Characterizing Camptocormia in Parkinson's Disease Using Muscle Ultrasonography.

BACKGROUND: Camptocormia (CC) is the forward-bending of the spine of more than 30 degrees that can be found in Parkinson's disease (PD) as a disabling complication. Detection of changes in paraspinal lumbar musculature in CC is of value for choosing treatment strategies. OBJECTIVE: To investigate whether these changes can be detected using muscle ultrasonography (mUSG). METHODS: Age and sex-matched groups comprised 17 PD patients with CC (seven acute, PD-aCC; 10 chronic PD-cCC), 19 PD patients with no CC, and 18 healthy controls (HC). Lumbar paravertebral muscles (LPM) on both sides were assessed using mUSG by two different raters blinded to the group assignment. Groups were compared with regard to the linear measurements of the muscle thickness as well as semi-quantitative and quantitative (grayscale) analyses of muscle echogenicity using a univariate general linear model. RESULTS: All assessments showed substantial interrater reliability. The PD-cCC group had significantly thinner LPM compared to groups with no CC (PD and HC). Groups of PD-aCC and PD-cCC differed from the groups of no CC in quantitative and semi-quantitative analyses of LPM echogenicity, respectively. CONCLUSION: Assessment of LPM in PD patients with CC can be reliably performed using mUSG. Also, mUSG may be used as a screening tool to detect CC-related changes in thickness and echogenicity of the LPM in patients with PD.

Progressive Camptocormia With Head Drop and Dysphagia.

A 72-year-old man had mild proximal weakness that developed into progressive camptocormia, head drop, numbness, and significant muscle wasting. What is your diagnosis?

Axial postural abnormalities and pain in Parkinson's disease.

Axial postural abnormalities and pain are two main determinants of poor quality of life in patients with Parkinson's disease (PD). Indeed, a detailed characterization of pain and other non-motor symptoms in patients with PAs has not been provided yet. The aim of this study is to assess the phenomenology of pain and other non-motor symptoms in PD patients with Pisa syndrome and camptocormia compared to PD patients without axial postural abnormality. Forty-five PD participants were equally distributed in three groups: patients with Pisa syndrome (PS), patients with Camptocormia (CC), and patients without postural abnormalities (PD). Pain characteristics were assessed by Kings Parkinson's Pain Scale (KPPS), brief pain inventory (BPI), and numeric pain rating scale (NRS). All participants completed clinical assessments by non-motor symptom scale (NMSS), and movement disorder society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) parts II-III. Patients with and without axial postural abnormalities showed one or more types of pain, being fluctuation, nocturnal, chronic, and musculoskeletal the most frequently reported in Pisa Syndrome and camptocormia. PD group compared with PS and CC groups showed differences in the KPPS, NMSS, BPI pain severity and interference, and NRS total scores. No significant differences were found between PS group compared with CC group with exception of the NMSS total scores. PD patients with Pisa syndrome or camptocormia have a higher burden of musculoskeletal, chronic and fluctuation pain than PD patients without axial postural abnormalities, suggesting different etiologies of pain and possible different treatments.

Prevalence of axial postural abnormalities and their subtypes in Parkinson's disease: a systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Axial postural abnormalities, mainly involving the spinal deformities, are disabling symptoms of Parkinson's disease (PD). However, the prevalence of axial postural abnormalities in PD and their clinical correlates remain unclear. The present study aimed to conduct a systematic review and meta-analysis of the prevalence of overall and subtypes of axial postural abnormalities in PD. METHODS: PubMed, Embase, Web of Science and Cochrane databases were searched up to 31st March, 2022. We identified studies that reported the prevalence of axial postural abnormalities in PD. The pooled estimate of prevalence was calculated using a random effect model. Subgroup analysis and meta-regression were performed. RESULTS: There were 19 studies met the inclusion criteria. The overall prevalence of axial postural abnormalities in PD was 22.1% (95% CI 19.7-24.5%). The prevalence of each subtype of axial postural abnormalities was 19.6% for scoliosis (95% CI 10.6-28.7%), 10.2% for camptocormia (95% CI 7.7-12.7%), 8% for Pisa syndrome (95% CI 4.7-11.4%), and 7.9% for antecollis (95% CI 3.9-11.9%). Subgroup analysis showed that the measuring method of axial postural abnormalities exerted significant effects on prevalence estimates. Axial postural abnormalities in PD were associated with older age, longer disease duration, higher H-Y stage, greater levodopa equivalent daily dose, more severe motor symptoms, motor fluctuations, and akinetic-rigid subtype. CONCLUSIONS: Axial postural abnormalities, which include scoliosis, camptocormia, Pisa syndrome, and antecollis, are not uncommon in patients with PD. Future research on axial postural abnormalities should be based on uniform diagnostic criteria and measuring methods.

Genetic animal modeling for idiopathic scoliosis research: history and considerations.

PURPOSE: Idiopathic scoliosis (IS) is defined as a structural lateral spinal curvature ≥ 10° in otherwise healthy children and is the most common pediatric spinal deformity. IS is known to have a strong genetic component; however, the underlying etiology is still largely unknown. Animal models have been used historically to both understand and develop treatments for human disease, including within the context of IS. This intended audience for this review is clinicians in the fields of musculoskeletal surgery and research. METHODS: In this review article, we synthesize current literature of genetic animal models of IS and introduce considerations for researchers. RESULTS: Due to complex genetic and unique biomechanical factors (i.e., bipedalism) hypothesized to contribute to IS in humans, scoliosis is a difficult condition to replicate in model organisms. CONCLUSION: We advocate careful selection of animal models based on the scientific question and introduce gaps and limitations in the current literature. We advocate future research efforts to include animal models with multiple characterized genetic or environmental perturbations to reflect current understanding of the human condition.

Spinal Curvatures, Deformities, and the Level of Disability in People with Bilateral Spastic Cerebral Palsy Living in South Africa; A 6-Year Follow-Up Study During Adulthood.

OBJECTIVE: Determine if spinal curvatures, deformities, as well as level of disability (due to back pain) changes with aging in adults with bilateral spastic cerebral palsy after receiving orthopedic interval surgery approach treatment in childhood. DESIGN: Consecutive case-series SETTING: Urban South Africa PARTICIPANTS: Twenty-seven ambulatory adults with cerebral palsy MAIN OUTCOME MEASURES: Spinal curvatures (scoliosis, thoracic kyphosis and lumbar lordosis) and deformities (spondylolysis and spondylolisthesis) were determined with X-rays, while the level of disability was assessed with the Oswestry Disability Index. RESULTS: The prevalence of spinal abnormalities were: 30% scoliosis (mild: <30°), 0% thoracic hyperkyphosis, 15% lumbar hyperlordosis, 0%; spondylolysis, and 0% spondylolisthesis. No changes in scoliosis and lumbar lordosis angles were observed, while the change in thoracic kyphosis angle was smaller than the minimal clinically important difference and moved closer toward the norm-values for typically developing adults. Level of disability remained similar with 63% reporting minimal disability, 26% moderate disability and 11% severe disability. No associations with spinal curvatures were found. CONCLUSIONS: No clinically meaningful changes in spinal curvatures, deformities and level of disability due to pain were seen during the 6 years follow-up period in adults with cerebral palsy who have been treated with interval surgery approach in childhood.

Abdominal changes in patients with degenerative spinal deformity: A comparative study.

ABSTRACT: The incidence of degenerative spinal deformity (DSD) is increasing with the age while the effect of DSD on the abdominal cavity parameters is unclear.To identify the characteristics of abdominal change in DSD and to explore the correlation between the abdominal cavity volume (ACV) and various types of DSD.The retrospective study included 95 patients with DSD and 100 subjects without deformity as control group. The Cobb angle, thoracic kyphosis angle, thoracolumbar kyphosis (TLK) angle, and lumbar kyphosis angle were obtained through full-length X-ray. The ACV was calculated by measuring the longitudinal, transversal, and coronal diameters of the abdominal cavity on magnetic resonance imaging (MRI). The rotation of the diaphragm (DR) were measured in the sagittal plane. DSD ones were divided into degenerative lumbar scoliosis (DLS group), degenerative kyphosis (DK group), and degenerative lumbar scoliokyphosis (DKS group).Compared to control group, ACV of the DLS and DKS group was smaller. The distance between the xiphoid process and spine in DLS group was shorter and DR in DK group and DKS group was smaller. The inter-group analysis showed ACV and the shortest distance between xiphoid process and spine in DLS and DKS group were significantly lower than those in DK group. The degree of DR in DK group and DKS group was higher than that in the DLS group. Multiple linear regression analysis showed Cobb angle and weight were influencing factors of ACV with ACV = 0.67 × weight - 0.19 × Cobb angle + 2231.8. The DR was affected by TLK with DR = 25.82 - 0.42 × TLK.DLS can cause the decrease of ACV. DK will not cause changes of ACV but is related to the degree of kyphosis. DKS will impact both ACV and DR.

Impact of COVID-19 on the pain and disability of patients with adult spinal deformity.

PURPOSE: To evaluate the pain and functional effect of the COVID-19 pandemic on patients with ASD reflected by their response to SRS-22, ODI, and SF-36 questionnaires. METHODS: Patients who had stable pain and functional outcome scores over the preceding 2 years were enrolled in a local prospectively collected adult spinal deformity (ASD) database. A reanalysis of their SRS22, ODI and SF-36 data 14 days into confinement were compared to their last pre-confinement scores. RESULTS: 89 patients were included in this study (average age 60.7 years, 91% female) with an average time from last FU until confinement of 9.6 months. The ODI total score worsened by 5 points post-confinement with no difference seen in personal care, walking and social life. In contrast, the SRS-22 score showed small improvements in function/activity and satisfaction, but no significant differences for the other domains. Similarly, the SF-36 showed small improvements in physical function, physical and emotional role, vitality and PCS. CONCLUSION: The global COVID-19 pandemic and ensuing confinement had variable overall effects on ASD patients, without the expected marked worsening. In addition, this study illustrates that the SRS-22 questionnaire is less influenced by environmental and psychological factors than the ODI supporting its objectivity and accuracy in the evaluation of the QoL of ASD patients.

Postural Stability and Dynamic Balance in Adult Spinal Deformity: Prospective Pilot Study.

OBJECTIVE: We sought to evaluate dynamic balance and postural stability in patients with adult spinal deformity (ASD) compared with published age-matched normative data. METHODS: Eleven patients with ASD were prospectively enrolled. Postural stability was tested using static and dynamic posturography; patients stood on a movable platform with an integrated force plate and performed standardized sensory organization testing (SOT), evaluating the influence of sensory processing on postural stability under 6 conditions, and motor control testing, assessing reflexive postural reactions to an external perturbation. Patient performance was compared with that of published age-matched controls. Quality of life metrics included scores on the Scoliosis Research Society-22 questionnaire, SF-36, and Morse Fall Scale. Correlations between postural stability and radiographic measurements were performed. RESULTS: ASD patients demonstrated significantly lower SOT scores (P ≤ 0.03) in 5 of 6 conditions tested and greater latency of limb movement during backward translation (P = 0.04) compared with controls. Lower SOT scores were associated with a history of falls. ASD patients who self-reported falling in the previous 6 months, when compared with nonfallers, demonstrated significantly lower SOT scores (P = 0.04) and significantly lower Scoliosis Research Society-22 self-image subscores (P = 0.003). Thoracic kyphosis and mediolateral sway (predictor of falls) were positively correlated in the eyes-open and eyes-closed conditions (P ≤ 0.04). CONCLUSIONS: ASD patients demonstrated impaired postural stability, diminished sensory integration, and delayed response to external perturbations compared with normal control data. Postural stability and quality of life metrics correlated with self-reported falls. These findings suggest that ASD patients have abnormal postural stability and may be at elevated risk of falls.

Sleep Disturbance and Its Clinical Implication in Patients with Adult Spinal Deformity: Comparison with Lumbar Spinal Stenosis.

Purpose: The purpose of this study was to investigate the prevalence of sleep disturbance and its clinical implication in patients with ASD. Methods: A total of 44 patients with ASD and 137 patients with lumbar spinal stenosis (LSS) were enrolled in the study. Forty four patients were selected from the LSS group after propensity score matching. Global Pittsburgh Sleep Quality Index (PSQI) score, demographic data, visual analog scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and EuroQol 5-dimension questionnaire (EQ-5D) were compared between both groups. Multiple regression analysis was performed with VAS for back pain as the dependent variable and age, sex, PSQI, and VAS for leg pain as the independent variables in the ASD group. Results: 33 (75.0%) and 32 (72.7%) patients were classified as poor sleepers in the ASD group and the LSS group, respectively. In the ASD group, the VAS score for back pain was 7.7 ± 1.7 in the poor sleeper group and 5.6 ± 2.2 in the nonpoor sleeper group. In the LSS group, poor sleep quality was associated with the ODI score, ODI score without a sleep component, and EQ-5D. The regression model for predicting VAS for back pain in the ASD group suggested that poor sleep quality and increased leg pain were associated with increased back pain. Conclusions: Because sleep quality is a critical factor in augmenting back pain in patients with ASD, this study underlines the need to investigate sleep quality during the routine examination of patients with ASD.

Collapse of VBX Balloon-Expandable Endoprosthesis in Bilateral Common Iliac Arteries in a Lean, Elderly Patient with Bent Back.

An 87-year-old woman who had previously received bare nitinol self-expandable stent implantation twice into the bilateral common iliac artery (CIA) due to repeated in-stent restenosis presented with acute onset of intermittent claudication. Computed tomography (CT) showed bilateral CIA obstruction with thrombus. Because thrombectomy and ballooning did not achieve recanalization, kissing VBX balloon-expandable endoprostheses were deployed in both CIAs, which resolved the patient's symptoms. However, the symptoms recurred 9 days later, and CT revealed collapsed VBX stent grafts surrounded by blood thrombus. X-rays showed spinal compression of the VBX stent while standing, which might have caused the collapse. We report a case of the collapse of a VBX balloon-expandable endoprosthesis in the bilateral CIAs of an elderly patient with a bent back. Physicians should consider that a bent back could be the cause of VBX collapse even in the CIA when elderly persons present with this deformity.

Uncertainty in the Relationship Between Sagittal Alignment and Patient-Reported Outcomes.

BACKGROUND: Previous studies have reported correlations and precise quantitative relationships between sagittal alignment and health-related quality-of-life (HRQOL) scores. These studies have not reported the extent of uncertainty in these relationships. OBJECTIVE: To explore the uncertainty in the overall relationships between sagittal alignment and HRQOL and in the predictions of individual patient pain and disability. METHODS: A retrospective analysis of all new adult patients with long-cassette radiographs and complete outcomes questionnaires presenting to the senior author from 2012 to 2014 was performed. Univariable maximum a posteriori linear regression analyses using Bayesian methods were performed. High-density probability intervals for mean regression relationships and for individual values were calculated using minimally informative prior distributions. RESULTS: A total of 134 patients satisfied inclusion criteria and were included. For Oswestry Disability Index (ODI) vs pelvic incidence-lumbar lordosis (LL), the 90% high-density probability interval ranged from -0.04 to 0.23, indicating that both the magnitude and direction of the relationship were uncertain. For both ODI vs sagittal vertical axis and ODI vs LL, there was uncertainty in the magnitude of the slope. Wide regions of uncertainty were also seen for predicting individual patient scores. CONCLUSION: We report the previously unpublished degree of uncertainty in the mean quantitative relationships between radiographic sagittal alignment and patient-reported outcomes and in individual patient outcomes scores. Based on these results, establishing treatment thresholds or predicting an individual's outcome is unreliable. Further research efforts should be focused on developing multilevel hierarchical models incorporating parameter uncertainty and heterogeneous effects.

Automated and objective measures of gait dynamics in camptocormia Parkinson's Disease subthalamic deep brain stimulation.

OBJECTIVE: Axial motor features are common in Parkinson's disease (PD). These include gait impairment and postural abnormalities, such as camptocormia. The response of these symptoms to deep brain stimulation (DBS) is variable and difficult to assess objectively. For the first time, this study analyzes the treatment outcomes of two PD patients with camptocormia that underwent bilateral subthalamic nucleus (STN)-DBS evaluated with disruptive technologies. PATIENTS AND METHODS: Two patients with PD and camptocormia who underwent STN-DBS were included. Gait parameters were quantitatively assessed before and after surgery by using the NeuroKinect system and the camptocormia angle was measured using the camptoapp. RESULTS: After surgery, patient 1 improved 29 points in the UPDRS-III. His camptocormia angle was 68° before and 38° after surgery. Arm and knee angular amplitudes (117.32 ±â€¯7.47 vs 134.77 ±â€¯2.70°; 144.51 ±â€¯7.47 vs 169.08 ±â€¯3.27°) and arm swing (3.59 ±â€¯2.66 vs 5.40 ±â€¯1.76 cm) improved when compared with his preoperative measurements. Patient 2 improved 22 points in the UPDRS-III after surgery. Her camptocormia mostly resolved (47° before to 9° after surgery). Gait analysis revealed improvement of stride length (0.29 ±â€¯0.03 vs 0.35 ±â€¯0.03 m), stride width (18.25 ±â€¯1.16 vs 17.9 ±â€¯0.84 cm), step velocity (0.91 ±â€¯0.57 vs 1.33 ±â€¯0.48 m/s), arm swing (4.51 ±â€¯1.01 vs 7.38 ±â€¯2.71 cm) and arm and hip angular amplitudes (131.57 ±â€¯2.45° vs 137.75 ±â€¯3.18; 100.51 ±â€¯1.56 vs 102.18 ±â€¯1.77°) compared with her preoperative results. CONCLUSION: The gait parameters and camptocormia of both patients objectively improved after surgery, as assessed by the two quantitative measurement systems. STN-DBS might have a beneficial effect on controlling axial posturing and gait, being a potential surgical treatment for camptocormia in patients with PD. However, further studies are needed to derive adequate selection criteria for this patient population.

Spinal alignment, surgery, and outcomes in cervical deformity: A practical guide to aid the spine surgeon.

Compared to the thoracolumbar spine, the literature on cervical spine alignment is scarce. While a consistent number of articles have been published, few analyze the ideal surgical approaches for each type of deformity and the optimal amount of correction to achieve. This paper provides a comprehensive review of current literature on cervical spinal deformities (with or without myelopathy) and their surgical management; it is our goal to create a framework on which surgical planning can be made. A general assessment of the actually utilized parameters and correlation between the cervical and thoracolumbar spine alignment is presented. Moreover, we provide an analysis of cervical surgical approaches (anterior, posterior, or combined), techniques (laminoplasty, laminectomy and fusion, anterior cervical discectomy and fusion, corpectomy), and their indications. Finally, a complete evaluation of outcomes and postoperative health-related quality of life (HRQOL) measures based on questionnaires (NDI, VAS, SF-36, mJOA) is discussed. Several prospective studies would be useful in understanding how cervical alignment may be important in the assessment and treatment of cervical deformities with or without myelopathy. In particular, future works should concentrate on the correlation between cervical alignment parameters, disability scores, and myelopathy outcomes. We propose, via comprehensive literature review, a guide of practical key points on surgical techniques, cervical alignment, and symptom improvement goals surgeons should aim to achieve for each patient.

Trends in spinal deformity surgery in Marfan syndrome.

STUDY DESIGN: Analysis of a national database. OBJECTIVE: To analyze trends in fusion surgery for spinal deformity in Marfan syndrome (MFS) patients, compare patients with and without Marfan, and evaluate differences in surgical approaches. SUMMARY OF BACKGROUND DATA: National trends of fusion surgery for spinal deformities in MFS patients are not known. Given the rarity of MFS and the nuanced differences in the spinal deformity it causes, it is important to explore differences in fusion surgery between spinal deformity patients with and without MFS. METHODS: We identified 314 patients (1,410 weighted) with a diagnosis of MFS and spinal deformity who underwent spinal fusion between the years 2003 and 2014. Our primary outcome was national trends in the use of posterior (PSF), anterior-posterior (APSF), and anterior (ASF) spinal fusions. We also compared perioperative complications, mortality rate, length of stay, and hospital charges in a propensity score matched sample of spinal fusion patients with and without a diagnosis of MFS. RESULTS: The proportion of PSF surgeries increased significantly (p<.01) from 66.7% in 2003 to 92.0% in 2014. MFS patients were more likely to have higher neurologic (2.4% vs. 0.79%, p=.01) complications. There was a significant association between age and approach (p<.01). PSF had a mean age of 20.2, whereas APSF and ASF had mean ages of 27.1 and 35.2, respectively. Approximately 62% of cervical fusions used ASF. CONCLUSIONS: Our study provides findings from the largest sample analyzed to date and is the only thus far that investigates national trends. Our results are largely consistent with those of other works in that MFS patients undergoing spinal fusion surgery have higher neurologic complications. We also report that surgical treatment has shifted toward a posterior approach. Our findings can give surgeons a better understanding of the postoperative complications and changing national trends in spinal fusion surgery for patients with MFS.

Prospective Observational Cohort Study of Health-related Quality of Life: Marked Adult Sagittal Deformity (ASD) in Comparison With Mild to Moderate ASD.

STUDY DESIGN: Retrospective analysis of prospective observational cohort OBJECTIVE.: This study assessed the difference in health-related quality of life (HRQOL) between participants with a mild to moderate adult sagittal deformity (ASD) (sagittal vertical axis [SVA] ≤9.5 cm) and those with a marked deformity (SVA >9.5 cm). We also evaluated predisposing factors for a marked deformity. SUMMARY OF BACKGROUND DATA: Sagittal imbalance is closely associated with HRQOL for the patient. However, how the effect changes depending on the degree of imbalance has not been fully evaluated. The understanding of the predisposing factor associated with marked deformity also lacks. METHODS: A total of 124 elderly persons with a stooping posture were enrolled. Questionnaires related to HRQOL were administered. Sagittal alignment parameters and pelvic parameters were measured with a whole spine x-ray. Lumbar spine magnetic resonance imaging was used to assess the presence of pathologic conditions, muscle quality and quantity. Multivariate logistic regression analysis was conducted to analyze potential risk factors. RESULTS: Marked ASD was associated with female sex, lower height and weight, and osteoporosis (P < 0.05). Back pain (assessed by a visual analogue scale) and the Oswestry Disability Index were significantly higher in the marked deformity group (P = 0.012, 0.002, respectively). Multivariate logistic regression analysis showed significant relationships between the following parameters and marked deformity: preexisting compression fracture (odds ratio [OR] = 7.793; 95% confidence interval [CI], 1.527-39.768), severe L5/S1 Pfirrmann disc degeneration grade (OR = 1.916; 95% CI, 1.086-3.382), and lower quantities of multifidus and psoas muscles (OR = 0.994, 0.997; 95% CI, 0.991-0.998, 0.994-0.999, respectively). CONCLUSION: Participants with a marked ASD showed different features from those with a mild to moderate ASD. This study also implies that anatomical factors, including the vertebrae, intervertebral discs, and paraspinal muscles, synergistically contribute to progression into marked deformity. LEVEL OF EVIDENCE: 3.

The Effects of Liver Disease on Surgical Outcomes Following Adult Spinal Deformity Surgery.

BACKGROUND: As the prevalence of chronic liver disease continues to rise in the United States, understanding the effects of liver dysfunction on surgical outcomes has become increasingly important. The objective of this study was to assess the effects of chronic liver disease on 30-day complications following adult spinal deformity (ASD) surgery. METHODS: We performed a retrospective cohort study of 2337 patients in the 2008-2015 American College of Surgeons National Surgical Quality Improvement Program database who underwent corrective ASD surgery. Patients with liver disease were identified based on a Model for End-Stage Liver Disease-Na score ≥10. A univariate analysis was performed to compare 30-day postoperative complications between patients with and without liver disease. A multivariate regression analysis adjusting for differences in baseline patient characteristics was performed to identify complications that were associated with liver disease. RESULTS: Patients with liver disease had a significantly greater incidence of postoperative pulmonary complications (6.3% vs. 2.9%; P < 0.001), blood transfusion (34.6% vs. 24.0%; P < 0.001), sepsis (2.2% vs. 0.9%; P = 0.011), prolonged hospitalization (19.0% vs. 8.0%; P < 0.001), as well as any 30-day complication (45.4% vs. 29.4%; P < 0.001). The multivariate regression analysis identified liver disease as a risk factor for prolonged hospitalization (odds ratio [OR] 2.16; 95% confidence interval [CI] 1.64-2.84; P < 0.001), pulmonary complications (OR 1.78; 95% CI 1.16-2.74; P = 0.009), blood transfusion (OR 1.67; 95% CI 1.36-2.05; P < 0.001), and any 30-day complication (OR 1.43; 95% CI 1.15-1.77; P = 0.001). CONCLUSIONS: The multisystem pathophysiology of liver dysfunction predisposes patients to postoperative complications following ASD surgery. A multidisciplinary approach in surgical planning and preoperative optimization is needed to minimize liver disease-related complications and improve patient outcomes.

Severidade da disfunção temporomandibular e sua relação com a postura corporal / Gravedad de la disfunción temporomandibular y su relación con la postura corporal / Severity of temporomandibular dysfunction and its relationship with body posture

RESUMO O objetivo deste estudo foi identificar se existe correlação entre a severidade da disfunção temporomandibular (DTM) e postura corporal, bem como evidenciar as diferenças existentes na postura corporal nos diferentes graus de severidade. Foram avaliadas 71 mulheres de 18 a 35 anos quanto à severidade da DTM e à postura corporal, sendo divididas em grupo sem DTM e grupo com DTM. Foram utilizados o questionário Mandibular Function Impairment Questionnaire e o software Digital Image-Based Postural Assessment de avaliação postural por fotogrametria. Foi realizada análise estatística com ANOVA de um fator e teste de correlação Tau B de Kendall (α<0,05). Os grupos com e sem DTM apresentaram diferenças estatísticas, com tamanho de efeito grande (ŋ2>0,528), para: lordose cervical, pulsão e inclinação da pelve. Quanto à correlação da postura com a severidade da DTM, índices fracos, mas significativos, foram encontrados: ângulo da lordose cervical (τ=0,250), ângulo da cifose dorsal (τ=0,192), ângulo de inclinação pélvica (τ=−0,222) e medida de pulsão da pelve (τ=0,283). Esses resultados indicam que a lordose cervical e a pulsão da pelve se apresentam em aumento da lordose e da pulsão conforme o acréscimo da severidade da DTM, enquanto o ângulo de inclinação se apresenta em menor grau, tendendo à retroversão. Apesar das correlações fracas, os resultados evidenciam alguma relação da postura corporal com a DTM.

RESUMEN El objetivo de este estudio fue identificar si existe una correlación entre la gravedad de la disfunción temporomandibular (DTM) y la postura corporal, así como mostrar las diferencias en la postura corporal en diferentes grados de gravedad. Se evaluó la la postura corporal de 71 mujeres de 18 a 35 años, divididas en dos grupos: sin DTM y con DTM. Se utilizó el cuestionario Mandibular Function Impairment Questionnaire y el software Digital Image-Based Postural Assessment de evaluación postural por fotogrametría. Se realizó análisis estadístico con Anova de un factor y prueba de correlación Tau B de Kendall (α<0,05). Los grupos con y sin DTM presentaron diferencias estadísticas, con tamaño de efecto grande (ŋ2>0,528) para: lordosis cervical, pulsión e inclinación de la pelvis. En cuanto a la correlación de la postura con la gravedad de la DTM, índices débiles pero significativos fueron encontrados: ángulo de la lordosis cervical (τ=0,250), ángulo de la cifosis dorsal (τ=0,192), ángulo de inclinación pélvica (τ=−0,222) y medida de pulsión de la pelvis (τ=0,283). Estos resultados indican que la lordosis cervical y la pulsión de la pelvis aumentan según la gravedad de la DTM, mientras que el ángulo de inclinación se presenta en menor grado, tendiendo a la retroversión. A pesar de las correlaciones débiles, los resultados evidencian cierta relación de la postura corporal con la DTM.

ABSTRACT This study aimed to identify if there is a correlation between temporomandibular dysfunction (TMD) severity and body posture, as well as to show the differences in body posture in different degrees of severity. Seventy-one women aged 18-35 years were assessed for TMD severity and body posture and were divided into: Group without TMD and Group with TMD. We used the Mandibular Function Impairment Questionnaire and the Digital Image-Based Postural Assessment software for postural evaluation by photogrammetry. Statistical analysis was performed with one-way ANOVA and Kendall's Tau B correlation test (α<0.05). The groups with and without TMD presented statistical differences, with large effect size (ŋ2>0.528), for: cervical lordosis, drive and pelvic tilt. Regarding the correlation of posture with TMD severity, weak but significant indexes were found: cervical lordosis angle (τ=0.250), dorsal kyphosis angle (τ=0.192), pelvic tilt angle (τ=−0.222) and pelvic drive measurement (τ=0.283). These results indicate that cervical lordosis and pelvic drive are increased according to the severity of the TMD, while the pelvic tilt angle decreases, tending to a retroversion. Despite the weak correlations, the results show some relationship between body posture and TMD.