European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Multicenter Study
Sagittal spinopelvic alignment in 654 degenerative spondylolisthesis.
Degenerative spondylolisthesis (DS) is common degenerative spinal disease. Recent studies highlighted relationship between DS and high pelvic incidence (PI). Moreover, impact of spinopelvic alignment on clinical outcomes has been emphasized. We aimed at describing epidemiologic and sagittal spinopelvic parameters in patients with DS, comparing them with asymptomatic volunteers, and determining a classification of DS patients. ⋯ Predominance of high PI and female gender was emphasized in DS population. Moreover, these findings highlighted the importance of sagittal alignment analysis in DS with 24 % of patients with anterior malalignment and in the remaining 76 % (normal C7Tilt), more than 50 % had pelvic retroversion. Consequently, DS sagittal malalignment should lead to specific surgical correction adapted to each subgroup of patients.
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Comparative Study
Comparison of radiographic sagittal spinopelvic alignment between skeletally immature and skeletally mature individuals with Scheuermann's disease.
The aim of this study was to compare radiographic sagittal spinopelvic parameters between skeletally immature and skeletally mature patients with Scheuermann's disease (SD). ⋯ There is no significant difference in sagittal spinopelvic parameters between skeletally immature and mature subjects with SD. Pelvic incidence in both groups of SD patients was significantly lower than PI in normal children, adolescents, and adults. This challenges the role of PI in predicting desired LL in patients with SD.
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To analyze the disc hydration and volumetric changes of the intervertebral disc after scoliosis surgery depending on the sagittal spino-pelvic organization. ⋯ This prospective MRI study showed a significant and sustainable improvement in T2 hypersignal of the disc, indirectly indicating improvement of disc hydration content after AIS surgery. Analysis of disc volumetric changes according to the pelvic incidence suggests that these changes are under the influence of the sagittal spino-pelvic alignment. PI seems to play a key role in the homeostasis of the discs under fusion and should be taken into account for preoperative planning. The restoration of the lumbo-pelvic congruence may help to limit early degenerative changes in the free-motion segment discs after AIS surgery. Hydration content was less sensitive to surgery when PI was high, suggesting higher shear stress in the lower discs. Longer follow-up is required to confirm this hypothesis.
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Alignment of the cervical spine (CS) in adolescent idiopathic scoliosis (IS) as well as in asymptomatic adult populations has recently been studied and described as being less lordotic in the adolescent IS population. However, few studies have examined the sagittal alignment of the CS in adult IS or its association with other radiological variables and clinical relevance. The aim of this study is to analyse the sagittal alignment of CS in adult IS and its association with age, alignment of the thoracic, lumbar and global spinal column as well as health-related quality of life (HRQOL) parameters. ⋯ The sagittal alignment of the CS in adult IS is less lordotic than the normal average while less kyphotic than that of IS of a younger age. It correlates with age, thoracic kyphosis and some global sagittal alignment parameters. These findings suggest that CS alignment is likely a component of the global sagittal alignment strongly affected by thoracic kyphosis, and most probably does not affect HRQOL by itself.
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To explore the relationship between cervical spine and the global spine alignment and to postulate the hypotheses that a lordotic alignment of cervical spine is not the only standard to identify asymptomatic subjects, and the degenerative modification of cervical curves depends primarily on their spinal-pelvic alignment. ⋯ The cervical alignment correlates with their global spine and pelvic curves. And lordosis is not the only presentation in asymptomatic subjects. The degenerative modification of cervical disc angles was the compensation of global spine degeneration for horizontal gaze. Cervical angles are influenced by their TK angles, occipital-C2 joint and the tilt of T1 vertebral body. The occipital-C2 joint has a compensating mechanism in all Roussouly types in cervical spondylosis.