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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In this article, we summarize our work on understanding the influence of cervical sagittal malalignment on the mechanics of the cervical spine. ⋯ The results of our biomechanical studies have improved our understanding of the impact of cervical sagittal malalignment on pathomechanics of the cervical spine. We believe this improved understanding will assist in clinical decision-making.
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In this paper, the authors propose classifying the epiphenomenon of spinal deformity in two different categories: structural deformity, when the main driver of the observed deformity is a fixed and stiff alteration of the spinal segments, and compensatory deformity, which includes cases where the observed deformity is due to focal abnormalities. This last category comprises, but is not limited to, spinal stenosis, spondylolisthesis, disc herniation, infection or tumor, hip disease or neurological disease (such as Parkinson's disease). ⋯ The compensatory mechanisms involved in adaptive deformity represent an attempt to maintain a global alignment, to escape from pain or to control body posture. These slides can be retrieved under Electronic Supplementary material.
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To review the current understanding and data of sagittal balance and alignment considerations in paraplegic patients. ⋯ Current available literature data have not defined normal sagittal parameters for paraplegic patients. There are significant differences in postural sagittal parameters and muscle activations in paraplegic and non-spinal cord injury patients that can lead to differences in sagittal alignment and balance. Treatment goal in spine surgery for paraplegic patients should address their global function, sitting balance, and ability to perform self-care rather than the accepted radiographic parameters for adult spinal deformity in ambulatory patients.
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Meta Analysis
Incidence and risk factors for postoperative shoulder imbalance in scoliosis: a systematic review and meta-analysis.
This is the first systematic review and meta-analysis to detect the incidence and risk factors for postoperative shoulder imbalance (PSI) in scoliosis. ⋯ The pooled incidence of PSI in scoliosis was 25%. Risser sign, preoperative LC, postoperative RSH, correction rate of PTC at follow-up, correction rate of MTC at follow-up, and LC at follow-up were risk factors for PSI in patients with scoliosis. Adding-on might be a compensatory mechanism for PSI. It is recommended that (1) sufficient correction of PTC and moderate correction of MTC and LC in the operation should be performed; (2) PSI should be prevented not only for the patients' postoperative appearance, but also for preventing the adding-on phenomenon.
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Cervical spine is part of the spine with the most mobility in the sagittal plane. It is important for surgeons to have reliable, simple and reproducible parameters to analyse the cervical. ⋯ The most important parameters to analyse the cervical sagittal balance according to the literature available today for good clinical outcomes are the following: C7 or T1 slope, average value 20°, must not be higher than 40°. cSVA must not be less than 40°C (mean value 20 mm). SCA (spine cranial angle) must stay in a norm (83° ± 9°). Future studies should focus on those three parameters to analyse and compare pre and post op data and to correlate the results with the quality of life improvement.