Maintaing Global Balance

The body is a complex machine that often compensates to maintain balance. Our recent study sheds light on the importance of global alignment and lower extremity compensation.

We found that asymptomatic volunteers used compensatory mechanisms such as slight pelvis retroversion, knee flexion, and neck extension to maintain an aligned sagittal posture with their head centered over their knees (Not the pelvis).

In asymptomatic volunteers, sagittal alignment parameters saw a slow and steady change across age groups most exemplified by an increase in Thoracic kyphosis, while lumbar lordosis did not show a significant decrease across age groups.

Read the full article: Age- and Gender-based Global Sagittal Spinal Alignment in Asymptomatic Adult Volunteers: Results of the Multiethnic Alignment Normative Study (MEANS)
https://pubmed.ncbi.nlm.nih.gov/35797648/

Sagittal alignment of a 26-year-old volunteer (A) and a 68-year-old volunteer (B). The figure is representative of the volunteer population as it shows a higher thoracic kyphosis in the older volunteer while maintaining the odontoid-knee distance by using compensatory mechanisms such as slight knee flexion and cervical extension.

#neurosurgery #physicaltherapy #chiropractor #spine #spinehealth #spinesurgery #scoliosis #scoliosissurgeon #spinedeformity #spinaldeformity #idiopathicscoliosis #degenerativescoliosis #kyphosis #flatback #spinalalignment

Individualized Surgical Planning using the #MEANS concepts

Matching the Thoracic kyphosis, Lumbar Lordosis, and Pelvic Incidence in the sagittal plane is the key to optimal alignment in adult spinal deformity surgery

The concept applies to the coronal plane as well. We need to match the fractional lumbosacral curve, lumbar scoliosis, and thoracic scoliosis.

This patient with a prior harrington rod who underwent surgery for difficulty standing upright, back leg and radiculopathy.

We can see that the patient is compensating preop using their lower extremities. Considering the PI, TK, LL match I planned for a lordosis of 31 in this patient with thoracic kyphosis of only 8 and pelvic incidence of 50.

Similarly, I planned partial reduction of the lumbar scoliosis using differently shaped rods to match the thoracic scoliosis.

Screws were planned around the existing rods.

Postop X-rays show a well aligned spine in both planes with no further need for additional compensation from the lower extremities

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For a consultation or second opinion, please call 212-932-5187

To learn more about this topic. Read our article titled: Sagittal spinal alignment varies with an individual’s race: results of the multi-ethnic alignment normative study (MEANS)

#SpinalHealth #UniqueSpines #PelvicIncidence #LumbarLordosis #ThoracicKyphosis #Orthopedics #orthopedicsurgery #neurosurgery #physicaltherapy #pt #physicianassistant #nurse #patientcare #patientsafety #futuredoctor #futuresurgeon #medicine #medstudent #medicalstudent #spine #spinehealth #spinesurgery #spinesurgery #scoliosis #scoliosissurgeon #spinedeformity #spinaldeformity #idiopathicscoliosis #degenerativescoliosis #kyphosis #flatback #Spondylolisthesis #HarringtonRods #stenosis

Spinal alignment varies with an individual’s race !


A Multi-Ethnic Alignment Normative Study (MEANS)

Spinal alignment is determined by more than just the PI or SS.
We compared individuals from three main races: Asian (A), Arabo-Bèrbère (B), and Caucasian (C).

Key points:
-Pelvic morphology including pelvic incidence (A: 51.0, B: 52.0, C: 52.5, p = 0.37), pelvic tilt (A: 11.9, B: 12.3, C: 12.9, p = 0.44), and sacral slope (A: 39.1, B: 39.7, C: 39.6, p = 0.77) were similar amongst the 3 races
– Thoracic Kyphosis (A: 32.9, B: 43.3, C: 40.0, p < 0.0001) and Lumbar lordosis (A: – 54.2, B: – 60.4, C: – 59.6, p < 0.0001) were lower in Asians compared to Caucasian and Arabo-Bèrbère volunteers despite having similar PI, PT, SS.
– The spine community has placed a lot of emphasis on the pelvis and not enough on the harmonious relationship between the lumbar spine and the thoracic spine
– There are likely genetic, environmental, cultural factors that determine the thoracic kyphosis and the eventual lumbar lordosis in addition to the influence of the pelvis.
– We need to start thinking of the PI LL TK mismatch instead of just the PI LL mismatch.

Read the full article: Sagittal spinal alignment varies with an individual’s race: results of the multi-ethnic alignment normative study (MEANS)

https://pubmed.ncbi.nlm.nih.gov/37428432

#neurosurgery#physicaltherapy#chiropractor#spine#spinehealth#spinesurgery#spinesurgery#scoliosis#scoliosissurgeon#spinedeformity#spinaldeformity#idiopathicscoliosis#degenerativescoliosis#kyphosis#flatback#spinalalignment

Here are lateral X-rays of three asymptomatic volunteers with similar pelvic morphology (Pelvic Incidence, Pelvic Tilt, Sacral Slope) but different cervical lordosis, thoracic kyphosis, and lumbar lordosis, leading to different spinal shape

Guidelines for Assessment and Management of Osteoporosis in Adult Patients Undergoing Elective Spinal Reconstruction

Following the topic of Bone Health in Adults undergoing spine surgery from my previous post. Here are the guidelines we published for evaluation and treatment of patients with osteoporosis.

neurosurgery #physicaltherapy #chiropractor #spine #spinehealth #spinesurgery #spinesurgery #scoliosis #scoliosissurgeon #spinedeformity #spinaldeformity #idiopathicscoliosis #degenerativescoliosis #kyphosis #flatback #spinalalignment

https://pubmed.ncbi.nlm.nih.gov/34690329/

Bone Health treatment before spine surgery

Alignment may be #1 but Bone Health is a close #2 in preventing mechanical failure in patients undergoing adult spinal deformity surgery

This study published by us in JBJS shows the significance of medical treatment of osteoporosis prior to adult spinal deformity surgery.

Next step is to identify the osteopenic patients who will benefit from preop treatment as well.

neurosurgery #physicaltherapy #chiropractor #spine #spinehealth #spinesurgery #spinesurgery #scoliosis #scoliosissurgeon #spinedeformity #spinaldeformity #idiopathicscoliosis #degenerativescoliosis #kyphosis #flatback #spinalalignment

https://www.jbjs.org/reader.php?rsuite_id=734f992f-c03d-43e7-9372-0ca7bbfe5c72&source=The_Journal_of_Bone_and_Joint_Surgery/106/3/206&topics=sp#info

What is Normal Lumbar Spine Alignment and segmental lordosis ?


A Multi-Ethnic Alignment Normative Study (MEANS)

Here is what we learnt for Lumbar segmental alignment and distribution from the MEANS population.

Key Points:

  • L4-S1 lordosis has a very weak correlation with PI and essentially is independant of PI. So, high PI does NOT mean high L4-S1 lordosis ! Average L4-S1 lordosis is around 35°-38° across the range of high to low PI
  • L1-L4 lordosis correlates with PI and increases with PI to add that extra lordosis for people with high PI
  • High PI leads to increase in L1-L4 lordosis and more cranial migration of the Apex of the Lumbar lordosis
  • Lumbar Lordosis Apex was most commonly at L4 (56.6%, Mean PI: 49) followed by L3 (40.2%, Mean PI: 56)
  • Age did not correlate with Lumbar Lordosis
  • PI-LL mismatch varies with PI as well. Low PI patients have LL HIGHER than PI. High PI patients have LL closer to or slightly LOWER than PI

Equation for predicting L1-L4 lordosis which I use:
L1-L4 = -0.4(PI) + 2.2

Equations for predicting L1-S1 lordosis were given in the earlier post. L4-S1 lordosis can be calculated as a difference between total lordosis and L1-L4 lordosis

Key Results:
Mean PI: 52.0°
Mean LL: −57.4°
Mean L1-L4: −20.6°
Mean L4-S1: −36.8°
Percentage of LL attributed to L4-S1 was 65.0% (95% CI: 63.9%, 66.2%)

#neurosurgery #physicaltherapy #chiropractor  #spine #spinehealth #spinesurgery #spinesurgery #scoliosis #scoliosissurgeon #spinedeformity #spinaldeformity #idiopathicscoliosis #degenerativescoliosis #kyphosis #flatback #spinalalignment

Variation in Lumbar Shape and Lordosis in a Large Asymptomatic Population

https://www.ingentaconnect.com/content/wk/brs/2023/00000048/00000011/art00006

What is Normal Spinal Alignment ?


A Multi-Ethnic Alignment Normative Study (MEANS)

We have had the privilege of collaborating with multiple international sites to establish a cohort of asymptomatic volunteers (468) with no prior spinal pathology. This was done to develop a more detailed understanding of spinal alignment. We have to understand normal to identify abnormal !

I am proud to share that we now have several publications addressing this topic and I will try to share some key points in upcoming posts.

Key Points:

  • Thoracic Kyphosis does NOT correlate with PI
  • Lumbar lordosis is better predicted if we use PI AND thoracic kyphosis – PI alone is only partly useful.
  • Age accounts for minimal decrease in Lumbar lordosis in asymptomatic people
  • Thoracic kyphosis increases with age
  • Cervical lordosis increases with age to compensate for increasing thoracic kyphosis. Therefore, Cervical SVA (C2-C7 SVA) is maintained with age
  • Slight cervical kyphosis in young people is NORMAL
    cervical alignment is dependant on throacic alilgnment: CL=−24.5+1.1 (T1slope)

Key results:
Cervical lordosis from C2 to C7: −0.4±12.7°
T1-slope: 23.0±7.9°
Thoracic kyphosis (TK) from T4 to T12: 37.4±10.9°
L1–S1 lumbar lordosis (LL): −57.4±11.3°
Pelvic incidence (PI): 52.0±10.7°
Pelvic tilt (PT): 12.5±7.3°
PI-LL mismatch: −5.4±10.7°
Cervical sagittal vertical axis (cSVA): 19.0±9.8 mm

Age based equations for predicting LL which I use routinely now:
Age 18-28: LL=8.6+0.55(PI)+0.61(TK); r2=0.77
Age 29-37: LL=5.8+0.62(PI)+0.57(TK); r2=0.75
Age 38-50: LL=5.9+0.57(PI)+0.58(TK); r2=0.78
Age 51-64: LL=8.6+0.56(PI)+0.46(TK); r2=0.69
Age > 64: LL=4.0+0.51(PI)+0.53(TK); r2=0.66

Regarding PI-LL mismatch:
60% of volunteers met the PI-LL criteria within ±10°
PI-LL mismatch of ≥10° in only 8.3%
LL was higher than PI by ≥10° in 32.1%

#neurosurgery #physicaltherapy #spine #spinehealth #spinesurgery #spinesurgery #scoliosis #scoliosissurgeon #spinedeformity #spinaldeformity #idiopathicscoliosis #degenerativescoliosis #kyphosis #flatback #spinalalignment

Age and Gender Based Spinopelvic and Regional Spinal Alignment in Asymptomatic Adult Volunteers

https://journals.lww.com/spinejournal/fulltext/2022/10010/age_and_gender_based_spinopelvic_and_regional.6.aspx

Navigating Airport Security with Spinal Implants

Attention to those with spinal fusion implants or considering scoliosis surgery! You may be detected by metal detectors at the airport. Ease your travel by filling out the TSA notification card and present it to the agents. Opting for the Advanced Imaging Technology (AIT) machine is often a smoother choice instead of the walk-through metal detector

Click the TSA notification card and take control of your travel experience today. Share with those who may benefit.

Dr. Sardar specializes in treating scoliosis, kyphosis, and other complex spinal conditions.

Please call 212-932-5100 for a consult

http://www.sardarspine.com

#Scoliosis #AdolescentScoliosis #ScoliosisAwareness #SpinalHealth #ScoliosisJourney #ScoliosisWarrior #ScoliosisStrong #ScoliosisSurgeon #scoliolsissurgery #SpineHealth #spineexpert, #spinesurgery, #spinedeformity, #spinaldeformity, #idiopathicscoliosis, #degenerativescoliosis, #kyphosissurgeon, #kyphosis, #flatback, #Spondylolisthesis, #HarringtonRods #JourneyWithScoliosis #cgscoliosis

Title: 🚨 Untreated Scoliosis Alert! Consequences of delay in detection or treatment 💔

⚠️ Parents & Teens ⚠️ Untreated scoliosis can lead to severe progression, pain, limited mobility, and even affect lung function. Early detection is vital!

These are X-rays from a patient of mine in her early 40s whose scoliosis went unnoticed and untreated, now facing severe consequences in her 40s.

Early treatment as a child could have avoided the much bigger surgery that she now needs

🙏 Share to Care 🙏 Spread awareness and protect our futures!

Dr. Sardar specializes in treating scoliosis, kyphosis, and other complex spinal conditions.

Please call 212-932-5100 for a consult

http://www.sardarspine.com

#Scoliosis #AdolescentScoliosis #ScoliosisAwareness #SpinalHealth #ScoliosisJourney #ScoliosisWarrior #ScoliosisStrong #ScoliosisSurgeon #scoliolsissurgery #SpineHealth #spineexpert, #spinesurgery, #spinedeformity, #spinaldeformity, #idiopathicscoliosis, #degenerativescoliosis, #kyphosissurgeon, #kyphosis, #flatback, #Spondylolisthesis, #HarringtonRods #JourneyWithScoliosis #cgscoliosis

X-rays posted with patient’s permission. Please do not duplicate

🌟 Scoliosis Screening with a Scoliometer: Your Pediatrician’s Powerful Tool! 👨‍⚕️

Hello, teens and parents! 🌈 Today, let’s dive into how your pediatrician or primary care physician can use a scoliometer to screen for scoliosis. This simple yet effective tool is a game-changer in ensuring early detection and optimal spine health!

📋 What is a Scoliometer?

A Scoliometer is a device that your pediatrician might use during a routine checkup to measure the rotation of your back. It helps them identify potential signs of scoliosis at an early stage!

🔍 The Screening Process:

The pediatrician will have your teen stand with their feet together and slowly bend forward to touch their toes. They will gently place the Scoliometer on their back’s highest point and measure the degree of rotation.

If the scoliometer reading is higher than 5-7 degrees, further evaluation by a spine specialist, such as an orthopedic surgeon or a pediatrician, is necessary. The specialist may conduct a more comprehensive examination, which may include X-rays or other imaging tests, to confirm the presence and severity of scoliosis.

🤝 Let’s raise awareness about scoliosis screening with Scoliometers! Share this post to empower others with knowledge. Tag your pediatrician to appreciate their dedication in supporting your spine health! 🙌

Dr. Sardar specializes in treating scoliosis, kyphosis, and other complex spinal conditions.

Please call 212-932-5100 for a consult

http://www.sardarspine.com

#Scoliosis #AdolescentScoliosis #ScoliosisAwareness #SpinalHealth #ScoliosisJourney #ScoliosisWarrior #ScoliosisStrong #ScoliosisSurgeon #scoliolsissurgery #SpineHealth #spineexpert, #spinesurgery, #spinedeformity, #spinaldeformity, #idiopathicscoliosis, #degenerativescoliosis, #kyphosissurgeon, #kyphosis, #flatback, #Spondylolisthesis, #HarringtonRods #JourneyWithScoliosis #cgscoliosis