Shah Anoli A, Lemans Justin Vc, Zavatsky Joseph, Agarwal Aakash, Kruyt Moyo C, Matsumoto Koji, Serhan Hassan, Agarwal Anand K, Goel Vijay
Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, Colleges of Engineering and Medicine, University of Toledo, Toledo, OH.
University Medical Center Utrecht, Utrecht, Netherlands.
J Biomech Eng. 2019 May 2. doi: 10.1115/1.4043650.
In the normal spine due to its curvature in various regions, C7 plumb line (C7PL) passes through the sacrum so that the head is centered over the pelvis-ball and socket hip joints and ankle joints. This configuration leads to the least muscular activities to maintain the spinal balance. For any reason like deformity, scoliosis, kyphosis, trauma, and/or surgery this optimal configuration gets disturbed requiring higher muscular activity to maintain the posture and balance. Several parameters like the thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), Hip- and leg position influence the sagittal balance and thus the optimal configuration of spinal alignment. Global sagittal imbalance is energy consuming and often painful compensatory mechanisms are developed, that in turn negatively influence the quality of life. This review looks at the clinical aspects of spinal imbalance, and the biomechanics of spinal balance as dictated by the deformities- ankylosing spondylitis, scoliosis and kyphosis; surgical corrections- pedicle subtraction osteotomies and long segment stabilizations and consequent postural complications like the proximal and distal junctional kyphosis. This review suggests several potential research topics as well.
在正常脊柱中，由于其在不同区域的弯曲，C7垂线（C7PL）穿过骶骨，使得头部位于骨盆 - 球窝髋关节和踝关节的中心上方。这种构型导致维持脊柱平衡所需的肌肉活动最少。由于任何原因，如畸形、脊柱侧弯、驼背、创伤和/或手术，这种最佳构型会受到干扰，需要更高的肌肉活动来维持姿势和平衡。几个参数，如胸椎后凸（TK）、腰椎前凸（LL）、骨盆倾斜度（PI）、骶骨坡度（SS）、髋关节和腿部位置，会影响矢状面平衡，进而影响脊柱排列的最佳构型。整体矢状面失衡会消耗能量，并且往往会产生疼痛的代偿机制，这反过来又会对生活质量产生负面影响。本综述探讨了脊柱失衡的临床方面，以及由强直性脊柱炎、脊柱侧弯和驼背等畸形所决定的脊柱平衡生物力学；手术矫正——椎弓根截骨术和长节段固定，以及随之而来的姿势并发症，如近端和远端交界性驼背。本综述还提出了几个潜在的研究课题。
