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Study Design: Cross-sectional observational study. Purpose: To examine whether pelvic rotation as a compensatory mechanism for sagittal imbalance is related to quality of life (QOL). Overview of Literature: Poor sagittal alignment is associated with compensatory pelvic retroversion and decreased QOL. Whether the compensatory pelvic tilt (PT) influences QOL is unclear. Methods: Overall, 134 subjects aged ≥20 years with lower back pain were included (104 females; mean age, 70±9.8 years). Sagittal vertical alignment (SVA) and PT were analyzed radiographically. Patients were stratified into three groups based on SVA values: good alignment (group G), intermediate alignment (group I), and poor sagittal alignment (group P). Patients in group I were further categorized into two groups: low PT and high PT. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used for clinical assessment, and the scores were compared between groups. Results: As SVA increased, PT and lumbar lordosis (LL) increased and decreased, respectively. PT and LL differed significantly between groups G and P (p <0.01 for each comparison). Within group I, there was no significant difference in SVA between the high PT and low PT groups, suggesting that the high PT group had acquired a compensated sagittal balance. Importantly, all domains in the JOABPEQ (except for lower back pain) were significantly lower in the high PT group than in the low PT group (p <0.05 for every comparison). Conclusions: This study showed that focusing solely on SVA as a single indicator can cause important losses in QOL to be overlooked in patients with lumbar disorders. Although pelvic retroversion can compensate for sagittal balance, it is associated with a significant decrease in QOL. To improve the assessment of patients with lumbar disorders, PT should be considered besides SVA. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study. Purpose: The purpose of this study was to investigate the influence of sagittal alignment of the strut graft on graft subsidence and clinical outcomes after anterior cervical corpectomy and fusion (ACCF). Overview of Literature: ACCF is a common technique for the treatment of various cervical pathologies. Although graft subsidence sometimes occurs after ACCF, it is one cause for poor clinical results. Malalignment of the strut graft is probably one of the factors associated with graft subsidence. However, to the best of our knowledge, no prior reports have demonstrated correlations between the alignment of the strut graft and clinical outcomes. Methods: We evaluated 56 patients (33 men and 23 women; mean age, 59 years; range, 33-84 years; 45 with cervical spondylotic myelopathy and 11 with ossification of the posterior longitudinal ligament) who underwent one-or two-level ACCF with an autogenous fibular strut graft and anterior plating. The Japanese Orthopaedic Association (JOA) score recovery ratio for cervical spondylotic myelopathy was used to evaluate clinical outcomes. The JOA score and lateral radiograms were evaluated 1 week and 1 year postoperatively. Patients were divided into two groups (a straight group [group I] and an oblique group [group Z]) based on radiographic assessment of the sagittal alignment of the strut graft. Results: Group I showed a significantly greater JOA score recovery ratio (p<0.05) and a significantly lower graft subsidence than group Z (p<0.01). Conclusions: Our findings suggest that a straight alignment of the strut graft provides better clinical outcomes and lower incidence of graft subsidence after ACCF. In contrast, an oblique strut graft can lead to significantly increased strut graft subsidence and poor clinical results. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study. Purpose: To assess treatment outcomes of snowboarding-related spinal and spinal cord injuries. Overview of Literature: Snowboarding-related spinal or spinal cord injury have a great impact on social and sporting activities. Methods: A retrospective review of 19 cases of surgically treated snowboard-related injury was done. Analyzed parameters included site of injury, type of fracture, peri- and postoperative complications, pre- and postoperative neurological status, activities of daily living, and participation in sports activities at the final follow-up. Results: The major site of injury was the thoracolumbar junction caused by fracture-dislocation (13/19 cases). The remaining 6 cases had cervical spine injuries. Over 60% of the patients had Frankel A and B paralysis. All patients were surgically treated by posterior fusion with instrumentation. Five underwent additional anterior fusion. Surgical outcome was restoration of ambulatory capacity in 12 patients (63.2%). Ultimately, 15 patients (78.9%) could return to work. Patients with complete paralysis upon admission showed reduced ambulatory capacity compared to those with incomplete paralysis. None of the patients again participated in any sports activities, including snowboarding. Conclusions: Snowboarding-related spinal or spinal cord injury has a great impact on social as well as sports activities. It is necessary to enhance promotion of injury prevention emphasizing the snowboarders' responsibility code. [ABSTRACT FROM AUTHOR]