• 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.

• Journal of The Korean Society of Integrative Medicine
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• v.7 no.4
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• pp.265-272
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• 2019

Purpose : Excessive computer use frequently results in musculoskeletal disorders of the neck and shoulder such as forward head posture (FHP). The purpose of this study was to investigate effects of neck and shoulder exercise program on spino-pelvic alignment and the correlation between change in head and neck posture and spino-pelvic alignment in FHP. Methods : The study included 44 participants with FHP. The participants performed the exercise for correction of FHP 2-3 times a week for 4 weeks. We examined whole spine X-ray images in the lateral standing position with both arms crossed. We measured anterior head translation distance (AHT), craniovertebral angle (CVA), cervical lordosis (CL), thoracic kyphosis (TK), lumbosacral lordosis (LSL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) of the subjects. The association between change in AHT and each spino-pelvic parameter was also subjected to Pearson's correlation coefficient analysis. Results : There were statistically significant differences before and after exercise in the parameters of AHT, CVA, and SS (p<.05). Significant negative correlation was observed between the change in AHT and CVA (r=-.768, p<.001), and CL (r=-.388, p<.05). There was significant positive correlation between the change in AHT and SS (r=.328, p<.05), and PI (r=.333, p<.05). However, no significant correlation was observed in change in AHT with that of TK, LSL, and PT. Conclusion : Based on the above results, we conclude that there is a relationship between change in AHT, which is a parameter associated with forward displacement of the head, and that of CVA, CL, SS, and PI after exercise in cases of FHP.

• Journal of The Korean Society of Integrative Medicine
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• v.8 no.3
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• pp.173-180
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• 2020

Purpose : The aim of this study was to assess the intra- and inter-rater reliability and validity of measurements of head, neck, and pelvis posture using a mobile application in subjects with forward head posture. Methods : Forty-eight volunteers (22 men, 26 women) participated in this study. Two raters independently examined whole body picture images in a lateral standing posture with arms crossed using a CA-Smart Posture Reminder (CA-SPR), and a rater took and calculated posture images twice to assess reliability. We measured five parameters: craniovertebral angle 1 (CVA1), anterior shoulder translation (AST), pelvic tilt (PT), knee angle (KA), and ankle angle (AA) in the subject's sagittal plane using CA-SPR. We examined whole spine X-ray images in the same position to assess validity. We measured four variables in the subjects: CVA2, translation distance (AHT), anterior pelvic plane (APP), and sacral slope (SS). The intra- and inter-rater reliability were calculated using the intraclass correlation coefficient (ICC). Convergent validity was calculated using Pearson's correlation coefficient. Results : The intra-rater reliability (ICC=.889 -.989) and inter-rater reliability (ICC=.800 -.980) were excellent for all variables measured using CA-SPR. The variables measured using CA-SPR and X-ray were significantly positively correlated (r=.623, p<.01). However, the correlation of the variables in the pelvis was not statistically significant. Conclusion : This study shows that a mobile application (CA-SPR) is a useful tool for measuring head and neck posture in subjects with forward head posture. However, further study is needed to measure pelvic variables when using a mobile application.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.560-566
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• 2017

Objectvie : The global sagittal postural patterns as characterized by Roussouly classification have been previously described in various ethnicities, there were no studies investigated in Koreans. To analyze the distribution of the global sagittal postural patterns in Korean adults using Roussouly classification, the author prospectively studied. Methods : 252 asymptomatic Korean adults was recruited. Data was obtained by reviewing the films for each subject. Spinopelvic parameters were measured and sagittal postural patterns were then determined according to Roussouly classification. We compared the data across different ethnicities from our study and a previous study to further characterize Korean sagittal postures. Results : The subject included 151 males and 101 females, with mean age of $33.2{\pm}8.2years$. The average descriptive results were as below : thoracic kyphosis $28.6{\pm}7.7^{\circ}$, lumbar lordosis $48.3{\pm}10.2^{\circ}$, sacral slope $37.8{\pm}5.8^{\circ}$, pelvic incidence $45.1{\pm}7.5^{\circ}$, pelvic tilt $9.4{\pm}6.7^{\circ}$, spinosacral angle $130.1{\pm}5.4^{\circ}$, and sagittal vertical axis $16.25{\pm}22.5mm$. 125 subjects among 252 (49.6%) belonged to Roussouly type 3 (namely neutral). There were also 58 (23%), 33 (13.1%), and 36 (14.3) subjects in type 1, 2, and 4 (namely non-neutral), respectively. Conclusion : Enrolling 252 asymptomatic Korean adults, this prospective study found that 49.6% of asymptomatic Korean adults possessed a sagittal posture of Roussouly type 3. All radiologic parameters follows general concept of spinal sagittal balance pattern. Overall, this study might be a basis for further investigation of spinal sagittal balance.

• Journal of Korean Neurosurgical Society
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• v.62 no.5
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• pp.577-585
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• 2019

Objective : Comparing the effects of magnetically controlled growing rod (MCGR) and traditional growing rod (TGR) techniques on the sagittal plane in the treatment of early-onset scoliosis (EOS). Methods : Twelve patients were operated using dual MCGR technique in one center, while 15 patients were operated using dual TGR technique for EOS in another center. Patients' demographic characteristics, complications and radiological measurements such as cobb angle, thoracic kyphosis, lumbar lordosis, T1-S1 range (mm), proximal junctional angle, distal junctional angle, sagittal balance, coronal balance, pelvic incidence, sacral slope and pelvic tilt were assessed and compared in preoperative, postoperative and last follow-up period. Results : Age and sex distributions were similar in both groups. The mean number of lengthening in the MCGR group was 12 (8-15) and 4.8 (3-7) in the TGR group. Two techniques were shown to be effective in controlling the curvature and in the increase of T1-S1 distance. In TGR group, four patients had rod fractures, six patients had screw pull-out and four patients had an infection, whereas three patients had screw pull-out and one patient had infection complications in the MCGR group. Conclusion : There was no significant difference between the two groups in terms of cobb angle, coronal and sagittal balance and sagittal pelvic parameters. MCGR can cause hypokyphosis and proximal junctional kyphosis in a minimum 2-year follow-up period. The implant-related complications were less in the MCGR group. However, larger case groups and longer follow-up periods are required for the better understanding of the superiority of one method on other in terms of complications.

• Hip & pelvis
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• v.35 no.1
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• pp.6-14
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• 2023

Purpose: The aim of this study was to determine correlation between the spinopelvic parameters in sitting and standing positions (sacral slope [SS], lumbar lordosis [LL], spinopelvic tilt [SPT], pelvic incidence [PI], and pelvic femoral angle [PFA]), with hip function assessed using the modified Harris hip scores (mHHs) in patients with symptomatic femoroacetabular impingement (FAI) at diagnosis. Materials and Methods: A retrospective study of 52 patients diagnosed with symptomatic FAI was conducted. Evaluation of the spinopelvic complex in terms of SS, LL, SPT, PI and PFA was performed using lateral radiographs of the pelvis and lumbosacral spine in standing and sitting positions. Assessment of hip function at diagnosis was performed using the mHHs. Calculation of spinopelvic mobility was based on the difference (Δ) between measurements performed in standing and sitting position. Results: The median time of pain evolution was 11 months (interquartile range [IQR], 5-24 months) with a median mHHs of 66.0 points (IQR, 46.0-73.0) at diagnosis. The mean change of LL, SS, SPT, and PFA was 20.9±11.2°, 14.2±8.6°, 15.5±9.0°, and 70.7±9.5°, respectively. No statistically significant correlation was observed between spinopelvic parameters and the mHHs (P>0.05). Conclusion: Radiological parameters of the spinopelvic complex did not show correlation with hip function at the time of diagnosis in patients with symptomatic FAI. Conduct of further studies will be required in the effort to understand the effect of the spinopelvic complex and its compensatory mechanics, primarily between the hip and spine, in patients with FAI before and after hip arthroscopy.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.9
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• pp.347-355
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• 2017

The purpose of this study was to investigate the effects of pelvic adjustment on low back pain and spino-pelvic parameters in middle-aged women. Thirty-eight middle-aged women with chronic low back pain were randomly assigned to the pelvic adjustment (n = 20) oruntreated control (n = 18) group. Pelvic adjustment interventionswereperformed four times a week for 8 weeksin the former group. At baseline and after 8 weeks, the back pain and back function were evaluated using the visual analogue scale (VAS), Oswestry disability index (ODI), and back flexibility. Additionally, the spino-pelvic radiographic parameters and serum C-reactive protein (CRP) levels were assessed. After 8 weeks, the VAS, ODI, and back flexibility significantly improved in the pelvic adjustment group compared with the control group. It was found that the changes from baseline in the lumbar lordotic angle, sacral slope, pelvic crest unleveling, and femoral head height inequality were significantly greater in the pelvic adjustment group than in the control group. There were no significant changes in the pelvic incidence or serum CRP levels in either group. In conclusion, pelvic adjustment has beneficial effects on chronic low back pain and back function, suggesting that the effects of pelvic adjustment on back pain may at least in part result from changes in the spino-pelvic alignment.

• Journal of Acupuncture Research
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• v.27 no.2
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• pp.97-104
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• 2010

Objectives : The authors aimed to determine the presence of relationships between cervical pain and cervical curvature, lumbar curvature, sacral slope and sagittal spinal balance. Methods : Medical records of outpatients who made their first visits to the Department of Acupuncture and Moxibustion in the Spine center at Kyung Hee East-West Neo Medical Center between September 1, 2008 and October 31, 2009 were evaluated. A total of 50 patients visiting within the time period had visited with a chief complaint of cervical pain, and had lateral entire spine X-rays taken. After excluding patients with previous spine operations, 46 patients were selected for the final analysis. The cervical lordotic angle(CLA), lumbar lordotic angle(LLA), Ferguson's angle(FA), and sagittal vertical axis(SVA) were measured on the lateral entire spine X-ray cuts, and the relationships between these values and patient gender, age, chief complaint, and duration of symptoms were assessed. Results : No significant difference was found in relationships between gender and measured values. SVA showed statistically significant correlation between age, but CLA, LLA, and FA was not. There was a significant difference in SVA between patients with only cervical pain and those with both cervical pain and low back pain. Patients with a duration of symptoms longer than 6 months showed a statistically significant difference in SVA with those who had shorter symptoms. Correlation analysis between measured values was statistically significant only between LLA and FA. Conclusions : Evaluation and treatment of sagittal imbalance should be considered in patients presenting with cervical pain if symptoms have persisted for over 6 months or have accompanying low back pain.

• Asian Spine Journal
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• v.12 no.6
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• pp.1060-1068
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• 2018

Study Design: Retrospective study. Purpose: Lumbar intervertebral disc degeneration is an important cause of low back pain. Overview of Literature: Spinal fusion is often reported to have a good course for adolescent idiopathic scoliosis (AIS). However, many studies have reported that adjacent segment degeneration is accelerated after lumbar spinal fusion. Radiography is a simple method used to evaluate the orientation of the vertebral column. magnetic resonance imaging (MRI) is the method most often used to specifically evaluate intervertebral disc degeneration. The Pfirrmann classification is a well-known method used to evaluate degenerative lumbar disease. After spinal fusion, an increase in stress, excess mobility, increased intra-disc pressure, and posterior displacement of the axis of motion have been observed in the adjacent segments. Methods: we retrospectively secured and analyzed the data of 15 patients (four boys and 11 girls) with AIS who underwent a spinal fusion surgery. We studied the full-length view of the spine (anterior-posterior and lateral) from the X-ray and MRI obtained from all patients before surgery. Postoperatively, another full-length spine X-ray and lumbosacral MRI were obtained from all participants. Then, pelvic tilt, sacral slope, curve correction, and fused and free segments before and after surgery were calculated based on X-ray studies. MRI images were used to estimate the degree to which intervertebral discs were degenerated using Pfirrmann grading system. Pfirrmann grade before and after surgery were compared with Wilcoxon signed rank test. While analyzing the contribution of potential risk factors for the post-spinal fusion Pfirrmann grade of disc degeneration, we used generalized linear models with robust standard error estimates to account for intraclass correlation that may have been present between discs of the same patient. Results: The mean age of the participant was 14 years, and the mean curvature before and after surgery were 67.8 and 23.8, respectively (p<0.05). During the median follow-up of 5 years, the mean degree of the disc degeneration significantly increased in all patients after surgery (p<0.05) with a Pfirrmann grade of 1 and 2.8 in the L2-L3 before and after surgery, respectively. The corresponding figures at L3-L4, L4-L5, and L5-S1 levels were 1.28 and 2.43, 1.07 and 2.35, and 1 and 2.33, respectively. The lower was the number of free discs below the fusion level, the higher was the Pfirrmann grade of degeneration (p<0.001). Conversely, the higher was the number of the discs fused together, the higher was the Pfirrmann grade. Conclusions: we observed that the disc degeneration aggravated after spinal fusion for scoliosis. While the degree of degeneration as measured by Pfirrmann grade was directly correlated by the number of fused segments, it was negatively correlated with the number of discs that remained free below the lowermost level of the fusion.

• Journal of Korean Neurosurgical Society
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• v.65 no.5
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• pp.719-729
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• 2022

Objective : The ossification of the ligamentum flavum (OLF) is one of the major causes of thoracic myelopathy. Surgical decompression with or without instrumented fusion is the mainstay of treatment. However, few studies have reported on the added effect of instrumented fusion. The objective of this study was to compare clinical and radiological outcomes between surgical decompression without instrumented fusion (D-group) and that with instrumented fusion (F-group). Methods : A retrospective review was performed on 28 patients (D-group, n=17; F-group, n=11) with thoracic myelopathy due to OLF. The clinical parameters compared included scores of the Japanese Orthopedic Association (JOA), the Visual analogue scale of the back and leg (VAS-B and VAS-L), and the Korean version of the Oswestry disability index (K-ODI). Radiological parameters included the sagittal vertical axis (SVA), the pelvic tilt (PT), the sacral slope (SS), the thoracic kyphosis angle (TKA), the segmental kyphosis angle (SKA) at the operated level, and the lumbar lordosis angle (LLA; a negative value implying lordosis). These parameters were measured preoperatively, 1 year postoperatively, and 2 years postoperatively, and were compared with a linear mixed model. Results : After surgery, all clinical parameters were significantly improved in both groups, while VAS-L was more improved in the F-group than in the D-group (-3.4±2.5 vs. -1.3±2.2, p=0.008). Radiological outcomes were significantly different in terms of changes in TKA, SKA, and LLA. Changes in TKA, SKA, and LLA were 2.3°±4.7°, -0.1°±1.4°, and -1.3°±5.6° in the F-group, which were significantly lower than 6.8°±6.1°, 3.0°±2.8°, and 2.2°±5.3° in the D-group, respectively (p=0.013, p<0.0001, and p=0.037). Symptomatic recurrence of OLF occurred in one patient of the D-group at postoperative 24 months. Conclusion : Clinical improvement was achieved after decompression surgery for OLF regardless of whether instrumented fusion was added. However, adding instrumented fusion resulted in better outcomes in terms of lessening the progression of local and regional kyphosis and improving leg pain. Decompression with instrumented fusion may be a better surgical option for thoracic OLF.