This review article summarizes research from the Spinal Deformity Study Group on classifying spondylolisthesis based on sagittal spinopelvic alignment. The classification defines 6 types based on grade of slip, pelvic incidence, and spino-pelvic alignment. Research found abnormal pelvic and spinal parameters in spondylolisthesis patients compared to controls. For low grade slips, some have increased pelvic tilt and lordosis ("shear" type) while others have decreased parameters ("nutcracker" type). High grade slips were found to have two alignment subgroups - a "balanced" group standing with high sacral slope and a "retroverted/unbalanced" group with low sac
—Kyphosis and lordosis changes might be related to back extensor weakness and osteoporosis. The purpose of this study was to find out the correlations between thoracic kyphosis, lumbar lordosis with back extensor strength (BES) and bone mineral density (BMD). Methods: Thoracic kyphosis, lumbar lordosis, maximal isometric strength of the back extensors and BMD of the lumbar vertebral were evaluated in 47 elderly (50-75 years old)women. BMD of the lumbar vertebral was measured using Dual-Energy X-Ray Absorptiometry (DEXA) and kyphosis and lordosis degree were assayed using a flexible ruler. The maximal isometric strength of the back extensors was measured using an isometric manual muscle tester (MMT). Data were analyzed using ANOVA and independent t-test at p≤0.05 level of acceptance. Results: A significant reverse correlation was shown between BES and kyphosis (p=0.044, r=-0.30). No significant correlation were found between BES and lordosis degree, nor between lumbar vertebral BMD and, both, kyphosis and lordosis degrees. However, there was a significant difference in BES between three groups with various degree of kyphosis (p≤ 0.05). Conclusion: It can be concluded that the severity of thoracic kyphosis may be influenced by BES. So, stronger back extensor can prevent thoracic kyphosis despite decreased BMD.
This study aims to investigate the relationship between posture, spinal balance, muscle fatigue, and symptoms in patients with lumbar spinal stenosis before and one year after surgery. Over 120 patients will undergo clinical assessments, questionnaires, radiological imaging, biomechanical testing, and activity monitoring at baseline, 6 months post-op, and 1 year post-op. Biomechanical testing will involve measuring posture and gait with and without induced paraspinal muscle fatigue. The study aims to determine if outcomes correlate with severity of stenosis, muscle degeneration, compensation strategies, and changes after surgery. Results may help understand the condition and guide treatment and rehabilitation.
Selective fusion for idiopathic scoliosis review by dr.shashidhar b kDr. Shashidhar B K
SCOLIOISIS SURGEON BANGALORE
SCOLIOSIS SURGEON INDIA
Website: http://spinesurgeonbangalore.com/
My goal is to provide spine care with a patient centeric-holistic approach in Bangalore, encompassing all aspects of non-operative and operative management of spinal disorders with special interest in the management of spinal deformities (scoliosis and kyphosis).
Bangalore Spine Specilaist Clinic. For Appointment contact : Call: 08025442552( 9 am to 9 pm). Whatsapp: +919448311068. Email: drshashidharbk@gmail.com.
This study examined whether hip involvement negatively impacts radiographic outcomes after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis patients with thoracolumbar kyphosis. 44 patients underwent one-level lumbar PSO and were divided into two groups based on their hip involvement scores. Both groups had similar corrections of local kyphosis, but the group with hip involvement had significantly larger sagittal vertical axis and pelvic tilt postoperatively, indicating hip involvement can negatively impact radiographic outcomes after lumbar PSO. Additional osteotomies may be needed for patients with hip involvement to achieve satisfactory correction.
The document discusses variations in the number of sacral pieces, which can range from 4 to 6, occasionally 7. It analyzes 30 sacra and finds the number of pieces varies from 4 to 6, with abnormalities including sacralization of L5, lumbarization of S1, and incorporation of the coccyx. These variations are associated with changes in spine biomechanics and low back pain.
The document summarizes the natural aging process of the spine over time. It discusses how the spine's curves and range of motion change with age. The pelvis also changes orientation, causing the lumbar lordosis to decrease and thoracic kyphosis to increase. These changes are due to disc degeneration and loss of muscle strength/tone. Understanding interactions between genes and lifestyle may help delay the aging process of the spine.
Age related change in strength, joint laxity, and walking patterns. are they ...FUAD HAZIME
1) The study examined age-related changes in knee laxity, quadriceps strength, and walking patterns in young, middle-aged, and older adults without knee OA, and compared them to individuals with knee OA.
2) They found that older adults had weaker quadriceps strength compared to younger groups, but knee laxity was only greater in those with OA and not different between middle-aged and older controls.
3) During walking, older adults exhibited greater quadriceps activity but similar knee motion compared to younger groups, unlike those with OA who had less knee flexion and more knee adduction.
Assessment of the Muscle Strength and Range of
Motion Ankle in Boys With and Without Flatfoot by Kasbparast Mehdi in Research & Investigations in Sports Medicine
—Kyphosis and lordosis changes might be related to back extensor weakness and osteoporosis. The purpose of this study was to find out the correlations between thoracic kyphosis, lumbar lordosis with back extensor strength (BES) and bone mineral density (BMD). Methods: Thoracic kyphosis, lumbar lordosis, maximal isometric strength of the back extensors and BMD of the lumbar vertebral were evaluated in 47 elderly (50-75 years old)women. BMD of the lumbar vertebral was measured using Dual-Energy X-Ray Absorptiometry (DEXA) and kyphosis and lordosis degree were assayed using a flexible ruler. The maximal isometric strength of the back extensors was measured using an isometric manual muscle tester (MMT). Data were analyzed using ANOVA and independent t-test at p≤0.05 level of acceptance. Results: A significant reverse correlation was shown between BES and kyphosis (p=0.044, r=-0.30). No significant correlation were found between BES and lordosis degree, nor between lumbar vertebral BMD and, both, kyphosis and lordosis degrees. However, there was a significant difference in BES between three groups with various degree of kyphosis (p≤ 0.05). Conclusion: It can be concluded that the severity of thoracic kyphosis may be influenced by BES. So, stronger back extensor can prevent thoracic kyphosis despite decreased BMD.
This study aims to investigate the relationship between posture, spinal balance, muscle fatigue, and symptoms in patients with lumbar spinal stenosis before and one year after surgery. Over 120 patients will undergo clinical assessments, questionnaires, radiological imaging, biomechanical testing, and activity monitoring at baseline, 6 months post-op, and 1 year post-op. Biomechanical testing will involve measuring posture and gait with and without induced paraspinal muscle fatigue. The study aims to determine if outcomes correlate with severity of stenosis, muscle degeneration, compensation strategies, and changes after surgery. Results may help understand the condition and guide treatment and rehabilitation.
Selective fusion for idiopathic scoliosis review by dr.shashidhar b kDr. Shashidhar B K
SCOLIOISIS SURGEON BANGALORE
SCOLIOSIS SURGEON INDIA
Website: http://spinesurgeonbangalore.com/
My goal is to provide spine care with a patient centeric-holistic approach in Bangalore, encompassing all aspects of non-operative and operative management of spinal disorders with special interest in the management of spinal deformities (scoliosis and kyphosis).
Bangalore Spine Specilaist Clinic. For Appointment contact : Call: 08025442552( 9 am to 9 pm). Whatsapp: +919448311068. Email: drshashidharbk@gmail.com.
This study examined whether hip involvement negatively impacts radiographic outcomes after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis patients with thoracolumbar kyphosis. 44 patients underwent one-level lumbar PSO and were divided into two groups based on their hip involvement scores. Both groups had similar corrections of local kyphosis, but the group with hip involvement had significantly larger sagittal vertical axis and pelvic tilt postoperatively, indicating hip involvement can negatively impact radiographic outcomes after lumbar PSO. Additional osteotomies may be needed for patients with hip involvement to achieve satisfactory correction.
The document discusses variations in the number of sacral pieces, which can range from 4 to 6, occasionally 7. It analyzes 30 sacra and finds the number of pieces varies from 4 to 6, with abnormalities including sacralization of L5, lumbarization of S1, and incorporation of the coccyx. These variations are associated with changes in spine biomechanics and low back pain.
The document summarizes the natural aging process of the spine over time. It discusses how the spine's curves and range of motion change with age. The pelvis also changes orientation, causing the lumbar lordosis to decrease and thoracic kyphosis to increase. These changes are due to disc degeneration and loss of muscle strength/tone. Understanding interactions between genes and lifestyle may help delay the aging process of the spine.
Age related change in strength, joint laxity, and walking patterns. are they ...FUAD HAZIME
1) The study examined age-related changes in knee laxity, quadriceps strength, and walking patterns in young, middle-aged, and older adults without knee OA, and compared them to individuals with knee OA.
2) They found that older adults had weaker quadriceps strength compared to younger groups, but knee laxity was only greater in those with OA and not different between middle-aged and older controls.
3) During walking, older adults exhibited greater quadriceps activity but similar knee motion compared to younger groups, unlike those with OA who had less knee flexion and more knee adduction.
Assessment of the Muscle Strength and Range of
Motion Ankle in Boys With and Without Flatfoot by Kasbparast Mehdi in Research & Investigations in Sports Medicine
This document summarizes key aspects of spinal alignment evaluation. It describes normal cervical, thoracic, thoracolumbar, and lumbar spinal curves. Spinal balance is defined as maintaining the center of gravity over the base of support with minimal postural sway. Key parameters for evaluating sagittal alignment include sagittal vertical axis, Cobb's method, pelvic incidence, pelvic tilt, sacral slope, PI-LL mismatch, global sagittal axis, and lower extremity compensation. Maintaining these alignment parameters is important for spinal health and function.
1) The study compared muscle activity in the thoracic and lumbar erector spinae muscles and spinal curvature during prone trunk extension exercises between subjects with and without slouched thoracic posture.
2) While total erector spinae muscle activity did not differ between groups, subjects with slouched posture showed decreased selective recruitment of the thoracic erector spinae pars thoracis muscle and increased thoracic kyphosis and lumbar lordosis during the exercises.
3) The findings suggest exercises to strengthen the back in individuals with slouched posture need to maintain a neutral spine posture and facilitate muscle activity in the thoracic erector spinae to be effective.
This document discusses sacroiliac joint dysfunction. It covers anatomy of the sacrum, sacral motions including nutation and counter nutation, and types of sacral somatic dysfunction. Diagnosis involves history, physical exam including special tests like Faber, Gillett and Yeoman's tests, and sacroiliac joint injections which are the gold standard. Management can include soft tissue techniques, muscle energy techniques, counterstrain and other osteopathic manipulative medicine.
12-year-old Male with Slipped Capital Femoral Epiphysis_ CurranCara Curran
This case report describes a 12-year-old male who presented to physical therapy 10 weeks post-op for an in-situ pinning procedure on his right hip due to a stable slipped capital femoral epiphysis. He had a history of hypothyroidism and obesity. Physical therapy focused on reducing pain and improving mobility, strength, and coordination through manual therapy, exercises, and neuromuscular retraining. Outcome measures showed a 72% increase on the Modified Harris Hip Score and decreased risk of injury on the Star Excursion Balance Test by the end of treatment. The report provides insight into examining and treating similar pediatric orthopedic patients.
Isthmic spondylolisthesis is caused by a defect in the pars interarticularis that results in the anterior displacement of one vertebra on another. It commonly occurs at L5-S1 due to repetitive extension stresses. While often asymptomatic, it can cause back pain and radiculopathy. Diagnosis involves imaging like CT or MRI to view the pars defect. Treatment begins conservatively with rest, medication, and physical therapy. Surgery with fusion and instrumentation may be considered for persistent or progressive symptoms. Key factors like pelvic incidence correlate with severity and influence biomechanical stresses on the lumbar spine.
1) The study examined whether individuals with patella alta experience higher patellofemoral joint stress during walking compared to pain-free controls.
2) Magnetic resonance images and gait analysis were used to calculate subject-specific knee biomechanics and patellofemoral joint stress during normal and fast walking speeds.
3) During fast walking, individuals with patella alta had significantly less patellofemoral joint contact area and significantly higher joint stress compared to controls, due to reductions in contact area while joint reaction forces were similar between groups.
1. Interspinous process spacers are implants placed between adjacent lumbar spinous processes as a less invasive alternative to spinal fusion surgery. They are designed to preserve motion while reducing pain by decreasing pressure on spinal discs and facets.
2. Biomechanical studies show that spacers reduce intradiscal pressure and facet joint contact area at implanted levels without affecting adjacent segments. Clinical reports also suggest spacers provide short-term symptom improvement for appropriately selected patients.
3. However, concerns exist that the spacers may cause local pain over time and weaken spinal stability by disrupting ligaments and maintaining facet joints in distraction. Further research is still needed to establish the long-term efficacy and safety of interspin
Comparison of 3 d shoulder complex kinematic part 1Satoshi Kajiyama
This study compared shoulder complex kinematics between individuals with and without shoulder pain. Transcortical bone pins were inserted into the clavicle, scapula, and humerus of 12 asymptomatic and 10 symptomatic individuals. Angular positions of the sternoclavicular, acromioclavicular, and scapulothoracic joints were measured during shoulder motions. Differences were found between groups for sternoclavicular and scapulothoracic joint positions, with symptomatic individuals demonstrating less sternoclavicular posterior rotation and scapulothoracic upward rotation. However, the magnitude of differences was small and clinical implications are not fully understood.
Assessing the Relationship between Body Composition and Spinal Curvatures in ...peertechzpublication
This study investigated the relationship between body composition and spinal curvatures in young adults. Body composition analysis was performed on 67 participants to determine ratios of total fat, body fat, visceral fat, and total muscle. Spinal curvatures of the thoracic and lumbar regions were also measured. The results showed a significant positive correlation between total fat ratio and lumbar lordosis, as well as between visceral fat ratio and lumbar lordosis. Thoracic kyphosis was positively correlated with total fat ratio and visceral fat ratio. Total muscle ratio showed a negative correlation with lumbar lordosis and thoracic kyphosis. The study suggests that increased fat ratios and decreased muscle ratios can shift spinal alignment in a way that may negatively impact
This study examined differences in strength and activation timing of the ankle dorsiflexors and evertors between individuals with functionally unstable ankles and uninjured controls using a stretch-shortening cycle protocol. 30 subjects (15 with unilateral ankle instability and 15 controls) performed concentric contractions of the ankle muscles at two speeds on an isokinetic dynamometer. The study found no significant differences in peak torque normalized to body weight or time to peak torque between the groups. This suggests that differences in strength and muscle activation timing during the stretch-shortening cycle do not exist between those with and without ankle instability.
This study examined the relationship between lumbar scoliosis and osteoporosis in postmenopausal women. The researchers analyzed dual-energy x-ray absorptiometry (DXA) scans of 900 randomly selected postmenopausal women aged 64-88 years old. They measured the Cobb angle to assess lumbar scoliosis and bone mineral density at the femoral neck, total hip, and spine to assess osteoporosis. They found that both the incidence and degree of lumbar scoliosis, defined as a Cobb angle over 10 degrees, increased significantly with age. However, after adjusting for covariates like age, weight and ethnicity, there was no significant association between bone mineral density at any site and the Cobb angle.
This case study describes a 56-year-old female seen for physical therapy two months post lumbar laminectomy and fusion surgery. Despite surgery and prior physical therapy, she continued to experience right lower extremity weakness, hip stiffness, and pain with sitting, standing, and activities. A physical examination revealed decreased hip strength and range of motion on the right side. Due to persistent groin pain and minimal functional improvements, the physical therapist referred the patient to an orthopedic specialist who diagnosed severe right hip osteoarthritis requiring hip replacement surgery. Following hip surgery, the patient's pain and function significantly improved.
This research report studied the influence of the depth of the trochlear groove on patellar kinematics in subjects with and without patellofemoral pain (PFP). 23 women with PFP and 12 women without PFP underwent kinematic magnetic resonance imaging during resisted knee extension. The depth of the trochlear groove was found to correlate with increased lateral patellar tilt and displacement at certain flexion angles in subjects with PFP. Shallower trochlear grooves were predictive of abnormal patellar tracking patterns. The results indicate that bony structure influences patellar kinematics and is an important determinant of patellar alignment, especially near full extension.
Scapular dyskinesis refers to abnormal static positioning or dynamic motion of the scapula during arm elevation and is associated with shoulder injury. It has multiple potential causes including muscle weakness or imbalance. The document discusses the muscular attachments of the scapula, types of scapular dyskinesis, its effects on dynamic stability and shoulder strength, assessment methods, and rehabilitation treatments focusing on strengthening the lower trapezius and serratus anterior muscles to achieve optimal scapular positioning.
This study examined core stability measures in male and female athletes to determine if these measures predict lower extremity injury risk. The study tested hip abduction, external rotation, trunk endurance, and abdominal strength in 80 female and 60 male athletes. Males showed greater strength and endurance compared to females. Athletes who avoided injury also showed greater hip strength. Logistic regression revealed that weaker hip external rotation predicted injury risk. The study suggests that improving core stability may help prevent lower extremity injuries, especially in female athletes.
This study evaluated the ability of rasterstereography to detect changes in posture induced by different neuromuscular stimulation techniques and proprioceptive insoles. 27 healthy volunteers underwent rasterstereography to measure 14 posture parameters under 6 test conditions: normal stance, foot elevation, foot exercises, loose jaw, biting, and wearing proprioceptive insoles. Rasterstereography measurements had low variability. Several posture parameters showed significant changes between test conditions, indicating that neuromuscular stimulation and insoles induce detectable postural shifts. Proprioceptive insoles specifically altered lateral spine deviation, demonstrating rasterstereography's sensitivity to subtle posture variations.
This case report describes the conservative treatment of a 40-year-old female patient presenting with a left ipsilateral sciatic scoliosis using McKenzie method physical therapy techniques over 17 sessions in 3 months. The patient's lateral shift deformity and lower extremity pain resolved, muscle weakness improved, and disability levels decreased substantially. Corrective side glide mobilizations and self-techniques were effective at reducing the disc protrusion and decompressing the nerve root, resolving the patient's symptoms and abnormal posture.
Spinal Functioning and the Vestibular System_Kauffman_InserviceJere Hess
The document discusses the relationship between back pain and the vestibular system. It provides information on spine anatomy and how poor posture can lead to back pain. It notes that back pain is a leading cause of disability. The vestibular system controls balance, spatial orientation, and upright posture. Two studies are summarized that show older adults with neck pain have poorer balance and rely more on the vestibular system for stability compared to controls without neck pain. The document suggests strengthening the vestibular system may help correct mechanical issues that lead to poor posture and back pain.
Adjacent segment degeneration is a common complication following lumbar fusion surgery. It occurs when the vertebral segments above or below the fused portion of the spine deteriorate over time due to increased stress and abnormal biomechanics. Risk factors include older age, smoking, obesity, female gender, number of fused levels, preexisting degeneration, and abnormal spinal alignment. Symptoms range from asymptomatic radiographic changes to back pain and neurogenic symptoms. Treatment depends on the severity of symptoms and may involve conservative care, injections, or additional surgery.
Differences in landing and balance deficits at the ankle joint on stable and ...AJHSSR Journal
ABSTRACT: A flexible ankle joint is suggested to be a contributing factor for sport performance, body
control. The purpose of the present study was to investigate the differences in proprioception in static and
dynamic movements between subjects with good ankle joint mobility (FL) and poor ankle joint mobility (IN) in
male adolescent handball players. The dorsiflexion and plantarflexion of the ankle ROM was measured, at knee
extension angle of 120°, with a goniometer. 26 male handball players participated (21.1 ± 4 yrs, 80.8 ± 10 kg,
182 ± 7.38 cm). Furthermore, the players fulfilling previously recommended criteria were assigned to the
flexible (n = 6) and inflexible (n = 6) groups and executed two test of static and dynamic movement (BESS Test
and Star Excursion Balance Test). Results of the T TEST on IMB SPSS 26 revealed a significant (p < 0.05)
group effect as (FL) group had less errors than (IN) group on BESS test. In addition, the results of the total sum
on stable and unstable surface in star excursion test showed significant differences in the directions:
anterolateral (7.4), posterolateral (8.6), posteromedial (7.9), medial (10.8) and anterior medial (8.1). In
conclusion, there is a correlation between poor ankle joint mobility and poor proprioception, balance control and
athletic movements.
KEYWORDS: ankle stability, ankle joint mobility, BESS test, handball athletes, injury risk, star excursion
balance test
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
This document summarizes key aspects of spinal alignment evaluation. It describes normal cervical, thoracic, thoracolumbar, and lumbar spinal curves. Spinal balance is defined as maintaining the center of gravity over the base of support with minimal postural sway. Key parameters for evaluating sagittal alignment include sagittal vertical axis, Cobb's method, pelvic incidence, pelvic tilt, sacral slope, PI-LL mismatch, global sagittal axis, and lower extremity compensation. Maintaining these alignment parameters is important for spinal health and function.
1) The study compared muscle activity in the thoracic and lumbar erector spinae muscles and spinal curvature during prone trunk extension exercises between subjects with and without slouched thoracic posture.
2) While total erector spinae muscle activity did not differ between groups, subjects with slouched posture showed decreased selective recruitment of the thoracic erector spinae pars thoracis muscle and increased thoracic kyphosis and lumbar lordosis during the exercises.
3) The findings suggest exercises to strengthen the back in individuals with slouched posture need to maintain a neutral spine posture and facilitate muscle activity in the thoracic erector spinae to be effective.
This document discusses sacroiliac joint dysfunction. It covers anatomy of the sacrum, sacral motions including nutation and counter nutation, and types of sacral somatic dysfunction. Diagnosis involves history, physical exam including special tests like Faber, Gillett and Yeoman's tests, and sacroiliac joint injections which are the gold standard. Management can include soft tissue techniques, muscle energy techniques, counterstrain and other osteopathic manipulative medicine.
12-year-old Male with Slipped Capital Femoral Epiphysis_ CurranCara Curran
This case report describes a 12-year-old male who presented to physical therapy 10 weeks post-op for an in-situ pinning procedure on his right hip due to a stable slipped capital femoral epiphysis. He had a history of hypothyroidism and obesity. Physical therapy focused on reducing pain and improving mobility, strength, and coordination through manual therapy, exercises, and neuromuscular retraining. Outcome measures showed a 72% increase on the Modified Harris Hip Score and decreased risk of injury on the Star Excursion Balance Test by the end of treatment. The report provides insight into examining and treating similar pediatric orthopedic patients.
Isthmic spondylolisthesis is caused by a defect in the pars interarticularis that results in the anterior displacement of one vertebra on another. It commonly occurs at L5-S1 due to repetitive extension stresses. While often asymptomatic, it can cause back pain and radiculopathy. Diagnosis involves imaging like CT or MRI to view the pars defect. Treatment begins conservatively with rest, medication, and physical therapy. Surgery with fusion and instrumentation may be considered for persistent or progressive symptoms. Key factors like pelvic incidence correlate with severity and influence biomechanical stresses on the lumbar spine.
1) The study examined whether individuals with patella alta experience higher patellofemoral joint stress during walking compared to pain-free controls.
2) Magnetic resonance images and gait analysis were used to calculate subject-specific knee biomechanics and patellofemoral joint stress during normal and fast walking speeds.
3) During fast walking, individuals with patella alta had significantly less patellofemoral joint contact area and significantly higher joint stress compared to controls, due to reductions in contact area while joint reaction forces were similar between groups.
1. Interspinous process spacers are implants placed between adjacent lumbar spinous processes as a less invasive alternative to spinal fusion surgery. They are designed to preserve motion while reducing pain by decreasing pressure on spinal discs and facets.
2. Biomechanical studies show that spacers reduce intradiscal pressure and facet joint contact area at implanted levels without affecting adjacent segments. Clinical reports also suggest spacers provide short-term symptom improvement for appropriately selected patients.
3. However, concerns exist that the spacers may cause local pain over time and weaken spinal stability by disrupting ligaments and maintaining facet joints in distraction. Further research is still needed to establish the long-term efficacy and safety of interspin
Comparison of 3 d shoulder complex kinematic part 1Satoshi Kajiyama
This study compared shoulder complex kinematics between individuals with and without shoulder pain. Transcortical bone pins were inserted into the clavicle, scapula, and humerus of 12 asymptomatic and 10 symptomatic individuals. Angular positions of the sternoclavicular, acromioclavicular, and scapulothoracic joints were measured during shoulder motions. Differences were found between groups for sternoclavicular and scapulothoracic joint positions, with symptomatic individuals demonstrating less sternoclavicular posterior rotation and scapulothoracic upward rotation. However, the magnitude of differences was small and clinical implications are not fully understood.
Assessing the Relationship between Body Composition and Spinal Curvatures in ...peertechzpublication
This study investigated the relationship between body composition and spinal curvatures in young adults. Body composition analysis was performed on 67 participants to determine ratios of total fat, body fat, visceral fat, and total muscle. Spinal curvatures of the thoracic and lumbar regions were also measured. The results showed a significant positive correlation between total fat ratio and lumbar lordosis, as well as between visceral fat ratio and lumbar lordosis. Thoracic kyphosis was positively correlated with total fat ratio and visceral fat ratio. Total muscle ratio showed a negative correlation with lumbar lordosis and thoracic kyphosis. The study suggests that increased fat ratios and decreased muscle ratios can shift spinal alignment in a way that may negatively impact
This study examined differences in strength and activation timing of the ankle dorsiflexors and evertors between individuals with functionally unstable ankles and uninjured controls using a stretch-shortening cycle protocol. 30 subjects (15 with unilateral ankle instability and 15 controls) performed concentric contractions of the ankle muscles at two speeds on an isokinetic dynamometer. The study found no significant differences in peak torque normalized to body weight or time to peak torque between the groups. This suggests that differences in strength and muscle activation timing during the stretch-shortening cycle do not exist between those with and without ankle instability.
This study examined the relationship between lumbar scoliosis and osteoporosis in postmenopausal women. The researchers analyzed dual-energy x-ray absorptiometry (DXA) scans of 900 randomly selected postmenopausal women aged 64-88 years old. They measured the Cobb angle to assess lumbar scoliosis and bone mineral density at the femoral neck, total hip, and spine to assess osteoporosis. They found that both the incidence and degree of lumbar scoliosis, defined as a Cobb angle over 10 degrees, increased significantly with age. However, after adjusting for covariates like age, weight and ethnicity, there was no significant association between bone mineral density at any site and the Cobb angle.
This case study describes a 56-year-old female seen for physical therapy two months post lumbar laminectomy and fusion surgery. Despite surgery and prior physical therapy, she continued to experience right lower extremity weakness, hip stiffness, and pain with sitting, standing, and activities. A physical examination revealed decreased hip strength and range of motion on the right side. Due to persistent groin pain and minimal functional improvements, the physical therapist referred the patient to an orthopedic specialist who diagnosed severe right hip osteoarthritis requiring hip replacement surgery. Following hip surgery, the patient's pain and function significantly improved.
This research report studied the influence of the depth of the trochlear groove on patellar kinematics in subjects with and without patellofemoral pain (PFP). 23 women with PFP and 12 women without PFP underwent kinematic magnetic resonance imaging during resisted knee extension. The depth of the trochlear groove was found to correlate with increased lateral patellar tilt and displacement at certain flexion angles in subjects with PFP. Shallower trochlear grooves were predictive of abnormal patellar tracking patterns. The results indicate that bony structure influences patellar kinematics and is an important determinant of patellar alignment, especially near full extension.
Scapular dyskinesis refers to abnormal static positioning or dynamic motion of the scapula during arm elevation and is associated with shoulder injury. It has multiple potential causes including muscle weakness or imbalance. The document discusses the muscular attachments of the scapula, types of scapular dyskinesis, its effects on dynamic stability and shoulder strength, assessment methods, and rehabilitation treatments focusing on strengthening the lower trapezius and serratus anterior muscles to achieve optimal scapular positioning.
This study examined core stability measures in male and female athletes to determine if these measures predict lower extremity injury risk. The study tested hip abduction, external rotation, trunk endurance, and abdominal strength in 80 female and 60 male athletes. Males showed greater strength and endurance compared to females. Athletes who avoided injury also showed greater hip strength. Logistic regression revealed that weaker hip external rotation predicted injury risk. The study suggests that improving core stability may help prevent lower extremity injuries, especially in female athletes.
This study evaluated the ability of rasterstereography to detect changes in posture induced by different neuromuscular stimulation techniques and proprioceptive insoles. 27 healthy volunteers underwent rasterstereography to measure 14 posture parameters under 6 test conditions: normal stance, foot elevation, foot exercises, loose jaw, biting, and wearing proprioceptive insoles. Rasterstereography measurements had low variability. Several posture parameters showed significant changes between test conditions, indicating that neuromuscular stimulation and insoles induce detectable postural shifts. Proprioceptive insoles specifically altered lateral spine deviation, demonstrating rasterstereography's sensitivity to subtle posture variations.
This case report describes the conservative treatment of a 40-year-old female patient presenting with a left ipsilateral sciatic scoliosis using McKenzie method physical therapy techniques over 17 sessions in 3 months. The patient's lateral shift deformity and lower extremity pain resolved, muscle weakness improved, and disability levels decreased substantially. Corrective side glide mobilizations and self-techniques were effective at reducing the disc protrusion and decompressing the nerve root, resolving the patient's symptoms and abnormal posture.
Spinal Functioning and the Vestibular System_Kauffman_InserviceJere Hess
The document discusses the relationship between back pain and the vestibular system. It provides information on spine anatomy and how poor posture can lead to back pain. It notes that back pain is a leading cause of disability. The vestibular system controls balance, spatial orientation, and upright posture. Two studies are summarized that show older adults with neck pain have poorer balance and rely more on the vestibular system for stability compared to controls without neck pain. The document suggests strengthening the vestibular system may help correct mechanical issues that lead to poor posture and back pain.
Adjacent segment degeneration is a common complication following lumbar fusion surgery. It occurs when the vertebral segments above or below the fused portion of the spine deteriorate over time due to increased stress and abnormal biomechanics. Risk factors include older age, smoking, obesity, female gender, number of fused levels, preexisting degeneration, and abnormal spinal alignment. Symptoms range from asymptomatic radiographic changes to back pain and neurogenic symptoms. Treatment depends on the severity of symptoms and may involve conservative care, injections, or additional surgery.
Differences in landing and balance deficits at the ankle joint on stable and ...AJHSSR Journal
ABSTRACT: A flexible ankle joint is suggested to be a contributing factor for sport performance, body
control. The purpose of the present study was to investigate the differences in proprioception in static and
dynamic movements between subjects with good ankle joint mobility (FL) and poor ankle joint mobility (IN) in
male adolescent handball players. The dorsiflexion and plantarflexion of the ankle ROM was measured, at knee
extension angle of 120°, with a goniometer. 26 male handball players participated (21.1 ± 4 yrs, 80.8 ± 10 kg,
182 ± 7.38 cm). Furthermore, the players fulfilling previously recommended criteria were assigned to the
flexible (n = 6) and inflexible (n = 6) groups and executed two test of static and dynamic movement (BESS Test
and Star Excursion Balance Test). Results of the T TEST on IMB SPSS 26 revealed a significant (p < 0.05)
group effect as (FL) group had less errors than (IN) group on BESS test. In addition, the results of the total sum
on stable and unstable surface in star excursion test showed significant differences in the directions:
anterolateral (7.4), posterolateral (8.6), posteromedial (7.9), medial (10.8) and anterior medial (8.1). In
conclusion, there is a correlation between poor ankle joint mobility and poor proprioception, balance control and
athletic movements.
KEYWORDS: ankle stability, ankle joint mobility, BESS test, handball athletes, injury risk, star excursion
balance test
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Labelle.pdf
1. REVIEW ARTICLE
Spino-pelvic sagittal balance of spondylolisthesis: a review
and classification
Hubert Labelle • Jean-Marc Mac-Thiong •
Pierre Roussouly
Received: 11 July 2011 / Accepted: 11 July 2011 / Published online: 2 August 2011
Ó Springer-Verlag 2011
Abstract
Introduction In L5-S1 spondylolisthesis, it has been
clearly demonstrated over the past decade that sacro-pelvic
morphology is abnormal and that it can be associated to an
abnormal sacro-pelvic orientation as well as to a disturbed
global sagittal balance of the spine. The purpose of this
article is to review the work done within the Spinal
Deformity Study Group (SDSG) over the past decade,
which has led to a classification incorporating this recent
knowledge.
Material and methods The evidence presented has been
derived from the analysis of the SDSG database, a multi-
center radiological database of patients with L5-S1
spondylolisthesis, collected from 43 spine surgeons in
North America and Europe.
Results The classification defines 6 types of spondylo-
listhesis based on features that can be assessed on sagittal
radiographs of the spine and pelvis: (1) grade of slip, (2)
pelvic incidence, and (3) spino-pelvic alignment. A reli-
ability study has demonstrated substantial intra- and
inter-observer reliability similar to other currently used
classifications for spinal deformity. Furthermore, health-
related quality of life measures were found to be signifi-
cantly different between the 6 types, thus supporting the
value of a classification based on spino-pelvic alignment.
Conclusions The clinical relevance is that clinicians need
to keep in mind when planning treatment that subjects with
L5-S1 spondylolisthesis are a heterogeneous group with
various adaptations of their posture. In the current con-
troversy on whether high-grade deformities should or
should not be reduced, it is suggested that reduction tech-
niques should preferably be used in subjects with evidence
of abnormal posture, in order to restore global spino-pelvic
balance and improve the biomechanical environment for
fusion.
Keywords Spondylolisthesis Classification
Sagittal balance Spino-pelvic alignment
Introduction
Sagittal sacro-pelvic morphology and orientation modulate
the geometry of the lumbar spine and consequently, the
mechanical stresses at the lumbo-sacral junction. In L5-S1
spondylolisthesis, it has been clearly demonstrated over the
past decade that sacro-pelvic morphology is abnormal and
that combined with the presence of a local lumbo-sacral
deformity and dysplasia, it can result in an abnormal sacro-
pelvic orientation as well as to a disturbed global sagittal
balance of the spine. These findings have important
implications for the evaluation and treatment of patients
with spondylolisthesis, and especially for those with a
high-grade slip. In the current controversy on whether
high-grade deformities should or should not be reduced,
they provide a compelling rationale to reduce and realign
the deformity, in order to restore global spino-pelvic
balance and improve the biomechanical environment for
fusion [1]. This has stimulated a renewed interest for the
radiological evaluation and classification of spino-pelvic
H. Labelle () J.-M. Mac-Thiong
Division of Orthopedic Surgery, CHU Sainte-Justine,
University of Montreal, 3175 Côte-Sainte-Catherine,
Montreal, QC H3T 1C5, Canada
e-mail: hubert.labelle@umontreal.ca
P. Roussouly
Department of Orthopedic Surgery,
Centre Des Massues, Lyon, France
123
Eur Spine J (2011) 20 (Suppl 5):S641–S646
DOI 10.1007/s00586-011-1932-1
2. alignment in this condition [2]. The commonly used clas-
sification systems from Wiltse et al. [3] and from Marchetti
and Bartolozzi [4] are useful to identify the underlying
pathology, but they are of little help to guide surgical
treatment. Recently, the Spinal Deformity Study Group
(SDSG) has proposed a classification system [5] in six
different sagittal postures, based on the radiographic
measurement of slip grade and spino-pelvic alignment
(pelvic incidence, sacro-pelvic and spinal balance). The
purpose of this article is to review the work done within the
SDSG on this subject over the past decade, which has led to
the proposed classification and to illustrate its clinical
relevance to guide surgical decision-making in L5-S1
spondylolisthesis. The evidence presented has been derived
from the analysis of the SDSG database, a multi-center
radiological database of patients with L5-S1 developmental
or acquired stress fracture [4] spondylolisthesis, which now
contains standing lateral radiographs of the spine and pel-
vis of 816 subjects with grade 1 to 5 spondylolisthesis,
aged between 10 to 40 years and collected from 43 spine
surgeons in North America and Europe.
Evidence for abnormal sagittal spino-pelvic alignment
When compared to a control population, Pelvic Incidence
(PI), Sacral Slope (SS), Pelvic Tilt (PT), and Lumbar
Lordosis were shown by Labelle et al. [6] to be significantly
greater in a cohort of 214 subjects with spondylolisthesis.
Furthermore, the differences between the two populations
increased in a direct linear fashion as the severity of the
spondylolisthesis increases. Although the correlation
between PI and spondylolisthesis is evident, there is still no
clear data in the literature that has demonstrated a cause/
effect relationship between the two. However, since PI is a
morphological parameter describing the shape of the pelvis,
an abnormally high PI is typically associated with a high
lumbar lordosis predisposing to altered mechanical stresses
in the lumbar spine and lumbo-sacral junction, suggesting a
higher risk of presenting spondylolisthesis.
Not all patients with L5-S1 spondylolisthesis do, how-
ever, present with a higher than normal PI. Roussouly et al.
[7] noted two different subgroups of sacro-pelvic balance
and shape in 82 subjects with low-grade spondylolisthesis
that might be affected by a different pathogenic mecha-
nism. In their opinion, patients with high PI and sacral
slope have increased shear stresses at the lumbo-sacral
junction, causing more tension on the pars interarticularis
at L5: the shear type (Fig. 1). On the opposite, patients
with a low PI and a smaller sacral slope would have
impingement of the posterior elements of L5 between L4
and S1 during extension, thereby causing a ‘‘nutcracker’’
effect on the pars interarticularis at L5 (Fig. 1). Based on
K-means cluster analysis, Labelle et al. [5]. have confirmed
the existence of distinct subgroups of sacro-pelvic balance
in a larger SDSG cohort of 540 low-grade isthmic spond-
ylolisthesis: a subgroup with normal PI and SS values
averaging respectively 52 ± 7° and 41 ± 7°, and a sub-
group with high PI and SS values averaging respectively
74 ± 10° and 53 ± 7°, thereby strongly supporting the
existence of the shear type spino-pelvic posture with high
PI and high SS. In a further analysis of the same first
subgroup of subjects with normal PI values, using this time
an unsupervised two-step cluster analysis, Mac-Thiong
et al. [8] were able to recognize two further significantly
different spino-pelvic alignment postures: a smaller spe-
cific subgroup with low PI (42 ± 5°) and SS (35 ± 4°),
thereby corresponding to the nutcracker type, and another
larger group with normal PI (54 ± 4°) and SS (45 ± 4°)
with a similar spino-pelvic alignment to the one found in a
normal control population.
As for high-grade spondylolisthesis, Hresko et al. [9]
have identified two subgroups of sacro-pelvic alignment
using K-means cluster analysis in an initial cohort of 133
patients: balanced versus unbalanced pelvis (Fig. 2). The
‘‘balanced’’ group includes patients standing with a high
SS and a low PT, a posture similar to a control subgroup of
individuals with high PI but no evidence of spondylolis-
thesis, while the ‘‘unbalanced’’ group includes patients
standing with a retroverted pelvis and a vertical sacrum,
corresponding to a low SS and a high PT. More recently, a
similar study [5] on a larger cohort of 276 subjects has
confirmed the existence of these 2 different sacro-pelvic
alignments, and has demonstrated that almost all subjects
with high-grade slips have above average PI values C 608.
This is in distinct contrast with subjects having low-grade
spondylolisthesis in which low, normal or above average PI
values are noted.
Fig. 1 The shear and nutcracker spino-pelvic postures reported by
Roussouly et al. [7] in low grade spondylolisthesis
S642 Eur Spine J (2011) 20 (Suppl 5):S641–S646
123
3. Furthermore, it was found that global spinal balance,
as measured with the C7 plumb line, was significantly
higher ([3 cm) in subjects with a retroverted (unbal-
anced) posture[5], thereby suggesting that positive sag-
ittal spine imbalance can be associated with this type of
spino-pelvic alignment. In support of this last finding,
using a postural model of spino-pelvic balance showing
the relationships between parameters of each successive
anatomical segment from the thoracic spine to the sacro-
pelvis, Mac-Thiong et al. [10] have observed in a study
comparing 120 controls to 131 subjects with spondylo-
listhesis that a relatively normal global trunk posture was
maintained in low-grade spondylolisthesis, while it was
abnormal in high-grade spondylolisthesis. Again, in high-
grade spondylolisthesis, the spino-pelvic balance was
particularly disturbed in the subgroup with an unbalanced
sacro-pelvis.
Spinal deformity study group classification
Based on a systematic review of the literature, Mac-Thiong
and Labelle [11] have presented a classification system
incorporating this recent knowledge in sagittal spino-pelvic
balance and intended to guide surgical treatment of
developmental spondylolisthesis in children, adolescents
and young adults. In addition to slip grade and spino-pelvic
balance, this first attempt at classification also incorporated
the degree of bony dysplasia and proposed eight different
types of deformity. Unfortunately, in a subsequent vari-
ability study [12], the authors found only fair overall inter-
observer reliability (kappa: 0.49) for this classification
system, mainly due to the difficulty in accurately deter-
mining the degree of dysplasia (inter-observer kappa: 0.43)
on radiographs. Consequently, the SDSG has decided to
exclude assessment of dysplasia and the classification has
been further refined and simplified. It is based on three
important characteristics that can be assessed on sagittal
radiographs of the spine and pelvis: (1) the grade of slip
(low or high), (2) the pelvic incidence (low, normal or
high), and (3) the spino-pelvic balance (balanced or
unbalanced). Accordingly, six different subtypes can be
identified (Fig. 3).
To classify a patient, the degree of slip is quantified first
from the lateral radiograph, in order to determine if it is
low-grade (grades 0, 1 and 2, or50% slip) or high-grade
(grades 3, 4 and spondyloptosis, or C50% slip). Next, the
sagittal balance is measured by determining sacro-pelvic
and spino-pelvic alignment, using measurements of PI, SS,
PT and the C7 plumb line. For low-grade spondylolisthesis,
three types of sacro-pelvic balance can be found: type 1,
the nutcracker type, a subgroup with low PI ( 45°),
type 2, a subgroup with normal PI (between 45 and 60°),
and type 3, the shear type, a subgroup with high PI (C60°).
For high-grade spondylolisthesis, three types are also
found. Each subject is first classified as having a balanced
or an unbalanced sacro-pelvis using PI and SS values and
the nomogram provided by Hresko et al. [9] (Fig. 4). When
SS and PT are located above the threshold line, the subject
is classified as high SS/low PT. On the other hand, when SS
and PT are located below the threshold line, the subject is
classified as low SS/high PT. Next, spino-pelvic balance is
determined using the C7 plumb line. If this line falls over
or behind the femoral heads, the spine is balanced, while if
it lies in front of the femoral heads, the spine is unbalanced.
In our experience, the spine is almost always balanced in
low-grade and in high-grade spondylolisthesis [10] with a
balanced sacro-pelvis and therefore, spinal balance needs
to be measured mainly in high-grade deformities with an
unbalanced pelvis. Therefore, the three types in high grade
spondylolisthesis are: type 4 balanced pelvis, type 5 ret-
roverted pelvis with balanced spine and type 6 retroverted
Balanced pelvis Retroverted pelvis
Fig. 2 The balanced and retroverted pelvic postures reported by
Hresko et al. [9] in high grade spondylolisthesis.
L5-S1 spondy
Low grade
High grade
Type 1: PI45° (nutcracker)
Type 3: PI60°
Type 4: Balanced Pelvis
Retroverted Pelvis
Type 2: PI 45 to 60°
Type 5: Balanced spine
Type 6: Unbalanced spine
SDSG L5-S1 Spondylolisthesis Classification
Fig. 3 Classification of spondylolisthesis based on spino-pelvic
posture
Eur Spine J (2011) 20 (Suppl 5):S641–S646 S643
123
4. pelvis with unbalanced spine. Figure 5 illustrates clinical
examples of theses six postures.
In a recent clinical assessment of this refined version of
the classification system, Mac-Thiong et al. [13] found
improved and substantial intra- and inter-observer reli-
ability similar to other currently used classifications for
spinal deformity, with an overall intra- and inter-observer
agreements of 80% (kappa: 0.74) and 71% (kappa: 0.65),
respectively. Further improvements in reliability are
expected with a computer-assisted classification technique.
Clinical relevance for treatment of spondylolisthesis
Currently, most treatment protocols proposed in the liter-
ature for developmental spondylolisthesis have focused
mainly on the abnormalities noted at the L5-S1 junction,
mostly the slip grade. Surgery is usually recommended for
patients with low-grade deformities, which are unrespon-
sive to conservative management, and for all high-grade
slips. While slip grade is an important component of the
deformity, the evidence presented above demonstrates that
Fig. 4 Nomogram reported by
Hresko et al. [9] to classify
balanced vs retroverted pelvic
posture using SS and PT values
Fig. 5 Lateral radiographs
demonstrating the 6 types of
spino-pelvic postures
S644 Eur Spine J (2011) 20 (Suppl 5):S641–S646
123
5. sacro-pelvic morphology and balance are strong determi-
nants of sagittal spino-pelvic alignment and that they
should be considered in any treatment algorithm. The
presence of different patterns of sagittal spino-pelvic bal-
ance suggests that the biomechanics involved in spondyl-
olisthesis may differ from one patient to the other.
Accordingly, the specific pattern of sagittal spino-pelvic
balance for each patient should influence the risk of pro-
gression and the treatment outcome. In support of this
concept [14], a cohort of 397 adolescents with L5-S1
spondylolisthesis has been compared to an aged-matched
control population: health-related quality of life measures
were found to be clearly abnormal in spondylolisthesis,
with significant differences according to various types of
spino-pelvic alignment, thus supporting the value of a
classification based on spino-pelvic alignment.
Abnormal spino-pelvic balance alters the biomechanical
stresses at the lumbo-sacral junction and the compensation
mechanisms used to maintain an adequate posture. Since PI
is always much greater than normal in high-grade spond-
ylolisthesis, this suggests that the risk of progression in
types 1 and 2 with lower or normal PI may be lower than in
the shear type 3 with abnormally high PI and SS values
imposing higher shear stresses at the L5-S1 junction. In
these subjects as well as those with type 4 alignment, there
is an increased lumbar lordosis in order to keep the center
of gravity and C7 plumb line behind the hips to maintain a
balanced posture. This first compensation mechanism
occurs by increasing the intervertebral segmental lordosis
and/or by including more vertebrae in the lordotic segment.
For each patient, there is a maximal attainable lumbar
lordosis beyond which the patient will then attempt to
maintain a balanced posture by progressive retroversion of
the pelvis. This second compensation mechanism corre-
sponds to the abnormal posture found in types 5 and 6 with
a retroverted pelvis/vertical sacrum. Because each patient
has a fixed pelvic incidence, since it is an anatomic
parameter, SS decreases along with the retroversion of the
pelvis and PT increases as the sacrum becomes vertical.
When the limit of these two compensation mechanisms is
reached, the patient develops sagittal trunk imbalance,
most often characterized either by compensatory hip flex-
ion, by forward leaning of the trunk with positive sagittal
imbalance of the spine, or a combination of both, as seen in
type 6 posture.
The SDSG classification is the first that organizes sub-
groups of spondylolisthesis in an ascending order of
severity according to prognosis and/or spino-pelvic align-
ment. Because the classification is designed so that sub-
groups are in an ascending order of severity, it becomes
easier and more intuitive to develop an associated surgical
algorithm because the complexity of the surgery should
increase, as the severity of the spondylolisthesis increases.
While the need for reduction in the surgical treatment of
spondylolisthesis is still debated, three studies provide
some insight for the decision-making process. Hresko et al.
[9] stated that the failure to analyze sacro-pelvic balance
and therefore to distinguish between a balanced and an
unbalanced sacro-pelvis could account for the variability
found in the literature regarding the outcome of reduction
for high-grade spondylolisthesis. Accordingly, they suggest
that reduction techniques might preferably be considered in
types 5 and 6 with an unbalanced sacro-pelvis. Mac-Thiong
et al. [10] also suggested attempting reduction of high-
grade spondylolisthesis in types 5 and 6 with an unbal-
anced sacro-pelvis since these patients present with an
abnormal spino-pelvic balance, as compared to the normal
population. Finally, in a retrospective multi-center study
analysis of spino-pelvic alignment after surgical correction
of 73 subjects with high grade slips, Labelle et al. [15] have
shown that while sacro-pelvic shape (PI) is unaffected by
attempts at surgical reduction, proper repositioning of L5
over S1 significantly improves sacro-pelvic balance and the
shape of the lumbar spine in developmental spondylolis-
thesis. Their results also emphasize the importance of sub-
dividing subjects with high-grade spondylolisthesis into
types 4, 5 and 6, and further support the contention that
reduction techniques might preferably be considered for
types 5 and 6 of the classification.
In summary, the proposed classification emphasizes that
subjects with L5-S1 spondylolisthesis are a heterogeneous
group with various adaptations of their posture and that
clinicians need to keep this fact in mind for evaluation and
treatment. Although outcome studies are obviously needed
before a definitive treatment algorithm can be established
for each subtype, it is suggested that for subjects with a
type 4 spino-pelvic alignment, forceful attempts at reduc-
tion of the deformity may not be required and that simple
instrumentation and fusion after postural reduction may be
sufficient to maintain adequate sagittal alignment. For
subjects with type 5 posture, reduction and realignment
procedures should preferably be attempted, but in difficult
cases, instrumentation and fusion after postural reduction
may also be sufficient to achieve adequate sagittal align-
ment, since spinal alignment is maintained. Reduction and
realignment procedures would appear mandatory in type 6
deformities where sagittal alignment is severely disturbed.
Acknowledgments This research was assisted by support from the
Spinal Deformity Study Group. This research was funded by an
educational/research grant from Medtronic Sofamor Danek. The
authors would like to acknowledge the other members of the
Spondylolisthesis section of the Spinal Deformity Study Group: Eric
Berthonnaud, PhD, Courtney Brown, MD, John Dimar, MD, Timothy
Hresko, Serena Hu, Julie Joncas, RN, Stefan Parent, MD, Mark
Weidenbaum, MD.
Conflict of interest None.
Eur Spine J (2011) 20 (Suppl 5):S641–S646 S645
123
6. References
1. Mardjetko S, Albert T, Andersson G, Bridwell K, DeWald C,
Gaines R, Geck M, Hammerberg K, Herkowitz H, Kwon B,
Labelle H, Lubicky J, McAfee P, Ogilvie J, Shufflebarger H,
Whitesides T (2005) Spine/SRS Spondylolisthesis Summary
Statement. Spine, 30(6 Suppl):S3
2. Labelle H, Roussouly P, Berthonnaud E et al (2005) The
importance of spinopelvic balance in L5-S1 developmental
spondylolisthesis: a review of pertinent radiologic measurements.
Spine 30(suppl):27–34
3. Wiltse LL, Newman PH, Macnab I (1976) Classification of
spondylolysis and spondylolisthesis. Clin Orthop 117:23–29
4. Marchetti PC, Bartolozzi P (1997) Classification of spondylolis-
thesis as a guideline for treatment. In: Bridwell KH, DeWald RL,
Hammerberg KW, et al., (eds) The textbook of spinal surgery, 2
edn. Lippincott-Raven, Philadelphia pp 1211–1254
5. Labelle H, Roussouly P, Berthonnaud E, Mac-Thiong JM, Hresko
T, Dimar, J, Parent S, Weidenbaum M, Brown C, Hu S (2009)
Spondylolisthesis classification based on spino-pelvic alignment,
Podium presentation at the 2009 Scoliosis Research Society
Annual Meeting, San Antonio, USA
6. Labelle H, Roussouly P, Berthonnaud E, Transfeldt E, O’Brien M,
Hresko T, Chopin D, Dimnet J (2004) Spondylolisthesis, pelvic
incidence and sagittal spino-pelvic balance: a correlation study.
Spine 29(18):2049–2054
7. Roussouly P, Gollogly S, Berthonnaud E, Labelle H, Weiden-
baum M (2006) Sagittal alignment of the spine and pelvis in the
presence of L5–S1 isthmic lysis and low-grade spondylolisthesis.
Spine 31(20):2484–2490
8. Mac-Thiong JM, Roussouly P, Hresko MT, Labelle H (2010) The
importance of sagittal spino-pelvic alignment in low grade
spondylolisthesis. Identification of subgroups based on Pelvic
Incidence and Sacral Slope, Podium presentation at the Scoliosis
Research Society Annual Meeting, Kyoto, Japan, September
2010
9. Hresko MT, Labelle H, Roussouly P, Berthonnaud E (2007)
Classification of high grade spondylolisthesis based on pelvic
version and spinal balance: possible rationale for reduction. Spine
32(20):2208–2213
10. Mac-Thiong JM, Labelle H, Wang Z, de Guise JA (2008)
Postural model of sagittal spino-pelvic balance and its relevance
for lumbosacral developmental spondylolisthesis. Spine 33(21):
2316–2325
11. Mac-Thiong JM, Labelle H (2006) A proposal for a surgical
classification of pediatric lumbosacral spondylolisthesis based on
current literature. Eur Spine J 15:1425–1435
12. Mac-Thiong JM, Labelle H, Parent S, Hresko MT, Deviren V,
Weidenbaum M (2008) Reliability and development of a new
classification of lumbosacral spondylolisthesis. Scoliosis 3:19
13. Mac-Thiong JM, Duong L, Parent S, Hresko MT, Dimar J,
Weidenbaum M, Labelle H. Reliability of the SDSG classifica-
tion of lumbosacral spondylolisthesis, Submitted to Spine, April
2010
14. Labelle H, Roussouly P, Mac-Thiong JM, Parent S, Hresko MT
(2010) Relationship between HRQL measures and spino-pelvic
alignment in adolescent spondylolisthesis compared to a control
population, Podium presentation at the Scoliosis Research Soci-
ety Annual Meeting, Kyoto, Japan, September 2010
15. Labelle H, Roussouly P, Chopin D, Berthonnaud E, Hresko T,
O’Brien M (2008) Spino-pelvic alignment after surgical correc-
tion for developmental spondylolisthesis. Eur Spine J
17:1170–1176
S646 Eur Spine J (2011) 20 (Suppl 5):S641–S646
123