

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The relationship of global sagittal malalignment to fatty infiltration in the aging spine

et al. 2021

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Purpose To investigate associations between muscle size, fat infiltration (FI), and global sagittal alignment in patients with adult spinal deformity (ASD). Methods Retrospective cohort study was conducted on a single-institution database of ASD patients with preoperative radiographs and CTs. Following multiplanar reconstructions of CTs, images in the plane of each vertebra were generated. The posterior vertebral musculature (PVM) was contoured on axial images at three vertebral levels (T2, T10, L3). FI was calculated by comparing Hounsfield units within muscles to the normative values of fat. Correlation analyses were conducted between demographics, alignment, and muscle characteristics. Results 107 patients underwent preoperative spine CT (58yo, 79%F, BMI 27 kg/m2). Muscle data were available for 49 pts at T2, 39 pts at T10, and 81 pts at L3. Mean FI was T2 = 33% ± 18, T10 = 28% ± 19, L3_Erector = 39% ± 19, and L3_Psoas = 19% ± 9. FI correlated across levels (T2 vs. T10 r = 0.698; T10 vs L3_Erector r = 0.506; L3_Erector vs Psoas r = 0.419) and with demographics; older pts had greater fat percentages (r = 0.31–0.45) and BMIs (r = 0.24–0.51). Increased FI at T2, T10, and L3 was associated with increased pelvic retroversion (PT: r = 0.25–0.43), global deformity (TPA: r = 0.27–0.45), and anterior malalignment (SVA: r = 0.23–0.41). The degree of FI in the PVM increased with the severity of SRS-Schwab PT and SVA modifiers. Conclusion In ASD patients, global sagittal malalignment is related to FI of the PVM throughout the lumbar and thoracic spine, as identified through CT. Future research should investigate how FI relates to ASD pathogenesis.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The relationship of global sagittal malalignment to fatty infiltration in the aging spine

et al. 2021

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“…Previous studies have highlighted the importance of the sagittal spine for pain and patient quality of life [2][3][4]. Trunk muscles have an important role in maintaining normal vertebral alignment and the stability of the spine [5]. Therefore, trunk muscles involved in lumbar-stabilization are at the forefront of research needs.…”

Section: Discussionmentioning

confidence: 99%

“…Recent evidence has revealed that increased fat infiltration and decreased muscle volumes in trunk muscles are associated with sagittal malalignment in DSD patients [5], suggesting that trunk muscle dysfunction is related to DSD. Trunk muscles control balance and posture, which are essential for normal functional activities, e.g.…”

Section: Introductionmentioning

confidence: 99%

Assessment of isokinetic trunk muscle strength and its association with health-related quality of life in patients with degenerative spinal deformity

Yang

Chen

et al. 2020

BMC Musculoskelet Disord

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Background A considerable portion of the elderly population are increasingly afflicted by degenerative spinal deformity (DSD), which seriously affects patient health-related quality of life (HRQoL). HRQoL index is used across many studies to show correlations between radio-graphical alignment, disability, and pain in patients with DSD. However, imaged structural deformity represents only one aspect for consideration, namely, the disability effect of DSD. We assessed the isokinetic strength of trunk muscle in patients with degenerative spinal deformity (DSD), and investigated its relationship with HRQoL. Methods In total, 38 patients with DSD (DSD group) and 32 healthy individuals (control group) were recruited. Both groups were homogeneous for age, weight, height and body mass index (BMI). Assessments were performed using the isokinetic dynamometer IsoMed-2000; trunk extensor, flexor strength and flexion/extension (F/E) ratios were explored concentrically at speeds of 30°, 60° and 120° per second. The grip strength of both hands was measured using a hand-held dynamometer. Visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI), a Roland-Morris disability questionnaire (RDQ), and a 36-item Short Form Health Survey (SF-36) evaluated patient HRQoL. Correlations between trunk strength and HRQoL were analyzed. Results When compared with the control group, the DSD group showed lower trunk extensor strength at three velocity movements, and higher F/E ratios at 60° and 120°/s (p < 0.05). Both groups exhibited similar trunk flexor strength and grip strength (p > 0.05). In DSD group, trunk extensor strength at 60°/s was negatively associated with ODI and RDQ (p < 0.05). A negative relationship between trunk flexor strength at 120°/s and ODI was also recorded (p < 0.05). In addition, trunk extensor strength at 60°/s and trunk flexor strength at 120°/s were positively correlated with physical functioning and role-physical scores according to the SF-36 (p < 0.05). Conclusions We identified isolated trunk extensor myopathy in DSD, which causes an imbalance in trunk muscle strength. Isokinetic trunk extensor strength at 60°/s and trunk flexor strength at 120°/s can predict disability, and decrease physical HRQoL in DSD patients.

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What patient parameters influence lumbar stiffness in patients with hip pathology?

Verhaegen,

Alves Batista,

Foster

et al. 2023

Journal Orthopaedic Research

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Lumbar stiffness leads to greater hip dependence to achieve sagittal motion and increases instability after total hip arthroplasty (THA). We aimed to determine parameters that influence lumbar stiffness among patients with hip pathology. We hypothesized that modifiable (degenerative changes, spinal canal stenosis, facet orientation) and nonmodifiable factors (muscle condition) would be associated with lumbar spine stiffness. In this retrospective case‐cohort study from a tertiary referral center, consecutive patients presenting at a hip specialist clinic underwent standing and deep‐seated radiographic assessment to measure lumbar lordosis (∆LL) (stiffness: ∆LL < 20°), hip flexion (∆PFA: pelvic femoral angle), and degree of degenerative‐disc‐disease (DDD) (facet osteoarthritis, disc height, endplate proliferative changes). Of these, 65 patients were selected with previous lumbar spine magnetic resonance imaging, allowing to determine lumbar facet orientation, spinal canal stenosis (Schizas classification), and flexor‐ and extensor‐muscle atrophy (Goutallier classification). Mean ∆LL was 45° (range: 11°–72°) and four patients (6%) exhibited spine stiffness. Patients with multilevel DDD (n = 22) had less ∆LL than those with no/single level (n = 43) DDD (34° [range: 11°–53°] vs. 51° [21°–72°]; p < 0.001). Number of DDD levels correlated strongly with ∆LL (ρ = −0.642; p < 0.001). Spinal stiffness was only seen in patients with ≥4 DDD levels. There was no correlation between ∆LL and facet orientation (p > 0.05). ∆LL correlated strongly with extensor atrophy at L3–L4 (ρ = −0.473), L4–L5 (ρ = −0.520), and L5–S1 (ρ = −0.473) and poorly with flexors at L4–L5 (ρ = −0.134) and L5–S1 (ρ = −0.227). Lumbar stiffness is dependent on modifiable (muscle atrophy) and nonmodifiable (extend of DDD) factors. This can guide nonoperative management of hip pathology, emphasizing the relevance of core muscle rehabilitation to improve posture and stiffness. Identification ≥4 DDD levels should alert surgeons of increased THA instability risk. Level of evidence: level IV, cohort series.

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Relationships between radiographic parameters and spinopelvic muscles in adult spinal deformity patients

Cited by 25 publications

References 33 publications

The relationship of global sagittal malalignment to fatty infiltration in the aging spine

The relationship of global sagittal malalignment to fatty infiltration in the aging spine

Assessment of isokinetic trunk muscle strength and its association with health-related quality of life in patients with degenerative spinal deformity

What patient parameters influence lumbar stiffness in patients with hip pathology?

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