Aims. The aim of this study is to test the hypothesis that three grades of sagittal
Purposes and Background. Musculoskeletal disorders including as back and neck pain are leading causes of work disability. Effective interventions exist (i.e. functional restoration, multidisciplinary biopsychosocial rehabilitation, workplace-based interventions, etc.), but it is difficult to select the optimal intervention for specific patients. The Work Assessment Triage Tool (WATT) is a clinical decision support tool developed using machine learning to help select interventions. The WATT algorithm categorizes patients based on individual, occupational, and clinical characteristics according to likelihood of successful return-to-work following rehabilitation. Internal validation showed acceptable classification accuracy, but WATT has not been tested beyond the original development sample. Our purpose was to externally validate the WATT. Methods and Results. A population-based cohort design was used, with administrative and clinical data extracted from a Canadian provincial
Purposes of the study and background. Clinical assessment of spinal function is a routine part of low back pain (LBP) assessment, yet there is no clear consensus on what constitutes ‘spinal dysfunction’ and how this informs treatment. This study's aims to develop a spinal function classification framework by gaining expert academic and clinical consensus on (i) spinal function assessment tests (ii) encountered LBP motor control/movement impairment (MCI/MI) sub-types (iii) their characteristics and (iii) exercises and feedback for each sub-type. Methods and Results. An online 2-round Delphi-survey of 4 world-leading academic experts and 36 clinical physiotherapists world-wide was employed. A five-point response scale was used to rate level of agreement on 174 items with a priori consensus defined by a ≠>80% level of agreement (LOA). Out of 15 spinal function assessment tests, 5 reached consensus with forward bend and sitting/standing tests highest scoring. 7 MCI/MI sub-types reached consensus as clinically encountered. 12 out of 128 of posture/movement descriptors within the 7 sub-types reached consensus. 7 exercises gained consensus in being considered as ‘important’ or ‘very important’ with exercises involving sitting, standing, forward bend scoring highest. Consensus was reached on MCI/MI sub-type specific exercises,
Purposes and Background. Musculoskeletal disorders are leading causes of work disability. Our purpose was to develop a predictive model in a cohort from 2012 and validate the model in 2016 data. Methods and Results. Prospectively collected data was used to identify inception cohorts in 2012 (n=1652) and 2016 (n=199). Data from back pain claimants receiving treatment in physiotherapy clinics and the Ontario workers'
Background. Trunk muscle activity and thoraco-lumbar kinematics have been shown to discriminate non-specific chronic low back pain (NSCLBP) subgroups from healthy controls. Thoracic spine kinematics and muscle activity whilst intuitively associated with NSCLBP, has received less attention and the possibility of intra-regional interactions remains an area for exploration. Purpose. Determine relationships between muscle activation and kinematics in active extension pattern (AEP) and flexion pattern (FP) subgroups and no-low back pain controls during a sagittal bending task. Methods. Fifty NSCLBP subjects (27 FP, 23 AEP) and 28 healthy controls underwent 3D motion analysis (Vicon™) and surface electromyography whilst bending to retrieve a pen from the floor. Mean sagittal angle for the upper and lower thoracic and lumbar regions (UTx, LTx, ULx, LLx) were compared with normalised mean amplitude electromyography of 4 bilateral trunk muscles. Pearson correlations were computed to assess relationships. Results. Significant relationships between lumbar multifidus and ULx/LLx were identified in AEP during bending and return (p<0.01). FP exhibited multiple significant interactions including between longissimus thoracis and lumbar multifidus and LLx/LTx (p<0.035); and external oblique activity and UTx/LTx (p<0.05) during bending and return (and LLx during bending). Correlations were moderate to strong (r= −0.812 to 0.664). Conclusion. Kinematic and trunk muscle activity measurements differentiated between NSCLBP sub-groups and controls, especially between LLx kinematics and lumbar multifidus activity. Contrasting muscle activation patterns between LLx and LTx regions in FP highlights the importance of regional thoracic measurements, and suggests likely
The aim of this study was to review the data held with the NHSLA database over the last 10 years for negligence in spine surgery with particular focus on why patients ‘claim’ and what is the likely outcome. Anonymous retrospective review. We contacted the NHSLA and asked them to provide all data held on their database under the search terms ‘spine surgery or spine surgeon.’. An excel sheet was provided, and this was then studied for reason of ‘claim’, whether the claim was open/closed and outcome. A total of 67 claims of negligence were made against spinal surgeries during this time (2000-09). The number of claims had increased over the last few years: 2000-03, n= 8, 2004-06, n= 46. The lumbar spine remains the most common area (Lumbar: 55/67, Thoracic : 6/67, Cervical 6/67). Documented reasons for claims were post-operative complications (n= 28; 42%), delayed/failure to diagnose (n=24; 36%), discontent with preoperative assessment including consent (n=2; 3%), intra-operative complications (n= 10; 15%) and anaesthesia complication (n=3; 4%). Twenty were closed and 47 remained open. The number of successful claims was 8/20 (40%). The mean
To identify the incidence and risk factors for five-year same-site recurrent disc herniation (sRDH) after primary single-level lumbar discectomy. Secondary outcome was the incidence and risk factors for five-year sRDH reoperation. A retrospective study was conducted using prospectively collected data and patient-reported outcome measures, including the Oswestry Disability Index (ODI), between 2008 and 2019. Postoperative sRDH was identified from clinical notes and the centre’s MRI database, with all imaging providers in the region checked for missing events. The Kaplan-Meier method was used to calculate five-year sRDH incidence. Cox proportional hazards model was used to identify independent variables predictive of sRDH, with any variable not significant at the p < 0.1 level removed. Hazard ratios (HRs) were calculated with 95% confidence intervals (CIs).Aims
Methods
Background. Current policy and practice aimed at tackling work disability due to low back pain is largely aligned with the Psychosocial Flags Framework, which focuses on addressing individual beliefs and behaviours (yellow and blue flags). However, our understanding of the systemic and contextual factors (black flags) that are also proposed to act as obstacles within this Framework is under-represented, resulting in a disproportionate evidence base and suboptimal interventions. Methods. A ‘best-evidence’ synthesis was conducted to collate the evidence on those ‘black flags’ proposed to be the most important: compensatory systems (worker's
To assess the clinical and radiologic outcome of MM patients with thoracic spine involvement and concomitant pathologic sternal fractures with a resultant severe sagittal plane deformity. A prospective cohort study (n=391) was performed over a 7-year period at a national tertiary referral centre for the management of multiple myeloma with spinal involvement. Clinical, serological and pathologic variables, radiologic findings, treatment strategies and outcome measures were prospectively collected. Pre-treatment and post-treatment clinical outcome measures utilised included EQ-5D, VAS, ODI and RMD scoring systems. 13 MM patients presented with a severe symptomatic progressive sagittal plane deformity with a history of pathologic thoracic compression fractures and concomitant pathologic sternal fracture. All patients with concomitant sternal fractures displayed the radiographic features and spinopelvic parameters of positive sagittal malalignment and attempted clinical
Aim:. To establish whether there is a direct relationship between pelvic morphology and lumbar segmental angulation in the sagittal plane. Methods:. 40 lateral whole spine radiographs with normal sagittal profiles were reviewed. Pelvic incidence (PI), Lumbar Lordosis (LL), Thoracic Kyphosis (TK) and segmental angulation at each level from L1 to the sacrum were measured (from endplate to endplate) distinguishing the vertebral body and intervertebral disc contribution. Pearson correlation coefficients were used to analyse any relationship between pelvic parameters and segmental angulation. Results:. A strong correlation was found between pelvic incidence and total lumbar lordosis and angulation at cephalad lumbar segments (L12, L23 and L34) P<0.0001 with the increased lordosis primarily (four fifths on average) found at the intervertebral disc. The proportion of total lumbar lordosis contributed at L45 and L5S1 reduced as pelvic incidence increased (P<0.0001). Discussion:. PI can predict segmental angulation. Although the majority of lumbar lordosis is produced at L45 and L5S1, cephalad-lumbar segments sequentially become increasingly important as PI increases. This describes a continuum that allows segmental abnormalities to be identified when
Aim. To compare spinal outcome measures between patients reviewed for medico-legal
Objective. To compare the radiological and clinical outcomes following three different techniques used in the correction of Scheuermann's kyphosis. Materials and Methods. Twenty three patients with comparable preoperative radiographic and physical variables (age, gender, height, weight, body mass index) underwent correction of thoracic kyphotic deformity using three different surgical methods. Group A (n=8) had combined anterior and posterior fusion with instrumentation using morselised rib graft. Group B (n=7) had combined anterior and posterior fusion with instrumentation using titanium interbody cages. Group C (n=8) had posterior segmental pedicle screw fixation only. All groups had posterior apical multi-level chevron osteotomy and posterior instrumentation extending from T2 to L2/3. Preoperative and postoperative curve morphometry studied on plain radiographs included Cobb angle, sagittal vertical axis (SVA), sacral inclination (SI) and lumbar lordosis (LL). Preoperative and postoperative questionnaires including ODI, VAS and SRS-22 were also analysed. Results. The average follow-up was 70 months for group A, 66 months for group B and 35 months for group C. For the whole cohort, the preoperative median cobb angle for thoracic Kyphosis was 88.4°, SVA +3.5 centimeters (cms), lumbar lordosis was 66 °, and the median sacral inclination angle was 40°. The average immediate postoperative cobb angle for thoracic kyphosis was 42°, SVA -1.5 cms, lumbar lordosis 45 ° and sacral inclination angle was 30°. At follow-up, the average cobb angle for thoracic kyphosis was 42.0°, SVA +1 cm, lumbar lordosis 42.0 ° and sacral inclination angle was 22.0 °. There was a significant difference between preoperative and postoperative measurements in all three groups, indicating that good correction and satisfaction was achieved. Three patients had distal junctional Kyphosis in early cases. There was no significant difference obtained in the final cobb angle between group A, group B and group C. All three groups retained the postoperative correction with respect to thoracic kyphosis, and changes in ODI and SRS-22 scores were similar in three groups. Conclusion. In all groups the SVA became negative following correction and at long-term follow-up it was observed to return towards normal physiological limits. The compensatory lumbar curve reduces and this was associated with a decrease in sacral inclination. This method of
To report the surgical outcome of patients with severe Scheuermann’s kyphosis treated using a consistent technique and perioperative management. We reviewed 88 consecutive patients with a severe Scheuermann's kyphosis who had undergone posterior spinal fusion with closing wedge osteotomies and hybrid instrumentation. There were 55 males and 33 females with a mean age of 15.9 years (12.0 to 24.7) at the time of surgery. We recorded their demographics, spinopelvic parameters, surgical correction, and perioperative data, and assessed the impact of surgical complications on outcome using the Scoliosis Research Society (SRS)-22 questionnaire.Aims
Methods
The purpose of this retrospective study was to investigate the
clinical relevance of increased facet joint distraction as a result
of anterior cervical decompression and fusion (ACDF) for trauma. A total of 155 patients (130 men, 25 women. Mean age 42.7 years;
16 to 87) who had undergone ACDF between 1 January 2001 and 1 January
2016 were included in the study. Outcome measures included the Neck
Disability Index (NDI) and visual analogue scale (VAS) for pain.
Lateral cervical spine radiographs taken in the immediate postoperative
period were reviewed to compare the interfacet distance of the operated
segment with those of the facet joints above and below.Aims
Patients and Methods
The objective of this study was to assess the association between whole body sagittal balance and risk of falls in elderly patients who have sought treatment for back pain. Balanced spinal sagittal alignment is known to be important for the prevention of falls. However, spinal sagittal imbalance can be markedly compensated by the lower extremities, and whole body sagittal balance including the lower extremities should be assessed to evaluate actual imbalances related to falls. Patients over 70 years old who visited an outpatient clinic for back pain treatment and underwent a standing whole-body radiograph were enrolled. Falls were prospectively assessed for 12 months using a monthly fall diary, and patients were divided into fallers and non-fallers according to the history of falls. Radiological parameters from whole-body radiographs and clinical data were compared between the two groups.Objectives
Methods
Pulsed electromagnetic field (PEMF) stimulation was evaluated after anterior cervical discectomy and fusion (ACDF) procedures in a randomized, controlled clinical study performed for United States Food and Drug Administration (FDA) approval. PEMF significantly increased fusion rates at six months, but 12-month fusion outcomes for subjects at elevated risk for pseudoarthrosis were not thoroughly reported. The objective of the current study was to evaluate the effect of PEMF treatment on subjects at increased risk for pseudoarthrosis after ACDF procedures. Two evaluations were performed that compared fusion rates between PEMF stimulation and a historical control (160 subjects) from the FDA investigational device exemption (IDE) study: a Objectives
Methods
The aim of this study was to determine if positive Waddell signs
were related to patients’ demographics or to perception of their
quality of life. This prospective cross-sectional study included 479 adult patients
with back pain from a university spine centre. Each completed SF-12
and Oswestry Disability Index (ODI) questionnaires and underwent
standard spinal examinations to elicit Waddell signs. The relationship
between Waddell signs and age, gender, ODI, Mental Component Score
(MCS), and Physical Component Score (PCS) scores was determined.Aims
Patients and Methods
Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine. A previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion.Objectives
Methods
Patients with multiple myeloma (MM) develop deposits in the spine
which may lead to vertebral compression fractures (VCFs). Our aim
was to establish which spinopelvic parameters are associated with
the greatest disability in patients with spinal myeloma and VCFs. We performed a retrospective cross-sectional review of 148 consecutive
patients (87 male, 61 female) with spinal myeloma and analysed correlations
between spinopelvic parameters and patient-reported outcome scores.
The mean age of the patients was 65.5 years (37 to 91) and the mean
number of vertebrae involved was 3.7 (1 to 15).Aims
Patients and Methods
Although vertebroplasty is very effective for relieving acute pain from an osteoporotic vertebral compression fracture, not all patients who undergo vertebroplasty receive the same degree of benefit from the procedure. In order to identify the ideal candidate for vertebroplasty, pre-operative prognostic demographic or clinico-radiological factors need to be identified. The objective of this study was to identify the pre-operative prognostic factors related to the effect of vertebroplasty on acute pain control using a cohort of surgically and non-surgically managed patients. Patients with single-level acute osteoporotic vertebral compression fracture at thoracolumbar junction (T10 to L2) were followed. If the patients were not satisfied with acute pain reduction after a three-week conservative treatment, vertebroplasty was recommended. Pain assessment was carried out at the time of diagnosis, as well as three, four, six, and 12 weeks after the diagnosis. The effect of vertebroplasty, compared with conservative treatment, on back pain (visual analogue score, VAS) was analysed with the use of analysis-of-covariance models that adjusted for pre-operative VAS scores.Objectives
Patients and Methods