Measurement of spinal sagittal curvatures using the laser triangulation method

The purpose of the first part of the study was to establish the variability of repeated measurements in different measuring conditions. In the second part, we performed in a large number of patients, a measurement of thoracic kyphosis and lumbar lordosis and compared them to age, gender, and level of nourishment. In the first part, measurements were performed on a plastic model of the back of a patient with a rigid and a normal spine. In the second part, 250 patients participated in the study (126 men and 124 women). For measuring spinal curvatures we used an apparatus for laser triangulation constructed at the Faculty of Mechanical Engineering, University of Ljubljana. A comparison of 30 repeated measurements was shown as the average value +/- 2 SD which included 95% of the results. Thirty repeated readings of one 3D measurement: thoracic kyphosis 41.2 degrees +/- 0.6 degrees, lumbar lordosis 4.4 degrees +/- 1.2 degrees; 30 measurements on a plastic model: thoracic kyphosis 36.8 degrees +/- 1.2 degrees, lumbar lordosis 30.9 degrees +/- 2.0 degrees; 30 measurements on a patient with a rigid spine: thoracic kyphosis 41.5 degrees +/- 2.4 degrees, lumbar lordosis 4.0 degrees +/- 1.8 degrees; 30 measurements on a patient with a normal spine: thoracic kyphosis 48.8 degrees +/- 7.4 degrees, lumbar lordosis 21.1 degrees +/- 4.4 degrees. The average size of thoracic kyphosis in 250 patients was 46.8 degrees (SD 10.1 degrees) and lumbar lordosis 31.7 degrees (SD 12.5 degrees). The angle size was statistically significantly correlated to gender (increased thoracic kyphosis and lumbar lordosis in women) and body mass index (increased thoracic kyphosis and lumbar lordosis in more nourished patients). Age was not significantly correlated to the observed angles. During measurements of the spinal angles it was important to pay attention to relaxation and the patient's position as well as to perform more measurements providing the average value. The age and the level of nourishment influence the size of the sagittal spinal angles. In the observed sample the effect of age was not confirmed.     

Length of the spinal dural sac, sex differences and correlation with the length of the spinal cord and vertebral column in adults

In 94 corpses (59 male and 35 female) of mature persons the length of the spinal dura mater sac has been studied. The average length of the sac is 621 +/- 3 mm. In men its average length is 636 +/- 4 mm, it makes 40 mm more in length than that in women (596 +/- 4 mm). The length of various parts in the dura mater sac is not the same: the cervical part makes 23% of the whole length, the thoracic--47%, the lumbar--23%, the sacral--7%. In men the cervical part of the sac in average is 6 mm longer than the lumbar part, and in women--quite the reverse, it is 7 mm shorter than the lumbar part. The sacral part of the sac in women is 3 mm longer that that in men. The sex differences noted are statistically significant. It is stated that the length of the spinal cord, its dura mater and the vertebral column are related as 1:1.5:1.7, the length of their cervical parts--as 1:1.5:1.4. the thoracic--as 1:1.3:1.3, the lumbar--as 1:2.4:3, the sacrococcygeal--as 1:1.4:4.9, respectively. During ontogenesis the greatest increase in the dura mater sac takes place in the cervical part as compared to the spinal cord and the vertebral column; in the thoracic part the intensity of their growth is equal: in the lumbar and in the sacrococcygeal part the increase of the vertebral column is the greatest.     

Lumbar portion of the human spinal canal at different age periods

The investigation was performed in 253 lumbosacral parts of the spinal column in fetuses, children and adult men in order to study age dynamics of the vertebral canal both at the level of the vertebra and at the level of the intervertebral disks. For the first time reliable data were obtained on dimentions of sagittal and frontal diameters of the canal at the lumbar level in practically healthy persons of different age. "Vertical comparison" of mean values of these parameters gave information on the character of spatial reaction of the canal dimentions and its form at various levels and demonstrated age peculiarities of these relations. In persons at the age of 22-74 years in vertibral segments of the lumbar part of the spinal column certain degenerative-destructive processes were revealed; they could affect the size and form of the canal. The rate, level and degree of these processes were demonstrated to vary in different age periods.     

Morphogenesis of structural elements of the cervical spine in the white rat in prenatal ontogeny

Embryonal development of the spinal column cervical part has been studied in 100 series of sagittal, transversal, frontal sections; time of the main structural elements anlagen (vertebral bodies, arches, joints, ligaments) is noted. The prenatal development of the spinal column cervical part is divided into 3 stages--mesenchymal, cartilagenous, osseous. The first stage lasts up to 16 days of development; during this period anlagen of vertebral bodies, arches, joints, ligaments are formed. The second stage--cartilagenous; mesenchyma is substituted for cartilagenous tissue, cartilagenous cells are differentiated. This stage lasts from the 16th up to the 18th day of embryogenesis. The third stage--osseous--lasts from the 18th up to the 21st day of embryogenesis. During this period structures of the spinal column cervical part acquire a definitive form, the cartilagenous tissue is substituted for the osseous one.     

The presence of endometrial cells in cervical smears in relation to the day of the menstrual cycle and the method of contraception

The presence of endometrial cells in cervical smears was studied in a large series of women participating in a population screening program for cervical cancer, in relation to different time periods of the menstrual cycle and to the method of contraception practiced. In the total group of women studied, endometrial cells were present in an average of 12% of the cervical smears. In women who were menstruating cyclically, the percentage of cervical smears containing endometrial cells was not age dependent. Only in women over 52 years was a lower number of endometrium-positive cervical smears found: in postmenopausal women, 0.6% of smears were found to contain endometrial cells. In menstruating women, the frequency of endometrial cells in cervical smears was highest during the menses. After day four, through the proliferative phase, the percentages of cervical smears containing endometrial cells markedly decreased. During the secretory phase, an average of 2% of the smears contained endometrial cells; in the premenstrual phase (after day 25), the percentages of endometrial cell-positive smears rose again. When related to the method of contraception practiced, significant differences in the percentages of cervical smears with endometrial cells appeared. In women using oral hormonal contraceptives, the average numbers of smears containing endometrial cells for the whole cycle as well as for each period of the cycle were significantly lower. This phenomenon might be due to endometrial atrophy on the basis of prolonged use of oral hormonal contraceptives. In women wearing an intrauterine device, at any moment the frequencies of smears with endometrial cells present were significantly higher than the values found in women using any other method of contraception or not using contraceptives. The evaluation of cells originating from the endometrium requires considerable experience. The identification of endometrial cells can be made with greater confidence when the cytologist is aware of the exact date of the menstrual cycle and of the impact on the presence of endometrial cells in cervical smears caused by different methods of contraception.     

Craniocervical morphology and posture in Australian aboriginals

The length of the spinal column as a percentage of stature is smaller in the Australian aboriginal than in most other ethnic groups (Abbie, 1957). It is conceivable that relative lengths of the cervical column might influence population differences in craniocervical posture and craniofacial morphology. The present study aimed to elucidate this relationship by comparing head posture and craniofacial morphology in Australian aboriginals to the same features in a previously studied sample of 120 Danish students (Solow and Tallgren, 1976). The aboriginal sample consisted of 42 young male adults from the Yuendumu settlement, Northern Territory, Australia. Cephalometric films of the natural head position were taken during a field trip to the settlement. The comparison comprised 18 postural and 61 morphological variables. In the aboriginals, the cervical column was shorter and had a less pronounced lordosis. The head was held about 3° lower, and the upper cervical column was 81/2° more forward inclined. As a consequence, the craniocervical angle was about 6° larger. Comparison of the craniofacial morphology in the two groups showed in the aboriginals a shorter upper facial height, a larger anterior lower facial height, and a larger vertical jaw relationship (NL/ML). The length of the posterior cranial base, s-ba, was 4 mm shorter (P <0.001) in the aboriginals, possibly developmentally related to the generally shorter spinal column in Australian aboriginals.     

The lumbar and sacrum movement pattern during the back squat exercise

An essential exercise for strength training of the lower limbs is the squat exercise. During this exercise, changes in lumbar lordosis are commonly used to indicate when the descent of the squat should cease, yet the behavior of the lumbar-scarum segments remains unclear. The purpose of this study was to quantify the lumbar-sacrum movements during the back squat, because the movement of the sacrum is influenced by the width of stance, this variable was also investigated. Thirty trained subjects, 18 men with 1 repetition maximum (1RM) squat of 123% (13.9%) of bodyweight and 12 women with 1RM squat of 93% (15.6%), performed a set of narrow and wide stance squats, each carrying an additional 50% of body weight as load. The timing and movement of the lumbar angle (T12/L1), sacrum angle (L5/S1), and lumbar flexion angle (lumbar lordosis) were measured in 3 dimensions for the ascent and decent phases. Men and women achieved similar lumbar angles for both width of stance and phase. Sacrum angles, lumbar flexion angles, and timing differed significantly (p < 0.05) between gender and width of stance. The lumbar flexion range during the descent phase for women in narrow and wide stance was 12.9° and 12.6°, respectively; for men, this range was significantly (p < 0.05) larger at 26.3° and 25.4°, respectively. Men and women developed different movement patterns for the squatting movement, and therefore, this needs to be considered in strength development and screening procedures. The lumbar spine became kyphotic as soon as a load was placed on the shoulders, and any teaching cues to maintain a curved lumbar spine when squatting must be questioned.     

Injuries of the spine sustained during gymnastic activities.

Between 1954 and 1984, 38 patients were seen as a result of gymnastic activities. Thirty three were men, five were women, and their ages ranged from 12 to 54, the mean age being 20. Thirty one had spinal injuries (28 in the cervical region, three in the thoracolumbar region), two no definite injury, and for five the information was incomplete. The accidents occurred largely because gymnasts landed on their heads, the force being transmitted to the cervical spine. Most took place in gymnasiums and were caused by a failure of supervision.     

Functional morphology of the primate head and neck

The vertebral column plays a key role in maintaining posture, locomotion, and transmitting loads between body components. Cervical vertebrae act as a bridge between the torso and head and play a crucial role in the maintenance of head position and the visual field. Despite its importance in positional behaviors, the functional morphology of the cervical region remains poorly understood, particularly in comparison to the thoracic and lumbar sections of the spinal column. This study tests whether morphological variation in the primate cervical vertebrae correlates with differences in postural behavior. Phylogenetic generalized least-squares analyses were performed on a taxonomically broad sample of 26 extant primate taxa to test the link between vertebral morphology and posture. Kinematic data on primate head and neck postures were used instead of behavioral categories in an effort to provide a more direct analysis of our functional hypothesis. Results provide evidence for a function-form link between cervical vertebral shape and postural behaviors. Specifically, taxa with more pronograde heads and necks and less kyphotic orbits exhibit cervical vertebrae with longer spinous processes, indicating increased mechanical advantage for deep nuchal musculature, and craniocaudally longer vertebral bodies and more coronally oriented zygapophyseal articular facets, suggesting an emphasis on curve formation and maintenance within the cervical lordosis, coupled with a greater resistance to translation and ventral displacement. These results not only document support for functional relationships in cervical vertebrae features across a wide range of primate taxa, but highlight the utility of quantitative behavioral data in functional investigations. Am J Phys Anthropol 156:531–542, 2015. © 2015 Wiley Periodicals, Inc.     

Women doctors in urban general practice: the patients.

A large study from a representative sample of general practitioners in Manchester showed that women doctors saw more women patients than men doctors, especially in the childbearing age group. They saw a similar range of diagnoses as men doctors, though they saw more women patients for cervical smears, contraception, and breast disorders. Preventive health care may not be adequately provided for these in practices without a woman partner.     

Changes in the lumbosacral angle, sacral inclination and the curvature of the lumbar spine during aging.

Measurements of the curvature of the lumbar spine are useful in the investigations of low back pain. It is unclear whether the degree of lumbar lordosis, sacral inclination and lumbosacral angulation are the same for all normal adults. Radiographic studies were carried out on the lumbar spines of subjects aged 9-61 years. Mean and 95% tolerance ranges of the values of lumbar lordosis, lumbosacral angle and sacral inclination for adult age groups up to the sixth decade are given. The results showed that all three parameters varied steadily with age. The pattern of changes differed in males and females. Females had greater angles than males. Sacral inclination appeared to be a more important determinant of the degree of lumbar lordosis. All three parameters showed a tendency to decrease after the sixth decade. The significance of the findings is discussed.     

Biomechanical investigation of post-operative C5 palsy due to ossification of the posterior longitudinal ligament in different types of cervical spinal alignment

Post-operative C5 palsies are among the most common complications seen after cervical surgery for ossification of the posterior longitudinal ligament (OPLL). Although C5 palsy is a well-known complication of cervical spine surgery, its pathogenesis is poorly understood and depends on many other factors. In this study, a finite element model of the cervical spine and spinal cord-nerve roots complex structures was developed. The changes in stress in the cord and nerve roots, posterior shift of the spinal cord, and displacement and elongation of the nerve roots after laminectomy for cervical OPLL were analyzed for three different cervical sagittal alignments (lordosis, straight, and kyphosis). The results suggest that high stress concentrated on the nerve roots after laminectomy could be the main cause of C5 palsy because ossification of ligaments increases spinal cord shifting and root displacement. The type of sagittal alignment had no influence on changes in cord stress after laminectomy, although cases of kyphosis with a high degree of occupying ratio resulted in greater increases in nerve root stress after laminectomy. Therefore, kyphosis with a high OPLL occupying ratio could be a risk factor for poor surgical outcomes or post-operative complications and should be carefully considered for surgical treatment.     

Rationale for stopping cervical screening in women over 50.

OBJECTIVE--To investigate whether the currently recommended age at which to stop cervical screening (64) can be lowered and what criteria should be used for safely doing so. DESIGN--Retrospective case analysis study. SETTING--Dundee and Angus districts of Scotland. SUBJECTS--Women diagnosed as having cervical intraepithelial neoplasia and microinvasive or invasive cancer of the cervix in 1989 and 1990 (798 cases). MAIN OUTCOME MEASURE--History of cervical cytology results according to age (age groups of five years) and screening interval (three years and five years). RESULTS--Cervical intraepithelial neoplasia was most common in women under 45 (711 cases in women of 45 and under v 38 cases in those of 46 and over). Cervical intraepithelial neoplasia occurring de novo was not seen in women over 50 who had been screened every three years. Microinvasive or invasive cancer of the cervix was diagnosed in 26 women over 50. None of these women had participated adequately in the cervical screening programme. CONCLUSION--Cervical intraepithelial neoplasia typically occurs in younger women. All women over 50 with an adequate history of negative results on smear testing every three years may be safely discharged from further screening if these findings are confirmed in other populations.     

Age,Gender and Normalization Covariates for Spinal Cord Gray Matter and Total Cross-Sectional Areas at Cervical and Thoracic Levels: A 2D Phase Sensitive Inversion Recovery Imaging Study

The source of inter-subject variability and the influence of age and gender on morphometric characteristics of the spinal cord, such as the total cross-sectional area (TCA), the gray matter (GM) and white matter (WM) areas, currently remain under investigation. Understanding the effect of covariates such as age, gender, brain volumes, and skull- and vertebra-derived metrics on cervical and thoracic spinal cord TCA and GM areas in healthy subjects would be fundamental for exploring compartment specific changes in neurological diseases affecting the spinal cord. Using Magnetic Resonance Imaging at 3T we investigated 32 healthy subjects using a 2D phase sensitive inversion recovery sequence and we measured TCA, GM and WM areas at 4 cervical and thoracic levels of the spinal cord. We assessed age and gender relationships of cord measures and explored associations between cord measures and a) brain volumes and b) skull- and vertebra-derived metrics. Age and gender had a significant effect on TCA, WM and GM areas (with women and elderly having smaller values than men and younger people respectively), but not on the GM area/TCA ratio. The total intracranial volume and C3 vertebra dimensions showed the highest correlations with cord measures. When used in multi-regression models, they reduced cord areas group variability by approximately a third. Age and gender influences on cord measures and normalization strategies here presented might be of use in the study of compartment specific changes in various neurological diseases affecting the spinal cord.     

Gender dependent cervical spine segmental kinematics during whiplash

Clinical and epidemiological studies have frequently reported that female occupants sustain whiplash injuries more often than males. The current study was based on the hypothesis that segmental level-by-level cervical intervertebral motions in females are greater than in males during rear impact. The hypothesis was tested by subjecting 10 intact human cadaver head-neck complexes (five males, five females) to rear impact loading. Intervertebral kinematics were analyzed as a function of spinal level at the time of maximum cervical S-curve, which occurred during the loading phase. Segmental angles were significantly greater (p<0.05) in female specimens at C2-C3, C4-C5, C5-C6, and C6-C7 levels. Because greater angulations are associated with stretch in the innervated components of the cervical spinal column, these findings may offer a biomechanical explanation for the higher incidence of whiplash-related complaints in female patients secondary to rear impact acceleration.     

Prevalence of nonspecific low back pain in schoolchildren in north-eastern Slovenia

The aim of the study was to investigate the prevalence of the nonspecific low back pain (LBP) in a population of schoolchildren in Maribor, north-eastern Slovenia. 100 children from an elementary school (age 11-15 y) and 90 children from a secondary school (age 17-18 y) were included in the study and investigated with a structured Watson questionnaire to assess low back pain prevalence, symptom characteristics, psychosocial factors, demographic, and anthropometric items. The data was statistically analysed using the SPSS software. 43% of children from elementary schools and 44% of children from secondary schools experienced back pain which lasted more than one day. No correlations between LBP and anthropometric items were found. Schoolchildren spend approximately 2 hours for learning, 2-3 hours for watching TV and approximately 2 hours for playing or working with the computer. Among important reasons for LBP, 44% of children mentioned carrying a school bag, 28% sitting on school chairs, and 18% intensive sport activity. Clinical examination of cervical, thoracic, and lumbar spine has shown that 12% of primary children and 12% of secondary children have increased cervical lordosis and 15% of primary schoolchildren have increased lumbar lordosis. In 5% of schoolchildren we found mild spinal scoliotic changes. Among our schoolchildren sedentary behaviour and low physical activity dominate. LBP may have an impact on their daily life, therefore it is important to recognise and treat it as soon as possible.     

Halo-vest辅助下前路手术治疗严重颈椎结核伴后凸畸形

目的：探讨使用halo-vest支具牵引复位并通过前路手术治疗严重颈椎结核并后凸畸形的方法和疗效。方法：通过对2004年10月至2010年9月在我科住院治疗的14例严重颈椎结核并后凸畸形的患者进行回顾性研究。本组患者中男8例,女6例,术前颈椎后凸Cobb角24-42°,平均34°。术前使用四联抗结核药物治疗2-4周,通过Halo-vest支具牵引复位。纠正颈椎后凸畸形后,采用一期前路手术治疗。手术处理包括：结核病灶清除、自体髂骨植骨或钛网植入、颈前路钢板内固定。术后继续抗结核治疗12-24个月。结果：术后随访12-48个月,平均26个月。所有颈椎结核并后凸畸形的患者都能通过halo-vest支具牵引恢复基本的颈椎序列,并能很好地耐受手术。术后患者局部疼痛和全身结核中毒症状明显缓解,神经功能均较术前有所恢复,后凸畸形得到矫正。术后3-6个月植骨融合,无内固定及伤口并发症,无严重halo-vest支具相关并发症,无结核复发。结论：对于严重颈椎结核并后凸畸形的患者,术前通过halo-vest支具牵引复位,可矫正畸形,恢复颈椎正常生理序列,为后期手术治疗创造条件并降低术中复位可能引起的脊髓损伤风险。Halo-vest辅助下的前路手术是治疗严重颈椎结核伴后凸畸形的有效手段。     

Monitoring of spine curvatures and posture during pregnancy using surface topography – case study and suggestion of method

Background

Low back and pelvic pain is one of the most frequently reported disorders in pregnancy, however etiology and pathology of this problem have not been fully determined. The relationship between back pain experienced during pregnancy and posture remains unclear. It is challenging to measure reliably postural and spinal changes at the time of pregnancy, since most imaging studies cannot be used due to the radiation burden. 3D shape measurement, or surface topography (ST), systems designed for posture evaluation could potentially fill this void. A pilot study was conducted to test the potential of monitoring the change of spine curvatures and posture during pregnancy using surface topography. A single case was studied to test the methodology and preliminarily assess the usefulness of the procedure before performing a randomized trial. The apparatus used in this study was metrologically tested and utilized earlier in scoliosis screening.

Case presentation

The subject was measured using a custom-made structured light illumination scanner with accuracy of 0.2 mm. Measurement was taken every 2 weeks, between 17th and 37th week of pregnancy, 11 measurements in total. From the measurement the thoracic kyphosis and lumbar lordosis angles, and vertical balance angle were extracted automatically. Custom-written software was used for analysis. Oswestry Low Back Pain Disability Questionnaire (ODI) was done with every measurement. The values were correctly extracted from the measurement. The results were: 50.9 ± 2.4° for kyphosis angle, 58.1 ± 2.1° for lordosis angle and 4.7 ± 1.7° for vertical balance angle. The registered change was 7.4° in kyphosis angle, 8.4° in lordosis angle and 5.5° in vertical balance angle. The calculated ODI values were between moderate disability and severe disability (22 to 58 %).

Conclusions

This case study presents that surface topography may be suitable for monitoring of spinal curvature and posture change in pregnant women. The ionizing radiation studies are contraindicated during pregnancy. Surface topography data connected with information from pain level questionnaires allows to investigate the connection between changes in posture and back pain.

     

Effect of certain professions on the structure of the cervical portion of the spine]

The roentgen-anatomical study of the cervical portion of the vertebral column (fluorography and roentgenography in 2 projections followed by morphometrical treatment) was performed in 603 representatives of different professions: turners, milling-machine operators, craftsmen, mechanicians, jugglers, engineers and constructors. The following facts were established: asymmetry of bodies CIV and CV of vertebra in turners and milling-machine operators; differently pronounced cervical lordosis in persons of different professions; specific features in the architectonics of the spongy substance of the cervical vertebra bodies.     

Curvature of the lumbar spine as a consequence of mechanical necessities in Japanese macaques trained for bipedalism

If trained to walk bipedally at a juvenile age and over periods of some months or years, Japanese monkeys gradually acquire a pronounced lordosis of the lumbar spine. This lordosis persists even in the 'normal', pronograde posture of these animals. It is due to a relative increase of the ventral lengths of the vertebral bodies. This morphological change is clearly an adaptation to the mechanical necessities of the upright body posture. Our result is in complete accordance with the development of a lordosis in human children between 1 and 5 years, as described recently by others.