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Study Design: This was a retrospective longitudinal observational study. Purpose: The purpose of this study was to analyze the results of cervical sagittal parameters on preoperative and postoperative lateral radiographs in anterior cervical discectomy and fusion (ACDF). ACDF is believed to change craniocervical parameters and thus cervical curvature using polyetheretherketone (PEEK) or titanium cages with or without self-locking as well as an anterior plate, the latter of which has not been shown to provide better clinical or radiological results. Overview of Literature: Cervical spondylotic myelopathy (CSM) is a common degenerative pathology that can affect one or more levels and treatment has varied over time trying to maintain sagittal parameters within acceptable values where the ACDF is the main treatment. Materials and Methods: The study was performed in patients with CSM who underwent anterior cervical discectomy, and their pre- and postoperative radiographs were analyzed using Surgimap software a few days before and 3 months after surgery. Results: Fifteen files were included in the study. Statistically significant sagittal balance variables were observed in cervical lordosis (CL) with an increase of 4.73° (P = 0.019) and T1 slope (T1S)-CL with a decrease of -5.93° (P = 0.007). Conclusions: CL and T1S-CL showed favorably modified values when performing ACDF using stand-alone PEEK cages without the need for self-blocking or an anterior plate.

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Introduction: Football soccer practice involves considerable risks of lesions, making it difficult to strike a balance between adequate preparation and the demand imposed on athletes. A high incidence of postural disorders among adolescents leads to questions about the influence of sports activity on the athletes' posture and sagittal balance. Methods: A cross-sectional study was conducted from panoramic spine radiographs of 110 professional Brazilian football (soccer) players. They were male and aged between 20 and 30 years. Measurements of pelvic incidence, pelvic tilt (PT), sacral slope, sagittal vertical axis (SVA), and lumbar lordosis were obtained by using the SurgimapⓇ software. Measurement values were compared with the Brazilian literature data. Lordosis type was categorized according to the classification of Roussouly et al., and the presence of spondylolysis and spondylolisthesis was analyzed. Results: Findings indicated that (1) among 110 radiographs analyzed, 104 had appropriate measurement quality; (2) values compared with the Brazilian mean demonstrated that PT and SVA were statistically lower in professional players (P=0.013 and P=0.037, respectively); (3) according to Roussouly et al. most participants presented Type 3 lordosis (54.8%), followed by Type 4 (26.9%); (4) eight athletes (7.7%) had spondylolysis, and among them, seven (6.7%) had spondylolisthesis. Conclusions: Significant differences in PT and SVA were found in professional athletes. The most common type of lordosis was the same as that found in the general population (Type 3), and the incidence of spondylolysis and spondylolisthesis was higher than that found in the general population, but lower than that found in football (soccer) players.

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The present study investigated the participation of the nitric oxide pathway in facilitating lordosis behavior induced by intrahypothalamic administration of apelin-13 in ovariectomized rats primed with estradiol benzoate (EB). The experiments involved the administration of a nitric oxide synthase inhibitor (L-NAME) or a nitric oxide-dependent, soluble guanylyl cyclase inhibitor (ODQ), and an inhibitor of protein kinase G (KT5823) to the ventromedial hypothalamus (VMH) of EB-primed rats 30 min before infusion of apelin-13 (0.75 µg/µl). This dose of apelin-13 consistently induces lordosis behavior at 30 min, 120 min, and 240 min following infusion. Results showed that injections of either L-NAME or KT5823 significantly reduced the lordosis induced by apelin at 120 and 240 min. However, VMH infusion of ODQ 30 min before apelin-13 infusion reduced but did not significantly inhibit, the lordosis elicited by this peptide at the same time points. We conclude that the nitric oxide pathway in the VMH plays an important role in lordosis induced by apelin-13 in EB-primed rats.

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Purpose: The aim of this study was to determine correlation between the spinopelvic parameters in sitting and standing positions (sacral slope [SS], lumbar lordosis [LL], spinopelvic tilt [SPT], pelvic incidence [PI], and pelvic femoral angle [PFA]), with hip function assessed using the modified Harris hip scores (mHHs) in patients with symptomatic femoroacetabular impingement (FAI) at diagnosis. Materials and Methods: A retrospective study of 52 patients diagnosed with symptomatic FAI was conducted. Evaluation of the spinopelvic complex in terms of SS, LL, SPT, PI and PFA was performed using lateral radiographs of the pelvis and lumbosacral spine in standing and sitting positions. Assessment of hip function at diagnosis was performed using the mHHs. Calculation of spinopelvic mobility was based on the difference (Δ) between measurements performed in standing and sitting position. Results: The median time of pain evolution was 11 months (interquartile range [IQR], 5-24 months) with a median mHHs of 66.0 points (IQR, 46.0-73.0) at diagnosis. The mean change of LL, SS, SPT, and PFA was 20.9±11.2°, 14.2±8.6°, 15.5±9.0°, and 70.7±9.5°, respectively. No statistically significant correlation was observed between spinopelvic parameters and the mHHs (P>0.05). Conclusion: Radiological parameters of the spinopelvic complex did not show correlation with hip function at the time of diagnosis in patients with symptomatic FAI. Conduct of further studies will be required in the effort to understand the effect of the spinopelvic complex and its compensatory mechanics, primarily between the hip and spine, in patients with FAI before and after hip arthroscopy.

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INTRODUCTION: Lumbar interbody fusion is a standard method to treat certain degenerative conditions that are refractory to conservative treatments. LLIF reduces posterior muscle damage, can relieve neurological symptoms through indirect decompression, provides increased stability with its wider cages, and promotes more significant segmental lordosis than standard posterior techniques. However, the technique possesses its issues, such as unusual positioning, possible plexus-related symptoms, and median segmental lordosis correction. Trying to ease those issues, the idea of a prone transpsoas technique occurred. METHODS: Retrospective, single-centric, comparative, and non-randomized study. The authors paired patients receiving lateral lumbar interbody fusion (LLIF) or prone transpsoas (PTP) to evaluate the technique's impact on the segmental lordosis correction. A correlation test selected the covariates for the matching. p-Values inferior to 0.05 were deemed significant. RESULTS: Seventy-one patients were included in the analysis, 53 in the LLIF group and 18 in the PTP group. The significant covariates to the segmental lordosis correction were technique, preoperative segmental lordosis, cage position, and preoperative pelvic tilt. After the paring model, PTP showed significant segmental lordosis correction potential regarding the LLIF. CONCLUSION: The prone transpsoas approach can significantly enhance the correction of segmental lordosis proportionated to the traditional LLIF approach.

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ABSTRACT: Introduction: In healthy individuals and in patients with adolescent idiopathic scoliosis (AIS), the curvature of the cervical spine varies greatly, with approximately 36-40% of AIS patients having kyphosis of the cervical spine. Aim: To assess the curvature of the cervical spine in AIS patients and subgroups according to Lenke's classification (1 to 6). Methods: 107 patients with AIS were assessed for cervical lordosis (C2-C7) using the Cobb method, subdivided into lordosis and cervical kyphosis. The following parameters were assessed and compared between the subgroups: T5-T12 thoracic kyphosis (TK); L1-S1 lumbar lordosis (LL), pelvic incidence (PI), sagittal vertical axis (SVA), T1 pelvic angle (TPA), C2-C7 cervical lordosis, C1-C2 cervical lordosis, T1 slope (T1s), neck tilt, thoracic inlet angle (TIA) and cervical sagittal axis (CSVA). Results: Kyphosis of the cervical spine was observed in 48% of patients. The Lenke classification curves (1 to 6) showed no difference with regard to the curvature of the cervical spine. In the subgroup with cervical lordosis, thoracic kyphosis, and T1 slope were significantly higher. Neck tilt was significantly higher in the subgroup with kyphosis. Conclusions: Almost half of the patients have kyphosis of the cervical spine, and the curvature of the cervical spine in AIS patients varies widely. Thoracic kyphosis, T1 slope, and neck tilt are significantly different between the subgroups of patients with lordosis or kyphosis. Level of Evidence III; Observational and Retrospective Study.

RESUMO: Introdução: Nos indivíduos saudáveis e nos pacientes com escoliose idiopática do adolescente (EIA) a curvatura da coluna cervical apresenta grande variação, sendo que aproximadamente 36-40% dos pacientes com EIA apresentam cifose da coluna cervical. Objetivo: Avaliar a curvatura da coluna cervical nos pacientes com EIA e nos subgrupos, de acordo com a classificação de Lenke (1 a 6). Métodos: Foram avaliados 107 pacientes com EIA quanto a lordose cervical (C2-C7), pelo método de Cobb, subdivididos em dois grupos: lordose e cifose cervical. Foram avaliados e comparados entre os subgrupos os seguintes parâmetros: cifose torácica T5-T12 (TK); lordose lombar L1-S1 (LL), incidência pélvica (PI), eixo sagital vertical (SVA), ângulo T1 pélvico (TPA), lordose cervical C2-C7, lordose cervical C1-C2, inclinação T1 (T1s), inclinação cervical (neck tilt), ângulo entrada torácica (TIA) e eixo cervical sagital (CSVA). Resultados: A cifose da coluna cervical foi observada em 48% dos pacientes. As curvas de classificação de Lenke (1 a 6) não apresentaram diferença com relação à curvatura da coluna cervical. No subgrupo com lordose cervical a cifose torácica e a inclinação de T1 foram significativamente maiores. A inclinação cervical foi significativamente maior no subgrupo com cifose. Conclusões: Quase a metade dos pacientes apresenta cifose da coluna cervical, sendo amplamente variável a curvatura da coluna cervical nos pacientes com EIA. A cifose torácica, a inclinação de T1 e a inclinação cervical são significativamente diferentes entre os subgrupos de pacientes com lordose ou cifose. Nível de Evidência III; Estudo Observacional e Retrospectivo.

RESUMEN: Introducción: En individuos sanos y en pacientes con escoliosis idiopática del adolescente (EIA), la curvatura de la columna cervical varía enormemente, y aproximadamente el 36-40% de los pacientes con EIA presentan cifosis de la columna cervical. Objetivo: Evaluar la curvatura de la columna cervical en pacientes con EIA y subgrupos según la clasificación de Lenke (1 a 6). Métodos: Se evaluó la lordosis cervical (C2-C7) de 107 pacientes con EIA mediante el método de Cobb, subdivididos en dos grupos: lordosis y cifosis cervical. Se evaluaron y compararon los siguientes parámetros entre los subgrupos: Cifosis torácica (TK) T5-T12; lordosis lumbar (LL) L1-S1, incidencia pélvica (PI), eje vertical sagital (SVA), ángulo pélvico T1 (TPA), lordosis cervical C2-C7, lordosis cervical C1-C2, inclinación T1 (T1s), inclinación del cuello, ángulo de la entrada torácica (TIA) y eje sagital cervical (CSVA). Resultados: Se observó cifosis de la columna cervical en el 48% de los pacientes. Las curvas de clasificación de Lenke (1 a 6) no mostraron diferencias con respecto a la curvatura de la columna cervical. En el subgrupo con lordosis cervical, la cifosis torácica y la inclinación T1 eran significativamente mayores. La inclinación cervical fue significativamente mayor en el subgrupo con cifosis. Conclusiones: Casi la mitad de los pacientes presentan cifosis de la columna cervical, y la curvatura de la columna cervical en los pacientes con EIA varía ampliamente. La cifosis torácica, la inclinación T1 y la inclinación cervical son significativamente diferentes entre los subgrupos de pacientes con lordosis o cifosis. Nivel de Evidencia: III; Estudio Observacional y Retrospectivo.

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ABSTRACT: Introduction: The correlation between sagittal and coronal parameters in patients with adolescent idiopathic scoliosis (AIS) presents contradictory results and is not fully understood. Objective: To evaluate the sagittal vertical axis (SVA) and its correlation with sagittal parameters and the main curve in patients diagnosed with AIS. Methods: 109 patients with AIS and indications for surgical treatment were evaluated. The correlation of the SVA with sagittal parameters (thoracic kyphosis, lumbar lordosis, pelvic incidence, lumbar lordosis, pelvic version, and sacral inclination) and with the main curves (main thoracic and thoracolumbar/lumbar) was evaluated. Results: The SVA ranged from -208 to 66.30 mm (mean -19.64 ± 36.21), above 50 mm in two patients (1.83%). There was no correlation between the sagittal parameters and the magnitude of the main curve and the SVA. Conclusion: The SVA showed great variability in the group of patients with AIS; a small percentage of patients had an SVA greater than 50 mm. The low percentage of patients with sagittal misalignment showed the compensatory capacity of young patients with vertebral deformity. Level of Evidence: III; Observational and Retrospective Study.

RESUMO: Introdução: A correlação entre os parâmetros sagitais e coronais nos pacientes com escoliose idiopática do adolescente (EIA) apresenta resultados contraditórios e não está totalmente esclarecida. Objetivo: Avaliar o eixo sagital vertical (SVA) e sua correlação com parâmetros sagitais e a curva principal de pacientes com diagnóstico de EIA. Métodos: Foram avaliados 109 pacientes com EIA e indicação de tratamento cirúrgico. Foi avaliada a correlação do SVA com parâmetros sagitais (cifose torácica, lordose lombar, incidência pélvica, lordose lombar, versão pélvica e inclinação do sacro) e com as curvas principais (torácica principal e toracolombar/lombar). Resultados: O SVA variou de -208 a 66,30 mm (média -19,64 ± 36,21), ficando acima de 50 mm em dois pacientes (1,83%). Não foi observada correlação dos parâmetros sagitais e da magnitude da curva principal com o SVA. Conclusão: O SVA apresentou grande variabilidade no grupo de pacientes com EIA e pequena porcentagem dos pacientes apresentaram SVA maior que 50 mm. A baixa porcentagem de pacientes com desalinhamento sagital evidenciou a capacidade compensatória dos pacientes jovens e com deformidade vertebral. Nível de Evidência: III; Estudo Observacional e Retrospectivo.

RESUMEN: Introducción: La correlación entre los parámetros sagitales y coronales en pacientes con escoliosis idiopática del adolescente (EIA) presenta resultados contradictorios y no se comprende completamente. Objetivo: Evaluar el eje vertical sagital (SVA) y su correlación con los parámetros sagitales y la curva principal en pacientes diagnosticados de EIA. Métodos: Se evaluaron 109 pacientes con EIA e indicación de tratamiento quirúrgico. Se evaluó la correlación del SVA con parámetros sagitales (cifosis torácica, lordosis lumbar, incidencia pélvica, lordosis lumbar, versión pélvica e inclinación sacra) y con las curvas principales (torácica principal y toracolumbar/lumbar). Resultados: El SVA osciló entre -208 y 66,30 mm (media -19,64 ± 36,21), siendo superior a 50 mm en dos pacientes (1,83%). No hubo correlación entre los parámetros sagitales o la magnitud de la curva principal y el SVA. Conclusión: El SVA mostró una gran variabilidad en el grupo de pacientes con EIA y un pequeño porcentaje de pacientes presentó una SVA superior a 50 mm. El bajo porcentaje de pacientes con desalineación sagital mostró la capacidad compensatoria de los pacientes jóvenes con deformidad vertebral. Nivel de Evidencia: III; Estudio Observacional y Retrospectivo.

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ABSTRACT: Objective: Evaluate the epidemiological and radiographic data of patients submitted to the Anterior Lumbar Interbody Fusion (ALIF) technique and the possible complications related to this procedure. Methods: A longitudinal and retrospective study was carried out to analyze electronic medical records and image files of patients who underwent spinal surgery using the ALIF technique between February 2019 and January 2021. Epidemiological data such as age, gender, and level of surgery were analyzed. Radiographic evaluations of lumbar lordosis from L1 to S1 were performed using the COBB technique and the anterior and posterior height of the disc space. The presence of intraoperative and postoperative complications in the patients was analyzed. Results: Initially, 70 patients were analyzed. The most prevalent operated level was L5-S1. The length of stay of the patients varied between 36 and 72 hours. Intraoperative bleeding ranged from 20mL to 400mL. Three patients had significant venous lesions. Differences between anterior and posterior lordosis and height measurements were significant (p < 0.001). Lordosis had a mean increase of 10.3°, anterior height had a mean increase of 7.9mm, and posterior height of 4.0mm. Six cases of intra and postoperative complications were observed. Conclusion: The patients showed improvement in the radiological parameters of the anterior and posterior height of the vertebral discs, with a significant increase in lumbar lordosis. Complication rates were 9.8%, and we had a short hospital stay. Level of Evidence II; Retrospective Longitudinal Study.

RESUMO: Objetivo: Avaliar os dados epidemiológicos e radiográficos de pacientes submetidos à técnica de Artrodese Lombar Anterior (ALIF) e avaliar as possíveis complicações relacionadas a este procedimento. Métodos: Realizou-se um estudo longitudinal e retrospectivo com análise dos prontuários eletrônicos e arquivos de imagem dos pacientes submetidos a cirurgia da coluna pela técnica de ALIF, no período entre fevereiro de 2019 e janeiro de 2021. Dados epidemiológicos como idade, sexo e nível de cirurgia foram analisados. Foram feitas avaliações radiográficas da lordose lombar de L1 a S1 através da técnica de COBB e da altura anterior e posterior do espaço discal. Foram analisados a presença de complicações intra e pós-operatórias dos pacientes. Resultados: Foram analisados inicialmente 70 pacientes. O nível operado mais prevalente foi L5-S1. O tempo de internamento dos pacientes variou entre 36 e 72 horas. O sangramento intraoperatório variou de 20mL a 400mL. Três pacientes apresentaram lesões venosas importantes. As diferenças entre as medidas de lordose e altura anterior e posterior foram significativas (p < 0,001). A lordose teve aumento médio de 10,3°, a altura anterior teve aumento médio de 7,9mm e a altura posterior de 4,0mm. Foram observados 06 casos de complicações intra e pós-operatórias. Conclusão: Os pacientes apresentaram melhora nos parâmetros radiológicos de altura anterior e posterior dos discos vertebrais, com um aumento da lordose lombar significativo. As taxas de complicações foram de 9,8 % e tivemos um curto período de internação hospitalar. Nível de Evidência II; Estudo Longitudinal e Retrospectivo.

RESUMEN: Objetivo: Evaluar los datos epidemiológicos y radiográficos de pacientes sometidos a la técnica de Artrodesis Lumbar Anterior (ALIF) y evaluar las posibles complicaciones relacionadas con este procedimiento. Métodos: Se realizó un estudio longitudinal y retrospectivo con análisis de historias clínicas electrónicas y archivos de imágenes de pacientes intervenidos de columna vertebral mediante la técnica ALIF, en el período comprendido entre febrero de 2019 y enero de 2021. Datos epidemiológicos como edad, sexo y nivel quirúrgico fueron analizados. Las evaluaciones radiográficas de la lordosis lumbar de L1 a S1 se realizaron mediante la técnica COBB y la altura anterior y posterior del espacio discal. Se analizó la presencia de complicaciones. Resultados: Se analizaron 70 pacientes. El nivel operado más prevalente fue L5-S1. El tiempo de estancia de los pacientes varió entre 36 y 72 horas. El sangrado intraoperatorio osciló entre 20 ml y 400 ml. Tres pacientes tenían lesiones venosas importantes. Las diferencias entre la lordosis anterior y posterior y las medidas de altura fueron significativas (p < 0,001). La lordosis tuvo un aumento medio de 10,3°, la altura anterior tuvo un aumento medio de 7,9 mm y la altura posterior de 4,0 mm. Se observaron seis casos de complicaciones intra y postoperatorias. Conclusiones: Los pacientes mostraron mejoría en los parámetros radiológicos de altura anterior y posterior de los discos vertebrales, con aumento significativo de la lordosis lumbar. Las tasas de complicaciones fueron del 9,8% y hubo una corta estancia hospitalaria. Nivel de Evidencia II; Estudio Longitudinal y Retrospectivo.

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ABSTRACT: Objective: To compare the effects of the two techniques (minimally invasive transforaminal inter somatic lumbar fusion [MIS-TLIF] and open transforaminal lumbar interbody fusion [TLIF]) in the treatment of lumbar degenerative disease. Methods: This is a retrospective cohort study. The outcomes investigated were: intensity of low back pain, functional disability of the lumbar spine, discharge time, return to work, lumbar lordosis angle, cost of individual sources due to the period of work-related absenteeism, and societal perspective costs in the treatment of low-grade lumbar degenerative disease. The data was obtained through the analysis of data contained in the electronic medical records of 100 patients who underwent one of the two surgical techniques from January 2019 to May 2021 in a High Complexity Orthopedic Surgery. The outcomes investigated were set 12 months postoperatively. Results: No statistical differences were observed in terms of sex, age, employment, and diagnosis grade between groups. MIS-TLIF was associated with significant improvement in the intensity of low back pain, functional disability of the lumbar spine, discharge time, return to work, cost of individual sources due to the period of work-related absenteeism, and societal perspective costs. The variation in the lumbar lordosis angle of the MIS-TLIF group was smaller when compared to TLIF. Conclusion: Considering that MIS-TLIF was achieved with satisfactory short-term improvements, it may be used as an alternative strategy to TLIF to promote clinical and economical improvements in treating lumbar degenerative disease. Level of Evidence III; Comparative Retrospective Study.

RESUMO: Objetivo: Comparar os efeitos das duas técnicas (fusão intersomática lombar transforaminal minimamente invasiva [MIS-TLIF] e fusão intersomática lombar transforaminal aberta [TLIF]) no tratamento da doença degenerativa lombar. Métodos: Trata-se de um estudo de coorte retrospectivo. Os desfechos investigados foram: intensidade da dor lombar, incapacidade funcional da coluna lombar, tempo de alta, retorno ao trabalho, ângulo de lordose lombar, costa de fontes individuais devido ao período de absenteísmo relacionado ao trabalho e custos da perspectiva social no tratamento de doença degenerativa lombar de baixo grau. Os dados foram obtidos por meio da análise dos dados contidos nos prontuários eletrônicos de 100 pacientes submetidos a uma das duas técnicas cirúrgicas no período de janeiro de 2019 a maio de 2021 em uma Cirurgia Ortopédica de Alta Complexidade. Os resultados investigados foram definidos 12 meses após a cirurgia. Resultados: Não foram observadas diferenças estatísticas quanto ao sexo, idade, vínculo empregatício, grau de diagnóstico entre os grupos. O MIS-TLIF foi associado a melhora significativa na intensidade da dor lombar, incapacidade funcional da coluna lombar, tempo de alta, retorno ao trabalho, custo de fontes individuais devido ao período de absenteísmo relacionado ao trabalho e custos de perspectiva social. A variação do ângulo da lordose lombar do grupo MIS-TLIF foi menor quando comparado ao TLIF. Conclusão: Considerando que o MIS-TLIF foi alcançado com melhoras satisfatórias em curto prazo, pode ser usado como uma estratégia alternativa ao TLIF para promover melhorias clínicas e econômicas no tratamento da doença degenerativa lombar. Nível de Evidência III; Estudo Retrospectivo Comparativo.

RESUMEN: Objetivo: Comparar los efectos de dos técnicas (fusión lumbar intersomática transforaminal mínimamente invasiva [MIS-TLIF] y fusión intersomática lumbar transforaminal abierta [TLIF]) en el tratamiento de la enfermedad degenerativa lumbar. Métodos: Este es un estudio de cohorte retrospectivo. Los desenlaces investigados fueron: intensidad del dolor lumbar, incapacidad funcional de la columna lumbar, tiempo de alta, regreso al trabajo, ángulo de lordosis lumbar, costa de fuentes individuales debido al período de ausentismo relacionado con el trabajo y costos de perspectiva social en el tratamiento de enfermedad degenerativa lumbar de bajo grado. Los datos se obtuvieron a través del análisis de los datos contenidos en las historias clínicas electrónicas de 100 pacientes que se sometieron a alguna de las dos técnicas quirúrgicas durante el período de enero de 2019 a mayo de 2021 en una Cirugía Ortopédica de Alta Complejidad. Los resultados investigados se establecieron 12 meses después de la operación. Resultados: No se observaron diferencias estadísticas en cuanto a sexo, edad, ocupación, grado de diagnóstico entre grupos. MIS-TLIF se asoció con una mejora significativa en la intensidad del dolor lumbar, la discapacidad funcional de la columna lumbar, el tiempo de alta, el regreso al trabajo, la costa de fuentes individuales debido al período de ausentismo relacionado con el trabajo y los costos de perspectiva social. La variación en el ángulo de lordosis lumbar del grupo MIS-TLIF fue menor en comparación con TLIF. Conclusión: considerando que MIS-TLIF se logró con mejoras satisfactorias a corto plazo, puede usarse como una estrategia alternativa a TLIF para promover mejoras clínicas y económicas en el tratamiento de la enfermedad degenerativa lumbar. Nivel de Evidencia III; Estudio Retrospectivo Comparativo.

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ABSTRACT: Objective: The analysis of the X-ray results of surgical treatment performed in patients with post-traumatic thoracolumbar kyphosis and identification of the compensatory mechanism for this deformity. Methods: The data of 140 patients surgically treated for painful post-traumatic kyphosis at the level of T12, L1, and L2 vertebrae was analyzed. Results: In the studied group, the initial kyphotic deformity was 23° to 81°, with a mean of 28.1°. All patients underwent staged surgical intervention in a single surgical session. Post-traumatic kyphosis (LK) was completely corrected, on average, to -0.25°. After kyphosis correction, increased thoracic kyphosis (TK) decreased lumbar lordosis (LL), including at the expense of low lumbar lordosis (LowLL), but no changes in pelvic balance parameters were observed. Statistically significant correlations of local kyphosis correction magnitude of 28.36±8.89°, with magnitudes of lumbar lordosis (LL), thoracic kyphosis (TK), low lumbar lordosis (LowLL) were obtained. The global sagittal and pelvic balance demonstrated no correlations with the magnitude of kyphosis correction. The X-ray parameters were studied in patients of Group I with no signs of initial sagittal imbalance and in Group II patients with signs of sagittal imbalance. The groups demonstrated statistically significant differences in global balance parameters and spinopelvic parameters both before and after correction surgery. Conclusion: The study revealed that the basic compensatory mechanism for post-traumatic thoracolumbar kyphosis is implemented by changes in the curves adjacent to kyphosis - a decrease in thoracic kyphosis and an increase in lumbar lordosis but not by changes in global or spinopelvic balance. Level of Evidence - III; A case-control study.

RESUMO: Objetivo: Análise dos resultados radiográficos do tratamento cirúrgico realizado em pacientes com cifose toracolombar pós-traumática e identificação do mecanismo compensatório dessa deformidade. Métodos: Foram analisados os dados de 140 pacientes tratados cirurgicamente por cifose pós-traumática dolorosa ao nível das vértebras T12, L1, L2. Resultados: No grupo estudado a deformidade cifótica inicial foi de 23° a 81°, média de 28,1°. Todos os pacientes foram submetidos à intervenção cirúrgica estadiada em uma única sessão cirúrgica. A cifose pós-traumática (LK) foi completamente corrigida, em média para -0,25°. Após a correção da cifose foi revelado aumento da cifose torácica (TK), diminuição da lordose lombar (LL), inclusive em detrimento da baixa lordose lombar (LowLL), mas não foram observadas alterações nos parâmetros de equilíbrio pélvico. Foram obtidas correlações estatisticamente significativas da magnitude de correção da cifose local de 28,36±8,89°, com magnitudes de lordose lombar (LL), cifose torácica (TK), lordose lombar baixa (LowLL). O equilíbrio sagital global e o equilíbrio pélvico não demonstraram correlações com a magnitude da correção da cifose. Os parâmetros radiográficos foram estudados nos pacientes do Grupo I sem sinais de desequilíbrio sagital inicial e naqueles do Grupo II com sinais de desequilíbrio sagital. Os grupos demonstraram diferenças estatisticamente significativas nos parâmetros de equilíbrio global e nos parâmetros espinopélvicos antes e após a cirurgia de correção. Conclusão: O estudo revelou que o mecanismo compensatório básico da cifose toracolombar pós-traumática é implementado por alterações nas curvas adjacentes à cifose - diminuição da cifose torácica e aumento da lordose lombar, mas não por alterações no equilíbrio global ou espinopélvico. Nível de Evidência III; Estudo caso controle.

RESUMEN: Objetivo: Análisis de los resultados radiológicos del tratamiento quirúrgico realizado a pacientes con cifosis toracolumbar postraumática e identificación del mecanismo compensador de esta deformidad. Métodos: Se analizaron los datos de 140 pacientes tratados quirúrgicamente por cifosis postraumática dolorosa a nivel de las vértebras T12, L1, L2. Resultados: En el grupo estudiado, la deformidad cifótica inicial osciló entre 23° y 81°, con un promedio de 28,1°. Todos los pacientes fueron sometidos a una intervención quirúrgica escalonada en una única sesión quirúrgica. La cifosis postraumática (LK) se corrigió completamente, en promedio a -0,25°. Después de la corrección de la cifosis, se reveló un aumento de la cifosis torácica (TK) y una disminución de la lordosis lumbar (LL), incluso a expensas de una lordosis lumbar baja (LowLL), pero no se observaron cambios en los parámetros del equilibrio pélvico. Se obtuvieron correlaciones estadísticamente significativas entre la magnitud de corrección de la cifosis local de 28,36±8,89°, con las magnitudes de lordosis lumbar (LL), cifosis torácica (TK), lordosis lumbar baja (LowLL). El equilibrio sagital global y el equilibrio pélvico no demostraron correlaciones con la magnitud de la corrección de la cifosis. Los parámetros radiológicos se estudiaron en pacientes del Grupo I sin signos de desequilibrio sagital inicial y en aquellos del Grupo II con signos de desequilibrio sagital. Los grupos demostraron diferencias estadísticamente significativas en los parámetros del equilibrio global y los parámetros espinopélvicos antes y después de la cirugía correctora. Conclusión: El estudio reveló que el mecanismo compensatorio básico de la cifosis toracolumbar postraumática se implementa mediante cambios en las curvas adyacentes a la cifosis (disminución de la cifosis torácica y aumento de la lordosis lumbar), pero no mediante cambios en el equilibrio global o espinopélvico. Nivel de Evidencia III; Estudio de casos y controles.

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Hypopressive exercises (HE) are part of the Low Pressure Fitness training program which is widely used by physical therapists in the rehabilitation of the pelvic floor, abdominal and spinal musculature. The aim of this study was to compare the effects of HE on the sagittal lumbo-pelvic posture in athletic and non-athletic females. It was hypothesized that a 5-week training program of HE could influence lumbo-pelvic position while reducing abdominal circumference and low back pain in athletic and non-athletic females. Twenty normoweight females (mean age = 24.8 (SD 3.5) years; body mass index = 22.4 (SD 1.6) kg/m2) participated in this study. Ten athletic females were rugby players (RG), and 10 females were non-athletic (SG). Participants completed twenty minutes of HE twice weekly for 5 weeks. Before and after the intervention, two-dimension photogrammetry was used to assess lumbar lordosis and pelvic horizontal alignment. A Visual Analog Scale was used to assess low back pain and cirtometry was used to assess abdominal circumferences at umbilical, supra and infra-umbilical levels. An analysis of variance between moments revealed no significant differences in lumbar lordosis and pelvic positioning but showed significant differences for abdominal circumferences between groups. No significant differences between groups were found for other variables. Significant correlations were found between the three different abdominal circumference measurements (p > 0.05) but not between lumbar lordosis and abdominal circumferences. These preliminary findings indicate that a 5-week HE intervention displayed non-significant changes in lumbar lordosis, pelvic horizontal alignment, and low back pain but a significant reduction in abdominal circumferences in non-athletic and athletic females.

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ABSTRACT Objective: Evaluate the influence of the most used surgical positioners for lumbar lordosis (LL) in asymptomatic individuals. Methods: Cross-sectional study based on demographic data and radiographic parameters of asymptomatic individuals. For this study, 16 volunteers, 15 males, and one female were selected, and the average age was 24.6 years. They were submitted to lateral radiographs of the lumbar spine in orthostasis in use of the following positioners: gel cushion, gel cushion with hip extension, four-point Relton-Hall and Wilson-type positioner. Results: The mean LL in the orthostatic position was 58.76º, whereas in the gel cushion positioner it was 52.51; on the gel cushion with hip extension of 58.23º, Relton-Hall/4points 37.63º and, finally, on the Wilson-type positioner of 40.87º. An average reduction of 5.42º of the LL was observed when positioning on the gel cushion in relation to the orthostasis. In the linear regression analysis, the data presented statistically significant results (p<0.05), demonstrating that the L4-S1 segment influences 60% in LL. Conclusion: The positioner with gel cushion and hip extension reproduces an LL similar to physiological values. Relton-Hall and Wilson-type positioners with hip flexion promote hypolordotic positioning compared to basal lordosis in orthostasis. Hip extension alone generated a 5.96º increase in the subject's lordosis. The L4-S1 segment has a 60% influence on the LL when the individuals are in the positioners. Level of evidence III; Controlled cross-sectional study.

RESUMO: Objetivo: Avaliar a influência dos posicionadores cirúrgicos na lordose lombar (LL) em indivíduos assintomáticos. Métodos: Estudo transversal com dados demográficos e parâmetros radiográficos de indivíduos assintomáticos. Utilizamos 16 voluntários, sendo 15 do gênero masculino e uma do gênero feminino, com idade média de 24,6 anos. Foram submetidos a realização de radiografias em perfil da coluna lombar em ortostase nos seguintes posicionadores: coxim em gel, coxim em gel com extensão do quadril, Relton-Hall em quatro pontos e posicionador tipo Wilson. Resultados: A média de LL na posição ortostática foi de 58,76º, já no posicionador coxim em gel de 52,51; no coxim em gel com extensão dos quadris de 58,23º, Relton-Hall/4pontos 37,63º e, por último, no posicionador tipo Wilson, de 40,87º. Houve redução média de 5,42º da LL ao posicionar no coxim em gel em relação a ortostase, na análise de regressão linear os dados apresentaram resultados estaticamente significativos (p<0,05), demostrando que o seguimento L4-S1 apresenta uma influência de 60% na LL. Conclusão: O posicionador coxins em gel e extensão do quadril reproduz uma LL semelhante à fisiológica. Posicionadores do tipo Relton-Hall e Wilson com flexão do quadril promovem um posicionamento hipolordótico comparada a lordose basal em ortostase. A extensão do quadril por si só foi capaz de gerar um aumento de 5,96º na lordose do indivíduo. O seguimento L4-S1 apresenta uma influência de 60% na LL quando os indivíduos estão nos posicionadores. Nível de Evidência III; Estudo Transversal Controlado.

RESUMEN: Objetivo: Evaluar la influencia de los posicionadores quirúrgicos para la lordosis lumbar (LL) en individuos asintomáticos. Métodos: Estudio transversal con datos demográficos y parámetros radiográficos de individuos asintomáticos. Utilizamos 16 voluntarios, 15 hombres y una mujer, edad media de 24,6 años. Sometidos a radiografías laterales de la columna lumbar en ortostasis en los siguientes posicionadores: almohadilla de gel, almohadilla de gel con extensión de cadera, posicionador de cuatro puntos y posicionador tipo Wilson. Resultados: El promedio de LL en posición ortostática fue de 58,76º, en el posicionador de almohadilla de gel fue de 52,51º; en almohadilla de gel con extensión de cadera de 58,23º, 4 puntos 37,63º y, por último, en posicionador tipo Wilson de 40,87º. Se observó una reducción promedio de 5,42º de LL al posicionarse sobre la almohadilla de gel en relación a ortostasis. En el análisis de regresión lineal, los datos presentaron resultados estadísticamente significativos (p<0,05), demostrando que el segmento L4-S1 tiene una influencia de 60% en LL. Conclusión: El posicionador con almohadilla de gel y con extensión de cadera reproduce una LL similar a la fisiológica. Relton-Hall y Wilson con flexión de cadera promueven el posicionamiento hipolordótico en comparación con la lordosis basal. La extensión de la cadera por sí sola fue capaz de generar un aumento de 5,96º en la lordosis. El segmento L4-S1 tiene una influencia del 60% en la LL cuando los individuos están en los posicionadores. Nivel de evidencia III; Estudio Transversal Controlado.

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Objectives To verify if there is a difference in postural hypervigilance in sitting in individuals with and without low back pain. Additionally, to observe whether there is a difference in the perception of correct sitting posture between individuals with low back pain and without low back pain. Methods The present study has a cross-sectional observational design, as a sample size of 92 individuals, later divided equally into two groups (with low back pain and without low back pain). Two instruments were used: the hypervigilance scale to analyze the frequency that volunteers correct their sitting posture during the day, and posture scans to investigate the perception of volunteers about the correct sitting posture. The data were submitted to the Shapiro-Wilk Normality test. To compare the values of Hypervigilance Scale, the Mann-Whitney, Chi-Square, and Fisher Exact tests were used to assess correct sitting posture. Results There was no significant difference between postural hypervigilance in sitting between individuals with low back pain and without low back pain. There was no significant difference between the choice of correct sitting posture between the group of individuals with and without low back pain. Conclusion There is no difference between the choice of correct sitting posture and the amount of postural hypervigilance in individuals with or without low back pain.

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Abstract Objectives To verify if there is a difference in postural hypervigilance in sitting in individuals with and without low back pain. Additionally, to observe whether there is a difference in the perception of correct sitting posture between individuals with low back pain and without low back pain. Methods The present study has a cross-sectional observational design, as a sample size of 92 individuals, later divided equally into two groups (with low back pain and without low back pain). Two instruments were used: the hypervigilance scale to analyze the frequency that volunteers correct their sitting posture during the day, and posture scans to investigate the perception of volunteers about the correct sitting posture. The data were submitted to the Shapiro-Wilk Normality test. To compare the values of Hypervigilance Scale, the Mann-Whitney, Chi-Square, and Fisher Exact tests were used to assess correct sitting posture. Results There was no significant difference between postural hypervigilance in sitting between individuals with low back pain and without low back pain. There was no significant difference between the choice of correct sitting posture between the group of individuals with and without low back pain. Conclusion There is no difference between the choice of correct sitting posture and the amount of postural hypervigilance in individuals with or without low back pain.

Resumo Objetivos Verificar se há diferença na hipervigilância postural sentada em indivíduos com e sem dor lombar. Além disso, observar se há diferença na percepção da postura correta sentada entre indivíduos com dor lombar e sem dor lombar. Métodos O presente estudo possui delineamento observacional transversal, como tamanho amostral de 92 indivíduos, posteriormente divididos igualmente em dois grupos (com dor lombar e sem dor lombar). Foram utilizados dois instrumentos: a escala de hipervigilância para analisar a frequência que voluntários corrigem a postura sentada no dia; e o quadro de posturas para investigar a percepção dos voluntários sobre a postura correta sentada. Os dados foram submetidos ao teste de Normalidade de Shapiro-Wilk. Para comparar os valores da Escala de Hipervigilância foi utilizado o teste de Mann-Whitney e o teste Qui-quadrado e exato de Fisher para avaliação da postura correta sentada. Resultados Não houve diferença significativa entre a hipervigilância postural sentada entre indivíduos com dor lombar e sem dor lombar. Não houve diferença significativa entre a escolha da postura correta sentada entre o grupo de indivíduos com e sem dor lombar. Conclusão Não há diferença entre a escolha da postura correta sentada e quantidade de hipervigilância postural em indivíduos com ou sem dor lombar.

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Objectives The present study aimed to assess whether preoperative spinopelvic parameters can influence the gain of segmental lordosis after one level of lateral lumbar interbody fusion. Methods The following radiological parameters were measured in the X-rays: pelvic incidence, lumbar lordosis, pelvic tilt, L4S1 lordosis, index level segmental lordosis, intraoperative index segmental lordosis, pelvic mismatch (IP-LL), distal lordosis proportion, delta segmental lordosis, Pelvic Titlt (PT) > 20, actual sacral slope, and ideal sacral slope, and the correlation of these variables with the gain of segmental lordosis was investigated. Afterwards, an exploratory cluster analysis was performed to identify common characteristics between patients and segmental lordosis gain. Results The sample of the present study comprised 104 patients, of which 76% presented segmental lordosis gain. The most correlated parameters with the segmental lordosis gain were preoperative segmental lordosis (-0.50) and delta intraoperative lordosis (0.51). Moreover, patients in the high PI groups had a trend to gain more segmental lordosis ( p < 0.05) and a reduced risk of losing segmental lordosis (Odds 6.08). Conclusion Patients with low-medium PI profiles presented higher odds of loss of segmental lordosis. However, the preoperative spinopelvic parameters alone do not seem to play a significant role in the fate of segmental lordosis gain.

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Objective The present study evaluates radiographic outcomes and the lumbar lordosis achieved with a transforaminal lumbar interbody fusion (TLIF) arthrodesis technique according to the positioning of an interbody device (cage) in the disc space. Methods This is a retrospective radiographic analysis of single-level surgical patients with degenerative lumbar disease submitted to a TLIF procedure and posterior pedicle instrumentation. We divided patients into two groups according to cage positioning. For the TLIF-A group, the cages were anterior to the disc space; for the TLIF-P group, cages were posterior to the disc space. Considering the superior vertebral plateau of the lower vertebra included in the instrumentation, cages occupying a surface equal to the anterior 50% of the midline were placed in the TLIF-A group, and those in a posterior position were placed in the TLIF-P group. We assessed pre- and postoperative orthostatic lateral radiographs to obtain the following measures: lumbar lordosis (LL) (angle L1-S1), segmental lordosis (LS) (L4-S1), and segmental lordosis of the cage (SLC). Results The present study included 100 patients from 2011 to 2018; 44 were males, and 46 were females. Their mean age was 50.5 years old (range, 27 to 76 years old). In total, 43 cages were "anterior" (TLIF-A) and 57 were "posterior" (TLIF-P). After surgery, the mean findings for the TLIF-A group were the following: LL, 50.7°, SL 34.9°, and SLC 21.6°; in comparison, the findings for the TLIF-P group were the following: LL, 42.3° ( p < 0.01), SL 30.7° ( p < 0.05), and SLC 18.8° ( p > 0.05). Conclusion Cage positioning anterior to the disc space improved lumbar and segmental lordosis on radiographs compared with a posterior placement.

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Abstract Objectives The present study aimed to assess whether preoperative spinopelvic parameters can influence the gain of segmental lordosis after one level of lateral lumbar interbody fusion. Methods The following radiological parameters were measured in the X-rays: pelvic incidence, lumbar lordosis, pelvic tilt, L4S1 lordosis, index level segmental lordosis, intraoperative index segmental lordosis, pelvic mismatch (IP-LL), distal lordosis proportion, delta segmental lordosis, Pelvic Titlt (PT) > 20, actual sacral slope, and ideal sacral slope, and the correlation of these variables with the gain of segmental lordosis was investigated. Afterwards, an exploratory cluster analysis was performed to identify common characteristics between patients and segmental lordosis gain. Results The sample of the present study comprised 104 patients, of which 76% presented segmental lordosis gain. The most correlated parameters with the segmental lordosis gain were preoperative segmental lordosis (−0.50) and delta intraoperative lordosis (0.51). Moreover, patients in the high PI groups had a trend to gain more segmental lordosis (p< 0.05) and a reduced risk of losing segmental lordosis (Odds 6.08). Conclusion Patients with low-medium PI profiles presented higher odds of loss of segmental lordosis. However, the preoperative spinopelvic parameters alone do not seem to play a significant role in the fate of segmental lordosis gain.

Resumo Objetivos O presente estudo teve como objetivo avaliar se os parâmetros espinopélvicos pré-operatórios podem influenciar o ganho da lordose segmental após fusão intersomática lombar por via lateral de um nível. Métodos Os seguintes parâmetros radiológicos foram medidos nos raios X: incidência pélvica, lordose lombar, versão pélvica, lordose L4S1, lordose segmental do nível operado, índice intraoperatório de lordose segmentar, mismatch pélvico (IP-LL), proporção de lordose distal, delta de lordose segmentar, PT > 20, inclinação sacral real e inclinação sacral ideal, e a correlação dessas variáveis com o ganho da lordose segmentar foi investigada. Posteriormente, foi realizada uma análise exploratória de cluster para identificar características comuns entre os pacientes e o ganho de lordose segmentar. Resultados O presente estudo contou com 144 pacientes, dos quais 76% apresentaram ganho de lordose segmentar. Os parâmetros mais correlacionados com o ganho de lordose segmentar foram lordose segmentar pré-operatória (−0,50) e delta intraoperatório de lordose (0,51). Além disso, os pacientes dos grupos de incidência pélvica (IP) alto tiveram tendência de ganho de lordose segmental maior (p< 0,05) e redução do risco de perda de lordose segmental (chances 6.08). Conclusão Pacientes com perfis de IP médios baixos apresentaram maiores chances de perda de lordose segmentar. No entanto, os parâmetros espinopélvicos pré-operatórios por si só não parecem desempenhar um papel significativo no destino do ganho da lordose segmentar.

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Abstract Objective The present study evaluates radiographic outcomes and the lumbar lordosis achieved with a transforaminal lumbar interbody fusion (TLIF) arthrodesis technique according to the positioning of an interbody device (cage) in the disc space. Methods This is a retrospective radiographic analysis of single-level surgical patients with degenerative lumbar disease submitted to a TLIF procedure and posterior pedicle instrumentation. We divided patients into two groups according to cage positioning. For the TLIF-A group, the cages were anterior to the disc space; for the TLIF-P group, cages were posterior to the disc space. Considering the superior vertebral plateau of the lower vertebra included in the instrumentation, cages occupying a surface equal to the anterior 50% of the midline were placed in the TLIF-A group, and those in a posterior position were placed in the TLIF-P group. We assessed pre- and postoperative orthostatic lateral radiographs to obtain the following measures: lumbar lordosis (LL) (angle L1-S1), segmental lordosis (LS) (L4-S1), and segmental lordosis of the cage (SLC). Results The present study included 100 patients from 2011 to 2018; 44 were males, and 46 were females. Their mean age was 50.5 years old (range, 27 to 76 years old). In total, 43 cages were "anterior" (TLIF-A) and 57 were "posterior" (TLIF-P). After surgery, the mean findings for the TLIF-A group were the following: LL, 50.7°, SL 34.9°, and SLC 21.6°; in comparison, the findings for the TLIF-P group were the following: LL, 42.3° (p< 0.01), SL 30.7° (p< 0.05), and SLC 18.8° (p> 0.05). Conclusion Cage positioning anterior to the disc space improved lumbar and segmental lordosis on radiographs compared with a posterior placement.

Resumo Objetivo Avaliar os resultados radiográficos e comparar a lordose pós-operatória em técnica de artrodese intersomática lombar transforaminal (TLIF, na sigla em inglês), considerando como variável o posicionamento do dispositivo intersomático (cage) em relação ao espaço discal. Métodos Análise retrospectiva radiográfica de pacientes cirúrgicos, em nível único, por doença lombar degenerativa, aplicando-se TLIF e instrumentação pedicular posterior. Os pacientes foram divididos, conforme a posição do cage, em 2 grupos: 1. TLIF-A - cages na posição anterior do espaço discal; e 2. TLIF-P, cages na posição posterior do espaço discal (considerando-se o platô vertebral superior da vértebra inferior incluída na instrumentação, cages que ocuparam a superfície correspondente a 50% anterior da linha média, compuseram o grupo TLIF-A; opostamente, cages em posicionamento posterior compuseram o grupo TLIF-P). Procedeu-se à avaliação dos exames radiográficos ortostáticos em perfil no pré- e pós-operatórios, com a tomada das seguintes medidas: lordose lombar (LL) (ângulo L1-S1); lordose segmentar (LS) (L4-S1) e lordose segmentar do cage (LSC). Resultados Cem pacientes foram incluídos de 2011 a 2018, sendo 44 homens e 46 mulheres, com idade média de 50.5 anos (27-76 anos). Um total de 43 cages foram classificados como "anteriores" (TLIF-A) e 57, "posteriores" (TLIF-P); considerando o grupo TLIF- A, os resultados pós-operatórios médios foram: LL 50.7°, LS 34.9° e LSC 21.6°; para o grupo TLIF-P, comparativamente: LL 42.3° (p< 0,01), LS 30.7° (p< 0,05) e LSC 18.8° (p> 0,05). Conclusão O posicionamento anterior do cage em relação ao espaço discal correlaciona-se a melhora da lordose lombar e segmentar na radiografia em comparação com o posicionamento posterior do implante.

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Abstract Objectives The present study aims to characterize the spinal balance (SB) in young adults with Schmorl nodes (SN). Methods A cross-sectional study was conducted on a sample of 47 young adults. Lumbar magnetic resonance imaging (MRI) was used to divide the patients into an SN group and a control group. Standing full spine radiographs were used to compare the spinopelvic SB parameters between groups: sagittal vertical axis, thoracic kyphosis, lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Results The LL and SS values were significantly lower in patients with SN when compared with the control group (54.5° versus 64.3°; 36.2° versus 41.4°, respectively). No significant differences were observed for the other parameters. Significant correlations were found in both groups between LL and SS; PI and PT; and PI and SS. Conclusions Young adults with SN have associated SB modifications, particularly lower LL and SS values, when compared with a control group. This flatter profile resembles that observed in patients with lower back pain and early disc pathology. We believe that SNs are relevant clinical findings that should prompt the study of the SB of a patient, as it may uncover variations associated with early disc degeneration. Level of Evidence III

Resumo Objetivos O presente estudo tem como objetivo caracterizar o equilíbrio sagital (SB, na sigla em inglês) espinhal em adultos jovens com nódulos de Schmorl (NS). Métodos Este é um estudo transversal de uma amostra composta por 47 adultos jovens. Ressonância magnética (RM) lombar foi usada para separar os pacientes em um grupo com NS e um grupo controle. Radiografias da coluna vertebral em pé foram usadas para comparar os parâmetros espinopélvicos do SB entre os grupos: eixo vertical sagital, cifose torácica, lordose lombar (LL), incidência pélvica (PI, na sigla em inglês), inclinação pélvica (PT, na sigla em inglês) e inclinação sacral (SS, na sigla em inglês). Resultados Os valores de LL e SS foram significativamente menores nos pacientes com NS em comparação com o grupo controle (54,5° versus 64,3°; 36,2° versus 41,4°, respectivamente). Não foram observadas diferenças significativas nos demais parâmetros. Os dois grupos apresentaram correlações significativas entre LL e SS, PI e PT e PI e SS. Conclusões Adultos jovens com NS apresentam modificações associadas ao SB, principalmente valores menores de LL e SS, em comparação com o grupo controle. Este perfil mais plano assemelha-se ao observado em pacientes com lombalgia e patologia discal em estágio inicial. Acreditamos que o NS seja um achado clínico relevante que deve levar ao estudo do SB de um paciente por poder revelar variações associadas aos primeiros estágios de degeneração discal. Nível de Evidência III

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Objective The present study aims to determine the intra- and inter-rater reliability and reproducibility of the Roussouly classification for lumbar lordosis types. Methods A database of 104 panoramic, lateral radiographs of the spine of male individuals aged between 18 and 40 years old was used. Six examiners with different expertise levels measured spinopelvic angles and classified lordosis types according to the Roussouly classification using the Surgimap software (Nemaris Inc., New York, NY, USA). After a 1-month interval, the measurements were repeated, and the intra- and inter-rater agreement were calculated using the Fleiss Kappa test. Results The study revealed positive evidence regarding the reproducibility of the Roussouly classification, with reasonable to virtually perfect (0.307-0.827) intra-rater agreement, and moderate (0.43) to reasonable (0.369) inter-rater agreement according to the Fleiss kappa test. The most experienced examiners showed greater inter-rater agreement, ranging from substantial (0.619) to moderate (0.439). Conclusion The Roussouly classification demonstrated good reliability and reproducibility, with intra- and inter-rater agreements at least reasonable, and reaching substantial to virtually perfect levels in some situations. Evaluators with highest expertise levels showed greater intra and inter-rater agreement.