Ouchida Jun, Nakashima Hiroaki, Ohara Tetsuya, Machino Masaaki, Ito Sadayuki, Segi Naoki, Yamauchi Ippei, Imagama Shiro
Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan.
Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan.
Eur Spine J. 2025 Feb;34(2):556-564. doi: 10.1007/s00586-024-08584-0. Epub 2024 Nov 29.
To classify sagittal spinopelvic alignment patterns of non-ambulatory scoliosis patients with paraplegia based on lateral sitting radiographs and explore their relation to clinical background and physical function.
We reviewed non-ambulatory scoliosis patients with paraplegia, excluding those with prior spinal surgery from a single-center database. Alignment patterns in sitting postures were classified into slump sitting (SS) and erect sitting (ES) based on the most posterior edge of the spine's location on lateral sitting radiographs. Radiographical spinopelvic sagittal alignment, demographics, and physical functions were analyzed. Clinical scoring for physical functions included Hoffer's ambulator classification, Hoffer's modified sitting classification, and the Modified Ashworth Score (MAS) for the severity of spasticity in the lower extremities. Percentages of patients without spasticity, with MAS of 0 indicating "no spasticity." were also compared between the two alignment patterns.
Of 172 patients screened, 86 met inclusion criteria, revealing two distinct alignment patterns: SS showed greater thoracic kyphosis, smaller lumbar lordosis, pelvic retroversion, and hip hyperflexion compared to ES. No significant differences in demographic data or curve patterns were observed between groups. The SS group had a significantly higher percentage of patients without spasticity compared to the ES group (39.2% vs. 14.3%, P = 0.016).
Identified were two distinct sagittal alignment patterns in seated scoliosis patients with paraplegia, with potential influences from spasticity in the lower extremities. Recognizing these patterns can aid in assessing the function of sitting balance that includes the hip joint and in optimizing strategies for the treatment of scoliosis patients with paraplegia.
基于侧位坐姿X线片对非行走型截瘫脊柱侧弯患者的矢状面脊柱-骨盆对线模式进行分类，并探讨其与临床背景和身体功能的关系。
我们回顾了来自单中心数据库的非行走型截瘫脊柱侧弯患者，排除既往有脊柱手术史的患者。根据侧位坐姿X线片上脊柱最后缘的位置，将坐姿对线模式分为 slumped sitting（SS，弯腰坐姿）和 erect sitting（ES，挺直坐姿）。分析影像学脊柱-骨盆矢状面排列、人口统计学数据和身体功能。身体功能的临床评分包括霍弗步行分类、霍弗改良坐姿分类以及下肢痉挛严重程度的改良Ashworth评分（MAS）。还比较了两种对线模式下无痉挛患者（MAS为0表示“无痉挛”）的百分比。
在筛选的172例患者中，86例符合纳入标准，揭示了两种不同的对线模式：与ES相比，SS表现出更大的胸椎后凸、更小的腰椎前凸、骨盆后倾和髋关节过度屈曲。两组之间在人口统计学数据或侧弯模式上未观察到显著差异。与ES组相比，SS组无痉挛患者的百分比显著更高（39.2%对14.3%，P = 0.016）。
在非行走型截瘫脊柱侧弯患者中确定了两种不同的矢状面对线模式，下肢痉挛可能有潜在影响。认识这些模式有助于评估包括髋关节在内的坐姿平衡功能，并优化非行走型截瘫脊柱侧弯患者的治疗策略。
