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Shakeri M, Mahdavi SM, Rikhtehgar M, Soleimani M, Ghandhari H, Jafari B, Daneshmand S. EOS® is reliable to evaluate spinopelvic parameters: a validation study. BMC Med Imaging 2024; 24:35. [PMID: 38321400 PMCID: PMC10845382 DOI: 10.1186/s12880-023-01178-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Sagittal and coronal standing radiographs have been the standard imaging for assessing spinal alignment. However, their disadvantages include distortion at the image edges and low interobserver reliability in some parameters. EOS® is a low-dose biplanar digital radiographic imaging system that can avoid distortion by obtaining high-definition images. METHODS This study aimed to evaluate spinopelvic parameters in conventional lateral C1S1 upright radiographs and EOS® images and compare them. Patients with non-deformity changes were subjected to routine clinical examinations. Plain AP and lateral X-ray radiographs were obtained along the entire spine length. Patients were also referred for full-length EOS® of the spine. Thoracic Kyphosis (TK), Lumbar Lordosis (LL), Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), and Sagittal Vertical Axis (SVA) were measured in the two studies by an orthopedic surgeon and a radiologist using PACS software. Also, the orthopedic surgeon evaluated the studies again after two weeks. Intra- and inter-observer reliability was then assessed using the interclass correlation coefficient (ICC). Also, the coefficient of variation was used to assess intra- and inter-observer reliability. Bland-Altman plots were drawn for each parameter. RESULTS The mean age was 48.2 ± 6.6 years. Among the 50 patients, 30 (60%) were female. The mean ICC for TK, LL, PT, SS, PI, and SVA in EOS® images are 0.95, 0.95, 0.92, 0.90, 0.94, and 0.98, respectively, and in C1S1 radiography images, it was 0.92, 0.87, 0.94, 0.88, 0.93, and 0.98, respectively which shows good to excellent results. The coefficient of variation for intraobserver reliability was relatively low (< 18.6%), while it showed higher percentages in evaluating interobserver reliability (< 54.5%). Also, the Bland-Altman plot showed good agreement for each parameter. CONCLUSION Spinopelvic parameters, e.g., TK, LL, SS, PI, and SS, in EOS® are reliable and comparable to those in conventional lateral upright C1S1 radiographs.
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Affiliation(s)
- Mohammadreza Shakeri
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mani Mahdavi
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masih Rikhtehgar
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Ghandhari
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behnam Jafari
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedehsan Daneshmand
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Kouyoumdjian P. How the hip-spine relationship influences total hip arthroplasty. Orthop Traumatol Surg Res 2024; 110:103773. [PMID: 38000509 DOI: 10.1016/j.otsr.2023.103773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/30/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Motion in the spine, pelvis and hips which make up the spinopelvic femoral complex (SPFC) implies mechanical relationships that help maintain trunk balance and optimize hip functionThe aim of this study was to understand the physiology of the SPFC and evaluate the dysfunctions of the SPFC and their implications for total hip arthroplasty considering the hip-spine relationship. METHODS A review of relevant and comprehensive studies on this subject is reported in order to highlight a pathophysiology that integrates the description of the evaluations of the spine-pelvic and hip parameters and recommendations for the kinematic planning of the THA procedure. The primary objective was to determine which type of hip-spine relationship has the highest risk for THA complications and to become proficient in selecting the priority surgical intervention when both the hip and spine are affected. Finally, this review attempted to assist hip surgeons with surgical technique, tools, implant selection, and goals of planning a THA that requires personalized kinematic alignment. Determine the influence of THA on these kinematics and the effect of stiffness of the lumbopelvic complex on the risk of THA failure. RESULTS When a person sits, the pelvis goes into retroversion and the acetabulum opens forward. This frees the femoral head and neck to allow hip flexion. The opposite - pelvic anteversion - occurs when a person stands. When pelvic mobility is limited, the hip must increase its range of motion to accommodate these posture changes. Disturbances in spinal and pelvic kinematics lead to abnormal hip function, which may contribute to complications following total hip arthroplasty (THA). CONCLUSION A precise evaluation of the parameters governing the SPFC must be taken into account in order to best optimize the placement and choice of THA implants. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Pascal Kouyoumdjian
- CHU de Nîmes, Faculté de Médecine Montpellier-Nîmes, Université Montpellier, Hôpital Carémeau, 4, place du Professeur-Robert-Debré, 30900 Nîmes, France.
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Kouyoumdjian P, Mansour J, Haignère V, Demattei C, Maury E, George D, Coulomb R. Hip-Spine Relationship between Sagittal Balance of the Lumbo-Pelvi-Femoral Complex and Hip Extension Capacity: An EOS Evaluation in a Healthy Caucasian Population. Global Spine J 2024; 14:265-271. [PMID: 35604878 PMCID: PMC10676160 DOI: 10.1177/21925682221103831] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN A prospective study of healthy volunteers. OBJECTIVES The influence of the sagittal alignment of the spine and its influence on the extension reserve have been reported in the literature. However, specific analysis of the intrinsic coxofemoral and extrinsic pelvic component in subjects without any spinal or hip pathologies remains poorly reported. The aim of this study was to categorize the hip extension capacity, or extension reserve (ER), in relation to spinal sagittal alignment whilst standing, in a young healthy population. We hypothesized that the global extension reserve (GER) of the hip joint was influenced by the sagittal spinopelvic alignment. METHODS We evaluated the ER of 120 healthy Caucasian volunteers (56 females (46.7%), 74 males (53.3%); mean age 25.6 years), using low dose radiographs from an EOS® X-ray imaging system in 2 functional positions; neutral standing position and in a forward lunge position. The GER is defined as the sum of the intrinsic (hip) extension reserve (IER) and the extrinsic (pelvic) extension reserve (EER). Cases were grouped into 4 sagittal alignment subtypes according to the Roussouly classification, and analyzed. RESULTS Global extension reserve values were not significantly different between the 4 Roussouly subtypes (P = .094), nor between patients with a sacral slope (SS) <35° (types 1/2) and ≥ 35° (type 3/4) (P = .837). Statistically significant differences were seen between IER in each subtype (P = .015), and EER (P = .006). No difference in ER was seen between subtypes regarding pelvic incidence (PI). CONCLUSION An inverse relationship was found between IER and EER among Roussouly subtypes. The range of motion of the pelvis and the hip joint was higher in patients with a greater sacral slope.
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Affiliation(s)
- Pascal Kouyoumdjian
- Centre Hospitalo-universitaire de Nîmes, Montpellier, France
- Laboratoire de Mécanique et Génie Civile (LMGC), Montpellier, France
| | - Jad Mansour
- Laboratoire de Mécanique et Génie Civile (LMGC), Montpellier, France
| | | | - Christophe Demattei
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nimes, Univ Montpellier, Nimes, France
| | - Etienne Maury
- Centre Hospitalier Universitaire de Montpellier. Hôpital Lapeyronie
| | - David George
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Remy Coulomb
- Centre Hospitalo-universitaire de Nîmes, Montpellier, France
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Bordes M, Thaunat M, Maury É, Bonin N, May O, Tardy N, Martz P, Gedouin JE, Kouyoumdjian P, Krantz N, Coulomb R. The influence of the sacral slope on pelvic kinematics and clinical manifestations in femoroacetabular impingement. Orthop Traumatol Surg Res 2023; 109:103688. [PMID: 37739169 DOI: 10.1016/j.otsr.2023.103688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION The radiological study of the sagittal alignment of the spine in static and dynamic positions has allowed a better understanding of the clinical results of total hip prostheses. According to the Roussouly classification, the sacral slope in a standing position characterizes the patient with a stiff spine (less than 35̊) or a flexible spine (greater than 35̊). The objectives of this study were to compare, in a population of patients operated on for femoroacetabular impingement (FAI), firstly, the kinematics of the lumbar-pelvic-femoral complex and secondly, the clinical presentation depending on whether the spine is stiff or flexible. HYPOTHESIS Patients with stiff spines (SS<35̊) were "hip users" and had less ability to compensate for their hip pathology. MATERIAL AND METHOD This prospective and comparative multicenter study was conducted with patients operated on arthroscopically for FAI between 2020 and 2021. All patients included received preoperative EOS imaging of the lower limbs and spine, in standing and seated positions. The following parameters were measured: pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), and sacral slope (SS), as well as dynamic parameters (intrinsic mobility of the hip: delta standing/sitting femoral sacral angle, and of the pelvis: delta standing/sitting sacral slope). The functional result was evaluated at 1 year. RESULTS In the stiff spine group, 62 patients were included versus 138 in the flexible spine group. The mean follow-up was 15.1±3.3 months (9.2-24.3). Nineteen patients were lost to follow-up and there were 2 revisions for iterative arthroscopy. Intrinsic pelvic mobility and intrinsic hip mobility were 16̊±13.5 (-12; 44) and 44.5̊±28.5 (-9; 99) respectively in the stiff spine group. In the flexible spine group, these same measurements were 22̊±11.5 (-30; 45) and 29.7̊±22.7 (-33; 82) respectively. In the stiff spine group, the symptoms occurred at a significantly younger age: 28.3 years±9.5 (18-51) versus 31 years±8 (18-54) (p=0.017). DISCUSSION The sacral slope is a determining factor in the kinematics of impingement and the appearance of symptoms. The sacral slope helps define the concept of a "hip user" in symptomatic FAI. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Maxence Bordes
- Service de chirurgie orthopédique et traumatologique, hôpital Lyon Sud, hospices civils de Lyon, Lyon, France.
| | - Mathieu Thaunat
- Centre orthopédique Santy, hôpital privé Jean-Mermoz, Ramsay-générale de santé, Lyon, France
| | - Étienne Maury
- Clinique Orthosud, 2, place de l'Europe, 34430 Saint-Jean-de-Vedas, Montpellier, France
| | - Nicolas Bonin
- Lyon Ortho Clinic, 29B, avenue des Sources, 69009 Lyon, France
| | - Olivier May
- Médipôle Garonne, clinique du sport, 45, rue de Gironis, 31036 Toulouse, France
| | - Nicolas Tardy
- Centre ostéoarticulaire des Cèdres, clinique des Cèdres, 5, rue des Tropiques, 38130 Échirolles, France
| | - Pierre Martz
- Service d'orthopédie, CHU de Dijon-Bourgogne, 12, boulevard Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France
| | | | - Pascal Kouyoumdjian
- Orthopedic and Traumatology Surgery Department, CHU of Nîmes, University Montpellier 1, Nîmes, France; Laboratory LMGC, CNRS UMR 5508, University of Montpellier II, Montpellier, France
| | - Nicolas Krantz
- Médipôle Garonne, clinique du sport, 45, rue de Gironis, 31036 Toulouse, France
| | - Rémy Coulomb
- Orthopedic and Traumatology Surgery Department, CHU of Nîmes, University Montpellier 1, Nîmes, France
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Jang HJ, Park JY, Kuh SU, Ha Y, Chin DK, Kim KS, Cho YE, Kim KH. Comparison of Whole Spine Sagittal Alignment in Patients with Spinal Disease between EOS Imaging System versus Conventional Whole Spine X-ray. Yonsei Med J 2022; 63:1027-1034. [PMID: 36303311 PMCID: PMC9629905 DOI: 10.3349/ymj.2022.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/01/2022] [Accepted: 08/23/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The biplanar whole body imaging system (EOS) is a new tool for measuring the whole body sagittal alignment in a limited space. This tool may affect the sagittal balance of patients compared to conventional whole spine X-ray (WSX). This study aimed to investigate the difference in sagittal alignment between WSX and EOS. MATERIALS AND METHODS We compared the spinal and pelvic sagittal parameters in 80 patients who underwent EOS and WSX within one month between July 2018 and September 2019. The patients were divided based on sagittally balanced and imbalanced groups according to pelvic tilt (PT) >20°, pelvic incidence-lumbar lordosis >10°, C7-sagittal vertical axis (SVA) >50 mm in WSX. RESULTS In the sagittally imbalanced group, compared to WSX, the pelvic parameters demonstrated compensation in EOS with smaller PT (27.4±11.6° vs. 24.9±10.9°, p=0.003) and greater sacral slope (SS), and the patients tended to stand more upright with smaller C7-SVA (58.4±17.0 mm vs. 48.9±57.3 mm, p=0.018), T1-pelvic angle (TPA), T5-T12, and T2-T12. However, in the sagittally balanced group, these differences were less pronounced only with smaller PT (10.8±6.9° vs. 9.4±4.7°, p=0.040), TPA and T2-T12 angle, but with similar SS and C7-SVA (p>0.05). CONCLUSION EOS showed a negative SVA shift and lesser PT compared to WSX, especially in patients with sagittal imbalance. When preparing a surgical plan, surgeons should consider these differences between EOS and WSX.
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Affiliation(s)
- Hyun Jun Jang
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Uk Kuh
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Kyu Chin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Su Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Eun Cho
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Heimkes B, Berger N, Frimberger V. [Lumbo-pelvino-acetabular alignment-basics and clinical consequences]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:962-968. [PMID: 36222867 PMCID: PMC9715524 DOI: 10.1007/s00132-022-04321-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 12/04/2022]
Abstract
The spinal shape and the pelvic ante-/retroversion of an individual are determined by its innate, genetically fixed lumbosacral angulation. This can be measured with little effort in the lateral standing radiograph of the patient. In spinal surgery, there are a lot of original papers on the topic. In hip surgery, however, the individual pelvic version and its consequences for the acetabular orientation have not received the same attention so far.This review focuses on previous data on the relationship between lumbosacral angulation and pelvic ante-/retroversion. Four anatomically definable pelvic types can be distinguished; three of those have to be considered as facultatively pathogenetic. Clinical consequences arise for the clinical pictures of spondylolisthesis, non-specific lower back pain, acetabular retroversion and developmental dysplasia of the hip, as well as for acetabular cup positioning in total hip arthroplasty.
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Affiliation(s)
- Bernhard Heimkes
- Klinik für Kinderchirurgie, Sektion Kinder- und Neuroorthopädie, Kliniken Dritter Orden gGmbH, Menzinger Straße 44, 80638 München, Deutschland
| | - Nina Berger
- Klinik für Kinderchirurgie, Sektion Kinder- und Neuroorthopädie, Kliniken Dritter Orden gGmbH, Menzinger Straße 44, 80638 München, Deutschland
| | - Vincent Frimberger
- Klinik für Kinderchirurgie, Sektion Kinder- und Neuroorthopädie, Kliniken Dritter Orden gGmbH, Menzinger Straße 44, 80638 München, Deutschland
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Xia W, Wang W, Zhu Z, Liu C, Xu S, Meng F, Liu H, Wang K. The compensatory mechanisms for global sagittal balance in degenerative spinal kyphosis patients: a radiological analysis of muscle-skeletal associations. BMC Musculoskelet Disord 2021; 22:733. [PMID: 34452605 PMCID: PMC8401063 DOI: 10.1186/s12891-021-04621-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The position of the head relative to the spine can be used to evaluate the true global balance in patients with degenerative spinal kyphosis (DSK). However, it is still not clear how the position of the head is related to the spinal-pelvic parameters and lumbar muscles, which are most commonly considered. METHODS Sixty-seven patients with DSK admitted in the hospital from January 2017 to January 2019 were retrospectively analyzed. All patients had whole spine X-ray and lumbar MRI. The head position parameters include: the angles of both lines joining the center of acoustic meati (CAM) to the center of the bi-coxofemoral axis (BA) (CAM-BA) and the most superior point of dentiform apophyse of C2 odontoid (OD) to BA (OD-BA) with the vertical line; the distance between the vertical line passing CAM and the posterior upper edge of the S1 (CAM-SVA). The spinal parameters include: C7 sagittal vertical axis (C7-SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), and lumbar lordosis (LL). The pelvic parameters include: pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). The relative cross-sectional area (RCSA) of bilateral multifidus, erector spinae and psoas muscle at L3/4 and L4/5 segments were measured. The correlations between head position parameters and the spinal-pelvic parameters and RCSA of lumbar muscles were analyzed, respectively. RESULTS Significant positive correlations were found between each two of CAM-SVA, C7-SVA, CAM-BA and OD-BA (p < 0.001). SS was found to be significantly positively correlated with CAM-BA (r = 0.377, p = 0.034) and OD-BA (r = 0.402, p = 0.023). CAM-BA was found to be significantly negatively correlated with TK (r = - 0.367, p = 0.039). Significant positive correlations were found between RCSA of multifidus at L3/4 level and CAM-SVA (r = 0.413, p = 0.021), CAM-BA (r = 0.412, p = 0.019) and OD-BA (r = 0.366, p = 0.04). CONCLUSIONS Our study showed that the head position relative to the spine were significantly correlated to some spinal-pelvic parameters, and the lower lumbar multifidus muscle. The compensatory mechanisms of the global sagittal balance status should also involve the head position area.
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Affiliation(s)
- Weiwei Xia
- Department of Spinal Surgery, Peking University People's Hospital, Xizhimen south street No. 11, Xicheng district, Beijing, 100044, China
| | - Weiyan Wang
- Department of Spinal Surgery, Peking University People's Hospital, Xizhimen south street No. 11, Xicheng district, Beijing, 100044, China
| | - Zhenqi Zhu
- Department of Spinal Surgery, Peking University People's Hospital, Xizhimen south street No. 11, Xicheng district, Beijing, 100044, China
| | - Chenjun Liu
- Department of Spinal Surgery, Peking University People's Hospital, Xizhimen south street No. 11, Xicheng district, Beijing, 100044, China
| | - Shuai Xu
- Department of Spinal Surgery, Peking University People's Hospital, Xizhimen south street No. 11, Xicheng district, Beijing, 100044, China
| | - Fanqi Meng
- Department of Spinal Surgery, Peking University People's Hospital, Xizhimen south street No. 11, Xicheng district, Beijing, 100044, China
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People's Hospital, Xizhimen south street No. 11, Xicheng district, Beijing, 100044, China
| | - Kaifeng Wang
- Department of Spinal Surgery, Peking University People's Hospital, Xizhimen south street No. 11, Xicheng district, Beijing, 100044, China.
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Hatem M, Martin HD. Low Back Pain Improves After Surgery for Lesser Trochanteric-Ischial Impingement. Arthroscopy 2021; 37:1503-1509. [PMID: 33460710 DOI: 10.1016/j.arthro.2021.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the effects of surgery for lesser trochanteric-ischial impingement (LTI) on low back pain. METHODS The records of patients with LTI who underwent endoscopic partial resection of the lesser trochanter (LT) between May of 2017 and February of 2019 were reviewed. Inclusion criteria were the presence of low back pain in association with hip pain, diagnosis of LTI, and partial resection of the LT to treat LTI. Exclusion criteria were less than 12 months of postoperative follow-up and hip or spine surgery after the LTI surgery. Patients were assessed before surgery and at the most recent follow-up with the modified Harris Hip Score and Oswestry Disability Index for lumbar spine. RESULTS Thirty patients (31 hips) met the inclusion criteria. Four patients were lost to follow-up. Two patients with borderline dysplasia and grade 1 and 2 osteoarthritis underwent total hip arthroplasty after the partial resection of the LT. The results are presented considering the remaining 24 patients (25 hips). The average age at surgery was 51 years (range 32-65 years). The mean follow-up after the surgery for LTI was 19 months (range 12-35 months). The mean ± SD ODI improved from 48% ± 15 before the LTI surgery to 21% ± 22 (P < .001) at the most recent follow-up. Improvement in the Oswestry Disability Index above the minimal clinical important difference was observed in 16 patients (67%) following the LTI surgery. The mean ± SD modified Harris Hip Score improved from 55.8 ± 14 before LTI surgery to 81.3 ± 14.3 (P < .001). CONCLUSIONS Decrease in low back pain above the minimal clinically important difference is observed in 2 of 3 patients after partial resection of the LT. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Munif Hatem
- Baylor University Medical Center at Dallas, Dallas, Texas, U.S.A..
| | - Hal David Martin
- Baylor University Medical Center at Dallas, Dallas, Texas, U.S.A
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Influence of sagittal degenerative spondylolisthesis on anteversion of the acetabular component in total hip arthroplasty. DER ORTHOPADE 2021; 50:664-673. [PMID: 33580282 DOI: 10.1007/s00132-021-04069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Degenerative lumbar spondylolisthesis (DSPL), as opposed to other degenerative spinal conditions, is disregarded in the assessment of hip stability after total hip arthroplasty (THA). This study aimed to determine whether patients with DSPL have different acetabular anteversion compared to patients with normal spine before and following THA. METHODS Preoperative and postoperative 6‑month lateral pelvic radiographs in standing and sitting positions from 91 patients who underwent primary THA were retrospectively compared for spinopelvic parameters between patients with DSPL (n = 31) and with normal spine (n = 34). RESULTS Compared to control patients in the standing position, patients with DSPL had significantly increased preoperative pelvic tilt (24° in DSPL vs. 8° in controls; p < 0.01), pelvic-femoral angle (194° in DSPL vs. 174° in controls; p < 0.05), decreased lumbar lordosis (35° in DSPL vs. 43° in controls; p < 0.05), increased postoperative pelvic tilt (22° in DSPL vs. 7° in controls; p < 0.01), pelvic-femoral angle (187° in DSPL vs. 179° in controls; p < 0.05), and acetabular anteversion (31° in DSPL vs. 23° in controls; p < 0.05). Preoperative (p = 0.181) and postoperative (p = 0.201) sitting pelvic tilt did not differ. There were positive correlations between preoperative standing pelvic tilt and postoperative standing acetabular anteversion, pelvic-femoral angle, and combined sagittal index (CSI) in DSPL (R2 = 0.8416; R2 = 0.9180; R2 = 0.9459, respectively, p < 0.01) and in controls (R2 = 0.6872; R2 = 0.6176; R2 = 0.7129, respectively, p < 0.01). CONCLUSION While the imbalance of seated sagittal plane is usually insignificant and compensable, the mechanism by which DSPL patients achieve a standing posture is different from control patients, with more hip extension and posterior tilt of the pelvis. Special attention should be paid to the risk of impingement caused by the increase of acetabular anteversion in the postoperative standing position.
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Hatem M, Khoury AN, Erickson LR, Jones AL, Martin HD. Femoral Derotation Osteotomy Improves Hip and Spine Function in Patients With Increased or Decreased Femoral Torsion. Arthroscopy 2021; 37:111-123. [PMID: 32828933 DOI: 10.1016/j.arthro.2020.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the outcomes of proximal femoral derotation osteotomy (PFDO) on the hip and spine function of patients with abnormal femoral torsion. METHODS This retrospective study included patients who underwent PFDO to treat increased or decreased femoral torsion between July 2014 and February 2019. The exclusion criteria were: previous fracture, fixation of slipped capital femoral epiphysis or osteotomy in the ipsilateral femur; PFDO associated to varus or valgus osteotomy; Tönnis grade 2 or 3 osteoarthritis; and PFDO performed to treat knee abnormalities. Hip function was assessed through the modified Harris Hip Score (mHHS). A subgroup of consecutive patients with low back pain before the PFDO and operated after 2017 had the spine function assessed through the Oswestry disability index (ODI). RESULTS A total of 37 hips (34 patients) were studied: 15 hips with increased femoral torsion and 22 with decreased femoral torsion. Eight patients were male and 26 were female. The average age at PFDO was 33 years (range, 15-54 years). At a mean follow-up of 24 months (range, 12-65 months), the mean mHHS improved from 58.1 ± 14.3 before PFDO to 82 ± 15.6 at the most recent follow-up (P < .001). Improvement in the mHHS above the minimum clinically important difference (MCID) was observed in 33 hips (89%). In the subgroup of 14 consecutive patients with ODI available, the ODI improved from a mean of 45% ± 16% before the PFDO to 22% ± 17% at the most recent follow-up (P = .001). Nine (64.3%) of the 14 patients presented improvement in the ODI above the MCID. Revision procedure with a larger intramedullary nail was necessary in 2 hips to treat nonunion. CONCLUSION Proximal femoral derotation osteotomy improves the hip and spine function in patients with increased or decreased femoral torsion and nonarthritic hips. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Munif Hatem
- Baylor University Medical Center at Dallas, Dallas, Texas, U.S.A..
| | | | | | | | - Hal David Martin
- Baylor University Medical Center at Dallas, Dallas, Texas, U.S.A
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11
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Khoury AN, Hatem M, Bowler J, Martin HD. Hip-spine syndrome: rationale for ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion leading to low back pain. J Hip Preserv Surg 2020; 7:390-400. [PMID: 33948195 PMCID: PMC8081421 DOI: 10.1093/jhps/hnaa054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
The term 'hip-spine syndrome' was introduced in recognition of the frequent occurrence of concomitant symptoms at the hip and lumbar spine. Limitations in hip range of motion can result in abnormal lumbopelvic mechanics. Ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion are increasingly linked to abnormal hip and spinopelvic biomechanics. The purpose of this narrative review is to explain the mechanism by which these three abnormal hip pathologies contribute to increased low back pain in patients without hip osteoarthritis. This paper presents a thorough rationale of the anatomical and biomechanical characteristics of the aforementioned hip pathologies, and how each contributes to premature coupling and limited hip flexion/extension. The future of hip and spine conservative and surgical management requires the implementation of a global hip-spine-pelvis-core approach to improve patient function and satisfaction.
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Affiliation(s)
- Anthony N Khoury
- Hip Preservation Center, Baylor University Medical Center at Dallas, 411 N. Washington Ave, Suite 7300, Dallas, TX 75246, USA
| | - Munif Hatem
- Hip Preservation Center, Baylor University Medical Center at Dallas, 411 N. Washington Ave, Suite 7300, Dallas, TX 75246, USA
| | - Joshua Bowler
- Orthopedic Surgery Department, Baylor University Medical Center at Dallas, 3500 Gaston Ave, Dallas, TX 75246, USA
| | - Hal David Martin
- Hip Preservation Center, Baylor University Medical Center at Dallas, 411 N. Washington Ave, Suite 7300, Dallas, TX 75246, USA
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Yeganeh A, Moghtadaei M, Ameri Mahabadi E, Mahdavi SM, Pirani A, Safdari F. Sagittal Spinopelvic Alignment in Asymptomatic Iranian Adults Aged 18 to 40 Years. ARCHIVES OF IRANIAN MEDICINE 2020; 23:391-396. [PMID: 32536176 DOI: 10.34172/aim.2020.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/12/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recent studies have revealed the increasing importance of sagittal spinopelvic alignment. Knowing the values of sagittal spinopelvic parameters, which are affected by ethnicity, is essential in the normal asymptomatic population. In the current study, these parameters were measured in a sample of asymptomatic Iranian population. METHODS Seventy asymptomatic participants without complaint of musculoskeletal problems were enrolled. They had no complaint about musculoskeletal problems. Lateral full-length spinal and pelvic x-rays were taken. The following parameters were measured on x-rays and presented as mean ± standard deviation: pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), lumbar tilt (LT) and thoracic tilt (TT). RESULTS The population consisted of 37 males and 33 females aged 26.6 ± 4.27 years. The mean values of PI, SS, PT, LL, TK, LT, and TT were 44.5 ± 10.1, 35.4 ± 6.7, 9.1 ± 7.9, 41.9 ± 14.7, 28.8 ± 8.3, 11.9 ± 7.4 and -7.5 ± 5.7 (median: -10; 5th percentile: -14; 95th percentile: 4.4) degrees, respectively. The variables were similar between males and females except for LL which was significantly higher in females (37.8 ± 16.5 versus 46.5 ± 11; P = 0.013). In addition, the linear regression model revealed age to be independently related with PI (beta = 0.344; P = 0.004) and PT (beta = 0.366; P = 0.002). PI (r = 0.344, P = 0.004) and PT (r = 0.359, P = 0.002) were positively correlated with age. Additionally, PI was positively correlated to SS, PT and LL and negatively to TT. CONCLUSION These findings may be used as referential values for sagittal spinopelvic parameters in the Iranian population. The positive correlation of PI with age questions the constancy of PI throughout life. However, larger studies are required.
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Affiliation(s)
- Ali Yeganeh
- Department of orthopedics, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Moghtadaei
- Department of orthopedics, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Ameri Mahabadi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mani Mahdavi
- Orthopedic Spine Surgery Department, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Pirani
- Department of orthopedics, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Safdari
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation, Tehran, Iran
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Multiple-rod constructs in adult spinal deformity surgery for pelvic-fixated long instrumentations: an integral matched cohort analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:886-895. [PMID: 31993784 DOI: 10.1007/s00586-020-06311-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 09/12/2019] [Accepted: 01/18/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Multiple-rod constructs (Multi-Rod: extra rods for additional pillar support) are occasionally used in adult spinal deformity (ASD) surgery. We aimed to compare and analyze the general outcome of multi-rod constructs with a matched two-rod cohort, to better understand the differences and the similitudes. METHODS This is a retrospective matched cohort study including patients with ASD that underwent surgical correction with long posterior instrumentation (more than five levels), pelvic fixation and a minimum 1-year follow-up. Matching was considered with demographical data, preoperative radiographical parameters, preoperative clinical status [health-related quality-of-life (HRQoL) scores] and surgical characteristics (anterior fusion, decompression, rod material, osteotomies). Postoperative radiographical and clinical parameters, as well as complications, were obtained. Univariate and multivariate analysis was performed regarding postoperative improvement, group variables comparison and parameters correlation. RESULTS Thirty-three patients with multi-rod construct and 33 matched with a two-rod construct were selected from a database with 346 ASD-operated patients. Both groups had a significant improvement with surgical management in the radiographical and HRQoL parameters (p < 0.001). Differences between groups for the postoperative radiographical, clinical and perioperative parameters were not significant. Rod breakage was more frequent in the two-rod group (8 vs 4, p = 0.089), as well as the respective revision surgery for those cases (6 vs 1 p = 0.046). Risk factors related to revision surgery were greater kyphosis correction (p = 0.001), longer instrumentation (p = 0.037) and greater sagittal vertical axis correction (p = 0.049). CONCLUSION No major disadvantage on the use of multi-rod construct was identified. This supports the benefit of using multi-rod constructs to avoid implant failure. These slides can be retrieved under Electronic Supplementary Material.
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Le Huec JC, Thompson W, Mohsinaly Y, Barrey C, Faundez A. Sagittal balance of the spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1889-1905. [DOI: 10.1007/s00586-019-06083-1] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 11/24/2022]
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Burkus M, Schlégl ÁT, József K, O'Sullivan I, Márkus I, Tunyogi-Csapó M. Analysis of Proximal Femoral Parameters in Adolescent Idiopathic Scoliosis. Adv Orthop 2019; 2019:3948595. [PMID: 31057973 PMCID: PMC6463608 DOI: 10.1155/2019/3948595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/05/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Assessment of the proximal femoral parameters in adolescent idiopathic scoliosis using three-dimensional radiological image reconstructions may allow better characterization than conventional techniques. METHODS EOS 3D reconstructions of spines and femurs of 320 scoliotic patients (10-18 years old) and 350 control children lacking spinal abnormality were performed and 6 proximal femoral parameters measured. RESULTS Individuals with adolescent idiopathic scoliosis showed a small but statistically significant decrease in neck shaft angle (average difference=2.58°) and a higher (0.22°) femoral mechanical axis-femoral shaft angle. When the two sides were compared based on curve direction, greater changes in the neck shaft angle and femoral mechanical axis-femoral shaft angle were found on the side of the convexity. CONCLUSIONS Patients with adolescent idiopathic scoliosis were found to have a small but significantly lower neck shaft angle and higher femoral mechanical axis-femoral shaft angle, which related to the curve direction. This is postulated to be due to mechanical compensation for altered balance and centre of gravity associated with a scoliosis deformity, although the observed difference likely has negligible clinical effect.
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Affiliation(s)
- Máté Burkus
- Department of Orthopedics, Medical School, University of Pécs, H-7623 Pécs, Akác St. 1., Hungary
| | - Ádám T. Schlégl
- Department of Orthopedics, Medical School, University of Pécs, H-7623 Pécs, Akác St. 1., Hungary
| | - Kristóf József
- Department of Orthopedics, Medical School, University of Pécs, H-7623 Pécs, Akác St. 1., Hungary
| | - Ian O'Sullivan
- Department of Orthopedics, Medical School, University of Pécs, H-7623 Pécs, Akác St. 1., Hungary
| | - István Márkus
- Department of Orthopedics, Medical School, University of Pécs, H-7623 Pécs, Akác St. 1., Hungary
| | - Miklós Tunyogi-Csapó
- Department of Orthopedics, Medical School, University of Pécs, H-7623 Pécs, Akác St. 1., Hungary
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Le Huec JC, Gille O, Fabre T. Sagittal balance and spine-pelvis relation: A French speciality? Orthop Traumatol Surg Res 2018; 104:551-554. [PMID: 29906521 DOI: 10.1016/j.otsr.2018.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Jean-Charles Le Huec
- Service orthopédie traumatologie 1, 2, 3, pôle chirurgie, CHU Pellegrin-Tripode, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Ollivier Gille
- Service orthopédie traumatologie 1, 2, 3, pôle chirurgie, CHU Pellegrin-Tripode, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Thierry Fabre
- Service orthopédie traumatologie 1, 2, 3, pôle chirurgie, CHU Pellegrin-Tripode, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Pumberger M, Schmidt H, Putzier M. Spinal Deformity Surgery: A Critical Review of Alignment and Balance. Asian Spine J 2018; 12:775-783. [PMID: 30060389 PMCID: PMC6068412 DOI: 10.31616/asj.2018.12.4.775] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/12/2017] [Indexed: 12/01/2022] Open
Abstract
Correction of the overall coronal and/or sagittal plane deformities is one of the main predictors of successful spinal surgery. In routine clinical practice, spinal alignment is assessed using several spinal and pelvic parameters, such as pelvic incidence and tilt, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis. Standard values have been defined for all these parameters, and the formulas of correction have been set for determining the surgical strategy. However, several factors can potentially bias these formulas. First, all standard values are measured using conventional plain radiographs and are, therefore, prone to bias. The radiologist, measuring surgeon, and patient are possible confounding influencing factors. Second, spino-pelvic compensatory effects and biomechanically relevant structures for the patient’s posture, including ligaments, tendons, and muscles, have received minimal consideration in the literature. Therefore, even in cases of appropriately planned deformity correction surgeries, complications, revision rates, and surgical outcomes significantly vary. This study aimed to illustrate the current clinical weaknesses of the assessment of spinal alignment and the importance of holistically approaching the musculoskeletal system for any spinal deformity surgery. We believe that our detailed insights regarding spinal, sagittal, and coronal alignments as well as the considerations of an individual’s spinal balance will contribute toward improvement in routine patient care.
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Affiliation(s)
- Matthias Pumberger
- Spine Department, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Hendrik Schmidt
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Putzier
- Spine Department, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Hey HWD, Tan KA, Kantharajanna SB, Teo AQA, Chan CX, Liu KPG, Wong HK. Using spinopelvic parameters to estimate residual lumbar lordosis assuming previous lumbosacral fusion-a study of normative values. Spine J 2018; 18:422-429. [PMID: 28822824 DOI: 10.1016/j.spinee.2017.08.232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/29/2017] [Accepted: 08/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pelvic incidence (PI)=pelvic tilt (PT)+sacral slope (SS) is an established trigonometric equation which can be expanded from studying the fixed pelvis with the spine to a fixed spinopelvic complex with the remnant spine, in scenarios of spinopelvic fusion or ankylosis. For a fixed spinopelvic complex, we propose the equation termed: lumbar incidence (LI)=lumbar tilt (LT)+lumbar slope (LS). PURPOSE This study aimed to establish reference values for LI, LT, and LS at each lumbar vertebral level, and to show how LI can be used to determine residual lumbar lordosis (rLL). STUDY DESIGN This is a cross-sectional study of prospectively collected data, conducted at a single academic tertiary health-care center. PATIENT SAMPLE The study included 53 healthy patients aged 19-35 with first episode mechanical low back pain for a period of <3 months. Patients with previous spinal intervention, those with known or suspected spinal pathologies, and those who were pregnant, were excluded. OUTCOME MEASURES Radiological measurements of LI, LT, LS, and rLL. METHODS All patients had full-body lateral standing radiographs obtained via a slot scanner. Basic global and regional radiographic parameters, spinopelvic parameters, and the aforementioned new parameters were measured. LI was correlated with rLL at each level by plotting LI against rLL on scatter plots and drawing lines-of-best-fit through the datapoints. RESULTS The mean value of L5I was 22.82°, L4I was 6.52°, L3I was -0.92°, L2I was -5.56°, and L1I was -5.95°. LI turns negative at L3, LS turns negative at the L3/L4 apex, and LT remains positive throughout the lumbar spine. We found that the relationship of LI with its corresponding rLL follows a parabolic trend. Thus, rLL can be determined from the linear equations of the tangents to the parabolic lumbar spine. We propose the LI-rLL method for determining rLL as the LI recalibrates via spinopelvic compensation post instrumentation, and thus the predicted rLL will be based on this new equilibrium, promoting restoration of harmonized lordosis. The rLL-to-LI ratio is a simplified, but less accurate, method of deriving rLL from LI. CONCLUSIONS This study demonstrates the extended use of PI=PT+SS proposed as LI=LT+LS. These new spinopelvic reference values help us better understand the position of each vertebra relative to the hip. In situations when lumbar vertebrae are fused or ankylosed to the sacrum to form a single spinopelvic complex, LI can be used to determine rLL, to preserve spinal harmony within the limits of compensated body balance.
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Affiliation(s)
- Hwee Weng Dennis Hey
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 11, 119228, Singapore.
| | - Kimberly-Anne Tan
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 11, 119228, Singapore
| | - Shashidhar Bangalore Kantharajanna
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 11, 119228, Singapore
| | - Alex Quok An Teo
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 11, 119228, Singapore
| | - Chloe Xiaoyun Chan
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228, Singapore
| | - Ka-Po Gabriel Liu
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 11, 119228, Singapore
| | - Hee-Kit Wong
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 11, 119228, Singapore
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Rivière C, Lazic S, Dagneaux L, Van Der Straeten C, Cobb J, Muirhead-Allwood S. Spine-hip relations in patients with hip osteoarthritis. EFORT Open Rev 2018; 3:39-44. [PMID: 29657844 PMCID: PMC5890167 DOI: 10.1302/2058-5241.3.170020] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Patients with hip osteoarthritis often have an abnormal spine-hip relation (SHR), meaning the presence of a clinically deleterious spine-hip and/or hip-spine syndrome. Definition of the individual SHR is ideally done using the EOS® imaging system or, if not available, with conventional lumbopelvic lateral radiographs. By pre-operatively screening patients with abnormal SHR, it is possible to refine total hip replacement (THR) surgical planning, which may improve outcomes. An important component of the concept of kinematically aligned total hip arthroplasty (KA THA) consists of defining the optimal acetabular cup design and orientation based on the assessment of an individual’s SHR, and use of the transverse acetabular ligament to adjust the cup positioning. The Bordeaux classification might advance the understanding of SHR and hopefully help improve THR outcomes.
Cite this article: EFORT Open Rev 2018;3:39-44. DOI: 10.1302/2058-5241.3.170020
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Affiliation(s)
- Charles Rivière
- MSK Lab, Imperial College London, UK.,South West London Elective Orthopaedic Centre, UK
| | - Stefan Lazic
- South West London Elective Orthopaedic Centre, UK
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20
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Jeon CH, Kwack KS, Park S, Lee HD, Chung NS. Combination of whole-spine lateral radiograph and lateral scanogram in the assessment of global sagittal balance. Spine J 2018; 18:255-260. [PMID: 28709947 DOI: 10.1016/j.spinee.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 06/28/2017] [Accepted: 07/06/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Global balance of human standing is analyzed as the geometric sum of the individual alignments extending from the spinal column to the pelvis, and to the lower limbs. The innovative EOS system has opened new perspectives for the global analysis of whole-body alignment, but its use is very limited because of its high cost. An alternative may be to combine the whole-spine lateral radiograph and the lateral scanogram in the global sagittal analysis of whole-body alignment. PURPOSE We examined to determine the validity and reliability of a lateral scanogram in the measurement of sacropelvic parameters. STUDY DESIGN/SETTING A retrospective radiological study was carried out. PATIENT SAMPLE We randomly selected 100 sets of digital radiographs, both whole-spine radiographs and lower-limb scanograms, from our database. OUTCOME MEASURES Sacropelvic parameters, including pelvic incidence, sacral slope, and pelvic tilt, were measured on both whole-spine radiographs and lower-limb scanograms by three independent examiners on three separate occasions. METHODS Agreement regarding the measurements on both image types was calculated to assess the validity of the lateral scanogram for use in whole-body alignment determinations. Intraobserver and interobserver reliabilities among the types of measurements were calculated. RESULTS The sacropelvic area on the lateral scanogram was not visible in 19 patients (19%). In the remaining 81 patients, the sacropelvic parameters on the lateral scanogram were similar to those on the whole-spine lateral radiograph (Pearson correlation coefficient, 0.764-0.805). Intraobserver and interobserver reproducibilities for both modalities were good to excellent (intraclass correlation coefficient, 0.657-0.984). CONCLUSIONS Sacropelvic parameter measurements on lateral scanogram were reliable and were similar to those measured on whole-spine lateral radiograph. Thus, global alignment can be evaluated using the lateral scanogram in combination with the whole-spine lateral radiograph.
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Affiliation(s)
- Chang-Hoon Jeon
- Department of Orthopaedic Surgery, Ajou University School of Medicine, San 5 Wonchon-dong, Youngtong-gu, Suwon 443-721, Republic of Korea
| | - Kyu-Sung Kwack
- Department of Radiology, Ajou University School of Medicine, San 5 Wonchon-dong, Youngtong-gu, Suwon 443-721, Republic of Korea
| | - Sunghoon Park
- Department of Radiology, Ajou University School of Medicine, San 5 Wonchon-dong, Youngtong-gu, Suwon 443-721, Republic of Korea
| | - Han-Dong Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, San 5 Wonchon-dong, Youngtong-gu, Suwon 443-721, Republic of Korea
| | - Nam-Su Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, San 5 Wonchon-dong, Youngtong-gu, Suwon 443-721, Republic of Korea.
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Al-Riyami K, Gnanasegaran G, Van den Wyngaert T, Bomanji J. Bone SPECT/CT in the postoperative spine: a focus on spinal fusion. Eur J Nucl Med Mol Imaging 2017; 44:2094-2104. [PMID: 28681193 DOI: 10.1007/s00259-017-3765-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/21/2017] [Indexed: 12/30/2022]
Abstract
Low back pain is a global problem affecting one in 10 people. The management of low back pain varies from conservative to more invasive methods with a spectacular increase in the number of patients undergoing spinal fusion surgery during the last decade. Conventional radiological and radionuclide studies are often used in the assessment of persistent or recurring pain after spinal surgery with several advantages and limitations related to each technique. This article reviews the key contribution of integrated bone SPECT/CT in evaluating patients with persistent or recurring pain after spinal surgery, focusing on spinal fusion. Current literature supports the use of bone SPECT/CT as an adjunct imaging modality and problem-solving tool in evaluating patients with suspicion of pseudarthrosis, adjacent segment degeneration, and hardware failure. The role of bone SPECT/CT in post-operative orthopaedic scenarios is evolving, and this review highlights the need for further research on the role of bone SPECT/CT in these patients.
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Affiliation(s)
- Khulood Al-Riyami
- Institute of Nuclear Medicine, University College London Hospitals, Tower 5, 235 Euston Road, London, NW1 2BU, UK
| | | | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospitals, Tower 5, 235 Euston Road, London, NW1 2BU, UK.
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Rivière C, Lazennec JY, Van Der Straeten C, Auvinet E, Cobb J, Muirhead-Allwood S. The influence of spine-hip relations on total hip replacement: A systematic review. Orthop Traumatol Surg Res 2017; 103:559-568. [PMID: 28373138 DOI: 10.1016/j.otsr.2017.02.014] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 02/02/2023]
Abstract
Sagittal pelvic kinematics along with spino-pelvic angular parameters have recently been studied by numerous investigators for their effect on total hip replacement (THR) clinical outcomes, but many issue of spine-hip relations (SHR) are currently unexplored. Therefore, our review aims at clarifying the following questions: is there any evidence of a relationship between articular impingement/dislocation risk in primary THR and (1) certain sagittal pelvic kinematics patterns, (2) pelvic incidence, and (3) types of SHRs? A systematic review of the existing literature utilising PubMed and Google search engines was performed in January 2017. Only clinical or computational studies published in peer-reviewed journals over the last five years in either English or French were reviewed. We identified 769 reports, of which 12 met our eligibility criteria. A review of literature shows that sagittal pelvic kinematics, but not the pelvic incidence, influences the risk of prosthetic impingement/dislocation. We found no study having assessed the relationship between this risk and the types of SHRs. Sagittal pelvic kinematics is highly variable among individuals and certain kinematic patterns substantially influences the risk of prosthetic impingement/dislocation. Recommendations for cup positioning are therefore switching from a systematic to a patient-specific approach, with the standing cup orientation Lewinneck safe zone progressively giving way to a new parameter of interest: the functional orientation of the cup. Based on a recently published classification for SHRs, We propose a new concept of "kinematically aligned THR" for the purposes of THR planning. Further studies are needed to investigate the relevance of such a classification towards the assumptions and hypothesis we have made. Level of evidence,- Level IV, systematic review of level III and IV studies.
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Affiliation(s)
- C Rivière
- MSK Lab, 7, Laboratory Block, Charing Cross Campus, Imperial college of London, W6 8RP London, UK.
| | - J-Y Lazennec
- Service de chirurgie orthopédique, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie, 47-83, boulevard de l'Hôpital, 75634 Paris cedex 13, France
| | - C Van Der Straeten
- MSK Lab, 7, Laboratory Block, Charing Cross Campus, Imperial college of London, W6 8RP London, UK
| | - E Auvinet
- MSK Lab, 7, Laboratory Block, Charing Cross Campus, Imperial college of London, W6 8RP London, UK
| | - J Cobb
- MSK Lab, 7, Laboratory Block, Charing Cross Campus, Imperial college of London, W6 8RP London, UK
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Lazennec JY, Folinais D, Bendaya S, Rousseau MA, Pour AE. The global alignment in patients with lumbar spinal stenosis: our experience using the EOS full-body images. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:713-24. [PMID: 27573076 DOI: 10.1007/s00590-016-1833-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 08/02/2016] [Indexed: 01/17/2023]
Abstract
Lumbar stenosis is frequently observed and treated by spine surgeons. The extent of neurological decompression and the potential spinal fixation are the basic concerns when surgery is planned. But this segmented approach to the problem is sometimes insufficient due to the complex functional situations induced by a sagittal imbalance of the patient and the combination of pathologies known as hip-spine or knee-spine syndromes. A total of 373 consecutive patients included from our EOS and clinical data base. Patients were divided in two groups. Group A included patients presenting exclusive spinal issues (172 cases) out of whom 117 (68 %) had sagittal imbalance. Among 201 patients with associated lower limbs issues (group B), 122 (61 %) had sagittal imbalance. The perception of imbalance was noticed in 54 % (93 cases) in group A and 57 % (115 cases) in group B. In the global series of 239 imbalanced cases, the key point was a spine issue for 165 patients (the 117 patients with only spine problems and 48/122 cases with combined spine and lower limbs problems). But in the patients with combined spine and lower limbs problems, we individualized hip-spine syndromes (24/122 patients) and knee-spine syndromes (13/122 patients). In some cases, (37/122 patients) the anatomical and functional situations were more complex to characterize a spine-hip or a hip-spine problem. The EOS full-body images provide new information regarding the global spinal and lower limbs alignment to improve the understanding of the patient functional posture. This study highlights the importance of the lower limb evaluation not only as compensatory mechanism of the spinal problems but also as an individualized parameter with its own influence on the global balance analysis. Level of evidence IV diagnostic case series.
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Affiliation(s)
- Jean Yves Lazennec
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpétrière hospital Assistance Publique - Hopitaux de Paris, UPMC, Paris, France. .,Biomechanics Lab (LBM), Arts et Metiers Paris-Tech, Paris, France. .,Department of Anatomy, UPMC, Paris, France.
| | | | - Samy Bendaya
- Rothschild Hospital Assistance Publique - Hopitaux de Paris, Paris, France
| | - Marc Antoine Rousseau
- Biomechanics Lab (LBM), Arts et Metiers Paris-Tech, Paris, France.,Avicenne Hospital Assistance Publique - Hopitaux de Paris, Bobigny, France
| | - Aidin Eslam Pour
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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Melhem E, Assi A, El Rachkidi R, Ghanem I. EOS(®) biplanar X-ray imaging: concept, developments, benefits, and limitations. J Child Orthop 2016; 10:1-14. [PMID: 26883033 PMCID: PMC4763151 DOI: 10.1007/s11832-016-0713-0] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/22/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE In 1992, Georges Charpak invented a new type of X-ray detector, which in turn led to the development of the EOS(®) 2D/3D imaging system. This system takes simultaneous anteroposterior and lateral 2D images of the whole body and can be utilized to perform 3D reconstruction based on statistical models. The purpose of this review is to present the state of the art for this EOS(®) imaging technique, to report recent developments and advances in the technique, and to stress its benefits while also noting its limitations. METHODS The review was based on a thorough literature search on the subject as well as personal experience gained from many years of using the EOS(®) system. RESULTS While EOS(®) imaging could be proposed for many applications, it is most useful in relation to scoliosis and sagittal balance, due to its ability to take simultaneous orthogonal images while the patient is standing, to perform 3D reconstruction, and to determine various relationships among adjacent segments (cervical spine, pelvis, and lower limbs). The technique has also been validated for the study of pelvic and lower-limb deformity and pathology in adult and pediatric populations; in such a study it has the advantage of allowing the measurement of torsional deformity, which classically requires a CT scan. CONCLUSIONS The major advantages of EOS(®) are the relatively low dose of radiation (50-80 % less than conventional X-rays) that the patient receives and the possibility of obtaining a 3D reconstruction of the bones. However, this 3D reconstruction is not created automatically; a well-trained operator is required to generate it. The EOS(®) imaging technique has proven itself to be a very useful research and diagnostic tool.
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Affiliation(s)
- Elias Melhem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
| | - Rami El Rachkidi
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon
| | - Ismat Ghanem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon ,Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
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Masquefa T, Verdier N, Gille O, Boissière L, Obeid I, Maillot C, Tournier C, Fabre T. Change in acetabular version after lumbar pedicle subtraction osteotomy to correct post-operative flat back: EOS® measurements of 38 acetabula. Orthop Traumatol Surg Res 2015; 101:655-9. [PMID: 26362041 DOI: 10.1016/j.otsr.2015.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 06/13/2015] [Accepted: 07/16/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Abnormalities in acetabular orientation can promote the development of hip osteoarthritis, femoro-acetabular impingement, or even acetabular cup malposition. The objective of the present study was to determine whether pedicle substraction osteotomy (PSO) to correct sagittal spinal imbalance affected acetabular orientation. HYPOTHESIS PSO performed to correct sagittal spinal imbalance affects acetabular orientation by changing the pelvic parameters. MATERIALS AND METHODS This was a descriptive study in which two observers measured the acetabular parameters on both sides in 19 patients (38 acetabula) before and after PSO for post-operative flat-back syndrome. Mean time from PSO to post-operative measurements was 19months. Measurements were taken twice at a 2-week interval, on standing images obtained using the EOS(®) imaging system and sterEOS(®) software to obtain 3D reconstructions of synchronised 2D images. Acetabular anteversion and inclination were measured relative to the vertical plane. Mean pre-PSO and post-PSO values were compared using the paired t-test, and P values lower than 0.05 were considered significant. To assess inter-observer and intra-observer reproducibility, we computed the intra-class correlation coefficients (ICCs). RESULTS The measurements showed significant acetabular retroversion after PSO, of 7.6° on the right and 6.5° on the left (P<0.001). Acetabular inclination diminished significantly, by 4.5° on the right and 2.5° on the left (P<0.01). Inclination of the anterior pelvic plane decreased by 8.4° (P<0.01). Pelvic incidence was unchanged, whereas sacral slope increased by 10.5° (P<0.001) and pelvic tilt decreased by 10.9° (P<0.001). The ICC was 0.98 for both inter-observer and intra-observer reproducibility. CONCLUSION Changing the sagittal spinal alignment modifies both the pelvic and the acetabular parameters. PSO significantly increases sacral slope, thus inducing anterior pelvic tilt with significant acetabular retroversion. The measurements obtained using sterEOS(®) showed good inter-observer and intra-observer reproducibility. To our knowledge, this is the first study of changes in acetabular version after PSO.
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Affiliation(s)
- T Masquefa
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France.
| | - N Verdier
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - O Gille
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - L Boissière
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - I Obeid
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - C Maillot
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - C Tournier
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | - T Fabre
- Service d'orthopédie traumatologie, hôpital Pellegrin, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
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