Öz
Amaç
Bu çalışmanın amacı yetişkinlerde düşme riskinin öngörücüleri olarak psoas kas indeksi ve omurga sagital hizalanmasını değerlendirmektir.
Gereç ve Yöntem
Ocak ve Mayıs 2024 arasında fiziksel tıp ve rehabilitasyon polikliniğini ziyaret eden toplam 126 hasta çalışmaya dahil edildi. Ayakta lateral omurga radyografileri, lomber manyetik rezonans görüntüleme (MRG) ve lomber bilgisayarlı tomografi (BT) görüntüleri analiz edildi. Sagital dikey eksen, torasik kifoz, servikal ve lomber lordoz açıları, pelvik insidans, sakral eğim, lumbosakral açı ve pelvik eğim ölçüldü. Psoas kas indeksi lomber MRG ve BT görüntülerinden hesaplandı. Katılımcılar Tinetti düşme risk indeksine göre gruplandırıldı ve sagital hizalama ve psoas kas indeksindeki farklılıklar değerlendirildi.
Bulgular
Bu kesitsel tanımlayıcı çalışmada, düşme risk grupları arasında cinsiyet ve yaş açısından anlamlı farklılıklar bulundu. Orta risk grubunda daha fazla kadın, yüksek risk grubunda ise daha fazla erkek ve daha yaşlıydı. Sagital dikey eksen, sakral eğim ve pelvik eğim açısı düşme riski grupları arasında istatistiksel olarak anlamlı farklılıklar gösterdi. Pozitif sagital dikey eksen orta ve yüksek riskli gruplarda düşük riskli gruba göre daha yaygındı. Sakral eğim değerleri düşüktü ve pelvik eğim açısı yüksek riskli grupta düşük riskli gruba göre daha yüksekti. Psoas kası AP/ML değerleri L4-5 seviyesinde düşme riski ile pozitif korelasyon gösterdi. Düşme riski grupları ile L3-4 ve L2-3 seviyelerinde anterior kenar boşluğu ve merkez boşluğu değerleri arasında negatif korelasyon bulundu. Ek olarak, psoas kası pozisyonu L3-4 ve L2-3 seviyelerinde yüksek ve orta riskli gruplarda daha negatifti.
Sonuç
Psoas kası analizi ve omurga hizalamasındaki bu değişikliklerin yetişkin bireylerde düşme riski ile ilişkisinin belirlenmesi uygun rehabilitasyon stratejilerinin oluşturulmasını sağlayacaktır.
Anahtar Kelimeler: Anahtar kelimeler: Düşme riski, pelvik parametreler, psoas kas indeksi, omurga sagital hizalaması, spinopelvik sagital denge
Kaynakça
Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing. 2022;51:afac205.
Lavedán A, Viladrosa M, Jürschik P, Botigué T, Nuín C, Masot O, et al. Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both? PLoS One. 2018;13:e0194967.
González-Gálvez N, Gea-García GM, Marcos-Pardo PJ. Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis. PLoS One. 2019;14:e0216180.
Zemková E, Cepková A, Muyor JM. The association of reactive balance control and spinal curvature under lumbar muscle fatigue. PeerJ. 2021;9:e11969.
Edwards MH, Dennison EM, Aihie Sayer A, Fielding R, Cooper C. Osteoporosis and sarcopenia in older age. Bone. 2015;80:126-30.
Sepúlveda-Loyola W, Phu S, Bani Hassan E, Brennan-Olsen SL, Zanker J, Vogrin S, et al. The joint occurrence of osteoporosis and sarcopenia (osteosarcopenia): definitions and characteristics. J Am Med Dir Assoc. 2020;21:220-5.
Clynes MA, Edwards MH, Buehring B, Dennison EM, Binkley N, Cooper C. Definitions of sarcopenia: associations with previous falls and fracture in a population sample. Calcif Tissue Int. 2015;97:445-52.
Ito H, Toyone T, Nagai T, Ishikawa K, Kuroda T, Inagaki K. Relationship between muscle mass of the lower limbs and falls caused by spinal misalignment in women aged 70 years: a retrospective study. Clin Spine Surg. 2021;34:E19-25.
Miyagi M, Inoue G, Hori Y, Inage K, Murata K, Kawakubo A, et al. Decreased muscle mass and strength affected spinal sagittal malalignment. Eur Spine J. 2022;31:1431-7.
Ağırcan D. Tinetti Balance and Gait Assessment’ın (Tinetti Denge ve Yürüme Değerlendirmesi) Türkçeye uyarlanması, geçerlilik ve güvenilirliği: Pamukkale Üniversitesi Sağlık Bilimleri Enstitüsü; Denizli. 2009.
Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986;34:119-26.
Abelin-Genevois K. Sagittal balance of the spine. Orthop Traumatol Surg Res. 2021;107:102769.
Laouissat F, Sebaaly A, Gehrchen M, Roussouly P. Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J. 2018;27:2002-11.
Bahat G, Turkmen BO, Aliyev S, Catikkas NM, Bakir B, Karan MA. Cut-off values of skeletal muscle index and psoas muscle index at L3 vertebra level by computerized tomography to assess low muscle mass. Clin Nutr. 2021;40:4360-5.
Jang HD, Won SH, Kim DW, Kim EH, Lee JC, Choi SW, et al. Magnetic resonance imaging characteristics and age-related changes in the psoas muscle: analysis of 164 patients with back pain and balanced lumbar sagittal alignment. World Neurosurg. 2019;131:e88-e95.
Jin Y, Ma X, Yang Z, Zhang N. Low L3 skeletal muscle index associated with the clinicopathological characteristics and prognosis of ovarian cancer: a meta-analysis. J Cachexia Sarcopenia Muscle. 2023;14:697-705.
Ishikawa Y, Miyakoshi N, Hongo M, Kasukawa Y, Kudo D, Shimada Y. Relationships among spinal mobility and sagittal alignment of spine and lower extremity to quality of life and risk of falls. Gait Posture. 2017;53:98-103.
Stewart Williams J, Kowal P, Hestekin H, O’Driscoll T, Peltzer K, Yawson A, et al. Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-incomecountries: results from the WHO study on global AGEing and adult health (SAGE). BMC Med. 2015;13:147.
Fang X, Shi J, Song X, Mitnitski A, Tang Z, Wang C, et al. Frailty in relation to the risk of falls, fractures, and mortality in older Chinese adults: results from the beijing longitudinal study of aging. J Nutr Health Aging. 2012;16:903-7.
Kasukawa Y, Miyakoshi N, Hongo M, Ishikawa Y, Noguchi H, Kamo K, et al. Relationships between falls, spinal curvature, spinal mobility and back extensor strength in elderly people. J Bone Miner Metab. 2010;28:82-7.
Ishikawa Y, Miyakoshi N, Kasukawa Y, Hongo M, Shimada Y. Spinal sagittal contour affecting falls: cut-off value of the lumbar spine for falls. Gait Posture. 2013;38:260-3.
Kobayashi T, Takeda N, Atsuta Y, Matsuno T. Flattening of sagittal spinal curvature as a predictor of vertebral fracture. Osteoporos Int. 2008;19:65-9.
Imagama S, Ito Z, Wakao N, Seki T, Hirano K, Muramoto A, et al. Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle-aged and elderly males. Eur Spine J. 2013;22:1346-53.
Kim DH, Choi DH, Park JH, Lee JH, Choi YS. What is the effect of spino-pelvic sagittal parameters and back muscles on osteoporotic vertebral fracture? Asian Spine J. 2015;9:162-9.
Cao Z, Wang G, Hui W, Liu B, Liu Z, Sun J. Percutaneous kyphoplasty for osteoporotic vertebral compression fractures improves spino-pelvic alignment and global sagittal balance maximally in the thoracolumbar region. PLoS One. 2020;15:e0228341.
Pan T, Qian BP, Qiu Y. Comparison of sagittal spinopelvic alignment in patients with ankylosing spondylitis and thoracolumbar fracture. Medicine (Baltimore). 2016;95:e2585.
Barrey C, Roussouly P, Le Huec JC, D’Acunzi G, Perrin G. Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J. 2013;22(Suppl 6):S834-41.
Miyazaki J, Murata S, Horie J, Uematsu A, Hortobágyi T, Suzuki S. Lumbar lordosis angle (LLA) and leg strength predict walking ability in elderly males. Arch Gerontol Geriatr. 2013;56:141-7.
Ozer AF, Kaner T, Bozdogan C. Sagittal balance in the spine. Turk Neurosurg. 2014;24:13-9.
Buckland AJ, Ayres EW, Shimmin AJ, Bare JV, McMahon SJ, Vigdorchik JM. Prevalence of sagittal spinal deformity among patients undergoing total hip arthroplasty. J Arthroplasty. 2020;35:160-5.
Le Huec JC, Thompson W, Mohsinaly Y, Barrey C, Faundez A. Sagittal balance of the spine. Eur Spine J. 2019;28:1889-905.
Lamartina C, Berjano P. Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms. Eur Spine J. 2014;23:1177-89.
Bai H, Li Y, Liu C, Zhao Y, Zhao X, Lei W, et al. Surgical management of degenerative lumbar scoliosis associated with spinal stenosis: does the PI-LL matter? Spine (Phila Pa 1976). 2020;45:1047-54.
Luo PJ, Tang YC, Zhou TP, Guo HZ, Guo DQ, Mo GY, et al. Risk Factor Analysis of the Incidence of Subsequent Adjacent Vertebral Fracture After Lumbar Spinal Fusion Surgery with Instrumentation. World Neurosurg. 2020;135:e87-93.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on sarcopenia in older people. Age Ageing. 2010;39:412-23.
Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, et al. Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol (1985). 2004;97:2333-8.
Lawlor MA, Oliveto JM, Geske JA, Khandalavala BN. Computerized tomography derived psoas muscle indices in a healthy young population in the United States. J Frailty Sarcopenia Falls. 2022;7:38-46.
Bo J, Zhao X, Hua Z, Li J, Qi X, Shen Y. Impact of sarcopenia and sagittal parameters on the residual back pain after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fracture. J Orthop Surg Res. 2022;17:111.
Nagai T, Miyagami M, Okano I, Nakamura S, Okazaki Y, Sakamoto K, et al. Association of Spinal alignment and abdominal circumference with sarcopenia status and fall risk in patients with osteoporosis: a retrospective study. Nutrients. 2023;15:2571.
Kudo D, Miyakoshi N, Hongo M, Kasukawa Y, Ishikawa Y, Mizutani T, et al. Impact of appendicular and trunk skeletal muscle mass and back extensor strength on sagittal spinal alignment in Japanese women without vertebral fracture. Osteoporos Sarcopenia. 2021;7:36-41.
Miyakoshi N, Hongo M, Maekawa S, Ishikawa Y, Shimada Y, Okada K, et al. Factors related to spinal mobility in patients with postmenopausal osteoporosis. Osteoporos Int. 2005;16:1871-4.
Kim DH, Lee SY, Park SJ, Lee YS. Relationships between spinal sarcopenia and spinal sagittal balance in older women. Ann Geriatr Med Res. 2019;23:141-8.
Park JS, Park YS, Kim J, Hur J, Choe DH. Sarcopenia and fatty degeneration of paraspinal muscle associated with increased sagittal vertical axis in the elderly: a cross-sectional study in 71 female patients. Eur Spine J. 2020;29:1353-61.
Lee D, Kang M. Correlation between psoas muscle index and degeneration of spinal back muscle in patients with back pain. Healthcare (Basel). 2021;9:1189.
