Research

15 pages, 4594 KiB

Open AccessArticle

Intra-Examiner Reliability and Validity of Sagittal Cervical Spine Mensuration Methods Using Deep Convolutional Neural Networks

by Mohammad Mehdi Hosseini, Mohammad H. Mahoor, Jason W. Haas, Joseph R. Ferrantelli, Anne-Lise Dupuis, Jason O. Jaeger and Deed E. Harrison

J. Clin. Med. 2024, 13(9), 2573; https://doi.org/10.3390/jcm13092573 (registering DOI) - 27 Apr 2024

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Abstract

Background: The biomechanical analysis of spine and postural misalignments is important for surgical and non-surgical treatment of spinal pain. We investigated the examiner reliability of sagittal cervical alignment variables compared to the reliability and concurrent validity of computer vision algorithms used in the [...] Read more.

Background: The biomechanical analysis of spine and postural misalignments is important for surgical and non-surgical treatment of spinal pain. We investigated the examiner reliability of sagittal cervical alignment variables compared to the reliability and concurrent validity of computer vision algorithms used in the PostureRay^® software 2024. Methods: A retrospective database of 254 lateral cervical radiographs of patients between the ages of 11 and 86 is studied. The radiographs include clearly visualized C1–C7 vertebrae that were evaluated by a human using the software. To evaluate examiner reliability and the concurrent validity of the trained CNN performance, two blinded trials of radiographic digitization were performed by an extensively trained expert user (US) clinician with a two-week interval between trials. Then, the same clinician used the trained CNN twice to reproduce the same measures within a 2-week interval on the same 254 radiographs. Measured variables included segmental angles as relative rotation angles (RRA) C1–C7, Cobb angles C2–C7, relative segmental translations (RT) C1–C7, anterior translation C2–C7, and absolute rotation angle (ARA) C2–C7. Data were remotely extracted from the examiner’s PostureRay^® system for data collection and sorted based on gender and stratification of degenerative changes. Reliability was assessed via intra-class correlations (ICC), root mean squared error (RMSE), and R² values. Results: In comparing repeated measures of the CNN network to itself, perfect reliability was found for the ICC (1.0), RMSE (0), and R² (1). The reliability of the trained expert US was in the excellent range for all variables, where 12/18 variables had ICCs ≥ 0.9 and 6/18 variables were 0.84 ≤ ICCs ≤ 0.89. Similarly, for the expert US, all R² values were in the excellent range (R² ≥ 0.7), and all RMSEs were small, being 0.42 ≤ RMSEs ≤ 3.27. Construct validity between the expert US and the CNN network was found to be in the excellent range with 18/18 ICCs in the excellent range (ICCs ≥ 0.8), 16/18 R² values in the strong to excellent range (R² ≥ 0.7), and 2/18 in the good to moderate range (R² RT C6/C7 = 0.57 and R² Cobb C6/C7 = 0.64. The RMSEs for expert US vs. the CNN network were small, being 0.37 ≤ RMSEs ≤ 2.89. Conclusions: A comparison of repeated measures within the computer vision CNN network and expert human found exceptional reliability and excellent construct validity when comparing the computer vision to the human observer. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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17 pages, 2066 KiB

Open AccessArticle

Sagittal Full-Spine vs. Sectional Cervical Lateral Radiographs: Are the Measurements of Cervical Alignment Interchangeable?

by Jason W. Haas, Paul A. Oakley, Joseph W. Betz, Jason E. Miller, Jason O. Jaeger, Ibrahim M. Moustafa and Deed E. Harrison

J. Clin. Med. 2024, 13(9), 2502; https://doi.org/10.3390/jcm13092502 - 24 Apr 2024

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Abstract

(1) Background: This study assessed the relationship between cervical spine parameters taken on standing full-spine lateral radiographic images compared to sectional lateral cervical radiographs. (2) Methods: Full-spine (FS) and sectional lateral cervical (LC) radiographs from four spine treatment facilities across the USA retrospectively [...] Read more.

(1) Background: This study assessed the relationship between cervical spine parameters taken on standing full-spine lateral radiographic images compared to sectional lateral cervical radiographs. (2) Methods: Full-spine (FS) and sectional lateral cervical (LC) radiographs from four spine treatment facilities across the USA retrospectively provided data collected on 220 persons to assess the comparison of three sagittal cervical radiographic measurements between the two views. The measures included cervical lordosis using the absolute rotation angle from C2-C7, sagittal cervical translation of C2-C7, and atlas plane angle to horizontal. Linear correlation and R² models were used for statistical comparison of the measures for the two views. (3) Results: The mean values of the three measurements were statistically different from each other: C2-C7 translation (FS = 19.84 ± 11.98 vs. LC = 21.18 ± 11.8), C2-C7 lordosis (FS = −15.3 ± 14.63 vs. LC = −18.32 ± 13.16), and atlas plane (FS = −19.99 ± 8.88 vs. LC = −22.56 ± 8.93), where all values were p < 0.001. Weak-to-moderate-to-strong correlations existed between the full-spine and sectional lateral cervical radiographic variables. The R² values varied based on the measurement were R² = 0.768 (p < 0.001) for sagittal cervical translation of C2-C7 (strong), R² = 0.613 (p < 0.001) for the absolute rotation angle C2-C7 (moderate), and R² = 0.406 (p < 0.001) for the atlas plane line (weak). Though a linear correlation was identified, there were consistent intra-person differences between the measurements on the full spine versus sectional lateral cervical radiographic views, where the full-spine view consistently underestimated the magnitude of the variables. (4) Conclusion: Key sagittal cervical radiographic measurements on the full spine versus sectional lateral cervical radiographic views show striking intra-person differences. The findings of this study confirm that full spine versus sectional lateral cervical radiographic views provide different biomechanical magnitudes of cervical sagittal alignment, and caution should be exercised by health care providers as these are not interchangeable. We recommend the LC view for measurement of cervical sagittal alignment variables. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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12 pages, 259 KiB

Open AccessArticle

Impact of Self-Reported Loss of Balance and Gait Disturbance on Outcomes following Adult Spinal Deformity Surgery

by Bassel G. Diebo, Daniel Alsoof, Renaud Lafage, Mohammad Daher, Mariah Balmaceno-Criss, Peter G. Passias, Christopher P. Ames, Christopher I. Shaffrey, Douglas C. Burton, Vedat Deviren, Breton G. Line, Alex Soroceanu, David Kojo Hamilton, Eric O. Klineberg, Gregory M. Mundis, Han Jo Kim, Jeffrey L. Gum, Justin S. Smith, Juan S. Uribe, Khaled M. Kebaish, Munish C. Gupta, Pierce D. Nunley, Robert K. Eastlack, Richard Hostin, Themistocles S. Protopsaltis, Lawrence G. Lenke, Robert A. Hart, Frank J. Schwab, Shay Bess, Virginie Lafage and Alan H. Daniels Show full author list Hide full author list

J. Clin. Med. 2024, 13(8), 2202; https://doi.org/10.3390/jcm13082202 - 11 Apr 2024

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Abstract

Background: The objective of this study was to evaluate if imbalance influences complication rates, radiological outcomes, and patient-reported outcomes (PROMs) following adult spinal deformity (ASD) surgery. Methods: ASD patients with baseline and 2-year radiographic and PROMs were included. Patients were grouped according to [...] Read more.

Background: The objective of this study was to evaluate if imbalance influences complication rates, radiological outcomes, and patient-reported outcomes (PROMs) following adult spinal deformity (ASD) surgery. Methods: ASD patients with baseline and 2-year radiographic and PROMs were included. Patients were grouped according to whether they answered yes or no to a recent history of pre-operative loss of balance. The groups were propensity-matched by age, pelvic incidence–lumbar lordosis (PI-LL), and surgical invasiveness score. Results: In total, 212 patients were examined (106 in each group). Patients with gait imbalance had worse baseline PROM measures, including Oswestry disability index (45.2 vs. 36.6), SF-36 mental component score (44 vs. 51.8), and SF-36 physical component score (p < 0.001 for all). After 2 years, patients with gait imbalance had less pelvic tilt correction (−1.2 vs. −3.6°, p = 0.039) for a comparable PI-LL correction (−11.9 vs. −15.1°, p = 0.144). Gait imbalance patients had higher rates of radiographic proximal junctional kyphosis (PJK) (26.4% vs. 14.2%) and implant-related complications (47.2% vs. 34.0%). After controlling for age, baseline sagittal parameters, PI-LL correction, and comorbidities, patients with imbalance had 2.2-times-increased odds of PJK after 2 years. Conclusions: Patients with a self-reported loss of balance/unsteady gait have significantly worse PROMs and higher risk of PJK. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

17 pages, 2521 KiB

Open AccessArticle

Can the Mismatch of Measured Pelvic Morphology vs. Lumbar Lordosis Predict Chronic Low Back Pain Patients?

by Deed E. Harrison, Jason W. Haas, Ibrahim M. Moustafa, Joseph W. Betz and Paul A. Oakley

J. Clin. Med. 2024, 13(8), 2178; https://doi.org/10.3390/jcm13082178 - 10 Apr 2024

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Abstract

Background: Measures of lumbar lordosis (LL) and elliptical modeling variables have been shown to discriminate between normal and chronic low back pain (CLBP) patients. Pelvic morphology influences an individual’s sagittal lumbar alignment. Our purpose is to investigate the sensitivity and specificity of [...] Read more.

Background: Measures of lumbar lordosis (LL) and elliptical modeling variables have been shown to discriminate between normal and chronic low back pain (CLBP) patients. Pelvic morphology influences an individual’s sagittal lumbar alignment. Our purpose is to investigate the sensitivity and specificity of lumbar sagittal radiographic alignment and modeling variables to identify if these can discriminate between normal controls and CLBP patients. Methods: We conducted a computer analysis of digitized vertebral body corners on lateral lumbar radiographs of normal controls and CLBP patients. Fifty normal controls were attained from a required pre-employment physical examination (29 men; 21 women; mean age of 27.7 ± 8.5 years), with no history of low back pain, a normal spinal examination, no pathologies, anomalies, or instability. Additionally, 50 CLBP patients (29 men; 29.5 ± 8 years of age) were randomly chosen and matched to the characteristics of the controls. The inclusion criteria required no abnormalities on lumbar spine radiographs. The parameters included the following: ARA L1-L5 lordosis, ARA T12-S1 lordosis, Cobb T12-S1, b/a elliptical modelling ratio, sacral base angle (SBA), and S1 posterior tangent to vertical (PTS1). Two measures of pelvic morphology were determined for each person—the angle of pelvic incidence (API) and posterior tangent pelvic incidence angle (PTPIA)—and the relationships between API − ARA T12-S1, API − Cobb T12-S1, and API − ARA L1-5 was determined. Descriptive statistics and correlations among the primary variables were determined. The receiver operating characteristic curves (ROC curves) for primary variables were analyzed. Results: The mean values of LL were statistically different between the normal and CLBP groups (p < 0.001), indicating a hypo-lordotic lumbar spine for the CLBP group. The mean b/a ratio was lower in the chronic pain group (p = 0.0066). The pelvic morphology variables were similar between the groups (p > 0.05). API had a stronger correlation to the SBA and Cobb T12-S1 than PTPIA did, while PTPIA had a stronger correlation to the S1 tangent and ARA T12-S1 than API did. While CLBP patients had a stronger correlation of ARA T12-S1 and Cobb T12-S1 relative to the pelvic morphology, they also had a reduced correlation of ARA L1-L5 lordosis relative to their SBA and pelvic morphology measures. API − T12-S1, API − L1-L5, and API − Cobb T12-S1 were statistically different between the groups, p < 0.001. Using ROC curve analyses, it was identified that ARA L1-L5 lordosis of 36° and ARA T12-S1 of 68° have a good sensitivity and specificity to discriminate between normal and CLBP patients. ROC curve analyses identified that lordosis ARAT12-S1 < 68° (AUC = 0.83), lordosis ARAL1-L5 < 36° (AUC = 0.78), API − ARA T12-S1 < −18° (AUC = 0.75), API − ARAL1-L5 > 35° (AUC = 0.71), and API − Cobb T12-S1 < −5° (AUC = 0.69) had moderate to good discrimination between groups (AUC = 0.83, 0.78, 0.75, and 0.72). Conclusions: Pelvic morphology is similar between normal and CLBP patients. CLBP patients have an abnormal ‘fit’ of their API − ARAT12-S1 and L1-L5 lumbar lordosis relative to their pelvic morphology and sacral tilt shown as a hypolordosis. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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17 pages, 2721 KiB

Open AccessFeature PaperArticle

Two Methods of Forward Head Posture Assessment: Radiography vs. Posture and Their Clinical Comparison

by Paul A. Oakley, Ibrahim M. Moustafa, Jason W. Haas, Joseph W. Betz and Deed E. Harrison

J. Clin. Med. 2024, 13(7), 2149; https://doi.org/10.3390/jcm13072149 - 08 Apr 2024

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Abstract

Background: Forward head posture (FHP) and altered cervical lordotic curvatures are common spine displacements often associated with neck pain and disability. Two primary categories for determining FHP exist: radiographic and postural measurements. Methods: This study investigated the correlation between the craniovertebral angle (CVA), [...] Read more.

Background: Forward head posture (FHP) and altered cervical lordotic curvatures are common spine displacements often associated with neck pain and disability. Two primary categories for determining FHP exist: radiographic and postural measurements. Methods: This study investigated the correlation between the craniovertebral angle (CVA), the radiographically measured C2–C7 sagittal vertical axis (SVA), and cervical lordosis (absolute rotation angle: ARA C2–C7) in a sample of participants with chronic myofascial pain (CMP). In 120 participants, we performed both a postural measurement of the CVA and a lateral cervical radiograph, where the C2–C7 SVA and ARA C2–C7 were measured. A linear-regression R² value to assess the correlation between the CVA, C2–C7 SVA, and ARA C2–C7 was sought. Results: A statistically significant weak linear fit was identified (Spearman’s r = 0.549; R² = 0.30, p < 0.001) between the CVA and C2–C7 SVA, having considerable variation between the two measures. A statistically significant linear fit (very weak) was identified for the lordosis ARA C2–C7 and the CVA: Spearman’s r = 0.524; R² = 0.275; p < 0.001. A value of 50° for the CVA corresponded to a value of 20 mm for the C2–C7 SVA on an X-ray. Conclusion: While the CVA and radiographic C2–C7 SVA are weakly correlated in an individual, they seem to represent different aspects of sagittal cervical balance. The CVA cannot replace radiographically measured cervical lordosis. We recommend that more emphasis be given to radiographic measures of sagittal cervical alignment than the CVA when considering patient interventions. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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13 pages, 2820 KiB

Open AccessArticle

The New Modular Sforzesco Brace (Modular Italian Brace) Is as Effective as the Classical One: A Retrospective Controlled Study from a Prospective Cohort

by Francesco Negrini, Francesca Febbo, Fabrizio Tessadri, Andrea Zonta, Marta Tavernaro, Sabrina Donzelli, Fabio Zaina and Stefano Negrini

J. Clin. Med. 2024, 13(7), 2075; https://doi.org/10.3390/jcm13072075 - 03 Apr 2024

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Abstract

Background: The Sforzesco brace is a very rigid push-up brace effective in adolescent idiopathic scoliosis (AIS). We recently developed a new Sforzesco brace based on modularity (the Modular Italian brace—MI brace) that could allow standardization, facilitating global expertise diffusion, increased modifiability and [...] Read more.

Background: The Sforzesco brace is a very rigid push-up brace effective in adolescent idiopathic scoliosis (AIS). We recently developed a new Sforzesco brace based on modularity (the Modular Italian brace—MI brace) that could allow standardization, facilitating global expertise diffusion, increased modifiability and adaptability, and cost savings due to longer brace life. We aimed to compare the short-term results of the two braces. Methods: The retrospective study included 231 consecutive AIS treated with a MI brace (N = 53) or Sforzesco brace (N = 178). The main outcome was the first 6-month follow-up out-of-brace radiograph Cobb angle change. Secondary outcomes included the in-brace Cobb degrees and aesthetics (TRACE), prominence (angle of trunk rotation and mm), kyphosis, and lordosis changes. Results: The two groups were similar at baseline, apart from more immature patients in MI brace. Both braces reduced the Cobb angle (−6° out-of-brace; −16° in-brace) without differences between groups. All secondary outcomes improved, apart from a statistically and clinically insignificant 3° kyphosis reduction. The MI brace participants were 4.9 times more likely to improve the Cobb angle than the Sforzesco brace (OR = 4.92; 95%CI 1.91–12.64; p = 0.001). Conclusions: These findings suggest that the MI-brace can be safely used instead of the classical Sforzesco brace. However, further studies of different designs and longer follow-ups are needed to confirm these findings. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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15 pages, 5288 KiB

Open AccessArticle

Improvement in Pain, Quality of Life, and Urinary Dysfunction following Correction of Lumbar Lordosis and Reduction in Lumbar Spondylolistheses Using Chiropractic BioPhysics^® Structural Spinal Rehabilitation: A Case Series with >1-Year Long-Term Follow-Up Exams

by Curtis A. Fedorchuk, Cole G. Fedorchuk and Douglas F. Lightstone

J. Clin. Med. 2024, 13(7), 2024; https://doi.org/10.3390/jcm13072024 - 30 Mar 2024

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Abstract

(1) Background: Lumbar spondylolisthesis affects ~20% of the US population and causes spine-related pain and disability. (2) Methods: This series reports on three patients (two females and one male) aged 68–71 years showing improvements in back pain, quality of life (QOL), and urinary [...] Read more.

(1) Background: Lumbar spondylolisthesis affects ~20% of the US population and causes spine-related pain and disability. (2) Methods: This series reports on three patients (two females and one male) aged 68–71 years showing improvements in back pain, quality of life (QOL), and urinary dysfunction following correction of lumbar spondylolistheses using CBP^® spinal rehabilitation. Pre-treatment radiographs showed lumbar hyperlordosis (−49.6°, ideal is −40°) and anterolisthesis (14.5 mm, ideal is 0 mm). Pre-treatment patient-reported outcome measures (PROMs) included a numeric rating scale (NRS) for back pain (7.3/10, ideal is 0), urinary urgency (8/10, ideal is 0), and SF-36 physical (PCS) and mental component score (MCS) (29.8 and 46.6, ideal is 46.8 and 52.8). Patients underwent 2–3 CBP^® sessions per week to correct lumbar hyperlordosis and lumbar anterolistheses. (3) Results: Post-treatment radiographs showed improvements in lumbar curvature (−42.8°) and anterolisthesis (4.2 mm). Post-treatment PROMs showed improvements in NRS for back pain (1/10), urinary urgency (2.3/10), and SF-36 PCS and MCS (50.2 and 57.7). Long-term follow-up radiographs and PROMs showed maintained improvements. (4) Conclusions: This series documents the first-recorded long-term corrections of lumbar spondylolisthesis and concomitant improvements in back pain, urinary urgency, and QOL using CBP^®. This series provides evidence for CBP^® as a non-surgical approach to lumbar spinal rehabilitation and the possible impacts of spinal alignment on pain, urinary dysfunction, and QOL. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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12 pages, 1343 KiB

Open AccessArticle

Identifying Predictors of Neck Disability in Patients with Cervical Pain Using Machine Learning Algorithms: A Cross-Sectional Correlational Study

by Ahmed A. Torad, Mohamed M. Ahmed, Omar M. Elabd, Fayiz F. El-Shamy, Ramzi A. Alajam, Wafaa Mahmoud Amin, Bsmah H. Alfaifi and Aliaa M. Elabd

J. Clin. Med. 2024, 13(7), 1967; https://doi.org/10.3390/jcm13071967 - 28 Mar 2024

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Abstract

(1) Background: Neck pain intensity, psychosocial factors, and physical function have been identified as potential predictors of neck disability. Machine learning algorithms have shown promise in classifying patients based on their neck disability status. So, the current study was conducted to identify predictors [...] Read more.

(1) Background: Neck pain intensity, psychosocial factors, and physical function have been identified as potential predictors of neck disability. Machine learning algorithms have shown promise in classifying patients based on their neck disability status. So, the current study was conducted to identify predictors of neck disability in patients with neck pain based on clinical findings using machine learning algorithms. (2) Methods: Ninety participants with chronic neck pain took part in the study. Demographic characteristics in addition to neck pain intensity, the neck disability index, cervical spine contour, and surface electromyographic characteristics of the axioscapular muscles were measured. Participants were categorised into high disability and low disability groups based on the median value (22.2) of their neck disability index scores. Several regression and classification machine learning models were trained and assessed using a 10-fold cross-validation method; also, MANCOVA was used to compare between the two groups. (3) Results: The multilayer perceptron (MLP) revealed the highest adjusted R2 of 0.768, while linear discriminate analysis showed the highest receiver characteristic operator (ROC) area under the curve of 0.91. Pain intensity was the most important feature in both models with the highest effect size of 0.568 with p < 0.001. (4) Conclusions: The study findings provide valuable insights into pain as the most important predictor of neck disability in patients with cervical pain. Tailoring interventions based on pain can improve patient outcomes and potentially prevent or reduce neck disability. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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16 pages, 5863 KiB

Open AccessArticle

The Improvement of Trunk Muscle Endurance in Adolescents with Idiopathic Scoliosis Treated with ScoliBrace^® and the ScoliBalance^® Exercise Approach

by Rosemary Marchese, Juan Du Plessis, Tamara Pooke and Jeb McAviney

J. Clin. Med. 2024, 13(3), 653; https://doi.org/10.3390/jcm13030653 - 23 Jan 2024

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Abstract

The impact of scoliosis bracing combined with physiotherapeutic scoliosis-specific exercises (PSSE) on trunk muscle endurance in adolescents with idiopathic scoliosis is unknown. ScoliBrace^®, a rigid, three-dimensional, over-corrective thoraco-lumbar-sacral orthosis (TLSO), and ScoliBalance^®, a PSSE program, were used to treat [...] Read more.

The impact of scoliosis bracing combined with physiotherapeutic scoliosis-specific exercises (PSSE) on trunk muscle endurance in adolescents with idiopathic scoliosis is unknown. ScoliBrace^®, a rigid, three-dimensional, over-corrective thoraco-lumbar-sacral orthosis (TLSO), and ScoliBalance^®, a PSSE program, were used to treat adolescent idiopathic scoliosis (AIS) patients. A retrospective study of the trunk muscle endurance of 33 AIS patients who received ScoliBrace^® and ScoliBalance^® was conducted. The patients were treated with ScoliBrace^® and an individualized ScoliBalance^® program. Trunk extensor muscle endurance (TE) and abdominal muscle endurance (AE) tests were performed at initial assessment and then at averages of 6.6 and 24.4 weeks of treatment. The data were analyzed using the Wilcoxon signed-rank test, Stata version 15.1. The participants were aged 13.24 years (SD = 1.64) with a mean Cobb angle of 38.97° (SD = 9.49°). TE improved significantly (p < 0.001) at both short- and medium-term intervals using ScoliBalance^® and ScoliBrace^® in the AIS patients. AE also showed significant improvement between baseline and short-term follow-up, with non-significant improvement at medium-term follow-up. Overall, trunk muscle endurance showed improvement in the AIS patients using ScoliBrace^® and ScoliBalance^®. Future research is required to determine the individual and combined effects of each treatment. However, it seems likely that trunk muscle endurance will not deteriorate in AIS patients with this combined treatment. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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20 pages, 3325 KiB

Open AccessArticle

Are Rotations and Translations of Head Posture Related to Gait and Jump Parameters?

by Nabil Saad, Ibrahim M. Moustafa, Amal Ahbouch, Nour Mustafa Alsaafin, Paul A. Oakley and Deed E. Harrison

J. Clin. Med. 2023, 12(19), 6211; https://doi.org/10.3390/jcm12196211 - 26 Sep 2023

Cited by 1 | Viewed by 3016

Abstract

This study assessed the relationship between head posture displacements and biomechanical parameters during gait and jumping. One hundred male and female students (20 ± 3 yrs) were assessed via the PostureScreen Mobile® app to quantify postural displacements of head rotations and translations including: [...] Read more.

This study assessed the relationship between head posture displacements and biomechanical parameters during gait and jumping. One hundred male and female students (20 ± 3 yrs) were assessed via the PostureScreen Mobile® app to quantify postural displacements of head rotations and translations including: (1) the cranio-vertebral angle (CVA) (°), (2) anterior head translation (AHT) (cm), (3) lateral head translation in the coronal plane (cm), and (4) lateral head side bending (°). Biomechanical parameters during gait and jumping were measured using the G-Walk sensor. The assessed gait spatiotemporal parameters were cadence (steps/min), speed (m/s), symmetry index, % left and right stride length (% height), and right and left propulsion index. The pelvic movement parameters were (1) tilt symmetry index, (2) tilt left and right range, (3) obliquity symmetry index, (4) obliquity left and right range, (5) rotation symmetry index, and (6) rotation left and right range. The jump parameters measured were (1) flight height (cm), (2) take off force (kN), (3) impact Force (kN), (4) take off speed (m/s), (5) peak speed (m/s), (6) average speed concentric phase (m/s), (7) maximum concentric power (kW), (8) average concentric power (kW) during the counter movement jump (CMJ), and (9) CMJ with arms thrust (CMJAT). At a significance level of p ≤ 0.001, moderate-to-high correlations (0.4 < r < 0.8) were found between CVA, AHT, lateral translation head, and all the gait and jump parameters. Weak correlations (0.2 < r < 0.4) were ascertained for lateral head bending and all the gait and jump parameters except for gait symmetry index and pelvic symmetry index, where moderate correlations were identified (0.4 < r < 0.6). The findings indicate moderate-to-high correlations between specific head posture displacements, such as CVA, lateral head translation and AHT with the various gait and jump parameters. These findings highlight the importance of considering head posture in the assessment and optimization of movement patterns during gait and jumping. Our findings contribute to the existing body of knowledge and may have implications for clinical practice and sports performance training. Further research is warranted to elucidate the underlying mechanisms and establish causality in these relationships, which could potentially lead to the development of targeted interventions for improving movement patterns and preventing injuries. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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16 pages, 2412 KiB

Open AccessArticle

Translational and Rotational Postural Aberrations Are Related to Pulmonary Functions and Skill-Related Physical Fitness Components in Collegiate Athletes

by May Tamim, Ibrahim M. Moustafa, Gopala K. Alaparthi, Paul A. Oakley and Deed E. Harrison

J. Clin. Med. 2023, 12(14), 4618; https://doi.org/10.3390/jcm12144618 - 11 Jul 2023

Cited by 1 | Viewed by 3907

Abstract

This study assessed the relationship between body posture displacements, cardiopulmonary exercise testing (CPET), and skill-related physical fitness tests. One hundred male (60%) and female collegiate athletes (22.2 ± 4 yrs) with normal body mass indexes (BMI up to 24.9) were assessed via the [...] Read more.

This study assessed the relationship between body posture displacements, cardiopulmonary exercise testing (CPET), and skill-related physical fitness tests. One hundred male (60%) and female collegiate athletes (22.2 ± 4 yrs) with normal body mass indexes (BMI up to 24.9) were assessed via the PostureScreen Mobile^® app to quantify postural displacements such as head, thorax, and pelvis rotations and translations. CPET and physical performance tests, including the agility t-test, vertical jump test, stork static balance test (SSBT), and dynamic Y-balance test (YBT), were performed. Spearman correlation (r) and p-values are reported. The postural parameters were found to have moderate-to-high associations with the CPET and agility test, moderate correlations with the vertical jump test and SSBT (head and pelvic postures only), and weak correlations with the YBT. As the postural parameters were more asymmetric, both the CPET and performance skills scores were worse. For example: (1) a medium positive correlation was found between cranio-vertebral angle (CVA) and the vertical jump test (r = 0.54; p-value < 0.001) and SSBT (r = 0.57; p-value < 0.001), while a strong negative correlation was found between CVA and the agility test (r = −0.86; p-value < 0.001). (2) A strong positive correlation was found between CVA and oxygen uptake efficiency slope, load watts VO2 at VT, VO2/kg, and load watts at the respiratory compensation point (RCP) (r = 0.65 and r = 0.71; p < 0.001). Conversely, a significant negative correlation was found between CVA and VE/VO2 at VT (r = −0.61; p < 0.001). Postural rotations and translations of the head, thorax, and pelvis were statistically correlated with the physical performance skills and CPET in the young collegiate athletes. There were moderate-to-high associations with cardiopulmonary functions and the agility tests, moderate correlations with the vertical jump test, and weak correlations with the YBT. Postural alignment may be important for optimal physical performance and optimal cardiopulmonary function. Further research is necessary to elucidate the reasons for these correlations found in our sample of young and healthy athletes. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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Review

Jump to: Research, Other

15 pages, 2952 KiB

Open AccessReview

Are the Spinal Changes in the Course of Scoliogeny Primary but Secondary?

by Theodoros B. Grivas, Elias Vasiliadis, Christina Mazioti, Despina Papagianni, Aristea Mamzeri, Michail Chandrinos, George Vynichakis, Konstantinos Athanasopoulos, Paschalis Christodoulides, Nikola Jevtic, Samra Pjanic, Danka Ljubojevic, Olga Savvidou, Angelos Kaspiris and Jarrett Grunstein

J. Clin. Med. 2024, 13(8), 2163; https://doi.org/10.3390/jcm13082163 - 09 Apr 2024

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Abstract

In this opinion article, there is an analysis and discussion regarding the effects of growth on the spinal and rib cage deformities, the role of the rib cage in scoliogeny, the lateral spinal profile in adolescent idiopathic scoliosis (AIS), the genetics and epigenetics [...] Read more.

In this opinion article, there is an analysis and discussion regarding the effects of growth on the spinal and rib cage deformities, the role of the rib cage in scoliogeny, the lateral spinal profile in adolescent idiopathic scoliosis (AIS), the genetics and epigenetics of AIS, and the interesting and novel field investigating the sleep impact at nighttime on AIS in relation to the sequence of the scoliogenetic changes in scoliotics. The expressed opinions are mainly based on the published peer-reviewed research of the author and his team of co-authors. Based on the analysis noted above, it can be postulated that the vertebral growth changes in the spine during initial idiopathic scoliosis (IS) development are not primary-intrinsic but secondary changes. The primary cause starting the deformity is not located within the vertebral bodies. Instead, the deformations seen in the vertebral bodies are the secondary effects of asymmetrical loads exerted upon them, due to muscular loads, growth, and gravity. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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16 pages, 483 KiB

Open AccessFeature PaperReview

Non-Surgical Approaches to the Management of Lumbar Disc Herniation Associated with Radiculopathy: A Narrative Review

by Ahmed M. El Melhat, Ahmed S. A. Youssef, Moustafa R. Zebdawi, Maya A. Hafez, Lamia H. Khalil and Deed E. Harrison

J. Clin. Med. 2024, 13(4), 974; https://doi.org/10.3390/jcm13040974 - 08 Feb 2024

Cited by 1 | Viewed by 3184

Abstract

Lumbar disc herniation associated with radiculopathy (LDHR) is among the most frequent causes of spine-related disorders. This condition is triggered by irritation of the nerve root caused by a herniated disc. Many non-surgical and surgical approaches are available for managing this prevalent disorder. [...] Read more.

Lumbar disc herniation associated with radiculopathy (LDHR) is among the most frequent causes of spine-related disorders. This condition is triggered by irritation of the nerve root caused by a herniated disc. Many non-surgical and surgical approaches are available for managing this prevalent disorder. Non-surgical treatment approaches are considered the preferred initial management methods as they are proven to be efficient in reducing both pain and disability in the absence of any red flags. The methodology employed in this review involves an extensive exploration of recent clinical research, focusing on various non-surgical approaches for LDHR. By exploring the effectiveness and patient-related outcomes of various conservative approaches, including physical therapy modalities and alternative therapies, therapists gain valuable insights that can inform clinical decision-making, ultimately contributing to enhanced patient care and improved outcomes in the treatment of LDHR. The objective of this article is to introduce advanced and new treatment techniques, supplementing existing knowledge on various conservative treatments. It provides a comprehensive overview of the current therapeutic landscape, thereby suggesting pathways for future research to fill the gaps in knowledge. Specific to our detailed review, we identified the following interventions to yield moderate evidence (Level B) of effectiveness for the conservative treatment of LDHR: patient education and self-management, McKenzie method, mobilization and manipulation, exercise therapy, traction (short-term outcomes), neural mobilization, and epidural injections. Two interventions were identified to have weak evidence of effectiveness (Level C): traction for long-term outcomes and dry needling. Three interventions were identified to have conflicting or no evidence (Level D) of effectiveness: electro-diagnostic-based management, laser and ultrasound, and electrotherapy. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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19 pages, 2954 KiB

Open AccessSystematic Review

Unveiling Timetable for Physical Therapy after Single-Level Lumbar Surgery for Degenerative Disc Disease: Insights from a Systematic Review and Meta-Analysis

by Alberto Ruffilli, Marco Manzetti, Alessandro Cargeli, Giovanni Viroli, Marco Ialuna, Matteo Traversari, Fabio Vita, Isabella Sofia Giannini and Cesare Faldini

J. Clin. Med. 2024, 13(9), 2553; https://doi.org/10.3390/jcm13092553 - 26 Apr 2024

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Abstract

Background: Postoperative physical therapy emerges as a pivotal element of the rehabilitation process, aimed at enhancing functional recovery, managing pain, and mitigating the risk of further complications. The debate concerning the optimal timing of physical therapy intervention post-surgery remains unresolved; in particular, whether [...] Read more.

Background: Postoperative physical therapy emerges as a pivotal element of the rehabilitation process, aimed at enhancing functional recovery, managing pain, and mitigating the risk of further complications. The debate concerning the optimal timing of physical therapy intervention post-surgery remains unresolved; in particular, whether to initiate physical therapy immediately or to wait weeks is of particular interest. The aim of this study is to review the available literature regarding the optimal timing of physical therapy initiation and the outcomes obtained. Methods: This review was carried out in accordance with the Preferential Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. This search was carried out in February 2024. Only peer-reviewed articles were considered for inclusion. Results: Fourteen studies were included. The primary outcomes assessed in the included studies were the following: 12-week and 12-month low back pain, return to work, function and disability, psychological status, patient satisfaction, and complications associated with early physical therapy. A meta-analysis was performed concerning low back pain after lumbar discectomy at 12 weeks and 12 months and complications after early physical therapy after lumbar discectomy and lumbar interbody fusion. A significant difference was found between early and standard physical therapy in terms of low back pain at 12–18 months (p = 0.0062); no significant differences were found in terms of complications, both for discectomy and arthrodesis. Conclusions: This review indicates that employing early rehabilitation strategies for intervertebral disc disease could enhance results in terms of pain and disability without an enhanced risk of complications. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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14 pages, 1671 KiB

Open AccessCase Report

Positive Outcomes Following Cervical Acceleration-Deceleration (CAD) Injury Using Chiropractic BioPhysics^® Methods: A Pre-Auto Injury and Post-Auto Injury Case Series

by Tim C. Norton, Paul A. Oakley, Jason W. Haas and Deed E. Harrison

J. Clin. Med. 2023, 12(19), 6414; https://doi.org/10.3390/jcm12196414 - 09 Oct 2023

Cited by 1 | Viewed by 2398

Abstract

This series illustrates how rear-end impact motor vehicle collisions (MVCs) alter the cervical spine’s alignment and demonstrates therapeutic use of cervical extension traction to improve lordotic alignment and other outcomes. This is a retrospective reporting of 7 adult patients (4 males and 3 [...] Read more.

This series illustrates how rear-end impact motor vehicle collisions (MVCs) alter the cervical spine’s alignment and demonstrates therapeutic use of cervical extension traction to improve lordotic alignment and other outcomes. This is a retrospective reporting of 7 adult patients (4 males and 3 females, 28–42 years) treated for cervical hypolordosis. These subjects received Chiropractic BioPhysics^® (CBP^®) rehabilitation and then were involved in a rear-end MVC. All cases had radiographic assessment that quantified the buckling of the cervical spine, presumably resulting directly from the CAD trauma. After an average of 3 years and 9 months (range: 1–7.6 years) following their initial program of care, the 7 patients sought care for a second time after the MVC. At this time, compared with their previously recorded post-treatment spine radiographs, there was an average 18.7° (range: 7.6–35.4°) reduction in cervical lordosis, a 9.2 mm (range: 3.6–19.8 mm) increase in anterior head translation (AHT), an 11.3° (range: 0.2–19.9°) decrease in the atlas plane line (APL), as well as a 35.7% (range: 22–52%) average neck disability index score (NDI) measured after the MVC. After the crash, a second round of CBP rehabilitation was administered, resulting in an average 15.1° improvement in cervical lordosis, 10.9 mm reduction in AHT, 10.4° increase in APL, and a 23.7% drop in NDI after an average of 35 treatments over 9 weeks. Treatment was universally successful, as an average 80% re-establishment of the lordosis toward its pre-injury state was found. There were no adverse events reported. This case series demonstrates that motor vehicle collisions may alter the alignment of the cervical spine. Rehabilitation of the cervical curve using extension traction improved the patients’ initial pre-crash alignments toward their pre-injury alignments and was likely responsible for improvement in the patients’ conditions. Clinical trials are needed to confirm these findings. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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