The incidence rate of degenerative spinal deformity (DSD) has gradually increased in the elderly. Currently, the relationship between the functional status of trunk muscle and the spinal-pelvic parameters of DSD patients remains unclear.
OBJECTIVE:
This paper aims to explore the relationship between the two factors and provide new clues for exploring the mechanism of the occurrence and development of DSD.
METHODS:
A total of 41 DSD patients treated in our hospital (DSD group) and 35 healthy volunteers (control group) were selected. Muscle strength was evaluated using an IsoMed-2000 isokinetic dynamometer, and the trunk flexor and extensor peak torque (PT) of subjects was measured at a low, medium, and high angular velocity of 30/s, 60/s, and 120/s, respectively. Hand grip strength (HGS) was assessed using an electronic grip dynamometer and Surgimap software was used to measure the spinal-pelvic parameters, including the sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence rate (PI), and PI-LL, and the relationship between trunk muscle function and various parameters was analyzed.
RESULTS:
Under the three angular velocities, the flexor and extensor PT values in the DSD group were lower than those in the control group, and only the extensor PT showed a statistically significant difference ( 0.05). There was no significant difference in HGS between the two groups ( 0.05). In the DSD group, the extensor PT at 30/s was significantly negatively correlated with SVA ( 0.05). At 60/s and 120/s, the extensor PT was significantly negatively correlated with SVA and PT ( 0.05).
CONCLUSION:
Trunk extensor strength is significantly lower in DSD patients than in normal controls. The decline in trunk extensor strength in DSD patients is a type of local muscle dysfunction more closely related to the deformity, which is likely involved in the compensatory mechanism of DSD and may reflect the overall imbalance of the trunk.
KobayashiTAtsutaYTakemitsuMMatsunoTTakedaN. A prospective study of de novo scoliosis in a community based cohort. Spine (Phila Pa 1976).2006; 31(2): 178-82.
5.
OgonITakebayashiTTakashimaH, et al. Magnetic resonance spectroscopic analysis of multifidus muscles lipid content and association with spinopelvic malalignment in chronic low back pain. Br J Radiol.2017; 90(1073): 20160753.
6.
YangSChenCDuS, et al. Assessment of isokinetic trunk muscle strength and its association with health-related quality of life in patients with degenerative spinal deformity. BMC Musculoskelet Disord.2020; 21(1): 827.
7.
SimonJLongisPMPassutiN. Correlation between radiographic parameters and functional scores in degenerative lumbar and thoracolumbar scoliosis. Orthop Traumatol Surg Res.2017; 103(2): 285-290.
8.
KyröläKRepoJMecklinJPYlinenJKautiainenHHäkkinenA. Spinopelvic Changes Based on the Simplified SRS-Schwab Adult Spinal Deformity Classification: Relationships With Disability and Health-Related Quality of Life in Adult Patients With Prolonged Degenerative Spinal Disorders. Spine (Phila Pa 1976).2018; 43(7): 497-502.
9.
FarajSDe KleuverMVila-CasademuntA, et al. Sagittal radiographic parameters demonstrate weak correlations with pretreatment patient-reported health-related quality of life measures in symptomatic de novo degenerative lumbar scoliosis: A European multicenter analysis. J Neurosurg Spine.2018; 28(6): 573-580.
10.
MakhniMCShillingfordJNLarattaJLHyunSJKimYJ. Restoration of sagittal balance in spinal deformity surgery. J Korean Neurosurg Soc.2018; 61(2): 167-179.
11.
XiaWFuHZhuZ, et al. Association between back muscle degeneration and spinal-pelvic parameters in patients with degenerative spinal kyphosis. BMC Musculoskelet Disord.2019; 20(1): 454.
12.
RothRDonathLKurzEZahnerLFaudeO. Absolute and relative reliability of isokinetic and isometric trunk strength testing using the IsoMed-2000 dynamometer. Phys Ther Sport.2017; 24: 26-31.
13.
ZhouZZhengLWeiDYeMLiX. Muscular strength measurements indicate bone mineral density loss in postmenopausal women. Clin Interv Aging.2013; 8: 1451-9.
14.
García-VaqueroMPBarbadoDJuan-RecioCLópez-ValencianoAVera-GarciaFJ. Isokinetic trunk flexion-extension protocol to assess trunk muscle strength and endurance: Reliability, learning effect, and sex differences. J Sport Health Sci.2020; 9(6): 692-701.
15.
YuROngSCheungOLeungJWooJ. Reference Values of Grip Strength, Prevalence of Low Grip Strength, and Factors Affecting Grip Strength Values in Chinese Adults. J Am Med Dir Assoc.2017; 18(6): 551.e9-551.e16.
16.
HortonWCBrownCWBridwellKHGlassmanSDSukSIChaCW. Is there an optimal patient stance for obtaining a lateral 36” radiograph? A critical comparison of three techniques. Spine (Phila Pa 1976).2005; 30(4): 427-33.
17.
HodgesPWBaileyJFFortinMBattiéMC. Paraspinal muscle imaging measurements for common spinal disorders: Review and consensus-based recommendations from the ISSLS degenerative spinal phenotypes group. Eur Spine J.2021; 30(12): 3428-3441.
18.
LamKSMehdianH. The importance of an intact abdominal musculature mechanism in maintaining spinal sagittal balance. Case illustration in prune-belly syndrome. Spine (Phila Pa 1976).1999; 24(7): 719-22.
19.
EstrázulasJAEstrázulasJAde JesusKde JesusKda SilvaRALibardoni Dos SantosJO. Evaluation isometric and isokinetic of trunk flexor and extensor muscles with isokinetic dynamometer: A systematic review. Phys Ther Sport.2020; 45: 93-102.
20.
AjlanSYalçınTM. Correlation between the Q angle and the isokinetic knee strength and muscle activity. Turk J Phys Med Rehabil.2018; 64(4).
21.
GreenBBourneMNPizzariT. Isokinetic strength assessment offers limited predictive validity for detecting risk of future hamstring strain in sport: A systematic review and meta-analysis. Br J Sports Med.2018; 52(5): 329-336.
22.
CheungJ. The importance of sagittal balance in adult scoliosis surgery. Ann Transl Med.2020; 8(2): 35.
23.
YagiMHosoganeNWatanabeKAsazumaTMatsumotoM. The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis. Spine J.2016; 16(4): 451-8.
24.
AkagiRTakaiYKatoE, et al. Relationships between muscle strength and indices of muscle cross-sectional area determined during maximal voluntary contraction in middle-aged and elderly individuals. J Strength Cond Res.2009; 23(4): 1258-62.
25.
HamrickMWMcGee-LawrenceMEFrechetteDM. Fatty infiltration of skeletal muscle: Mechanisms and comparisons with bone marrow adiposity. Front Endocrinol (Lausanne).2016; 7: 69.
26.
JainRMeenaMLSainMKDangayachGS. Impact of posture and upper-limb muscle activity on grip strength. Int J Occup Saf Ergon.2019; 25(4): 614-620.
27.
ShenFKimHJJeonSWChangBSLeeCKYeomJS. Influence of Handgrip Strength and Paraspinal Muscles' Volume on Clinical Outcomes in the Patients With Each Sagittal Imbalance and Lumbar Spinal Stenosis. Global Spine J. 2021: 21925682211001871.
28.
GallupACFinkB. Handgrip strength as a darwinian fitness indicator in men. Front Psychol.2018; 9: 439.
29.
JainRRanaKBMeenaML. Effect of work experience and upper-limb muscle activity on grip strength of manual workers. Int J Occup Saf Ergon. 2022: 1-6.
30.
Roman-LiuD. Maximum handgrip force in relation to upper limb posture – a meta-analysis. AIHA J (Fairfax, Va).2003; 64(5): 609-17.
31.
MathiowetzV. Comparison of Rolyan and Jamar dynamometers for measuring grip strength. Occup Ther Int.2002; 9(3): 201-9.
32.
NicoloPMagninCPedrazziniE, et al. Comparison of neuroplastic responses to cathodal transcranial direct current stimulation and continuous theta burst stimulation in subacute stroke. Arch Phys Med Rehabil.2018; 99(5): 862-872.e1.
33.
SmithJSShaffreyCIBessS, et al. Recent and emerging advances in spinal deformity. Neurosurgery.2017; 80(3S): S70-S85.
34.
SchwabFJBlondelBBessS, et al. Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: A prospective multicenter analysis. Spine (Phila Pa 1976).2013; 38(13): E803-12.
35.
DieboBGVargheseJJLafageRSchwabFJLafageV. Sagittal alignment of the spine: What do you need to know. Clin Neurol Neurosurg.2015; 139: 295-301.
36.
SchwabFUngarBBlondelB, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: A validation study. Spine (Phila Pa 1976).2012; 37(12): 1077-82.
37.
ProtopsaltisTSchwabFBronsardN, et al. TheT1 pelvic angle, a novel radiographic measure of global sagittal deformity, accounts for both spinal inclination and pelvic tilt and correlates with health-related quality of life. J Bone Joint Surg Am.2014; 96(19): 1631-40.
38.
DieboBGFerreroELafageR, et al. Recruitment of compensatory mechanisms in sagittal spinal malalignment is age and regional deformity dependent: A full-standing axis analysis of key radiographical parameters. Spine (Phila Pa 1976).2015; 40(9): 642-9.
39.
BarreyCRoussoulyPPerrinGLe HuecJC. Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms. Eur Spine J.2011; 20 Suppl 5(Suppl 5): 626-33.
40.
RyderJWBuxtonREGoetchiusE, et al. Influence of muscle strength to weight ratio on functional task performance. Eur J Appl Physiol.2013; 113(4): 911-21.
41.
ShimizuMKobayashiTChibaH, et al. Adult spinal deformity and its relationship with height loss: A 34-year longitudinal cohort study. BMC Musculoskelet Disord.2020; 21(1): 422.
42.
LafageVSchwabFPatelAHawkinsonNFarcyJP. Pelvic tilt and truncal inclination: Two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976).2009; 34(17): E599-606.
43.
LafageRSchwabFChallierV, et al. Defining spino-pelvic alignment thresholds: Should operative goals in adult spinal deformity surgery account for age. Spine (Phila Pa 1976).2016; 41(1): 62-8.
44.
YangSWuWZhangC, et al. Reliability and validity of three isometric back extensor strength assessments with different test postures. J Int Med Res.2020; 48(2): 300060519885268.
45.
VazGRoussoulyPBerthonnaudEDimnetJ. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J.2002; 11(1): 80-7.
46.
KatsuMOhbaTEbataSObaHKoyamaKHaroH. Potential role of paraspinal musculature in the maintenance of spinopelvic alignment in patients with adult spinal deformities. Clin Spine Surg.2020; 33(2): E76-E80.
47.
JunHSKimJHAhnJH, et al. The effect of lumbar spinal muscle on spinal sagittal alignment: evaluating muscle quantity and quality. Neurosurgery.2016; 79(6): 847-855.
48.
Rothenfluh DominiqueAMueller DanielAEsinRKanM. Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion. Eur Spine J.2015; 24(6).
LiangYTangXZhaoY, et al. Limited correction of lumbarlordosis in the treatment of degenerative scoliosis. Medicine (Baltimore).2020; 99(19): e19624.
51.
SinakiMItoiERogersJWBergstralhEJWahnerHW. Correlation of back extensor strength with thoracic kyphosis and lumbar lordosis in estrogen-deficient women. Am J Phys Med Rehabil.1996; 75(5): 370-4.
52.
MikaAUnnithanVBMikaP. Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis. Spine (Phila Pa 1976).2005; 30(2): 241-6.
