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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To analyse pre-operative and post-operative changes of cervical sagittal alignment (CSA) in Scheuermann's kyphosis (SK) patients. ⋯ Our study suggests that SK is not a homogenous group of patients. Two patterns of pre- and post-operative CSA are demonstrated in TK and TLK groups. T1 slope is the most important parameter in determining pre-operative CSA and correlates with other regional anatomical parameters (TK and LL). Post-operative CSA adaptations also correlate with T1 slope post-operative changes. However, post-surgical T1 slope correlates with different parameters in the two SK groups (TK and PT in TK group; TLK, LL, and PT in TLK group).
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Intervertebral disc degeneration is thought to contribute to low back pain. However, the pathophysiological mechanisms remain controversial. In a previous study, we developed an animal model that showed delayed gait disturbance after lumbar facetectomy in the rat. We believe that this gait disturbance was caused by low back pain, although the mechanisms of this gait abnormality remain unknown. The purpose of this study was to evaluate structural changes of the lumbar spine after facetectomy in the rat utilizing three-dimensional micro-computed tomography (3DμCT) compared to histology. ⋯ Degenerative changes were observed at the facetectomy level. These may correspond with the previously reported delayed gait disturbance after facetectomy. This animal model may be useful to create mechanically induced disc degeneration without direct tissue damage to the disc.
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In addition to the sagittal alignment, impact of transverse plane parameters (TPP) and rotatory subluxation on patients reported outcomes were highlighted. One of the hypotheses for genesis of degenerative scoliosis is disc degeneration with increased axial vertebral (AVR) and intervertebral rotation (AIR). Therefore, TPP analysis at early stage of the scoliosis seems of particular interest. This study aims at assessing reliability of tridimensional (3D) reconstructions of adult spinal deformity (ASD) patients. ⋯ 3D analysis was reliable for Cobb and sagittal parameters. 3D analysis for TPP was reproducible when Cobb is below 30°. However, uncertainty is larger for Cobb above 30°. Nevertheless, 3D reconstructions could help surgeons to anticipate onset of rotatory subluxation while assessing axial rotation evolution for small deformity and choose best delay for surgical treatment.
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Multicenter Study Clinical Trial
Surgical versus nonsurgical treatment of lumbar degenerative kyphosis.
Surgery is widely performed for lumbar degenerative kyphosis (LDK), but its effectiveness as compared with nonsurgical treatment has not been demonstrated. ⋯ Surgery might be a preferred treatment option for LDK, but great caution is needed. And conservative treatment could be the considerable treatment option for LDK who is unwilling or has poor medical condition to operate.