Objective: : This study aimed to elucidate the normative upper lumbar lordosis (ULL) and lower LL (LLL) based on individual pelvic and spinal morphology within an asymptomatic elderly population. Methods: : Whole spine standing radiographs were obtained from asymptomatic elderly populations who had not undergone previous spinal surgery. The LL, LLL and ULL were measured. Pelvic incidence (PI), upper lumbar distribution index (ULDI), and lower LDI were calculated. Pearson correlation and linear regression analyses were performed, and the mean value for each parameter was obtained according to PI subgroup (PI <40°, 40°≤ PI <50°, 50°≤ PI <60°, and 60°≤ PI) and “theoretical” Roussouly type. Results: : Overall, data from 150 male were retrospectively collected in the study, with an average age of 64.1±6.4 years. The mean height was 167.0±5.5 cm, weight was 67.3±9.8 kg, and body mass index was 24.1±3.1 kg/m2. The average LL was -57.5°±9.0°, LLL was -39.7°±6.8°, and PI was 48.6°±8.6°. Pelvic tilt (PT) tended to increase with ULL, PI-LL, PI-ULL, PI-LLL, and ULDI and decrease with LLL and LDI. However, PT was not significantly related to LL. The mean ULDI and LDI were 30.4%±11.7% and 69.7%±11.7%, respectively. The differences between PI and LL (PI-LL) and between PI and LLL (PI-LLL) were -8.9°±8.0° and 9.0°±9.3°, respectively. As PI increased from low (<40°) to high (≥60°), ULDI increased significantly from 25.9% to 38.9%, while LDI decreased from 74.1% to 61.1%. Additionally, LDI varied by Roussouly type, ranging from 62.6% to 81.0%. The LDIs of Roussouly types 1 and 4 were significantly higher and lower, respectively, than those of types 2 and 3 (p<0.001). Conclusion : As PI and Roussouly type increase, the contribution of ULL to overall LL rises, reaching up to 38.9%. Conversely, LLL substantially impacts LL in patients with a low PI and those classified as Roussouly type 1. PT is significantly related to LLL instead of LL according to PI.

Methods: In retrospectively collected data, 149 patients who underwent single-level ACDF for degenerative disease were enrolled and divided into non-plating (n=66) and plating (n=83). Interspinous motion (ISM) at the arthrodesis segment, Numeric Rating Scale (NRS) for neck pain, and Neck Disability Index (NDI) were serially evaluated at 3, 6, and 12 months postoperatively. Predictable factors for fusion, including age, sex, plating, diabetes, smoking, and type of grafts, were investigated, and fusion was defined as ISM <1 mm. Results: In both groups, ISM was the highest at 3 months and gradually decreased thereafter, and the plating group showed significantly lower serial ISM than the non-plating group at 12 months. The plating group had lower NRS and NDI scores than the nonplating group at 12 months, and the difference in the NRS scores was statistically significant, particularly at 3 and 6 months, although that of the NDI scores was not. In a multivariate analysis, plating was the most powerful predictor for fusion. Conclusions Plating significantly decreases the serial ISM compared with non-plating in single-level ACDF, and such decreased motion is correlated with decreased neck pain until 12 months postoperatively, particularly at 3 and 6 months. Given that plating was the most predictive factor for fusion, we recommend plating even in single-level ACDF for better early clinical outcomes.

Methods: Total 179 normal, asymptomatic Korean men were divided in to three groups (6th, 7th, and 8th decade) according to their age. Standard sagittal spinopelvic parameters, including TK and thoracolumbar kyphosis, were measured and subdivided into the following four segments: A (C7 upper end plate [UEP]–T5 UEP), B (T5 UEP–T10 UEP), C (T10 UEP–T12 lower end plate [LEP]), and D (T12 LEP–L2 LEP). These segments of the three study groups were analyzed. Results: In segment B, the segmental kyphosis of group 3 (20.2°±8.0°) showed a statistically larger value than that of group 1 (15.6°±6.8°) and group 2 (16.7°±8.8°) (p=0.017). In segment C, the segmental kyphosis of group 2 (12.9°±6.5°) and group 3 (12.2°±7.1°) showed statistically larger values than that of group 1 (9.5°±6.2°) (p=0.016). The A and D segments of the three groups were not significantly different. Conclusions Increased TK was observed in the middle (segment B) and lower (segment C) thoracic segments in normal asymptomatic male subjects with age. The results from the natural progression of segmental kyphosis with age would provide baseline reference data to help surgeons choose the optimal point of the upper instrumented vertebra level for preventing proximal junctional kyphosis.

BACKGROUND: Critical limb ischemia has been identified as a risk factor for the incidence of postoperative delirium in elderly patients. Limb amputation is the last option in critical limb ischemia treatments. We investigated the incidence and predisposing factors of postoperative delirium in patients undergoing major leg amputation. METHODS: From January 2012 to December 2016, 121 patients aged over 60 years who had undergone major leg amputation were enrolled in this study. Various factors related to the patients’ outcomes were assessed, including demographic, preoperative laboratory, anesthetic, surgical, and postoperative indicators. RESULTS: Twenty two patients were excluded and 99 patients were assigned to either the delirium group or no delirium group. Forty of them (40%) developed a delirium during 30 days postoperatively. Univariate analysis implied that end-stage renal disease on hemodialysis, alcohol consumption, C-reactive protein, staying in an intensive care unit (ICU), duration of an ICU stay, occurrence of complications, and mortality during six months, were the factors that accounted for significant differences between the two groups. In multivariate analysis, three factors were significantly related to the development of delirium: mortality during six months (odds ratio [OR] = 13.86, 95% CI [2.10–31.90]), alcohol (OR = 8.18, 95% CI [1.13–16.60]), and hemodialysis (OR = 4.34, 95% CI [2.06–93.08]). CONCLUSIONS: Approximately 40% of the elderly patients suffered from postoperative delirium in major leg amputation. Identifying those with risk factors for postoperative delirium and intervening at the early stage will be of great benefit in major leg amputations for the elderly population.
Aged* ; Alcohol Drinking ; Amputation* ; C-Reactive Protein ; Causality ; Delirium* ; Extremities* ; Humans ; Incidence ; Intensive Care Units ; Ischemia* ; Kidney Failure, Chronic ; Leg* ; Mortality ; Multivariate Analysis ; Renal Dialysis ; Retrospective Studies* ; Risk Factors

PURPOSE: Little is known with respect to changes in the segmental thoracic and thoracolumbar kyphosis, which are major parameters influencing sagittal balance of the spine. The authors investigated the detailed segmental changes of those parameters by ageing. MATERIALS AND METHODS: A total of 326 normal asymptomatic males were divided into 2 groups; group 1 (mean age, 21.2+/-1.7; n=175) and group 2 (mean age, 64.1+/-6.4; n=151). After taking a standing sagittal radiograph, the sagittal spinal and pelvic parameters were measured. Thoracic and thoracolumbar kyphosis were classified according to segments A, C7 UEP (upper end vertebra)-T5 UEP; B, T5 UEP-T10 UEP; C, T10 UEP-T12 LEP (lower end vertebra); and D, (T12 LEP-L2 LEP), and analyzed between 2 groups, respectively. RESULTS: Thoracic kyphosis (21.1degrees+/-7.7degrees vs. 30.0degrees+/-8.8degrees, p<0.001), segment B (15.8degrees+/-6.1degrees vs. 18.1degrees+/-7.9degrees, p=0.003), and segment C (5.3degrees+/-5.1degrees vs. 11.8degrees+/-6.5degrees, p<0.001) were increased in group 2. In group 2 segment A showed decreased kyphosis (12.1degrees+/-6.4degrees vs. 9.8degrees+/-6.4degrees, p=0.001). In segment D no significant difference was observed between groups. CONCLUSION: Increased thoracic kyphosis was observed in the middle and lower thoracic regions. The authors provided important references of sagittal parameters to determine the expected ranges of kyphosis for a normal asymptomatic male of a given age.
Humans ; Kyphosis* ; Male ; Spine ; Thoracic Vertebrae

STUDY DESIGN: A prospective comparative study. PURPOSE: To describe the changes in the spinopelvic parameters on normal Koreans more than 50 years of age. OVERVIEW OF LITERATURE: There are differing opinions regarding the changes in the thoracic kyphosis, lumbar lordosis, C7 plumb with age in the elderly population. METHODS: Sagittal standing radiographs of the whole spine including the pelvis in 132 Korean adult male volunteers more than 50 years of age were evaluated prospectively. Volunteers with a history of spine operation, spinal disease, pain in their back or legs, scoliosis, spondylolisthesis, monosegment disc space narrowing, or compression fracture in radiographs were excluded. The following parameters were included: thoracic kyphosis (T5 upper end plate [UEP]-T12 lower end plate [LEP]), thoracolumbar kyphosis (T10 UEP-L2 LEP), lumbar lordosis (T12 LEP-S1 UEP), lower lumbar lordosis (L4 UEP-S1 UEP), sacral slope, pelvic incidence, and the distances from the C7 plumb to the posterosuperior endplate of S1. These parameters in the 6th, 7th and 8th decade groups were compared and the changes in these parameters according to age were examined. RESULTS: The thoracic kyphosis demonstrated significant differences in the in the three age groups (p = 0.019), and increased with age (r = 0.239, p < 0.006). The other parameters did not show any significant difference or correlation. CONCLUSIONS: Similar global sagittal balances and spinopelvic parameters may be observed in Korean males older than 50 years, with a trend towards increasing thoracic kyphosis with age.
Adult ; Aged ; Animals ; Fractures, Compression ; Humans ; Incidence ; Kyphosis ; Leg ; Lordosis ; Male ; Pelvis ; Prospective Studies ; Scoliosis ; Spinal Diseases ; Spine ; Spondylolisthesis