Relationship between Knee Osteoarthritis and Spinopelvic Sagittal Alignment in Volunteers over 50 Years of Age

Yasuda Tatsuya,Togawa Daisuke,Hasegawa Tomohiko,Yamato Yu,Kobayashi Sho,Yoshida Go,Banno Tomohiro,Arima Hideyuki,Oe Shin,Hoshino Hironobu,Koyama Hiroshi,Hanada Mitsuru,Imada Takayuki,Matsuyama Yukihir 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.4

Study Design: Large cohort study of volunteers.Purpose: The purpose of this study was to investigate the relationship between the severity of knee osteoarthritis, assessed using the Kellgren-Lawrence (KL) grading scale, and spinopelvic sagittal alignment in older adult volunteers.Overview of Literature: The relationship between spinopelvic alignment in the sagittal plane and knee osteoarthritis in the coronal plane is unclear.Methods: Volunteers over 50 years of age underwent radiographic analysis. Radiographic parameters including pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), thoracic kyphosis, and sagittal vertical axis (SVA) were measured. The the three Scoliosis Research Society-Schwab sagittal modifiers (PT, SVA, I–LL) were categorized and the KL grade was assessed. Differences in spinopelvic parameters and Oswestry Disability Index (ODI) scores among KL grades were evaluated.Results: A total of 396 volunteers (160 men, 236 women; mean age, 74.4 years) were analyzed. PI–LL and PT in KL4 were significantly higher compared to that in the other KL grades. However, there were no significant group differences in SVA. In women, but not in men, higher frequencies of the worst modifier grade (++) were observed for PI–LL and PT in the KL3 and KL4 groups compared to those for the other KL grades. In women, the ODI score in KL4 was worse compared to that in the other KL grades.Conclusions: Individuals over 50 years of age with severe knee osteoarthritis had poor lumbo-pelvic sagittal alignment. Moreover, the progression severity of knee osteoarthritis had more impact onstronger relationship with lumbo-pelvic malalignment and disability-related low back pain in women than in men.

Is the Lipid Content of the Psoas Major Correlated with Chronic Low Back Pain and Spinopelvic Alignment? A Magnetic Resonance Spectroscopic Study

Ogon Izaya,Hiroyuki Takashima,Tomonori Morita,Tsutomu Oshigiri,Yoshinori Terashima,Mitsunori Yoshimoto,Makoto Emori,Atsushi Teramoto,Tsuneo Takebayashi,Toshihiko Yamashita 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.4

Study Design: Cross-sectional observational study.Purpose: This study aimed to analyze any potential associations of extramyocellular lipid (EMCL) and intramyocellular lipid (IMCL) contents with (1) the intensity of low back pain (LBP); (2) age, cross-sectional area (CSA), and fatty infiltration (FI) of the psoas major; and (3) spinopelvic parameters.Overview of Literature: The psoas major has clinically relevant function; however, the association of this muscle with chronic LBP is controversial. Magnetic resonance spectroscopy enables a detailed analysis of the composition of muscular fat tissues such as its EMCL and IMCL contents.Methods: The study population comprised 40 patients (19 males, 21 females; mean age, 61.7±2.4 years). Possible correlations of LBP Visual Analog Scale (VAS) scores, age, CSA, FI, and spinopelvic parameters with EMCL and IMCL contents of the psoas major were assessed.Results: No association was identified between the EMCL and IMCL contents and LBP VAS scores (<i>r</i>=0.05, <i>p</i>=0.79 and <i>r</i>=0.06, <i>p</i>=0.75, respectively). The EMCL content correlated with age (<i>r</i>=0.47, <i>p</i><0.01), body mass index (BMI) (<i>r</i>=0.44, <i>p</i><0.01), CSA (<i>r</i>=−0.59, <i>p</i>< 0.01), and FI (<i>r</i>=0.49, <i>p</i><0.01). EMCL content showed a significant negative correlation with sacral slope (SS) (<i>r</i>=−0.43, <i>p</i><0.05) and positive correlation with pelvic tilt (PT) (<i>r</i>=0.56, <i>p</i><0.01).Conclusions: EMCL content correlated with age, BMI, CSA, and FI of the psoas major, while IMCL content had no correlation. This study found correlations between SS and PT and EMCL content of the psoas major, but no correlations were found between spinopelvic parameters and IMCL content of the psoas major.

Comparison of Sagittal Spinopelvic Alignment between Lumbar Degenerative Spondylolisthesis and Degenerative Spinal Stenosis

Lim, Jae Kwan,Kim, Sung Min The Korean Neurosurgical Society 2014 Journal of Korean neurosurgical society Vol.55 No.6

Objective : The purpose of this study was to evaluate the differences in sagittal spinopelvic alignment between lumbar degenerative spondylolisthesis (DSPL) and degenerative spinal stenosis (DSS). Methods : Seventy patients with DSPL and 72 patients with DSS who were treated with lumbar interbody fusion surgery were included in this study. The following spinopelvic parameters were measured on whole spine lateral radiographs in a standing position : pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis angle (LL), L4-S1 segmental lumbar angle (SLL), thoracic kyphosis (TK), and sagittal vertical axis from the C7 plumb line (SVA). Two groups were subdivided by SVA value, respectively. Normal SVA subgroup and positive SVA subgroup were divided as SVA value (<50 mm and ${\geq}50mm$). Spinopelvic parameters/PI ratios were assessed and compared between the groups. Results : The PI of DSPL was significantly greater than that of DSS (p=0.000). The SVA of DSPL was significantly greater than that of DSS (p=0.001). In sub-group analysis between the positive (34.3%) and normal SVA (65.7%), there were significant differences in LL/PI and SLL/PI (p<0.05) in the DSPL group. In sub-group analysis between the positive (12.5%) and normal SVA (87.5%), there were significant differences in PT/PI, SS/PI, LL/PI and SLL/PI ratios (p<0.05) in the DSS group. Conclusion : Patients with lumbar degenerative spondylolisthesis have the propensity for sagittal imbalance and higher pelvic incidence compared with those with degenerative spinal stenosis. Sagittal imbalance in patients with DSPL is significantly correlated with the loss of lumbar lordosis, especially loss of segmental lumbar lordosis.

Effects of Sagittal Spinopelvic Alignment on Motor Symptom and Respiratory Function in Mild to Moderate Parkinson`s disease

( Dongyeon Kang ),( Sangmyung Cheon ),( Minji Son ),( Hyeryun Sung ),( Hyeyoung Lee ) 대한물리치료학회 2019 대한물리치료학회지 Vol.31 No.2

Purpose: This study examined the effects of sagittal spinopelvic alignment on the clinical parameters, motor symptoms, and respiratory function in patients with mild to moderate Parkinson’s disease (PD). Methods: This study was a prospective assessment of treated patients (n=28, Hoehn and Yahr (H&Y) stage 2-3) in a PD center. Twenty-eight subjects (68.5±5.7 yrs) participated in this study. The clinical and demographic parameters, including age, sex, symptoms duration, treatment duration, and H&Y stage, were collected. Kinematic analysis was conducted in the upright standing posture with a motion capture system. A pulmonary function test (PFT) was performed in the sitting position using a spirometer. The motor symptoms were assessed on part III of the movement disorder society sponsored version of the unified Parkinson’s disease rating scale (MDS-UPDRS). SPSS 18.0 was used to analyze the collected data. Results: The exceeding 12 degrees group of the lower trunk showed significantly higher on the clinical parameters than the below 12 degrees group. In addition, the exceeding 12 degrees group of the lower trunk showed a significantly lower forced expiratory volume at one second (FEV1) / forced vital capacity (FVC) (%) and 25-75% forced mid-expiratory flow (FEF) (L/s) than in the below group. On the other hand, there was no difference in the upper trunk and the cervical pelvis between the groups. Conclusion: These findings suggest that the sagittal balance in the lower trunk is related to the clinical parameters and respiratory function, but not the motor symptoms in patients with mild to moderate PD.

The Sagittal Balance of the Cervical Spine: Radiographic Analysis of Interdependence between the Occipitocervical and Spinopelvic Alignment

Alijani Babak,Rasoulian Javid 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.3

Study Design: This was a prospective clinical study.Purpose: Previous studies have indicated that cervical lordosis is a parameter influenced by segmental and global spinal sagittal balance parameters. However, this correlation still remains unclear. Therefore, a better understanding of the normal values and interdependencies between inter-segmental alignment parameters is needed. This is a preliminary analysis that helps to understand these factors.Overview of Literature: Change in global sagittal alignment is associated with poor health-related quality of life. Questions regarding which parameters play the primary roles in the progression of spinal sagittal imbalance and which might be compensatory factors remain unanswered.Methods: Prospectively, 420 adults (105 asymptomatic, 105 cervical symptomatic, 105 lumbar symptomatic, and 105 post-surgical) were selected. Whole-spine standing lateral radiographs were taken, and spinopelvic, thoracic, and cervical parameters were measured. Then, the data were analyzed using correlation coefficient test and multiple regression analysis.Results: All the parameters showed a normal distribution. The mean values of the cervical parameters are as follows: C₁C₂ Cobb angle, −27.07°±4.3°; C₂C₇ Cobb angle, −16.4°±5.6°; O_CC₂ Cobb angle, −14.5°±3.8°; O_CC₇ Cobb angle, −29.8°±5.6°; C₂C₇ Harrison angle, 20.4°±4.3°; and C₇ slope, −25.4°±5.6°. The analysis of these parameters revealed no statistically significant difference between asymptomatic, symptomatic, and post-surgical patients. C₇ sagittal vertical axis (SVA) correlated with the C₂C₇ Cobb angle (<i>r</i> =0.7) in all groups. No significant correlation was noted between cervical and spinopelvic parameters in asymptomatic patients. However, C₁C₂ Cobb angle correlated significantly with pelvic incidence (PI, <i>r</i> =−0.2), lumbar lordosis (LL, <i>r</i> =0.2), and pelvic tilt (PT, <i>r</i> =−0.2) in cervical symptomatic patients. Irrespective of the patient symptom sub-group (n=420), C₁C₂ Cobb angle correlated with LL (<i>r</i> =0.1) and C₂C₇ Harrison angle correlated with PI and PT (<i>r</i> =0.1).Conclusions: Our results indicate significant interdependence between the spinopelvic and cervical alignment, especially in cervical symptomatic patients. In addition, strong correlation was found between the C₇ SVA and C₂C₇ Cobb angle. Overall, the results of this study could help to better understand the cervical sagittal alignment and serve as preliminary data for planning surgical reconstruction procedures.

Difference of Sagittal Spinopelvic Alignments between Degenerative Spondylolisthesis and Isthmic Spondylolisthesis

Lim, Jae Kwan,Kim, Sung Min The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.53 No.2

Objective : The purpose of this study was to analyze the differences of spinopelvic parameters between degenerative spondylolisthesis (DSPL) and isthmic spondylolisthesis (ISPL) patients. Methods : Thirty-four patients with DSPL and 19 patients with ISPL were included in this study. Spinopelvic parameters were evaluated on whole spine X-rays in a standing position. The following spinopelvic parameters were measured : pelvic incidence (PI), sacral slope, pelvic tilt (PT), lumbar lordosis (LL), and sagittal vertical axis from C7 plumb line (SVA). The population of patients was compared with a control population of 30 normal and asymptomatic adults. Results : There were statistically significant differences in LL (p=0.004) and SVA (p=0.005) between the DSPL and ISPL group. The LL of DSPL ($42{\pm}13^{\circ}$) was significantly lower than that of the control group ($48{\pm}11^{\circ}$; p=0.029), but that of ISPL ($55{\pm}6^{\circ}$) was significantly greater than a control group (p=0.004). The SVA of DSPL ($55{\pm}49$ mm) was greater than that of a control group (<40 mm), but that of ISPL ($21{\pm}22$ mm) was within 40 mm as that of a control group. The PT of DSPL ($24{\pm}7^{\circ}$) and ISPL ($21{\pm}7^{\circ}$) was significantly greater than that of a control group ($11{\pm}6^{\circ}$; p=0.000). Conclusion : Both symptomatic DSPL and ISPL patients had a greater PI than that of the asymptomatic control group. In conclusion, DSPL populations are likely to have global sagittal imbalance (high SVA) compared with ISPL populations because of the difference of lumbar lordosis between two groups.

경남 일부지역 중-고교생의 성별에 따른 시상면상 척추-골반 정렬의 특성 비교 연구

김성렬(Kim, Sung-Ryul) 한국산학기술학회 2014 한국산학기술학회논문지 Vol.15 No.2

본 연구는 한국의 건강한 청소년을 대상으로 Rasterstereography를 이용하여 성별에 따른 척추-골반 정렬 패 턴을 분석하여 특성을 확인하고, 각 변수의 상관관계를 확인하기 위하여 수행하였다. 2013년 5월부터 10월까지 정상 청소년 61명(남 31명, 여 30명)을 대상으로 실시하였고, 평균 나이는16.40±2.20세였다. 그 결과 PSIS비율이 남자 21.15±2.40%, 여자 23.41±3.28%로 유의한 차이가 있었으며(p<.01), 요추전만각에서 남자 33.44±8.46°, 여자 38.96±8.11°로 유의한 차이가 있었으나(p<0.01), 그 외의 변수에서 성별에 따른 유의한 차이는 없었다(p>.05). 요추전 만각은 골반기울기(r=.348), 흉추후만각(r=.609)과 유의한 상관관계가 있었다. 척추회전각은 흉추후만각(r=-.278), 요추 전만각(r=-.256), 척추옆치우침(r=.493)과 유의한 상관관계를 보였다. 본 연구 결과는 한국 청소년의 성별에 따른 Rasterstereography를 이용한 척추-골반 정렬 분석의 기초자료가 될 것이고, 척추 및 골반에 구조적 질환을 가진 청소 년과 비교할 수 있는 자료로 활용할 수 있을 것이다. This study investigated the patterns and correlations of spinopelvic alignments in in middle school and high schools students of Gyeongnam areas in Korea using rasterstereography. Sixty-one subjects were recruited from May to October 2013, the average age of subjects was 16.40±2.20 years. In the present results, PSIS ratio was statistically different between the sexes(male 21.15±2.40%, female 23.41±3.28%)(p<.01) and lordotic angle was statistically different between the sexes(male 33.44±8.46°, female 38.96±8.11°)(p<.001), but other parameters were not statistically different between the sexes. However, we verified that lordotic angle was significant correlation separately with pelvic tilt(r=.348), kyphotic angle(r=.609). Surface rotation was significant correlation separately with kyphotic angle(r=-.278), lordotic angle(r=-.256), trunk inclination(r=.493). These finding could be used as basic data research to confirm normal pattern of spinopelvic alignment and balance in health adolescents, and might help understand adolescents with structure problem in spine and pelvis.

시상면 균형과 관련된 골반지표의 방사선학적 특성

김상범,이기수,원유건,전준범,황철목,홍창화 대한척추외과학회 2016 대한척추외과학회지 Vol.23 No.3

연구 계획: 척추 변형의 치료 시 골반지표의 방사선학적 특성에 대한 고찰. 목적: 이 문헌은 척추의 시상 정렬, 골반 지표, 정렬을 측정하는 방법을 평가하고, 이 지표들 사이의 관계를 연구하여 척추의 변형을 이해하고자 한다. 선행문헌의 요약: 척추와 골반의 시상면상 주요 지표들을 파악하고 서로의 상관관계를 아는 것은 여러 가지 척추 질환의 진단과 치료에 있어서 매우 중요하다. 대상 및 방법: 문헌 고찰결과: 골반 및 척추의 지표들은 상호간에 밀접한 상관관계의 양상을 보이므로 시상면 균형을 분석하는데 척추 지표뿐만 아니라 골반 지표를 계측하는 것은 필수적이다. 퇴행성 변화는 정상 척추의 만곡을 손상시킬 가능성이 있고, 이는 시상 부정정렬을 일으키게 된다. 시상 균형의 분석은 척추의 질환을 이해 하는데 중요한 요소이다. 또한, 수술적 치료의 결과는 방사선학적 척추-골반 지표와 이들의 변형의 관계를 이해함으로써 잘 판단 할 수 있다. 결론: 시상 정렬과 균형 그리고 보상기전의 관계를 인지하기 위한 척추와 골반 지표의 이해는 척추 변형의 본질과 이를 치료하는데 있어 포괄적인 개념을제공 한다. Study design: A literature review on the radiologic findings of pelvic parameters for treatment of spinal deformity. Objectives: This review examines sagittal spine alignment, pelvic parameters, and methods for assessing alignment, and examines the relationships among all of these parameters to understand spinal deformity. Summary of Literature Review: Understanding the main pelvic and sagittal spinal parameters and recognizing their correlation is imperative in the diagnosis and treatment of various spinal disorders. Materials and Methods: Review of the literature. Results: As spinal and pelvic parameters tend to have a strong correlation, it is essential to measure not only spinal parameters but also pelvic parameters in analyzing sagittal balance. Degenerative changes have the potential to greatly disrupt the normal curvature of the spine, leading to sagittal malalignment. Analysis of sagittal balance is crucial to optimizing the management of spinal diseases. Improvement in surgical outcomes may be achieved through better understanding of radiographic spino-pelvic parameters and their association with deformity. Conclusions: Understanding spinal and pelvic parameters raises awareness of the relationship among alignment and balance, the soft tissue envelope, and compensatory mechanisms, which will, in turn, provide a more comprehensive understanding of the nature of spinal deformity and the modalities with which it is treated.

Effects of Sagittal Spinopelvic Alignment on Motor Symptom and Respiratory Function in Mild to Moderate Parkinson's disease

Kang, DongYeon,Cheon, SangMyung,Son, MinJi,Sung, HyeRyun,Lee, HyeYoung 대한물리치료학회 2019 대한물리치료학회지 Vol.31 No.2

Purpose: This study examined the effects of sagittal spinopelvic alignment on the clinical parameters, motor symptoms, and respiratory function in patients with mild to moderate Parkinson's disease (PD). Methods: This study was a prospective assessment of treated patients (n=28, Hoehn and Yahr (H&Y) stage 2-3) in a PD center. Twenty-eight subjects ($68.5{\pm}5.7yrs$) participated in this study. The clinical and demographic parameters, including age, sex, symptoms duration, treatment duration, and H&Y stage, were collected. Kinematic analysis was conducted in the upright standing posture with a motion capture system. A pulmonary function test (PFT) was performed in the sitting position using a spirometer. The motor symptoms were assessed on part III of the movement disorder society sponsored version of the unified Parkinson's disease rating scale (MDS-UPDRS). SPSS 18.0 was used to analyze the collected data. Results: The exceeding 12 degrees group of the lower trunk showed significantly higher on the clinical parameters than the below 12 degrees group. In addition, the exceeding 12 degrees group of the lower trunk showed a significantly lower forced expiratory volume at one second (FEV1) / forced vital capacity (FVC) (%) and 25-75% forced mid-expiratory flow (FEF) (L/s) than in the below group. On the other hand, there was no difference in the upper trunk and the cervical pelvis between the groups. Conclusion: These findings suggest that the sagittal balance in the lower trunk is related to the clinical parameters and respiratory function, but not the motor symptoms in patients with mild to moderate PD.

Effects of Sagittal Spinopelvic Alignment on Motor Symptom and Respiratory Function in Mild to Moderate Parkinson`s disease

강문선,천상명,성혜련,이혜영 대한물리치료학회 2019 대한물리치료학회지 Vol.31 No.2

Purpose: This study examined the effects of sagittal spinopelvic alignment on the clinical parameters, motor symptoms, and respiratory function in patients with mild to moderate Parkinson’s disease (PD). Methods: This study was a prospective assessment of treated patients (n=28, Hoehn and Yahr (H&Y) stage 2-3) in a PD center. Twentyeight subjects (68.5±5.7 yrs) participated in this study. The clinical and demographic parameters, including age, sex, symptoms duration, treatment duration, and H&Y stage, were collected. Kinematic analysis was conducted in the upright standing posture with a motion capture system. A pulmonary function test (PFT) was performed in the sitting position using a spirometer. The motor symptoms were assessed on part III of the movement disorder society sponsored version of the unified Parkinson’s disease rating scale (MDS-UPDRS). SPSS 18.0 was used to analyze the collected data. Results: The exceeding 12 degrees group of the lower trunk showed significantly higher on the clinical parameters than the below 12 degrees group. In addition, the exceeding 12 degrees group of the lower trunk showed a significantly lower forced expiratory volume at one second (FEV1) / forced vital capacity (FVC) (%) and 25-75% forced mid-expiratory flow (FEF) (L/s) than in the below group. On the other hand, there was no difference in the upper trunk and the cervical pelvis between the groups. Conclusion: These findings suggest that the sagittal balance in the lower trunk is related to the clinical parameters and respiratory function, but not the motor symptoms in patients with mild to moderate PD.