Sagittal spinal alignment in paraplegics: a new paradigm for the rehabilitation under neuromuscular electrical stimulation.
METHODS
Radiographic analysis of sagittal spinal alignment of paraplegics in a standing position under surface neuromuscular electrical stimulation (NMES).


OBJECTIVE
Describing the radiographic parameters of the sagittal spinal alignment of paraplegics going through a rehabilitation program with NMES.


METHODS
The University Hospital's Ambulatory (UNICAMP), Campinas, São Paulo, Brazil.


METHODS
Panoramic X-ray images in profile were taken for 10 paraplegics. All patients participated in the rehabilitation program and were able to perform gait through NMES of the femoral quadriceps muscles. The radiographic parameters used for the analysis were the same as those described in the literature for healthy people. The results were didactically organized into three groups: anatomical shape of the spine, morphology and kinetics of the pelvis and spinopelvic alignment.


RESULTS
The physiological curvature of the spine in paraplegics showed average values similar to those described in the literature for healthy patients. The inversion of the pelvic tilt and the increase in the sacral slope were defined by the anterior backward rotation of the pelvis. The existing theoretical mathematical formulas that define lumbar lordosis, pelvic incidence and pelvic tilt showed normal values, despite the anterior intense sagittal imbalance.


CONCLUSIONS
The adaptive posture of the spine in paraplegics standing through the stimulation of the femoral quadriceps does not allow for a neutral sagittal alignment. This novel radiographic detailed description of the various segments of the spine can be of assistance toward the understanding of the global postural control for such subjects.
Department of Orthopaedic Surgery, School of Medicine, Campinas State University (UNICAMP), Campinas, Brazil. castromed@hotmail.com
R Castro
RC
de Medeiros
A P B
AP
Jaccard
A
A
Cliquet
D000328:Adult; D000886:Anthropometry; D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D007738:Kyphosis / Q000473:pathology; D007866:Leg / Q000502:physiology; D008141:Lordosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation* / Q000502:physiology*; D010243:Paralysis / Q000473:pathology; D010264:Paraplegia / Q000534:rehabilitation*; D011187:Posture / Q000502:physiology; D011859:Radiography; D012959:Socioeconomic Factors; D013131:Spine / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology*