Annals of Rehabilitation Medicine

Dynamic Changes of Pelvis and Lower Extremities after Operation in Lumbar Degenerative Kyphosis.: Lee, Su Seop , Yoo, Jong Yoon , Rhim, Seung Chul , Lee, Jung Woo , Byun, Jae Hyun; J Korean Acad Rehabil Med 2006;30(1):57-61.

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Objective
Gait pattern in patients with lumbar degenerative kyphosis (LDK) is disturbed because trunk bends forward due to decreased lumbar lordosis. Surgical therapy in LDK is required when conservative management fails. We investigated kinematic and kinetic changes of the pelvis, hip, and knee joints on the sagittal plane in patients with LDK before and after operation. Method: Fifteen patients underwent operations between March 1999 and September 2003. Gait analysis was performed for all patients. Results: Total lumbar lordotic angle increased from 10.50^o⁑11.22^o to 26.71^o⁑8.80^o postoperation. In gait analysis, anterior pelvic tilting angle increased from maximum 7.86^o⁑9.69^o, minimum 4.40^o⁑9.82^o to maximum 12.61^o⁑5.36^o, minimum 9.68^o⁑5.63^o (p＜0.05). Maximum hip flexion angle changed from 31.39^o⁑11.71^o to 35.83^o⁑5.84^o (p＜0.05). Maximum knee flexion angle in terminal stance phase decreased from 13.32^o⁑7.34^o to 8.30^o⁑6.38^o (p＜0.05). Conclusion: After corrective operation, an increase of lumbar spine lordosis and anterior pelvic tilt with decrease of knee flexion were observed. However, an increase of maximum hip flexion secondary to increased anterior pelvic tilting influenced ambulation negatively. Therefore, stretching of the hip flexor and strengthening of the hip extensor are required before and after operation. (J Korean Acad Rehab Med 2006; 30: 57-61)

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The Relationship between Lumbar Shape and Lumbar Disc Herniation.: Kim, Ho Seong , Jang, Sung Ho , Lee, Kyung Hoon , Lee, Sung Yong , Lee, Yang Gyun; J Korean Acad Rehabil Med 2005;29(6):619-623.

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Objective
We designed this study to investigate the relationship among lumbar disc herniation, vertebral endplate area and shape, and lumbar and sacral parameters. Method: 78 experimental patients with low back pain and 27 controls were enrolled. Experimental patients were divided into group A with low back pain without trauma and lumbar disc herniation and group B with low back pain due to lumbar disc herniation without trauma. Controls had low back pain due to recent trauma but no previous history of back pain and lumbar disc herniation. We reviewed MRI (magnetic resonance image) films of these patients with anteroposterior and transverse diameter of endplates, lumbarlordosis angle, and sacral angle. The relationship of these data and sex, age, body weight, height, intervertebral disc herniation, low back pain were statistically studied. Results: Patients' sex, age, body weight, height, vertebral endplate area and shape, lumbar and sacral parameters were not related to disc herniation. But the more circular vertebral shape was, the larger lumbar lordosis angle was. And the larger lumbar lordosis angle was, the less sacral angle was. Conclusion: There were no relationships between the development of disc herniation at L4-5, L5-S1 and the shape of the vertebral body at the endplate level. (J Korean Acad Rehab Med 2005; 29: 619-623)

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Comparison of Lumbar Lordosis according to Heel Height in Normal Adults and Patients with Spondylolisthesis.: Lee, Kyu Hoon , Kim, Yong Geol , Hwang, Chi Moon , Kim, Sung Soo , Choi, Hyun Jin , Kim, Hee Sang , Ahn, Kyung Hoi; J Korean Acad Rehabil Med 2000;24(6):1186-1190.

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Objective: To evaluate how to influence static lumbar lordosis by different heel heights in normal adults and patients with spondylolisthesis.

Method: The lumbolumbar angles, lumbosacral angles and slip angles were examined while standing on barefoot, on heel support with 5 cm heel, and with 10 cm heel in 14 normal adults and 10 patients with first grade of spondylolisthesis. Standing lumbar spine lateral view was performed by one half hour adaptation with corresponding shoe types.

Result: The lumbolumbar angles (angles between upper margin of 2nd lumbar body and low margin of 5th lumbar body) and the lumbosacral angles (between upper margin of 2nd lumbar body and low margin of 1st sacral body) in normal are 36.8⁑6.5^o, 50.1⁑9.5^oon barefoot, 36.0⁑7.3^o, 49.6⁑7.4^oon heel support with 5 cm heel, and 36.1⁑7.6^o, 49.7⁑8.3^owith 10 cm heel. Lumbolumbar angles and lumbosacral angles in 10 patients with spondylolisthesis 38.8⁑8.3°on barefoot, 47.2⁑10.4^oon heel support with 5 cm heel, 38.3⁑7.0^o, 47.7⁑9.2^owith 10 cm heel. The slip angles in 10 patients with spondylolisthesis are 29.8⁑1.2^oon barefoot, 30.2⁑1.8^oon heel support with 5 cm heel, and with 10 cm heel.

Conclusion: The changes of heel height did not significantly influence the lumbar lordosis in normal adults and patients with spondylolisthesis. There were no significant differences in average slip angle according to heel height in patients with spondylolisthesis were found.

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Comparison of Gait Analysis Using High-heeled Shoes and High-forefoot Shoes.: Song, Sun Hong , Yoo, Jong Yun , Ha, Sang Bae; J Korean Acad Rehabil Med 1997;21(5):1003-1009.

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Previous studies proved that, the high-heeled shoes caused postural changes, a loss of foot function, and deformities of foot. However the lumbar lordosis in gait is rarely measured. The purposes of this study were to compare kinematics and kinetics between high-heeled and high-forefoot gait by skin markers, and to find the influence of heel height to lumbar vertebral alignment. We used the Vicon 370 three-dimension Gait Analysis System.

In the present study, the lower extremity biomechanics in high-heeled and high-forefoot shoes were examined in 20 Korean female subjects. Results showed that the double support phase increased in high-forefoot gait in linear parameters. In sagittal plane kinematics, the lumbar lordosis slightly increased in high-forefoot gait, but that did not increase in high-heeled gait. The knee flexion and ankle plantarflexion increased in high-heeled gait, but ankle pantar flexion reduced in high-forefoot gait. Clinically the change of ankle motion was not significantly influenced to the lumbar lordosis. However, high-heeled shoe users with low back pain are probably influenced by the overstress of paraspinal muscles and vertebral ligments. Further studies are required for more precise analysis of high-heeled and high-forefoot gaits.

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Lumbar Lordosis in Low Back Pain Patients.: Joo, Byung Gyu , Chun, Min Ho , Ha, Sang Bae; J Korean Acad Rehabil Med 1997;21(2):368-375.

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The purposes of this study were to identify lumbar lordosis in low back pain patients and to investigate differences in lumbar lordosis in low back pain patients according to etiologies.

On the basis of the findings of spinal roentgenogram, MRI, and SPECT imagies, the patients were divided into four groups; 1) facet syndrome with facet joint inflammation or degenerative change, 2) disc herniation including disc bulging or extrusion, 3) combined low back pain accompaning facet joint lesion with disc herniation, 4) simple low back pain with no abnormal imaging findings.

There were statistically significant decrease in low back pain patients compared with normal controls in terms of lumbosacral curvature. No sex and age differences were observed within low back pain patients and normal controls in terms of lumbosacral curvature. The review disclosed a significant decrease of the lumbosacral angle in order of simple low back pain, disc herniation, combined low back pain compared with normal controls. But facet syndrome patients showed no change of lumbosacral angle. Patients with disc bulging showed no significant decrease of lumbosacral angle compared with normal controls but patients with disc extrusion showed significant decrease.

It is believed that the decrease of lumbosacral angle in low back patients results from a pathokinesiological effort to keep facet joint from pressure stemed from facet overlying and to minimize the shearing force over lumbosacral joint. The facet joint stiffness due to inflammation may play a major role in no change of lumbosacral angle in facet syndrome patients. In conclusion, different causes of low back pain should be taken into consideration for the assessment of lumbosacral angle.