IntroductionLumbar spinal stenosis (LSS) is the main problem for adult achondroplasia (Ach). Sagittal imbalance of the spine may play a role in LSS causing neurogenic claudication in Ach patients... Show moreIntroductionLumbar spinal stenosis (LSS) is the main problem for adult achondroplasia (Ach). Sagittal imbalance of the spine may play a role in LSS causing neurogenic claudication in Ach patients.Research questionThe purpose of this study is to describe the sagittal balance parameters in Ach patients.MethodsA single-centre retrospective study of Ach patients that visited the Neurosurgery outpatient clinic of the Leiden University Medical Centre (LUMC) between 2019 and 2022 was performed. We defined sagittal imbalance by a C7 sagittal vertical axis (SVA) of more than 10 mm.ResultsThere were 13 patients with a spinal sagittal imbalance and 15 patients with a balanced spine. In both groups, the sacral slope (SS) was comparable (45.0° and 49.0°, p = 0.305), but exceeding the mean SS in non achondroplasts (38.0°). Lumbar lordosis (LL) was more pronounced in the balanced group (55.5° versus 41.7°, p = 0.019), and positively correlated to SS in contrast to the absence of a correlation in the imbalanced group. Thoracolumbar kyphosis (TLK) was increased comparably in both groups (19.6° and 24.6°), and far exceeding the TLK in non achondroplasts (circa 0°), and in both groups negatively correlated with the LL, although not enough to compensate for the smaller LL in the imbalanced group.ConclusionOnly if the LL compensates for both a larger SS and TLK, the Ach spine can maintain sagittal balance. An explanation for the current data can be the failure of the lumbar spine to give sufficient lordosis due to degenerative processes. Show less
Voirin-Hertz, M.; Alegria, G.C.; Garrigues, F.; Simon, A.; Feydy, A.; Reijnierse, M.; ... ; Saraux, A. 2020
Objective: Scoliosis may impact the mechanical loading and cause secondary changes of the sacroiliac joints and lumbar spine. Our goal was to look how lumbar scoliosis modify the clinical and... Show moreObjective: Scoliosis may impact the mechanical loading and cause secondary changes of the sacroiliac joints and lumbar spine. Our goal was to look how lumbar scoliosis modify the clinical and imaging-study in patients with recent-onset inflammatory back pain (IBP) suggesting axial spondyloarthritis (axSpA).Methods: Baseline weight-bearing lumbar-spine radiographs obtained in the DESIR cohort of patients aged 18-50 years and having IBP for at least 3 months but less than 3 years suggesting axSpA were studied. After training on scoliosis detection based on Cobb's angle>10 degrees plus Nash-Moe grade >= 1, readers blinded to patient data measured spine lumbar scoliosis, sacral horizontal angle, lumbosacral angle and lumbar lordosis on the radiograph of the lumbar and scored sacroiliitis on the radiograph of the pelvis. Baseline MRIs T1 and STIR of the lumbar spine and sacroiliac joints were evaluated for respectively degenerative changes and signs of axSpA.Results: Of the 360 patients (50.8% females) 88.7% had lumbar pain and 69.3% met ASAS criteria for axSpA. Mean Cobb's angle was 3.2 degrees +/- 5.0 degrees and 28 (7.7%) patients had lumbar scoliosis. No statistical differences were observed for radiographic sacroiliitis, MRI sacroiliitis, modified Stoke Ankylosing Spondylitis Spinal Score, Pfirmmann score, high-intensity zone, protrusion, extrusion, MODIC score between patients with and without scoliosis. In both groups, degenerative changes by MRI were rare and predominated at L4-L5 and L5-S1.Conclusion: In patients with early IBP suggesting axSpA, lumbar scoliosis was not associated with inflammatory or degenerative changes. (C) 2019 Elsevier Inc. All rights reserved. Show less
