• Journal of Korean Neurosurgical Society
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• v.56 no.4
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• pp.315-322
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• 2014

Objective : Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. Methods : A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. Results : A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance ($R^2=0.286$, p=0.0005). Conclusion : Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back.

• Asian Spine Journal
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• v.12 no.6
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• pp.1037-1042
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• 2018

Study Design: Retrospective study. Purpose: This study aimed to investigate whether segmental lumbar hyperlordosis of the affected vertebra in patients with spondylolysis occurs only at L5 or also occurs at L4. Overview of Literature: To the best of our knowledge, increase in segmental lordosis of the spondylolytic vertebrae has only been investigated in bilateral L5 spondylolysis; it has not been examined at different levels of bilateral spondylolysis. According to the characteristics of segmental lordosis in bilateral L5 spondylolysis, patients with bilateral L4 spondylolysis may also have increased segmental lordosis of the L4 vertebra. Methods: Patients with bilateral spondylolysis of the L5 or L4 vertebra in 2013-2015 were retrospectively identified from the hospital database. Standing lateral lumbar radiographs were assessed for the angle of segmental lordosis of the L5 and L4 vertebra, sacral slope, and lumbar lordosis. The differences in segmental lordosis of the L5 and L4 vertebra, sacral slope, and lumbar lordosis were determined using non-paired Student t-test. Results: Overall, 15 cases of bilateral L4 spondylolysis and 41 cases of bilateral L5 spondylolysis satisfied the inclusion and exclusion criteria. Lordosis of the L4 vertebra was significantly greater in the bilateral L4 spondylolysis group ($24.2^{\circ}{\pm}7.0^{\circ}$) than that in the L5 spondylolysis group ($20.3^{\circ}{\pm}6.1^{\circ}$, p=0.047). Lordosis of the L5 vertebra was significantly lower in the L4 spondylolysis group ($27.7^{\circ}{\pm}8.2^{\circ}$) than that in the L5 spondylolysis group ($32.5^{\circ}{\pm}7.3^{\circ}$, p=0.040). The sacral slope and lumbar lordosis did not significantly differ between the groups. Conclusions: Adolescent patients with bilateral spondylolysis have segmental hyperlordosis of the affected vertebra not only at the L5 level but also at the L4 level.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.4 no.2
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• pp.13-20
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• 2009

Objectives : The purpose of this study was to investigate the Correlation between Pelvic angle and the Tibiofemoral angle in the Genu varum. Method : Age of All subjects were 20-37 years. 33(male 10, female 23) subjects were assessed by whole spine x-ray and orthogram. The collected data consisted of items on general characteristics, Pelvic Incidence(PI), Pelvic Tilt(PT), Sacral Slope(SS) and Tibiofemoral Angle(TFA) of the subjects. Results : The PI, PT and TFA had a relationship significantly. However, there was no relationship between SS and TFA. Conclusion : The results suggest that TFA is related to PI, PT. Internal rotation due to genu varum of femoral at hip influence that PI and PT increase.

• Journal of radiological science and technology
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• v.45 no.5
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• pp.391-396
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• 2022

The purpose of this study was to investigate the effect of cross arms and palms facing forward on spinopelvic parameters during the whole spine lateral radiography. In addition, we would like to present the usefulness of a posture with the palm facing forward during whole spine lateral radiography of the spine using EOS. The subjects of this study were images of a total of 50 patients (18 males, 32 females) who whole spine lateral radiography using the conventional method and the EOS method from October 2020 to March 2021. The posture used in this study was set as 'CAP' for cross arms and 'PUSH' for posture with palms facing forward. In this study, among the spinal stability factors, thoracic kyphosis (thoracic vertebrae 4 to 12), lumbar lordosis (lumbar vertebrae 1 to sacrum 1), sagittal vertical axis, sacral slope, and shoulder flexion angle were compared on average. The mean thoracic kyphosis was 34.52±12.46° for CAP and 28.46±10.81° for PUSH (p<0.01). The lumbar lordosis of CAP was 42.45±17.45°and that of PUSH was 40.56±16.14°(p>0.57). The sagittal vertical axis was 26.59±34.34 mm in CAP and 21.21±35.41 mm in PUSH (p>0.44). In CAP, the sacral slope was 30.96±10.29°, and in PUSH, it was 31.01±10.19° (p>0.98). shoulder flexion angle was 38.31±8.24° for CAP and 26,08±6.71° for PUSH(p<0.01). As a result of this study, the PUSH posture is considered to be a posture that can minimize the shoulder flexion angle and can perform a stable examination while minimizing changes in spino-pelvic parameter.

• Journal of Korean Neurosurgical Society
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• v.54 no.3
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• pp.207-210
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• 2013

Objective : To compare spinopelvic parameters in young adult patients with spondylolysis to those in age-matched patients without spondylolysis and investigate the clinical impact of sagittal spinopelvic parameters in patients with L5 spondylolysis. Methods : From 2009 to 2012, a total of 198 young adult male patients with spondylolysis were identified. Eighty age-matched patients without spondylolysis were also selected. Standing lateral films that included both hip joints were obtained for each subject. Pelvic incidence (PI), sacral slope (SS), pelvic tilt, lumbar lordosis angle, sacral inclination, lumbosacral angle, and sacral table angle were measured in both groups. A comparative study of the spinopelvic parameters of these two groups was performed using SPSS 15.0 (SPSS Inc., Chicago, IL, USA). Results : Among the aforementioned spinopelvic parameters, PI, SS and STA were significantly different between patients with spondylolysis and those without spondylolysis. PI and SS were higher in the spondylolysis group than in the control group, but STA was lower in the spondylolysis group than in the control group. Conclusion : PI and SS were higher in the spondylolysis group than in the control group, but STA was lower in the spondylolysis group than in the control group. Patients with spondylolysis have low STA at birth, which remains constant during growth; a low STA translates into high SS. As a result, PI is also increased in accordance with SS. Therefore, we suggest that STA is an important etiologic factor in young adult patients with L5 spondylolysis.

• Journal of Korean Society of Industrial and Systems Engineering
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• v.35 no.4
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• pp.10-15
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• 2012

The Mahalanobis-Taguchi System is a diagnosis and predictive method for analyzing patterns in multivariate cases. The goal of this study is diagnosis of the spondylolisthesis from biomedical data that is derived from the shape and orientation of the pelvis and lumbar spine. The data set has six attributes including pelvic incidence, pelvic tilt, lumbar lordosis angle, sacral slope, pelvic radius and grade of spondylolisthesis and two class including normal and abnormal. From University of California at Irvine machine learning repository, 100 normal and 150 spondylolisthesis patient's data were used for this study. Mahalanobis Taguchi System (MTS) application process and the diagnosis results were described in this paper.

• Journal of Korean Medicine Rehabilitation
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• v.20 no.3
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• pp.93-107
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• 2010

Objectives : The purpose of this study was to assess the efficacy of Chuna and taping treatment in patients with genu varum. Methods : Twenty-seven patients(male:10, female:17) with genu varum were recruited in this study. Chuna treatment at pelvic, and taping treatment at both legs were applied to whole participants. Outcomes were assessed using Q-angle(Quadriceps angle, QA), tibiofemoral angle(TFA), width and length of lesser trochanter(LT), pelvic incidence(PI), pelvic(PT), sacral slope(SS), lumber lordosis angle(LLA), meridian-electromyography(MEMG), Korean western ontario and McMaster universities osteoarthritis index(KWOMAC), and distance of femoral intercondylar distance(ICD). Results : 1. QA, LT width and LT length in radiograph were significantly increased. 2. PI, SS, PT and TFA in radiograph were significantly decreased. 3. The left vastus medialis portion contraction of female was significantly decreased after treatment. 4. The left rectus femoris portion fatigue was significantly decreased after treatment in male subjects. 5. The vastus medialis portion fatigue was significantly decreased after treatment in female subjects. 6. The distance of femoral ICD was significantly decreased. Conclusions : This study showed that Chuna and taping treatment could be used as an effective method for the treatment of genu varum.

• Journal of Korean Neurosurgical Society
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• v.53 no.2
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• pp.96-101
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• 2013

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.

• Journal of Korean Neurosurgical Society
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• v.54 no.3
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• pp.201-206
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• 2013

Objective : To investigate the sagittal sacropelvic morphology and balance of the patients with SIJ pain following lumbar fusion. Methods : Among 452 patients who underwent posterior lumbar interbody fusion between June 2009 and January 2013, patients with postoperative SIJ pain, being responded to SIJ block were enrolled. For a control group, patients matched for sex, age group, the number of fused level and fusion to sacrum were randomly selected. Patients were assessed radiologic parameters including lumbar lordosis, pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). To evaluate the sagittal sacropelvic morphology and balance, the ratio of PT/PI, SS/PI and PT/SS were analyzed. Results : A total of 28 patients with SIJ pain and 56 patients without SIJ pain were assessed. Postoperatively, SIJ pain group showed significantly greater PT (p=0.02) than non-SIJ pain group. Postoperatively, PT/PI and SS/PI in SIJ pain group was significantly greater and smaller than those in non-SIJ pain group respectively (p=0.03, 0.02, respectively) except for PT/SS (p=0.05). SIJ pain group did not show significant postoperative changes of PT/PI and SS/PI (p=0.09 and 0.08, respectively) while non-SIJ pain group showed significantly decrease of PT/PI (p=0.00) and increase of SS/PI (p=0.00). Conclusion : This study presents different sagittal sacropelvic morphology and balance between the patients with/without SIJ pain following lumbar fusion surgery. The patients with SIJ pain showed retroversed pelvis and vertical sacrum while the patients without SIJ pain have similar morphologic features with asymptomatic populations in the literature.

• Journal of Korean Neurosurgical Society
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• v.55 no.6
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• pp.331-336
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• 2014

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.