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. 2023 Jun 5;12(11):3854.
doi: 10.3390/jcm12113854.

Sagittal Spinal Alignment in People with Chronic Spinal Cord Injury and Normal Individual: A Comparison Study Using 3D Ultrasound Imaging

Niraj Singh Tharu  1 , Timothy Tin-Yan Lee  1   2 , Kelly Ka-Lee Lai  1 , Ting-Er Lau  1 , Chui-Yi Chan  1 , Yong-Ping Zheng  1   2
Affiliations

Sagittal Spinal Alignment in People with Chronic Spinal Cord Injury and Normal Individual: A Comparison Study Using 3D Ultrasound Imaging

Niraj Singh Tharu et al. J Clin Med. .

Abstract

The aim of this study was to compare the sagittal spinal alignment of people with chronic spinal cord injury (SCI) with normal individuals and to determine whether transcutaneous electrical spinal cord stimulation (TSCS) could cause a change in the thoracic kyphosis (TK) and lumbar lordosis (LL) to re-establish normal sagittal spinal alignment. A case series study was conducted, wherein twelve individuals with SCI and ten neurologically intact subjects were scanned using 3D ultrasonography. In addition, three people with SCI having complete tetraplegia participated further to receive a 12-week treatment (TSCS with task-specific rehabilitation) after evaluation of sagittal spinal profile. Pre- and post-assessments were conducted to evaluate the differences in sagittal spinal alignment. The results showed that the TK and LL values for a person with SCI in a dependent seated posture were greater than those of normal subjects for: standing (by TK: 6.8° ± 1.6°; LL: 21.2° ± 1.9°), sitting straight (by TK: 10.0° ± 4.0°; LL: 1.7° ± 2.6°), and relaxed sitting (by TK: 3.9° ± 0.3°; LL: 7.7° ± 1.4°), respectively, indicating an increased risk for spinal deformity. In addition, TK decreased by 10.3° ± 2.3° after the TSCS treatment, showing a reversible change. These results suggest that the TSCS treatment could be used to restore normal sagittal spinal alignment for individuals with chronic SCI.

Keywords: lumbar lordosis; rehabilitation; sagittal spinal alignment; spinal cord injury; thoracic kyphosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The 3D ultrasound scanning experimental setup and scanning procedure for an individual with SCI in dependent seated position, with both feet placed on the floor, and upper limbs supported over the thighs while maintaining the best upright erect posture.
Figure 2
Figure 2
(a) Ultrasound sagittal images of the spine; (b) Locations of the laminae (red dots) were identified and the corresponding coordinates were extracted for computation of the sagittal curvatures (T12 level is indicated by the white dotted line); (c) Thoracic kyphosis was defined as the angle formed between the line T4 and T5 coordinates and the line joining T11 and T12 laminae (yellow); in contrast, lumbar lordosis was defined as the angle formed between the line L1 and L2 coordinates and the line joining L4 and L5 laminae (light blue).
Figure 3
Figure 3
The schematic representation of the sagittal spinal alignment, particularly showing sagittal thoracic curvature and sagittal lumbar curvature of both SCI and non-SCI groups.
Figure 4
Figure 4
The comparison of the mean sagittal thoracic kyphosis and lumbar lordosis between individuals with SCI and non-SCI subjects (* p < 0.05, *** p < 0.001, **** p < 0.0001).
Figure 5
Figure 5
The sagittal profile of the spine based on the coordinates obtained from the sagittal ultrasound images using the laminae landmarks. Red dots indicate the levels of detected vertebral bodies in ultrasound images.
See this image and copyright information in PMC

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