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Baroncini A, Boissiere L, Yilgor C, Larrieu D, Alanay A, Pellisé F, Kleinstueck F, Pizones J, Charles YP, Roscop C, Bourghli A, Obeid I. Primary Pelvic Anteversion: Definition, Relevance And History After Surgery for Adult Spine Deformity. Spine (Phila Pa 1976) 2024:00007632-990000000-00604. [PMID: 38407226 DOI: 10.1097/brs.0000000000004971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVE To identify the best definition of primary anteverted pelvis in the setting of adult spine deformity (ASD), and to investigate whether this is a pathologic setting that requires surgical correction. SUMMARY OF BACKGROUND DATA While pelvic retroversion has been thoroughly investigated, pelvic anteversion (AP) is a far lesser discussed topic. Four different AP definitions have been proposed, and AP has been described as a normal or pathologic entity by different authors. METHODS All patients consulting for ASD at the five participating sites were included. Firstly, the four definitions of AP were compared with descriptive statistics (anatomic method - Pelvic Tilt <0°; Relative Pelvic Version method - RPV >5°; Roussouly method - Pelvic Incidence (PI)<50° and Sacral Slope (SS)>35°); low PT method - PT/PI <25th percentile). Secondly a subgroup analysis among operated AP patients with a two-year follow-up was performed. Complication rate, radiographic parameters and clinical scores (ODI, SF-36) were compared in a multivariate analysis between patients who did and did not maintain an AP at the 2-year follow-up. RESULTS 1163 patients were available for the first analysis. The RPV method appeared to be the most appropriate to define AP in ASD patient. For the second analysis, data on 410 subjects were available, and most of them were young adults with idiopathic scoliosis that did not require pelvic fixation. AP patients who maintained an AP after ASD surgery presented comparable radiographic and clinical outcomes to the patients who presented a normo/retroverted pelvis after surgery. CONCLUSIONS According to the results of the presented study, the RPV method is the most appropriate to define primary AP, which is not a pathologic condition and is most often observed in young adults with idiopathic scoliosis. Anteverted pelvis does not require direct surgical correction in this patient group.
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Affiliation(s)
- Alice Baroncini
- Department of Orthopaedics and Trauma Surgery, RWTH Uniklinik Aachen, Germany
| | - Louis Boissiere
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Bruges Cedex, France
| | - Caglar Yilgor
- Spine Center, Acibadem University School of Medicine, Istanbul, Turkey
| | - Daniel Larrieu
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Ahmet Alanay
- Spine Center, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Vall D'Hebron Hospital, Barcelona, Spain
| | | | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | - Cecile Roscop
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Anouar Bourghli
- Spine surgery department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Bruges Cedex, France
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Pan C, Bourghli A, Larrieu D, Boissiere L, Pizones J, Alanay A, PelIise F, Kleinstück F, Obeid I. Sagittal alignment of diverse mechanical complications following adult spinal deformity surgery. Eur Spine J 2024:10.1007/s00586-023-08126-0. [PMID: 38270602 DOI: 10.1007/s00586-023-08126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE To compare the sagittal alignment of patients with diverse mechanical complications (MCs) following adult spinal deformity (ASD) surgery with that of patients without MCs. METHODS A total of 371 patients who underwent ASD surgery were enrolled. The sagittal spinopelvic parameters were measured preoperatively and at the 6-month and last follow-up, and the global alignment and proportion (GAP) score was calculated. The subjects were divided into non-MC and MCs groups, and the MCs group was further divided into rod fracture (RF), screw breakage (SB), screw dislodgement (SD) and proximal junctional kyphosis (PJK) subgroups. RESULTS Preoperatively, the RF group had greater thoracolumbar kyphosis (TLK) and relative upper lumbar lordosis (RULL); the SB group had the largest pelvic incidence (PI) and lumbar lordosis (LL); the SD group had the least global sagittal imbalance; and the PJK group had the highest thoracic kyphosis (TK), TLK and RULL. At the last follow-up, the RF and SB groups featured a large PI minus LL (PI-LL), while the PJK group featured a prominent TK; all the MCs subgroups had sagittal malalignment and a higher GAP score, and the SB group had the most severe cases. Logistic regressions showed that the relative spinopelvic alignment (RSA) score was correlated with RF, SB and SD, while the RSA and age scores were associated with PJK. CONCLUSION Each patient with MCs had individual characteristics in the sagittal plane following ASD surgery, which may be helpful to understand the pathophysiology of poor sagittal alignment with its subsequent MCs and guide an eventual revision strategy.
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Affiliation(s)
- Changyu Pan
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Digital Spine Research Institute, Changsha, 410011, Hunan, China.
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O.Box 84400, 11671, Riyadh, Saudi Arabia
| | - Daniel Larrieu
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Louis Boissiere
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ferran PelIise
- Spine Surgery Unit, Hospital Universitario Vall Hebron, Barcelona, Spain
| | | | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
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Boissiere L, Bourghli A, Guevara-Villazon F, Pellisé F, Alanay A, Kleinstück F, Pizones J, Roscop C, Larrieu D, Obeid I. Rod Angulation Relationship with Thoracic Kyphosis after Adolescent Idiopathic Scoliosis Posterior Instrumentation. Children (Basel) 2023; 11:29. [PMID: 38255344 PMCID: PMC10813855 DOI: 10.3390/children11010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Surgery to correct spinal deformities in scoliosis involves the use of contoured rods to reshape the spine and correct its curvatures. It is crucial to bend these rods appropriately to achieve the best possible correction. However, there is limited research on how the rod bending process relates to spinal shape in adolescent idiopathic scoliosis surgery. METHODS A retrospective study was conducted using a prospective multicenter scoliosis database. This study included adolescent idiopathic scoliosis patients from the database who underwent surgery with posterior instrumentation covering the T4 to T12 segments. Standing global spine X-rays were used in the analysis. The sagittal Cobb angles between T5 and T11 were measured on the spine. Additionally, the curvature of the rods between T5 and T11 was measured using the tangent method. To assess the relationship between these measurements, the difference between the dorsal kyphosis (TK) and the rod kyphosis (RK) was calculated (ΔK = TK - RK). This study aimed to analyze the correlation between ΔK and various patient characteristics. Both descriptive and statistical analyses were performed to achieve this goal. RESULTS This study encompassed a cohort of 99 patients, resulting in a total of 198 ΔK measurements for analysis. A linear regression analysis was conducted, revealing a statistically significant positive correlation between the kyphosis of the rods and that of the spine (r = 0.77, p = 0.0001). On average, the disparity between spinal and rod kyphosis averaged 5.5°. However, it is noteworthy that despite this modest mean difference, there was considerable variability among the patients. In particular, in 84% of cases, the concave rod exhibited less kyphosis than the spine, whereas the convex rod displayed greater kyphosis than the spine in 64% of cases. It was determined that the primary factor contributing to the flattening of the left rod was the magnitude of the coronal Cobb angle, both before and after the surgical procedure. These findings emphasize the importance of considering individual patient characteristics when performing rod bending procedures, aiming to achieve the most favorable outcomes in corrective surgery. CONCLUSIONS Although there is a notable and consistent correlation between the curvature of the spine and the curvature of the rods, it is important to acknowledge the substantial heterogeneity observed in this study. This heterogeneity suggests that individual patient factors play a significant role in shaping the outcome of spinal corrective surgery. Furthermore, this study highlights that more severe spinal curvatures in the frontal plane have an adverse impact on the shape of the rods in the sagittal plane. In other words, when the scoliosis curve is more pronounced in the frontal plane, it tends to influence the way the rods are shaped in the sagittal plane. This underscores the complexity of spinal deformities and the need for a tailored approach in surgical interventions to account for these variations among patients.
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Affiliation(s)
- Louis Boissiere
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, 33520 Bruges, France
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, 08035 Barcelona, Spain
| | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Istanbul 34750, Turkey
| | - Frank Kleinstück
- Research and Development, Schulthess Klinik, 8008 Zurich, Switzerland
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Cécile Roscop
- Spine Surgery Unit, CHU Pellegrin, 33076 Bordeaux, France
| | - Daniel Larrieu
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, 33520 Bruges, France
| | - Ibrahim Obeid
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, 33520 Bruges, France
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Boissiere L, Bourghli A, Kieser D, Larrieu D, Alanay A, Pellisé F, Kleinstück F, Loibl M, Pizones J, Obeid I. Fixed coronal malalignment (CM) in the lumbar spine independently impacts disability in adult spinal deformity (ASD) patients when considering the obeid-CM (O-CM) classification. Spine J 2023; 23:1900-1907. [PMID: 37633521 DOI: 10.1016/j.spinee.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/20/2023] [Accepted: 08/13/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Postoperative flatback has been described in detail for sagittal plane considerations over the past 2 decades, and its correlations with disability are now accepted. Fixed Coronal Malalignment (CM) has been less described, and some authors report no significant association with the clinical outcome. The O-CM classification analyses CM and incorporates specific modifiers for each curve type. PURPOSE This study evaluates the O-CM classification modifiers according to age, sagittal alignment, and patient-reported outcome measures (PROMs). Our hypothesis is that fixed CM correlates with PROMs independently from sagittal alignment and age. STUDY DESIGN Retrospective analysis of a large adult spinal deformity (ASD) database prospectively collected. PATIENT SAMPLE We included 747 patients from the database with long lumbar fusion (more than 3 levels), with at least two years of follow-up. Three categories of patients met the inclusion criteria (prior surgery at baseline and no revision surgery afterward, prior surgery at baseline and revision afterward, no prior surgery at baseline but fusion>3 levels and 2 years follow-up). OUTCOME MEASURES All patients completed the Oswestry Disability Index (ODI), Short Form 36 (SF36), and Scoliosis Research Society 22 scores. METHODS The patients were classified according to the six modifiers of the O-CM classification. Central Sacral Vertical Line (CSVL) above 2, 3, and 4 cm's impact on PROMs was analyzed. Multivariate analysis was performed on the relationship between PROMS and age, global tilt (GT), and CM modifiers. RESULTS After multivariate analysis using age and GT as confounding factors, we found that CM independently affects PROMs starting at 2 cm offset. Disability increases linearly with CSVL. Patients classified with 2B modifiers have the worst SRS-22 total score, social life, and self-image. CONCLUSION In a fused spine, CM independently affects disability in ASD patients. Disability increases linearly with CSVL. Despite previous reports that failed to find correlations of CM with PROMs, our study showed that fixed postoperative CM, according to O-CM classification, correlates independently from sagittal malalignment with worse PROMs. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Louis Boissiere
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, Bruges, France.
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Hospital, Al Mathar Ash Shamali, Riyadh 11564, Saudi Arabia
| | - David Kieser
- School of Medicine, University of Otago, PO Box 4345, Christchurch 8140, New Zealand
| | - Daniel Larrieu
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, Bruges, France
| | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Kayışdağı Cd., 34750 Ataşehir/ Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron 119, 08035 Barcelona, Spain
| | - Frank Kleinstück
- Research and Development, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | - Markus Loibl
- Research and Development, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, P.º de la Castellana, 261, Madrid, Spain
| | - Ibrahim Obeid
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, Bruges, France
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Baroncini A, Frechon P, Bourghli A, Smith JS, Larrieu D, Pellisé F, Pizones J, Kleinstueck F, Alanay A, Kieser D, Cawley DT, Boissiere L, Obeid I. Adherence to the Obeid coronal malalignment classification and a residual malalignment below 20 mm can improve surgical outcomes in adult spine deformity surgery. Eur Spine J 2023; 32:3673-3680. [PMID: 37393421 DOI: 10.1007/s00586-023-07831-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/17/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Coronal balance is a major factor impacting the surgical outcomes in adult spinal deformity (ASD). The Obeid coronal malalignment (O-CM) classification has been proposed to improve the coronal alignment in ASD surgery. Aim of this study was to investigate whether a postoperative CM < 20 mm and adherence to the O-CM classification could improve surgical outcomes and decrease the rate of mechanical failure in a cohort of ASD patients. METHODS Multicenter retrospective analysis of prospectively collected data on all ASD patients who underwent surgical management and had a preoperative CM > 20 mm and a 2-year follow-up. Patients were divided in two groups according to whether or not surgery had been performed in adherence to the guidelines of the O-CM classification and according to whether or not the residual CM was < 20 mm. The outcomes of interest were radiographic data, rate of mechanical complications and Patient-Reported Outcome Measures. RESULTS At 2 years, adherence to the O-CM classification led to a lower rate of mechanical complications (40 vs. 60%). A coronal correction of the CM < 20 mm allowed for a significant improvement in SRS-22 and SF-36 scores and was associated with a 3.5 times greater odd of achieving the minimal clinical important difference for the SRS-22. CONCLUSION Adherence to the O-CM classification could reduce the risk of mechanic complications 2 years after ASD surgery. Patients with a residual CM < 20 mm showed better functional outcomes and a 3.5 times greater odd of achieving the MCID for the SRS-22 score.
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Affiliation(s)
- Alice Baroncini
- Department of Orthopaedics and Trauma Surgery, RWTH Uniklinik Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Paul Frechon
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- Department of Neurosurgery, Caen University Hospital, Caen, France
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Justin S Smith
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Daniel Larrieu
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Ferran Pellisé
- Spine Surgery Unit, Vall D'Hebron Hospital, Barcelona, Spain
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | - Ahmet Alanay
- Spine Center, Acibadem University School of Medicine, Istanbul, Turkey
| | - David Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
| | - Derek T Cawley
- Department of Spine Surgery, Mater Private Hospital, Dublin, Ireland
| | - Louis Boissiere
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Brugge Cedex, France
| | - Ibrahim Obeid
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Brugge Cedex, France
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Boissiere L, Guevara-Villazón F, Bourghli A, Abdallah R, Pellise F, Pizones J, Alanay A, Kleinstueck F, Larrieu D, Obeid I. Rod angulation does not reflect sagittal curvature in adult spinal deformity surgery: comparison of lumbar lordosis and rod contouring. Eur Spine J 2023; 32:3666-3672. [PMID: 37278877 DOI: 10.1007/s00586-023-07791-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/26/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE Relationship between rod and spinal shape in the sagittal plane in adult spinal deformity (ASD) surgery. BACKGROUND Corrective surgery for adult spinal deformity (ASD) involves the use of contoured rods to correct and modify the spinal curvatures. Adequate rod bending is crucial for achieving optimal correction. The correlation between rods and spinal shape in long constructs has not been reported previously. METHODS We conducted a retrospective analysis of a prospective, multicenter database of patients who underwent surgery for ASD. The inclusion criteria were patients who underwent pelvic fixation and had an upper instrumented vertebra at or above T12. Pre- and post-operative standing radiographs were used to assess lumbar lordosis at the L4S1 and L1S1 levels. The angle between the tangents to the rod at the L1, L4, and S1 pedicles was calculated to determine the L4S1 and L1S1 rod lordosis. The difference between the lumbar lordosis (LL) and the rod lordosis (RL) was calculated as ΔL = LL-RL. The correlation between this difference (ΔL) and various characteristics was analyzed using descriptive and statistical methods. RESULTS Eighty-three patients were included in the study, resulting in 166 analyzed differences (ΔL) between the rod and spinal lordosis. The values for rod lordosis were found to be both greater and lesser than those of the spine but were mostly lower. The range for total ΔL was -24 °-30.9 °, with a mean absolute ΔL of 7.8 ° for L1S1 (standard deviation (SD) = 6.0) and 9.1 ° for L4S1 (SD = 6.8). In 46% of patients, both rods had a ΔL of over 5 °, and over 60% had at least one rod with a ΔL difference of over 5 °. Factors found to be related to a higher ΔL included postoperative higher lumbar lordosis, presence of osteotomies, higher corrected degrees, older age, and thinner rods. Multivariate analysis correlated only higher postoperative L1S1 lordosis with higher ΔL. No correlation was found between a higher ΔL and sagittal imbalance. CONCLUSIONS Variations between spinal and rod curvatures were observed despite the linear regression correlation. The shape of the rod does not seem to be predictive of the shape of the spine in the sagittal plane in ASD long-construct surgeries. Several factors, other than rod contouring, are involved in explaining the postoperative shape of the spine. The observed variation calls into question the fundamentals of the ideal rod concept.
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Affiliation(s)
- Louis Boissiere
- Elsan, Polylinique Jean Villar Bruges, Bruges-Bordeaux, France
| | | | - Anouar Bourghli
- Spine Surgey Department King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ralph Abdallah
- Elsan, Polylinique Jean Villar Bruges, Bruges-Bordeaux, France
| | - Ferran Pellise
- Spine Surgery Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Ahmet Alanay
- Spine Surgery Unit, Acibadem University, Istanbul, Turkey
| | - Frank Kleinstueck
- Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland
| | - Daniel Larrieu
- Elsan, Polylinique Jean Villar Bruges, Bruges-Bordeaux, France
| | - Ibrahim Obeid
- Elsan, Polylinique Jean Villar Bruges, Bruges-Bordeaux, France.
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Bourghli A, Boissiere L, Konbaz F, Larrieu D, Almusrea K, Obeid I. Domino connector for thoracic pedicle subtraction osteotomy reduction: surgical technique and patient series. Eur Spine J 2023; 32:1800-1809. [PMID: 36935453 DOI: 10.1007/s00586-023-07650-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/16/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE Different techniques have been previously described to close the pedicle subtraction osteotomy (PSO) site for correction of sagittal malalignment; the use of a side-to-side domino connector as a correction tool in the thoracic spine has not been specifically studied. METHODS Twenty adult patients who underwent single-level thoracic PSO from T1 to T12 were included and retrospectively reviewed (two centers). Preoperative and postoperative full-body X-rays, perioperative data, clinical data and complications were recorded with a minimum 2 years of follow-up. Surgical technique and the nuances in using the domino connector were described in detail. RESULTS Patients had a mean age of 40y; 40% were female. Two different techniques involving the domino were applied for closure of the PSO site depending on the type of kyphosis (smooth vs. angular deformity). Both techniques provided significant correction of the local kyphosis (from 48° to 18°) with reciprocal reduction of compensatory cervical lordosis (from 37.6° to 18.6°, p < 0.01) in upper thoracic PSO or lumbar lordosis (from 74.5° to 46.6°, p < 0.01) in lower thoracic PSO. Four patients presented postoperative complications that resolved (hemothorax, GI bleeding), and two patients presented transient neurological deficit. Oswestry Disability Index score improved in the majority of the patients (from 32.7 to 22.5, p < 0.05). There were no pseudarthroses, symptomatic instrumentation breakage, or surgical site infection. CONCLUSION Use of a side-to-side domino connector in combination with two different rod cantilever techniques is effective for the reduction of thoracic pedicle subtraction osteotomy achieving satisfactory radiological and clinical outcome.
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Affiliation(s)
- Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Louis Boissiere
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Faisal Konbaz
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Daniel Larrieu
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Khaled Almusrea
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
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Konbaz F, Aldakhil S, Alhelal F, Abalkhail M, Bourghli A, Ateeq K, Aleissa S. Iatrogenic contralateral foraminal stenosis following lumbar spine fusion surgery: illustrative cases. J Neurosurg Case Lessons 2023; 5:CASE2317. [PMID: 36941201 PMCID: PMC10550679 DOI: 10.3171/case2317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/10/2023] [Indexed: 03/22/2023]
Abstract
BACKGROUND Lumbar spine fusion is the mainstay treatment for degenerative spine disease. Multiple potential complications of spinal fusion have been found. Acute contralateral radiculopathy postoperatively has been reported in previous literature, with unclear underlying pathology. Few articles reported the incidence of contralateral iatrogenic foraminal stenosis after lumbar fusion surgery. The aim of current article is to explore the possible causes and prevention of this complication. OBSERVATIONS The authors present 4 cases in which patients developed acute postoperative contralateral radiculopathy requiring revision surgery. In addition, we present a fourth case in which preventive measures have been applied. The aim of this article was to explore the possible causes and prevention to this complication. LESSONS Iatrogenic foraminal stenosis of the lumbar spine is a common complication; preoperative evaluation and middle intervertebral cage positioning are needed to prevent this complication.
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Affiliation(s)
- Faisal Konbaz
- Department of Spine Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Sahar Aldakhil
- Department of Orthopedics, King Abdulaziz Medical City, Central Region, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Fahad Alhelal
- Department of Orthopedics, King Abdulaziz Medical City, Central Region, National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; and
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Majed Abalkhail
- Department of Orthopedics, King Abdulaziz Medical City, Central Region, National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; and
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Anouar Bourghli
- Department of Spine Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Khawlah Ateeq
- Department of Orthopedics, King Abdulaziz Medical City, Central Region, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Sami Aleissa
- Department of Orthopedics, King Abdulaziz Medical City, Central Region, National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; and
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Bourghli A, Boissière L, Obeid I. The Obeid-coronal malalignment classification is reliable and helps guiding decision-making and surgical management of adult spinal deformities: letter to the editor of BMC Musculoskeletal Disorders. BMC Musculoskelet Disord 2023; 24:145. [PMID: 36823582 PMCID: PMC9948463 DOI: 10.1186/s12891-023-06257-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
A recently published article by Zhang et al. in BMC Musculoskeletal Disorders reported that the classification of coronal deformity based on preoperative global coronal malalignment for adult spinal deformity is questionable. The aim of the paper was to specifically discredit the Obeid-Coronal Malalignment (O-CM) classification. In this correspondence, we thought it judicious to clarify misunderstood concepts by the authors. We highlight several limitations of their study, and explain the deep interest of the classification from our perspective in order to avoid misleading the readers. Overarching, we aim to help the colleagues through a constructive rather than destructive approach to better understand the foundations of a coronal malalignment classification.
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Affiliation(s)
- Anouar Bourghli
- Spine surgery department, King Faisal Special Hospital and Research Center, P.O.Box 3354, 11211, Riyadh, Saudi Arabia.
| | - Louis Boissière
- Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
| | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
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Bourghli A, Al Araki A, Konbaz F, Almusrea K, Boissière L, Obeid I. Delayed atlantoaxial rotatory dislocation in a child with Crohn's disease: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22515. [PMID: 36794742 PMCID: PMC10550607 DOI: 10.3171/case22515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/21/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Atlantoaxial rotatory dislocation (AARD) in children may be caused by neck trauma or an upper respiratory tract infection. Here the authors describe the very rare association between inflammatory bowel disease and AARD in a child. OBSERVATIONS A 7-year-old girl presented with an 11-month history of torticollis that occurred spontaneously without a trauma context. Her history revealed a recent diagnosis of Crohn's disease. Physical exam of the cervical spine revealed a "cock-robin" posture. Neck radiography and three-dimensional computed tomography reconstruction established the diagnosis of AARD. Given the duration of the symptoms and failure of previous conservative treatments, the patient was taken to the operating room and underwent open reduction through posterior approach with a C1-2 fusion according to the Harms technique. The torticollis resolved with no recurrence at the last follow-up and minimal restriction of rotation. LESSONS This is the third report to describe the very rare association between inflammatory bowel disease and AARD but at a very early age, the youngest in the literature. One should be aware of such association as early diagnosis may prevent aggressive surgical management.
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Affiliation(s)
- Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmad Al Araki
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia; and
| | - Faisal Konbaz
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khaled Almusrea
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Louis Boissière
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
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Abul K, Yilgor C, Yucekul A, Alanay NA, Yavuz Y, Zulemyan T, Boissiere L, Bourghli A, Obeid I, Pizones J, Kleinstueck F, Perez-Grueso FJS, Pellise F, Alanay A. Long-term opioid medication profile of European adult spinal deformity patients: minimum five years follow-up study. Spine J 2023; 23:209-218. [PMID: 36336253 DOI: 10.1016/j.spinee.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/03/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND CONTEXT There remains significant variability in the use of postoperative opioids. On one end, it is proven that appropriate pain control is a critical aspect of patient management; on the other end, past few decades have been associated with major increases in opioid-related overdoses and addiction treatment. We hypothesized that several pre- and postoperative risk factors affecting long-term opioid use could be identified. PURPOSE Evaluation of factors associated with minimum 5-year postoperative opioid use following adult spinal deformity surgery. STUDY DESIGN/SETTING Prospectively followed study group database. PATIENT SAMPLE Adult spinal deformity patients who underwent elective spine surgery between 2009 and 2016 were included. OUTCOME MEASURES Opioid usage or otherwise at minimum 5 years follow-up. Use of nonopioid analgesics, weak and strong opioids METHODS: Retrospective analysis of patients undergoing elective spinal deformity surgery. A total of 37 factors comprising patient characteristics, radiographic measurements, operative details, preoperative and early postoperative opioid use, and mechanical complications and revisions were analyzed. Details on identified factors were provided. RESULTS A total of 265 patients (215F, 50M) from five sites were included. The mean follow-up duration was 68.4±11.7 (60-102) months. On average, 10.6±3.5 levels were fused. Preoperatively, 64 (24.2%) patients were using opioids. The rate of opioid users increased to 33.6% at 6 weeks and decreased to 21.5% at 6 months. During follow-up, there were patients who discontinued opioids, while others have started and/or restarted using opioids. As a result, 59 (22.3%) patients were still on opioids at the latest follow-up. Multivariate analyses showed that factors independently affecting opioid use at an average of 68 months postoperatively, in order of significance, were opioid use at sixth weeks, preoperative opioid use and opioid use at sixth months with the odds ratios of 2.88, 2.51, and 2.38 respectively. At these time points, factors such as age, number of comorbidities, tobacco use, the time of the last prior spine surgery and postoperative sagittal plane alignment affected opioid usage rates. CONCLUSIONS Opioid usage at 6 weeks was found to be more predictive of long-term opioid use compared to preoperative use. Patients should be well informed to have realistic expectations regarding opioid use when considering adult spinal deformity surgery.
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Affiliation(s)
- Kadir Abul
- Clinic of Orthopedics and Traumatology, Basaksehir Pine and Sakura City Hospital, Olimpiyat Bulvarı Yolu, 34480 Basaksehir, Istanbul, Turkey
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem University School of Medicine, Kayisdagi Cad 32, 34752 Icerenkoy, Atasehir, Istanbul, Turkey
| | - Altug Yucekul
- Department of Orthopedics and Traumatology, Acibadem University School of Medicine, Kayisdagi Cad 32, 34752 Icerenkoy, Atasehir, Istanbul, Turkey
| | - Nezih Arin Alanay
- Lycée Français Notre Dame de Sion, Cumhuriyet Cad 127, 34373 Sisli, Istanbul, Turkey
| | - Yasemin Yavuz
- Department of Biostatistics, Ankara University School of Medicine, Adnan Saygun Cad., 06230 Altindag, Ankara, Turkey
| | - Tais Zulemyan
- Comprehensive Spine Center, Acibadem University Maslak Hospital, Buyukdere Cad 40, 34457 Sariyer, Istanbul, Turkey
| | - Louis Boissiere
- Clinique du Dos, Elsan Jean Villar Private Hospital, 2 Av. de Terrefort, 33520 Bruges, Bordeaux, France
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Al Mathar Ash Shamali, 11564 Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, 2 Av. de Terrefort, 33520 Bruges, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Frank Kleinstueck
- Spine Center Division, Department of Orthopedics and Neurosurgery, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | | | - Ferran Pellise
- Spine Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem University School of Medicine, Kayisdagi Cad 32, 34752 Icerenkoy, Atasehir, Istanbul, Turkey.
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Kieser DC, Wyatt MC, Boissiere L, Hayashi K, Cawley DT, Yilgor C, Larrieu D, Alanay A, Acaroglu E, Kleinstueck F, Pellisé F, Perez-Grueso FJS, Bourghli A, Vital JM, Gille O, Obeid I. An age and sex matched study on the effect of obesity on the functional outcomes and complication rates in patients with adult spinal deformity undergoing primary multi-level thoracolumbar spinal fusion. Ann Jt 2022; 7:33. [PMID: 38529155 PMCID: PMC10929431 DOI: 10.21037/aoj-22-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/18/2022] [Indexed: 03/27/2024]
Abstract
Background The objective of this study was to determine the effect of obesity on the functional outcomes and complication rates of patients with adult spinal deformity (ASD) undergoing multi-level thoracolumbar fusion. Methods An age and sex matched comparison of functional outcomes [Numeric Rating Scale (NRS) back and leg scores, Core Outcome Measurement Index (COMI) back scores, Scoliosis Research Society 22 (SRS22) satisfaction and total scores, Short Form 36 (SF36) general health scores, Physical Component Score (PCS), Mental Component Score (MCS), Oswestry Disability Index (ODI) (including all domains)] at 6 months, 1, 2, 3 and 4 years and the complication rates at final follow-up between obese [body mass index (BMI) >30] and normal BMI (18.5-24.9) patients undergoing more than 3 levels of thoracolumbar fusion with a minimum 2-year follow-up. Patients who had undergone any previous spinal surgery were excluded. Results Thirty patients were included in each arm of the study. Baseline demographics, including the number of levels fused, were similar between the groups. Estimated blood loss (EBL) was higher in obese patients (1,916 vs. 1,099 mL, P=0.001), but operative time was similar (282 vs. 320 min, P=0.351). The functional outcomes and satisfaction scores were consistently poorer in the obese group at all time-points, but their satisfaction scores were similar. Obese patients had a higher complication rate (OR 3.05, P=0.038) predominantly due to dural tears and nerve root injuries, but a similar reoperation rate. Conclusions In patients with ASD undergoing multi-level thoracolumbar fusion, obesity results in a higher blood loss, poorer sagittal correction, poorer post-operative functional scores and higher complication rates than patients with a normal BMI. However, obesity does not affect operative times, length of hospital stay or reoperation rates. Furthermore, patients with obesity have similar post-operative satisfaction scores to patients with normal BMIs.
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Affiliation(s)
- David Christopher Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Michael Charles Wyatt
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Louis Boissiere
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Kazunori Hayashi
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | | | - Caglar Yilgor
- Acibadem University School of Medicine, Istanbul, Turkey
| | - Daniel Larrieu
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, Bordeaux, France
| | - Ahmet Alanay
- Acibadem University School of Medicine, Istanbul, Turkey
| | - Emre Acaroglu
- Spine Surgery Unit, Ankara Acibadem ARTES Spine Center, Ankara, Turkey
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Jean-Marc Vital
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Olivier Gille
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Ibrahim Obeid
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
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Bourghli A, Boissiere L, Cawley D, Larrieu D, Pizones J, Alanay A, PelIise F, Kleinstück F, Obeid I. Domino connector is an efficient tool to improve lumbar lordosis correction angle after pedicle subtraction osteotomy for adult spinal deformity. Eur Spine J 2022; 31:2408-2414. [PMID: 35857129 DOI: 10.1007/s00586-022-07322-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/10/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To compare the radiological outcomes and complications of adult spinal deformity patients who underwent a pedicle subtraction osteotomy (PSO) below L2 but categorized according to their construct where either a domino connector was applied for osteotomy correction or not. METHODS Retrospective review of a prospective, multicenter adult spinal deformity database (5 sites). Inclusion criteria were adult patients who underwent PSO between L3 and L5 with a minimum follow-up of 2 years. Among 1243 patients in the database, 79 met the inclusion criteria, 41 in the no-domino (ND) group and 38 in the domino (D) group. The domino technique consisted of using 2 parallel rods connected by a domino on one side of the PSO in order to achieve gradual and controlled compression at the osteotomy site. Demographic data, operative parameters, spinopelvic parameters and complications were collected. RESULTS Demographic data and operative parameters were globally similar between both groups, and they showed a comparable preoperative sagittal malalignment. Segmental lordosis improved by 22° and 31° (p < 0.05) and L1S1 lordosis improved by 23° and 32° (p < 0.05) in the ND and D group, respectively. The use of multiple rods was similar between the groups (58% vs. 57%). Also, mechanical complications rate was globally similar between both groups with no statistically significant difference (22% vs. 28.9%). CONCLUSION Domino connector is a safe, powerful and efficient tool for pedicle subtraction osteotomy site closure. It improved the lumbar lordosis correction angle with an acceptable rate of complications.
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Affiliation(s)
- Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O.Box 84400, Riyadh, 11671, Saudi Arabia.
| | - Louis Boissiere
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | | | - Daniel Larrieu
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ferran PelIise
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
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Bourghli A, Boissiere L, Al Araki A, Alsofyani MA, Obeid I. Surgical correction of a previously operated juvenile idiopathic scoliosis with crankshaft phenomenon: an illustrative case report. J Spine Surg 2022; 8:397-404. [PMID: 36285099 PMCID: PMC9547701 DOI: 10.21037/jss-22-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/29/2022] [Indexed: 11/06/2022]
Abstract
Background Crankshaft phenomenon secondary to posterior fusion for scoliotic deformity at a young age has become rare and its management can be very challenging. Case Description We report the case of an 11-year-old girl who has been complaining of a progressively increasing hump in her back with waist and shoulders asymmetry during the past 6 months. Three years prior to presentation, she underwent in another institution posterior correction fusion from T3 to L3 for a juvenile idiopathic scoliosis with a Cobb angle of 60°. After the initial correction, follow-up X-rays revealed a progressive increase of the scoliosis angulation with the onset of a coronal malalignment mainly at the cervicothoracic junction. Full spine anteroposterior and lateral X-rays revealed a long right thoracolumbar scoliosis of 70° with a rib-vertebra angle difference of 27° and the proximal right screw pulled out from the rod. CT scan confirmed the posterior fusion between the apical vertebras. MRI did not show any congenital anomaly. The patient underwent a revision surgery with instrumentation from T1 to L4, and posterior column osteotomies at 6 levels between T4 and T10. Coronal Cobb angle corrected to 11° with satisfactory sagittal alignment and a maintained correction at 3 years of follow-up. Conclusions This is the first case to thoroughly illustrate surgical management in the onset of a crankshaft phenomenon. Through a posterior-only approach, the use of posterior column osteotomies at the apex of the deformity in order to release the previous fusion is a safe and satisfactory option to reestablish proper coronal and sagittal alignment, with satisfactory clinical and radiological long-term results.
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Affiliation(s)
- Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Louis Boissiere
- Spine Clinic, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Ahmad Al Araki
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Mohammed A. Alsofyani
- Orthopedic Department, College of Medicine and University Hospital, University of Ha’il, Ha’il, Saudi Arabia
| | - Ibrahim Obeid
- Spine Clinic, Elsan Jean Villar Private Hospital, Bordeaux, France
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Kieser DC, Yuksel S, Boissiere L, Yilgor C, Cawley DT, Hayashi K, Alanay A, Kleinstueck FS, Pellise F, Perez-Grueso FJS, Jean-Marc V, Bourghli A, Acaroglu ER, Obeid I. Impact of radiologic variables on item responses of ODI, SRS22 and SF-36. in adult spinal deformity patients: differential item functioning (DIF) analysis results from a multi-center database. Eur Spine J 2022; 31:1166-1173. [PMID: 35059861 DOI: 10.1007/s00586-021-07088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/24/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine if responses given to each question of the Scoliosis Research Society-22 (SRS22), Oswestry disability index (ODI) and Short Form-36 (SF-36) questionnaires are influenced by the radiological parameters. METHODS Patients enrolled in a multi-centre prospectively collected adult spinal deformity database who had complete SRS22, ODI and SF-36 data at baseline and at one-year follow-up were analysed. The presence of a differential item function of each question within each score in relation to radiological parameters was analysed using a mixed Rasch model with the radiological threshold value(s) determined. RESULTS Of those patients analysed (n = 1745; 1406 female, average age 51.0 ± 19.8 years), 944 were surgically and 801 were non-surgically treated. For the SRS22, questions (Q) 3, 5 and 18 were sensitive to almost all radiological parameters and the overall score was found sensitive to the Cobb angle. For the ODI, Q3, 6, 9 and 10 were not sensitive to any radiologic parameters whereas Q4 and 5 were sensitive to most. In contrast, only 3 of the SF-36 items were sensitive to radiological parameters. CONCLUSIONS 78% of the SRS-22, 60% of the ODI and 8% of the questions in the SF-36 are sensitive to radiological parameters. Sagittal imbalance is independently associated with a poor overall outcome, but affects mental status and function more than pain and self-image. The assembly of questions responsive to radiological parameters may be useful in establishing a connection between changes in radiologic parameters and HRQL.
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Affiliation(s)
- D C Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, 2 Riccarton Avenue, 8011, Christchurch, New Zealand.
| | - S Yuksel
- School of Medicine Ankara, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - L Boissiere
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - C Yilgor
- Mater Private Hospital, Dublin, Ireland
| | - D T Cawley
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France.,Mater Private Hospital, Dublin, Ireland
| | - K Hayashi
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - A Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | | | - F Pellise
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Vital Jean-Marc
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - A Bourghli
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | | | - I Obeid
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
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Bourghli A, Boissière L, Kieser D, Larrieu D, Pizones J, Alanay A, Pellisé F, Kleinstück F, Obeid I. Multiple-Rod Constructs Do Not Reduce Pseudarthrosis and Rod Fracture After Pedicle Subtraction Osteotomy for Adult Spinal Deformity Correction but Improve Quality of Life. Neurospine 2021; 18:816-823. [PMID: 34670073 PMCID: PMC8752720 DOI: 10.14245/ns.2142596.298] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/05/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To compare the radiological and functional outcomes and complications of adult spinal deformity patients who underwent a pedicle subtraction osteotomy (PSO) below L2 but categorized according to their construct where either 2-rod or multiple-rod construct is applied.
Methods Sixty-seven patients met the inclusion criteria, and were categorized into 3 groups: 2 rods (2R), multiple rods around the PSO (MRP), multiple rods around the PSO and lumbosacral junction (MRL). Demographic data, operative parameters, spinopelvic parameters, functional outcomes, and complications were collected.
Results Health-related quality of life scores showed a better outcome at 6 months and last follow-up visits in the MRP and MRL groups which were noted on different domains of Scoliosis Research Society-22 questionnaire, 36-item Short Form Health Surve, and Oswestry Disability Index scores (p<0.05). The 3 groups showed similar rates of rod-related complications with no significant difference (p=0.95). And inside each group, distribution of complications between pseudarthrosis with revision and rod fracture without revision was also similar (p=0.99).
Conclusion The use of multiple rods across the PSO did not show a better outcome when compared to single rods in terms of incidence and types of mechanical complications. However, better postoperative coronal alignment and health-related quality of life scores in the multiple rods group could be seen demonstrating an improved functional outcome.
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Affiliation(s)
- Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Louis Boissière
- Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
| | - David Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine , Dunedin, New Zealand
| | - Daniel Larrieu
- Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
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Kieser DC, Boissiere L, Bourghli A, Hayashi K, Cawley D, Yilgor C, Alanay A, Acaroglu E, Kleinstueck F, Pizones J, Pellise F, Perez-Grueso FJS, Obeid I. Obeid-Coronal Malalignment Classification Is Age Related and Independently Associated to Personal Reported Outcome Measurement Scores in the Nonfused Spine. Neurospine 2021; 18:475-480. [PMID: 34610677 PMCID: PMC8497236 DOI: 10.14245/ns.2142458.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023] Open
Abstract
Objective To evaluate Obeid-coronal malalignment (O-CM) modifiers according to age, sagittal alignment, and patient-reported outcome measures (PROMs), in the mobile spine.
Methods Retrospective review of a prospective multicenter adult spinal deformity (ASD) database with 1,243 (402 nonoperative, 841 operative) patients with no prior fusion surgery. Patients were included if they were aged over 18 years and were affected by spinal deformity defined by one of: Cobb angle ≥ 20°, pelvic tilt ≥ 25°, sagittal vertical axis ≥ 5 cm, thoracic kyphosis ≥ 60°. Patients were classified according to the O-CM classification and compared to coronally aligned patients. Multivariate analysis was performed on the relationship between PROMs and age, global tilt (GT) and coronal malalignment (CM).
Results Four hundred forty-three patients had CM of more than 2 cm compared to 800 who did not. The distribution of these modifiers was correlated to age. After multivariate analysis, using age and GT as confounding factors, we found that before the age of 50 years, 2A1 patients had worse sex life and greater satisfaction than patients without CM. After 50 years of age, patients with CM (1A1, 1A2) had worse self-image and those with 2A2, 2B had worse self-image, satisfaction, and 36-item Short Form Health Survey physical function. Self-image was the consistent determinant of patients opting for surgery for all ages.
Conclusion CM distribution according to O-CM modifiers is age dependent. A clear correlation between the coronal malalignment and PROMs exists when using the O-CM classification and in the mobile spine, this typically affects self-image and satisfaction. Thus, CM classified according to O-CM modifiers is correlated to PROMs and should be considered in ASD.
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Affiliation(s)
- David Christopher Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Louis Boissiere
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Kazunori Hayashi
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Derek Cawley
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Caglar Yilgor
- Acibadem University School of Medicine, Istanbul, Turkey
| | - Ahmet Alanay
- Acibadem University School of Medicine, Istanbul, Turkey
| | - Emre Acaroglu
- Spine Surgery Unit, Ankara Acibadem ARTES Spine Center, Ankara, Turkey
| | | | | | - Ferran Pellise
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Ibrahim Obeid
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
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18
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Tafish RT, Alkhaldi AF, Bourghli A, Althunian TA. Effectiveness of topical vancomycin in the prevention of spinal surgical site infections: a retrospective cohort study. Antimicrob Resist Infect Control 2021; 10:136. [PMID: 34565484 PMCID: PMC8474778 DOI: 10.1186/s13756-021-01006-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The risk of surgical site infections (SSIs), particularly methicillin-resistant Staphylococcus aureus (MRSA) SSIs, after spinal surgeries is one of the most daunting experiences to patients and surgeons. Some authors suggest applying vancomycin powder on the wound before skin closure to minimize the risk of SSIs; however, this practice is not supported by well-established evidence. This study sought to assess the effectiveness of topical (i.e. intra-wound) vancomycin in minimizing the risk of SSIs in patients who underwent spinal surgeries at a Saudi hospital. METHODS A retrospective cohort study was conducted using the hospital database. Patients who underwent spinal surgeries from the period of 09/2013 to 09/2019 were included and followed up (observed from the time of the surgery) to 30 days (surgeries without implants) or 90 days (with implants). The odds ratio (OR) of the primary outcome between vancomycin treated versus non-treated patients was estimated using a logistic regression model adjusting for the measured confounders. A sensitivity analysis was conducted using propensity score analysis (inverse probability of treatment weighting [IPTW] with stabilized weights) to control for confounding by indication. All study analyses were completed using RStudio Version 1.2.5033. RESULTS We included 81 vancomycin treated vs. 375 untreated patients with 28 infections (8/81 vs. 20/375; respectively). The adjusted OR of SSIs between the two groups was 0.40 (95% confidence interval [CI] 0.11 to 1.34). The result of the propensity score analysis was consistent (OR: 0.97 [95% CI 0.35 to 2.68]). CONCLUSIONS We could not find a lower association of SSIs with intra-wound vancomycin in patients who underwent spinal surgeries. Further studies are needed to assess benefits of using topical vancomycin for this indication vs. the risk of antimicrobial resistance.
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Affiliation(s)
- Rawan T Tafish
- Kingdom Hospital and Consulting Clinics, Riyadh, Saudi Arabia
| | | | - Anouar Bourghli
- Kingdom Hospital and Consulting Clinics, Riyadh, Saudi Arabia
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19
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Cawley DT, Takemoto M, Boissiere L, Larrieu D, Kieser DC, Fujishiro T, Hayashi K, Bourghli A, Yilgor C, Alanay A, Perez Grueso FJ, Pelisse F, Kleinstück F, Vital JM, Obeid I. The Impact of Corrective Surgery on Health-Related Quality of Life Subclasses in Adult Scoliosis: Will Degree of Correction Prognosticate Degree of Improvement? Eur Spine J 2021; 30:2033-2039. [PMID: 33900475 DOI: 10.1007/s00586-021-06786-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/15/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Objectives in scoliosis corrective surgery include restoration of normal sagittal and coronal parameters to achieve patient satisfaction. HRQLs improvements remain limited after corrective surgery. The aim of this study was to evaluate the HRQL subclass variability specific to the sagittal and coronal correction in adult scoliosis surgery. METHODS This multi-centre prospective analysis of consecutive adult spinal deformity (ASD) patients, from five European centres, only included multilevel instrumentation for scoliosis. d-(delta) values for each parameter represented pre to post-operative changes. Parameters included demographics, baseline, 1- and 2-year. HRQL outcomes (Oswestry disability index (ODI), Scoliosis Research Society (SRS)-22 and Short Form (SF36)), sagittal correction including relative spinopelvic alignment (dRSA) and coronal correction including major Cobb (dCobb) angles. RESULTS A total of 353 patients reached 1-year and 2-year follow up. All HRQL total scores significantly improved postoperatively, including ODI, SRS-22 and SF36. HRQL subclasses which displayed persistent improvements correlated to dRSA included sex-life, self-image, fatigue, vitality, social functioning. The only HRQL subclass improvement that correlated with dCobb was self-image. CONCLUSION Adult scoliosis surgery improves overall HRQL, having a minimal effect on each variable. Importantly, greater coronal deformity correction affects only greater self-image scores, whereas with greater sagittal correction there are many greater HRQL sub-class impacts. Correction and restoration of coronal balance is one of the surgical goals in adult scoliosis but the degree to which Cobb angle is corrected, apart from self-image, does not correlate with gains in sub-classes of HRQL. These results need to be taken into account when planning surgery.
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Affiliation(s)
- D T Cawley
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France.
- Mater Private Hospital, Dublin 1, Ireland.
| | | | - L Boissiere
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - D Larrieu
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - D C Kieser
- Christchurch School of Medicine, University of Otago, Dunedin, New Zealand
| | - T Fujishiro
- Osaka Medical College, Takatsuki-shi, Osaka, Japan
| | - K Hayashi
- Osaka City University Graduate School of Medicine, Juso Hospital, Osaka, Japan
| | | | - C Yilgor
- Acibadem University School of Medicine, Istanbul, Turkey
| | - A Alanay
- Acibadem University School of Medicine, Istanbul, Turkey
| | | | - F Pelisse
- Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - J M Vital
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - I Obeid
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
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20
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Khattab MF, Bourghli A. Commentary on "History of Spinal Neurosurgery and Spine Societies". Neurospine 2021; 18:252-253. [PMID: 33819952 PMCID: PMC8021811 DOI: 10.14245/ns.2142208.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
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21
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Bourghli A, Boissière L, Konbaz F, Al Eissa S, Al-Habib A, Qian BP, Qiu Y, Hayashi K, Pizones J, Ames C, Vital JM, Obeid I. On the pedicle subtraction osteotomy technique and its modifications during the past two decades: a complementary classification to the Schwab's spinal osteotomy classification. Spine Deform 2021; 9:515-528. [PMID: 33206354 DOI: 10.1007/s43390-020-00247-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To propose a complementary classification to the Schwab's osteotomy classification that would regroup together under a common umbrella different published pedicle subtraction osteotomy (PSO) variations that are commonly used, to have a common language and complete the spine surgeon's armamentarium when dealing with rigid spinal deformities. METHODS The 2 general types corresponding to the grades 3 and 4 of the Schwab classification were separated into 6 gradual subtypes (grades 3A, 3B, 3C, 4A, 4B, 4C). The classification is based on the amount of resected pedicle, the inclusion or not of the disc above, and the location of the axis of rotation. Based on the proposed classification, a reliability study was performed using 18 cases that were classified by 8 readers with expertise in the management of adult deformities with the use of osteotomies. RESULTS Clinical cases were classified according to the 6 grades proposed in the classification. The intra-rater reliability for the classification was "almost perfect agreement" with a Fleiss kappa coefficient average of 0.92 (range 0.85-1.00). The inter-rater reliability was "almost perfect agreement" with a coefficient average of 0.90 for the 2 readings that were done at an interval of 2 weeks. CONCLUSION The developed classification proved to be reliable and intuitive. It is an original way to display a catalog of different available PSO modifications including the original technique, in a logical and gradual order to help the surgeons in their decisions and show them that between a grade 2 osteotomy and a grade 5 osteotomy, many intermediate options are available. Further work with a treatment algorithm for clinical practice based on the current classification may be developed in the future.
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Affiliation(s)
- Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, PO Box 84400, Riyadh, 11671, Saudi Arabia.
| | - Louis Boissière
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Faisal Konbaz
- Division of Orthopedics, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Sami Al Eissa
- Division of Orthopedics, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Amro Al-Habib
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Bang-Ping Qian
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Kazunori Hayashi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Christopher Ames
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Jean-Marc Vital
- Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
| | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
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22
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Alsofyani MA, Alsalmi S, Malaekah H, Alharthi M, Bourghli A, Obeid I, Boissière L. Resolution of Idiopathic Epidural Lipomatosis after Bariatric Surgery: Case Report and Literature Review. Asian J Neurosurg 2021; 16:217-220. [PMID: 34211899 PMCID: PMC8202365 DOI: 10.4103/ajns.ajns_294_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/07/2020] [Accepted: 12/17/2020] [Indexed: 11/24/2022] Open
Abstract
Spinal epidural lipomatosis (SEL) is traditionally a rare disorder defined as an abnormal accumulation of unencapsulated epidural fat. SEL can be classified into idiopathic and secondary. We report a 46-year-old obese male with idiopathic epidural lipomatosis with a clinical picture of bilateral L5 and S1 radiculopathy, with an L5 and S1 distribution. Magnetic resonance imaging (MRI) showed epidural lipomatosis at L4, L5, and S1. After 2-year of sleeve gastrectomy, his bilateral sciatic radiculopathy disappeared, and updated MRI showed complete resolution of epidural lipomatosis. We present a case of an unusual epidural lipomatosis, resolved completely by bariatric surgery. This case report set out the effect of metabolic surgery on the local and systemic metabolic process.
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Affiliation(s)
- Mohammad A Alsofyani
- Department of Surgery, College of Medicine and University Hospital, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Sultan Alsalmi
- Department of Neurosurgery, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Haifaa Malaekah
- Department of Surgical, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdurrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Majed Alharthi
- Department of Surgical, Security Forces Hospital, Makkah, Kingdom of Saudi Arabia
| | - Anouar Bourghli
- Department of Orthopedic and Spinal Surgery, Kingdom Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim Obeid
- Department of Spine Surgery, Specialist Terrefort Clinic, Bruges, France
| | - Louis Boissière
- Department of Spine Surgery, Specialist Terrefort Clinic, Bruges, France
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23
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Iwai C, Pizones J, Boissière L, Jakinapally S, Yilgor Ç, Larrieu D, Pellise F, Vital JM, Bourghli A, Obeid I. Static and dynamic sagittal lumbar apex: a new concept for the assessment of lumbar lordosis distribution in spinal deformity. Eur Spine J 2021; 30:1155-1163. [PMID: 33606102 DOI: 10.1007/s00586-021-06767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/20/2020] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Sagittal lumbar apex has been demonstrated to be a key parameter in sagittal plane morphology. Our aim was to understand its behavior with postural changes, analyzing two different concepts of lumbar apex. MATERIALS AND METHODS Prospective observational study with a cohort of patients presenting sagittal malalignment identified from a monocenter database of adult spinal deformities (ASD). Inclusion criteria were age > 30 years, SVA > 40 mm, and/or PT > 20. All patients had full-spine EOS radiographs in 2 different positions: (P1: natural position) and position 2 (P2: compensated position). Sagittal alignment, spinopelvic values, and two different methods of assessing lordosis apex location were analyzed in both P1 and P2 positions. Changes between P1 and P2 were compared using a paired t test with a significance level at p < 0.05. RESULTS Twenty-five patients were recruited (21 women and 4 men). The mean age was 64.8 years (range 21-79). The patient's main compensation was based on an increase in the femoral shaft angle, and pelvic retroversion, with a subsequent decrease in sacral slope, and therefore of the lower lumbar arc. When the lumbar apex was calculated as the most anterior point touching the vertical line in a lateral radiograph, postural compensation changes modified its location usually shifting it to a more caudal position. When the lumbar apex was assessed as the most distant point of the global lumbar lordosis, its position remained stable regardless of compensation. CONCLUSIONS Postural changes can modify the location of the lumbar apex when understanding its location as the cornerstone of sagittal plane harmonic distribution. This concept can be useful as an additional sign to assess compensation. However, if the lumbar apex was calculated as the angular point of the global lordosis, its position remained stable regardless of postural changes. This concept can help to mold lumbar lordosis in ASD surgery. LEVEL OF EVIDENCE IV Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Affiliation(s)
- Chizuo Iwai
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France.,Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Louis Boissière
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France
| | - Sreenath Jakinapally
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France
| | - Çaglar Yilgor
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Daniel Larrieu
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France
| | - Ferran Pellise
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | - Jean-Marc Vital
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France.
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24
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Konbaz FMS, Al Eissa SI, Alassiri SS, Bourghli A, Abaalkhail MS, Ahmed ME, Al Helal FH, Al Mahayni AO. Hemangioma of the Lumbar Spine Involving the Spinous Process: A Rare Case Report and Review of the Literature. Int J Spine Surg 2021; 14:S57-S65. [PMID: 33900946 DOI: 10.14444/7166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Hemangiomas of the spine are usually benign and asymptomatic. They can cause devastating complications such as pathological fractures of the spine and neurological disability. This report documents an atypical location of a hemangioma in a lumbar spinous process, in combination with a spondylolisthesis at the same level, which makes it even more uncommon. Surgery can be effective and safe and can significantly improve patient outcomes. Moreover, prior embolization can prevent acute hemorrhage in addition to providing careful diagnosis and evaluation.
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25
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Kieser DC, Bourghli A, Larrieu D, Cawley DT, Hayashi K, Jakinapally S, Pizones J, Boissiere L, Obeid I. Impact of COVID-19 on the pain and disability of patients with adult spinal deformity. Spine Deform 2021; 9:1073-1076. [PMID: 33651340 PMCID: PMC7923403 DOI: 10.1007/s43390-021-00315-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/16/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the pain and functional effect of the COVID-19 pandemic on patients with ASD reflected by their response to SRS-22, ODI, and SF-36 questionnaires. METHODS Patients who had stable pain and functional outcome scores over the preceding 2 years were enrolled in a local prospectively collected adult spinal deformity (ASD) database. A reanalysis of their SRS22, ODI and SF-36 data 14 days into confinement were compared to their last pre-confinement scores. RESULTS 89 patients were included in this study (average age 60.7 years, 91% female) with an average time from last FU until confinement of 9.6 months. The ODI total score worsened by 5 points post-confinement with no difference seen in personal care, walking and social life. In contrast, the SRS-22 score showed small improvements in function/activity and satisfaction, but no significant differences for the other domains. Similarly, the SF-36 showed small improvements in physical function, physical and emotional role, vitality and PCS. CONCLUSION The global COVID-19 pandemic and ensuing confinement had variable overall effects on ASD patients, without the expected marked worsening. In addition, this study illustrates that the SRS-22 questionnaire is less influenced by environmental and psychological factors than the ODI supporting its objectivity and accuracy in the evaluation of the QoL of ASD patients.
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Affiliation(s)
- D. C. Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, 2 Riccarton Avenue, Christchurch, 8011 New Zealand
| | - A. Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O. Box 84400, Riyadh, 11671 Saudi Arabia
| | - D. Larrieu
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, 33076 Bordeaux, France
| | | | - K. Hayashi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - S. Jakinapally
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, 33076 Bordeaux, France
| | - J. Pizones
- Spine Unit, Hospital La Paz, Madrid, Spain
| | - L. Boissiere
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, 33076 Bordeaux, France ,ELSAN, Polyclinique Jean Villar, Avenue Maryse Bastie, 33520 Bruges, France
| | - I. Obeid
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, 33076 Bordeaux, France ,ELSAN, Polyclinique Jean Villar, Avenue Maryse Bastie, 33520 Bruges, France
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26
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Bourghli A, Boissiere L, Obeid I. T12 pedicle subtraction osteotomy for post-laminectomy kyphoscoliotic deformity following resection of a thoracolumbar astrocytoma in an adolescent with a previous paraplegic context. Spine Deform 2021; 9:275-283. [PMID: 32965627 DOI: 10.1007/s43390-020-00206-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Case report. PURPOSE To describe a rare case of iatrogenic post-laminectomy thoracolumbar kyphoscoliosis in an adolescent, and its surgical management with pedicle subtraction osteotomy (PSO). BACKGROUND Kyphoscoliosis secondary to multilevel laminectomies for intradural astrocytoma resection is rare and its management can be very challenging. METHODS We report the case of 15-year-old boy who has been complaining of a progressively increasing hump in his back during the past 6 months. Two years prior to presentation, he underwent multilevel thoracolumbar laminectomies from T10 to L2 for resection of an intradural astrocytoma that was causing progressive paraplegia predominant on the right side. Full spine anteroposterior and lateral X-rays revealed a thoracolumbar kyphosis with an angulation of 73° between T10 and L1, with a long left thoracolumbar scoliosis of 24 degrees. CT scan confirmed the multilevel laminectomies and showed T12 anterior wedging. MRI did not show any tumor recurrence. RESULTS The patient underwent T12 PSO with instrumentation from T4 to L3 with the use of a one-sided domino on the convex side. Thoracolumbar kyphosis was corrected to 9°, and scoliosis was corrected to 7°, with a maintained correction at 7 years of follow-up. CONCLUSION Literature is sparse on the management of post-laminectomy kyphoscoliotic deformity after intradural astrocytoma resection. Despite previous paraplegia context, aggressive correction technique such as PSO can be a safe option if proper management of the scar tissues and adhesions is performed, with satisfactory clinical and radiological long-term results.
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Affiliation(s)
- Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O.Box 84400, Riyadh, 11671, Saudi Arabia.
| | - Louis Boissiere
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
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27
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Obeid I, Boissiere L, Bourghli A. Cervical Deformity Arising From Upper Thoracic Malalignment. Neurospine 2020; 17:568-573. [PMID: 33022161 PMCID: PMC7538347 DOI: 10.14245/ns.2040412.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/22/2020] [Indexed: 11/22/2022] Open
Abstract
This study aims to describe the surgical management of cervical deformity arising from outside the cervical spine because of upper thoracic malalignment, using pedicle subtraction osteotomy (PSO). Cervical spine deformity is a complex topic and it can be generally divided into 2 categories, the first category is when the primary deformity is inside the cervical spine and the treatment will focus on the cervical spine itself, whereas the second category is when the primary deformity is outside the cervical spine usually in the adjacent upper thoracic area, the cervical deformity is a compensation for the adjacent malalignment, and thus in this situation, the management will occur in the upper thoracic area. Description of a single surgeon’s technique for performing PSO to treat rigid upper thoracic deformity. PSO in the upper thoracic spine is a safe and effective procedure and can result in satisfying clinical and radiological outcome with indirect correction of the compensatory cervical deformity. Cervical deformity arising from upper thoracic malalignment should be dealt with by treating the problem at its origin outside the cervical spine by performing a PSO in the upper thoracic spine.
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Affiliation(s)
- Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Louis Boissiere
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
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28
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Hayashi K, Boissière L, Larrieu D, Bourghli A, Gille O, Vital JM, Guevara-Villazón F, Pellisé F, Pérez-Grueso FJS, Kleinstück F, Acaroglu E, Alanay A, Nakamura H, Obeid I. Prediction of satisfaction after correction surgery for adult spinal deformity: differences between younger and older patients. Eur Spine J 2020; 29:3051-3062. [DOI: 10.1007/s00586-020-06611-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/28/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
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29
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Alsofyani MA, Malaekah HM, Bashawyah A, Bawazeer M, Akkour K, Alsalmi S, Alkhairy A, Dajim NB, Khalifah S, Almalki IA, Kassab F, Barnawi M, Almalki M, Alharthi M, Alharthi M, Almalki A, Almalki AH, Bourghli A, Obeid I. Safety measures for COVID-19: a review of surgical preparedness at four major medical centres in Saudi Arabia. Patient Saf Surg 2020; 14:34. [PMID: 32922512 PMCID: PMC7474573 DOI: 10.1186/s13037-020-00259-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/18/2020] [Indexed: 01/10/2023] Open
Abstract
In view of the worldwide coronavirus disease 2019 (COVID-19) pandemic, hospitals need contingency planning. This planning should include preparation for an unexpected patient surge. This measure is evolving concomitantly with the implementation of the needed infection control rules. Here, we present our experience in contingency planning at four large tertiary hospitals in Saudi Arabia during this global pandemic, with a focus on dealing with COVID-19 patients who need to undergo surgery. The planning covers response measures required in the operating room and supporting units, including the administrative department, intensive care unit, and different sections of the surgical department. Furthermore, it covers the role of education and simulation in preparing health care providers and ensuring smooth workflow between all sections. We additionally discuss the guidelines and policies implemented in different surgical specialties. These measures are necessary to prevent the transmission of COVID-19 within healthcare facilities. Throughout the COVID-19 pandemic, the healthcare system should develop a comprehensive pandemic plan and set guidelines addressing the management of urgent and malignant cases. The guidelines should be in concordance with internal guidelines.
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Affiliation(s)
- Mohammad A. Alsofyani
- Orthopedic Department, College of Medicine and University Hospital, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Haifaa M. Malaekah
- General Surgery Department, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Bashawyah
- Anesthesiology Department, College of Medicine and King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed Bawazeer
- Critical Care Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Khalid Akkour
- Obstetrics and Gynecology Department, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sultan Alsalmi
- Department of Neurosurgery, Imam Abdulrahman Bin Faisal University, Dammam City, Kingdom of Saudi Arabia
| | - Abdu Alkhairy
- Department of Neurosurgery, King Faisal Medical City, Abha, Kingdom of Saudi Arabia
| | - Nayef Bin Dajim
- Neuroscience Center, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Salahaddeen Khalifah
- Neuroscience Center, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - Ibrahim A. Almalki
- Infection Control Department, Mental Health Hospital, Taif, Kingdom of Saudi Arabia
| | - Farid Kassab
- Musculoskeletal Center of Excellence, International Medical Center, Jeddah, Kingdom of Saudi Arabia
| | - Mohammad Barnawi
- Anesthesia Department, College of Medicine and University Hospital, Albaha University, Albaha, Kingdom of Saudi Arabia
| | - Mosfer Almalki
- Hematology Oncology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed Alharthi
- Biochemistry and Molecular Medicine Department, College of Medicine, Taibah University, Madinah, Kingdom of Saudi Arabia
| | - Majed Alharthi
- General Surgery Department, Security Forces Hospital, Makkah, Kingdom of Saudi Arabia
| | - Abdulaziz Almalki
- Urology Department, King Faisal Hospital, Taif, Kingdom of Saudi Arabia
| | - Abdullah H. Almalki
- Physical Medicine and Rehabilitation, Armed Forces Rehabilitation Center, Taif, Kingdom of Saudi Arabia
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim Obeid
- Spine Surgery Department, Specialist Terrefort Clinic, Bruges, France
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Bourghli A, Abduljawad SM, BoissiÈre L, Khalifa H, Obeid I. Aggressive Thoracic Hemangioma Leading to Secondary Kyphosis with Paraparesis in the Postpartum Period. A Case Report. Int J Spine Surg 2020; 14:418-425. [PMID: 32699766 DOI: 10.14444/7055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Aggressive vertebral hemangioma is rare, and its management can be very challenging. Methods In this report, we present the case of a 30-year-old female with a normal twin pregnancy. She had been complaining of midthoracic pain after the seventh month of pregnancy with no other symptoms. Normal delivery was done under spinal anesthesia, but the patient's back pain worsened after the delivery, and she left the hospital on Day 4 with the onset of an unsteady gait. She was seen in the spinal clinic on Day 14, referred by her gynecologist, with a paraparetic presentation that was rapidly worsening. Urgent magnetic resonance imaging (MRI) was done and revealed aggressive hemangioma of T6 with kyphosis and significant cord compression. Results The patient was admitted and was operated the following morning. Posterior decompression with fixation from T4 to T8 and kyphosis correction was done. Samples from the vertebrae were sent to the lab for pathology analysis, and the results confirmed the diagnosis of vertebral hemangioma. She could walk on Day 1 with progressive neurological recovery, but distal junctional kyphosis in the form of a "chance fracture" of T8 occurred at 2 months and was treated conservatively. She showed a satisfactory clinical and radiological result at 2 years with no recurrence. Conclusions Literature is sparse on the management of vertebral hemangioma in the context of pregnancy and postpartum, with only case reports, and its presentation as a kyphotic fracture is extremely rare. The current case shows how, in the context of delivery, a benign procedure such as spinal anesthesia should be done with extreme caution, as it may play a role in aggravating an undiagnosed aggressive hemangioma; rapid management after the onset of paraparetic symptoms enables a full neurological recovery, but close monitoring later on with regular MRI is mandatory for detection of any recurrence.
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Affiliation(s)
- Anouar Bourghli
- Orthopaedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Salim M Abduljawad
- Orthopaedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Louis BoissiÈre
- Orthopaedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
| | - Hani Khalifa
- Obstetrics and Gynecology Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Orthopaedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
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Khattab MF, Kannan TMA, Morsi A, Al-Sabbagh Q, Hadidi F, Al-Sabbagh MQ, M Taha M, Bourghli A, Obeid I. The short-term impact of COVID-19 pandemic on spine surgeons: a cross-sectional global study. Eur Spine J 2020; 29:1806-1812. [PMID: 32591880 PMCID: PMC7317075 DOI: 10.1007/s00586-020-06517-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/29/2020] [Accepted: 06/18/2020] [Indexed: 01/08/2023]
Abstract
Purpose The outbreak of COVID-19 erupted in December 2019 in Wuhan, China. In a few weeks, it progressed rapidly into a global pandemic which resulted in an overwhelming burden on health care systems, medical resources and staff. Spine surgeons as health care providers are no exception. In this study, we try to highlight the impact of the crisis on spine surgeons in terms of knowledge, attitude, practice and socioeconomic burden.
Methods This was global, multicentric cross-sectional study on 781 spine surgeons that utilized an Internet-based validated questionnaire to evaluate knowledge about COVID-19, availability of personal protective equipment, future perceptions, effect of this crisis on practice and psychological distress. Univariate and multivariate ordinal logistic regression analyses were used to evaluate the predictors for the degree of COVID-19 effect on practice.
Results Overall, 20.2%, 52% and 27.8% of the participants were affected minimally, intermediately and hugely by COVID-19, respectively. Older ages (β = 0.33, 95% CI 0.11–0.56), orthopedic spine surgeons (β = 0.30, 95% CI 0.01–0.61) and those who work in the private sector (β = 0.05, 95% CI 0.19–0.61) were the most affected by COVID-19. Those who work in university hospitals (β = − 0.36, 95% CI 0.00 to − 0.71) were affected the least. The availability of N95 masks (47%) and disposable eye protectors or face shields (39.4%) was significantly associated with lower psychological stress (p = 0.01). Only 6.9%, 3.7% and 5% had mild, moderate and severe mental distress, respectively.
Conclusion While it is important to recognize the short-term impact of COVID-19 pandemic on the practice of spine surgery, predicting where we will be standing in 6–12 months remains difficult and unknown. The COVID-19 crisis will probably have an unexpected long-term impact on lives and economies.
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Affiliation(s)
- Mohamed Fawzy Khattab
- Orthopedic Surgery Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Tareq M A Kannan
- Spine Unit, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Ahmed Morsi
- Orthopedic Surgery Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Qussay Al-Sabbagh
- Spine Unit, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Fadi Hadidi
- Spine Unit, Jordan University Hospital, University of Jordan, Amman, Jordan
| | | | - Muzahem M Taha
- Orthopaedic Surgery Department, Kirkuk University, Kirkuk, Iraq
| | - Anouar Bourghli
- Orthopedic and Spine Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Spine Surgery Unit, Elsan Group Jean Villar Private Hospital, Bruges-Bordeaux, France.
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Hayashi K, Boissière L, Guevara-Villazón F, Larrieu D, Núñez-Pereira S, Bourghli A, Gille O, Vital JM, Pellisé F, Sánchez Pérez-Grueso FJ, Kleinstück F, Acaroğlu E, Alanay A, Obeid I. Factors influencing patient satisfaction after adult scoliosis and spinal deformity surgery. J Neurosurg Spine 2020; 31:408-417. [PMID: 31075761 DOI: 10.3171/2019.2.spine181486] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/19/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Achieving high patient satisfaction with management is often one of the goals after adult spinal deformity (ASD) surgery. However, literature on associated factors and their correlations with patient satisfaction is limited. The aim of this study was to determine the clinical and radiographic factors independently correlated with patient satisfaction in terms of management at 2 years after surgery. METHODS A multicenter prospective database of ASD surgery was retrospectively reviewed. The demographics, complications, health-related quality of life (HRQOL) subdomains, and radiographic parameters were examined to determine their correlation coefficients with the Scoliosis Research Society-22 questionnaire (SRS-22R) satisfaction scores at 2 years (Sat-2y score). Subsequently, factors determined to be independently associated with low satisfaction (Sat-2y score ≤ 4.0) were used to construct 2 types of multivariate models: one with 2-year data and the other with improvement (score at 2 years - score at baseline) data. RESULTS A total of 422 patients who underwent ASD surgery (mean age 53.1 years) were enrolled. All HRQOL subdomains and several coronal and sagittal radiographic parameters had significantly improved 2 years after surgery. The Sat-2y score was strongly correlated with the SRS-22R self-image (SI)/appearance subdomain (r = 0.64), followed by moderate correlation with subdomains related to standing (r = 0.53), body pain (r = 0.49-0.55), and function (r = 0.41-0.55) at 2 years. Conversely, the correlation between radiographic or demographic parameters with Sat-2y score was weak (r < 0.4). Multivariate analysis to eliminate confounding factors revealed that a worse Oswestry Disability Index (ODI) score for standing (≥ 2 points; OR 4.48) and pain intensity (≥ 2 points; OR 2.07), SRS-22R SI/appearance subdomain (< 3 points; OR 2.70) at 2 years, and a greater sagittal vertical axis (SVA) (> 5 cm; OR 2.68) at 2 years were independent related factors for low satisfaction. According to the other model, a lower improvement in ODI for standing (< 30%; OR 2.68), SRS-22R pain (< 50%; OR 3.25) and SI/appearance (< 50%; OR 2.18) subdomains, and an inadequate restoration of the SVA from baseline (< 2 cm; OR 3.16) were associated with low satisfaction. CONCLUSIONS Self-image, pain, standing difficulty, and sagittal alignment restoration may be useful goals in improving patient satisfaction with management at 2 years after ASD surgery. Surgeons and other medical providers have to take care of these factors to prevent low satisfaction.
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Affiliation(s)
- Kazunori Hayashi
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France.,2Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Louis Boissière
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France.,3ELSAN, Polyclinique Jean Villar, Bruges, France
| | | | - Daniel Larrieu
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | | | - Anouar Bourghli
- 5Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Olivier Gille
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Jean-Marc Vital
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Ferran Pellisé
- 4Spine Surgery Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | | | | | | | - Ahmet Alanay
- 9Comprehensive Spine Center, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ibrahim Obeid
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France.,3ELSAN, Polyclinique Jean Villar, Bruges, France
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Kieser DC, Wyatt MC, Boissiere L, Hayashi K, Cawley DT, Yilgor C, Larrieu D, Fujishiro T, Alanay A, Acaroglu E, Kleinstueck F, Pellisé F, Perez-Grueso FJS, Bourghli A, Vital JM, Gille O, Obeid I. The effect of increasing body mass index on the pain and function of patients with adult spinal deformity. J Spine Surg 2020; 5:535-540. [PMID: 32043004 DOI: 10.21037/jss.2019.11.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Both adult spinal deformity (ASD) and obesity are growing concerns internationally. This study therefore aims to determine the effect of increasing body mass index (BMI) on the pain and function of patients with ASD. Methods A retrospective review of prospectively collected data from a multicentre European database was undertaken. Initially a univariate analysis was performed on the effect of BMI on the initial presentation of functional scores in patients with ASD. The functional scores included the Numerical Rating Scale (NRS) back and leg score, Core Outcome Measures Index (COMI) back score, SRS22 total score, Short Form 36 (SF-36) [general health, physical component score (PCS) and mental component score (MCS)] and Oswestry Disability Index (ODI) score (including all domains). Subsequently a multivariate analysis controlling for age, sex, comorbidities, employment status, smoking status and radiological parameters [coronal cobb, coronal balance, sagittal balance, global tilt, and pelvic incidence minus lumbar lordosis (PI - LL) mismatch] was performed. Results A total of 1,004 patients were included in this study (166 male, 838 female). On univariate analysis a statistically significant (P<0.05) moderate correlation between NRS leg pain, ODI (walking, standing, sex life, social life and total score), SF-36 (physical component), sagittal balance, global tilt and age were recognised (P<0.05). A statistically significant low correlation was identified for all other outcomes, except coronal balance (P=0.640). On multivariate analysis BMI remained significantly related to all functional outcomes except ODI-pain and ODI-travelling (P>0.05). Conclusions Increasing BMI has a significant adverse effect on the pain and functioning of patients with ASD. Clinicians should recognise this association and treat patients accordingly.
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Affiliation(s)
- David Christopher Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
| | - Michael Charles Wyatt
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
| | - Louis Boissiere
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Kazunori Hayashi
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | | | - Caglar Yilgor
- Acibadem University School of Medicine, Istanbul, Turkey
| | - Daniel Larrieu
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Takashi Fujishiro
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Ahmet Alanay
- Acibadem University School of Medicine, Istanbul, Turkey
| | - Emre Acaroglu
- Spine Surgery Unit, Ankara Acibadem ARTES Spine Center, Ankara, Turkey
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Jean-Marc Vital
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Olivier Gille
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Ibrahim Obeid
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
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Cecchinato R, Bourghli A, Obeid I. Revision surgery of spinal dynamic implants: a literature review and algorithm proposal. Eur Spine J 2020; 29:57-65. [PMID: 31916002 DOI: 10.1007/s00586-019-06282-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/14/2019] [Accepted: 12/29/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Dynamic stabilization of the spine has been performed since the 1990s with the double purpose of restoring spinal segmental stability and allowing residual movement at the operated level. When we take into account the different motion-preserving devices and the spinal areas where they are applied, we can identify three categories of spinal implants: anterior cervical, anterior lumbar, and posterior lumbar. However, as in all prosthetic procedures performed in orthopedic surgery, the life span of a joint replacement device is a central topic of discussion, and this is true also for spinal dynamic devices, being revision surgery a complex procedure in specific cases. MATERIALS AND METHODS We performed a literature review on the different dynamic spinal implants and the most common causes of failure, providing clinical cases as illustrative options for revision surgery. RESULTS The review of the literature showed a 11.3% to 22.6% revision rate in posterior lumbar dynamic systems, with a peak of 40.6% in case of adjacent segment disease. In lumbar TDRs, infection and severe dislocations are the most frequent causes of anterior revisions, while posterior pedicle screw fixation could be a suitable option in minimal subsidence or TDR displacement. An algorithm for the planning of revision surgery is proposed. CONCLUSIONS Surgical revision of spinal dynamic implants could be a demanding surgery especially in anterior approaches. Anterior cervical revision remains globally safe, but careful preoperative evaluation of vessels and ureter are suggested to avoid intraoperative complications in the lumbar spine. In posterior revision, a proper sagittal alignment of the spine should be restored. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- R Cecchinato
- GSpine4, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - A Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - I Obeid
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France
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Bourghli A, Boissiere L, Obeid I. Thoracic Kyphotic Deformity Secondary to Old Pseudomonas aeruginosa Spondylodiscitis in an Immunocompromised Patient With Persistent Infection Foci-A Case Report. Int J Spine Surg 2019; 13:392-398. [PMID: 31741828 DOI: 10.14444/6054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Kyphosis secondary to pyogenic spondylodiscitis is rare and its management can be very challenging. Methods In this report, we present the case of a 28-year-old woman, with past history of type 1 diabetes and kidney failure on hemodialysis. Her current complaint is chronic middle and low back pain with kyphotic attitude. She had undergone posterior fixation for T12 fracture 3 years earlier, which was complicated by surgical site infection to Pseudomonas aeruginosa, with secondary kyphosis proximally. X-ray showed a 64° kyphosis with complete fusion between T8 and T10, and MRI showed persistent infection foci. Results The patient underwent a pedicle subtraction osteotomy at the level of T9 with instrumentation from T5 to L1. Thoracic kyphosis was corrected to 39°. Samples taken from the remaining collections returned positive for multidrug-resistant Pseudomonas aeruginosa, and the patient was kept on intravenous antibiotic (Colistine) for 2 months. She could walk on day 1, with a satisfactory clinical and radiological result at 3 years. Conclusions Literature is sparse on the management of post-pyogenic infection kyphosis in immunocompromised patients. The current case shows that aggressive correction techniques such as pedicle subtraction osteotomy can be performed in such cases but within a multidisciplinary team to deal simultaneously with the different issues of the fragile patient.
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Affiliation(s)
- Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Louis Boissiere
- Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
| | - Ibrahim Obeid
- Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
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Obeid I, Diebo BG, Boissiere L, Bourghli A, Cawley DT, Larrieu D, Pointillart V, Challier V, Vital JM, Lafage V. Single Level Proximal Thoracic Pedicle Subtraction Osteotomy for Fixed Hyperkyphotic Deformity: Surgical Technique and Patient Series. Oper Neurosurg (Hagerstown) 2019; 14:515-523. [PMID: 28973349 DOI: 10.1093/ons/opx158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 06/08/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Thoracic hyperkyphosis can display pathological deterioration, resulting in either hyperlordotic cervical compensation or sagittal malalignment. Various techniques have been described to treat fixed malalignment. Pedicle subtraction osteotomy (PSO) is commonly used in the lumbar spine and frequently limited to the distal thoracic spine. This series focuses on the surgical specificities of proximal thoracic PSO, with clinical and radiological outcomes. OBJECTIVE To report the surgical specificities and assess the clinical and radiological outcomes of proximal thoracic osteotomies for correction of rigid kyphotic deformities. METHODS This is a retrospective review of 10 consecutive patients who underwent single level proximal thoracic PSO (T2-T5). Preoperative and postoperative full-body EOSTM radiographs, perioperative data, and complications were recorded. The surgical technique and its nuances were described in detail. RESULTS Patients had mean age of 41.8 yr and 50% were female. The technique provided correction of segmental and global kyphosis, 26.6° and 29.5°, respectively. Patients reported reciprocal reduction in C2-C7 cervical lordosis (37.6°-18.6°, P < .001), significantly correlating with the reduction of thoracic hyperkyphosis (R = 0.840, P = .002). Mean operative time was 291 min, blood loss 1650 mL, and mean hospital stay was 13.8 d. Three patients reported complications that were resolved, including 1 patient who was revised because of a painful cross link. There were no neurological complications, pseudarthroses, instrumentation breakage, or wound infections at a minimum of 2-yr follow-up. CONCLUSION Proximal thoracic PSO can be a safe and effective technique to treat fixed proximal thoracic hyperkyphosis leading to kyphosis reduction and craniocervical relaxation.
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Affiliation(s)
- Ibrahim Obeid
- Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France
| | - Bassel G Diebo
- Department of Orthopaedic Sur-gery, State University of New York, Down-state Medical Center, Brooklyn, New York
| | - Louis Boissiere
- Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Derek T Cawley
- Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France
| | - Daniel Larrieu
- Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France
| | - Vincent Pointillart
- Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France
| | - Vincent Challier
- Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France
| | - Jean Marc Vital
- Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, New York
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Bourghli A, Boissiere L, Obeid I. Dual iliac screws in spinopelvic fixation: a systematic review. Eur Spine J 2019; 28:2053-2059. [PMID: 31300882 DOI: 10.1007/s00586-019-06065-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/14/2019] [Accepted: 07/08/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE The classical spinopelvic fixation includes 1 iliac screw on each side. The purpose of this study is to specify the indications of the "dual iliac screw" (DIS) construct, i.e., when to put 2 iliac screws on each side, to describe its biomechanical advantages, and to define its related technical aspects. METHODS A primary search on Medline through PubMed distribution was performed, with the use of the terms "pelvic fixation" or "spinopelvic" or "lumbo-iliac" and the terms "dual iliac screw" or "double iliac screw." English papers corresponding to the inclusion criteria were analyzed regarding the specific indications of the DIS construct and its surgical technique and advantages. RESULTS Eleven papers were identified according to the research criteria and included in this review. Three main indications were identified for the DIS technique according to three types of pathologies: in adult deformities when a long construct is needed in an osteoporotic patient or when correction requires three-column osteotomy of the sacrum; in trauma when a U-shaped fracture-dislocation of the sacrum is involved; in sacral tumors when a sacrectomy is performed or when destructive metastatic lesions of the sacrum require palliative surgical treatment. Biomechanically, the DIS technique proved to have higher construct stiffness in terms of compression and torsion. CONCLUSION In specific cases, affecting different areas of spinal diseases, the DIS technique is more advantageous, when compared to the "single iliac screw" version, as it would provide a stronger and safer fixation at the base of the spinopelvic construct. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O. Box 84400, Riyadh, 11671, Saudi Arabia.
| | - Louis Boissiere
- Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
| | - Ibrahim Obeid
- Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
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Obeid I, Berjano P, Lamartina C, Chopin D, Boissière L, Bourghli A. Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline. Eur Spine J 2018; 28:94-113. [PMID: 30460601 DOI: 10.1007/s00586-018-5826-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/06/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition. METHODS This is an expert's opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified. RESULTS Two main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers. CONCLUSION Coronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Ibrahim Obeid
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.
| | | | | | - Daniel Chopin
- Neuro-Orthopedic Spine Unit, Lille University Hospital, Lille, France
| | - Louis Boissière
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
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Bourghli A, Abouhashem S, Abo Wali R, Obeid I, Boissiere L, Vital JM, Al Sarawan M. Management of a posterior gunshot injury with a floating pedicle and cerebrospinal fluid leak. Eur Spine J 2018. [DOI: 10.1007/s00586-018-5537-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Alzakri A, Boissière L, Cawley DT, Bourghli A, Pointillart V, Gille O, Vital JM, Obeid I. L5 pedicle subtraction osteotomy: indication, surgical technique and specificities. Eur Spine J 2017; 27:644-651. [PMID: 29188373 DOI: 10.1007/s00586-017-5403-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 08/30/2017] [Accepted: 11/18/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the radiographic, functional outcomes, complications and surgical specificities of L5 pedicle subtraction osteotomy for fixed sagittal and coronal malalignment. METHODS A retrospective cohort of consecutive patients with prospectively collected data. Ten patients who underwent PSO at L5 were eligible for a 2-year minimum follow-up (average, 4.0 years). Patients were evaluated by standardized upright radiographs. Preoperative and postoperative radiographies, surgical data and complications were collected. RESULTS All surgeries were revision surgeries. The mean lumbar lordosis before surgery was - 22.5° (range, 8° to - 33°) and improved to - 58.5° (range, - 40° to - 79°). The sagittal vertical axis demonstrated a preoperative mean sagittal malalignment of 13.7 cm (range 3.5 to 20 cm), with correction to 4.6 cm postoperatively. Three patients required additional surgery at the latest follow-up for rod breakage. CONCLUSIONS PSO of L5 can be a safe and effective technique to treat and correct fixed sagittal imbalance and provide biomechanical stability. The high complication rate mandates a careful assessment of the risk/benefit ratio of such a major surgery. Most patients are satisfied, particularly when sagittal balance is achieved.
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Affiliation(s)
- Abdulmajeed Alzakri
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France. .,Orthopaedic Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Louis Boissière
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Derek T Cawley
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Vincent Pointillart
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Olivier Gille
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Jean-Marc Vital
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Ibrahim Obeid
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
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Obeid I, Bourghli A, Larrieu D, Laouissat F, Challier V, Pointillart V, Gille O, Vital JM, Senegas J, Boissière L. THE GLOBAL TILT: EVALUATION OF A PARAMETER CONSIDERING THE GLOBAL
SPINOPELVIC ALIGNMENT. ACTA ACUST UNITED AC 2017; 64:146-51. [PMID: 28850202 DOI: 10.12816/0031523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Regarding the close interaction
between the spinal balance and the pelvis orientation no
parameter is routinely used to describe and to evaluate the
global spinopelvic balance, taking into account simultaneously
the spinal part and the pelvic part of the global alignment.
The global tilt was described to analyze malalignment,
considering spinal and pelvic imbalance together. From a
geometrical point of view, the global tilt is the sum of the
C7 vertical tilt and the pelvic tilt. The aim of this study is to
evaluate the global tilt by analyzing its correlation with spinal
malalignment. METHODS A cohort of patients who underwent
a lumbar pedicle subtraction osteotomy (PSO) for major
sagittal malalignment was realized. All patients had preoperative
and postoperative full spine EOS radiographies to
measure spinopelvic parameters. The lack of lordosis was
calculated after prediction of theoretical lumbar lordosis.
Correlation analysis between different spinopelvic parameters,
including the global tilt, was performed for preoperative
and postoperative values. RESULTS Thirty-one consecutive
patients were included. All parameters were correlated with
spinal malalignment but the global tilt was the most correlated
parameter in preoperative (r = 0.71) and in postoperative
(r = 0.78). When spinal and pelvic parameters were analyzed
separately, 19% of patients presented mismatches
between spine and pelvis. CONCLUSION This study highlights
the interest of a global parameter evaluating the spinal
balance and the pelvic balance together. The global tilt
appeared to be the most correlated parameter in this study
with spinal malalignment and could be used for the interpretation
of clinical series in spine surgery.
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Boissière L, Takemoto M, Bourghli A, Vital JM, Pellisé F, Alanay A, Yilgor C, Acaroglu E, Perez-Grueso FJ, Kleinstück F, Obeid I. Global tilt and lumbar lordosis index: two parameters correlating with health-related quality of life scores-but how do they truly impact disability? Spine J 2017; 17:480-488. [PMID: 27815217 DOI: 10.1016/j.spinee.2016.10.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 09/26/2016] [Accepted: 10/13/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Many radiological parameters have been reported to correlate with patient's disability including sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence minus lumbar lordosis (PI-LL). European literature reports other parameters such as lumbar lordosis index (LLI) and the global tilt (GT). If most parameters correlate with health-related quality of life scores (HRQLs), their impact on disability remains unclear. PURPOSE This study aimed to validate these parameters by investigating their correlation with HRQLs. It also aimed to evaluate the relationship between each of these sagittal parameters and HRQLs to fully understand the impact in adult spinal deformity management. STUDY DESIGN A retrospective review of a multicenter, prospective database was carried out. PATIENT SAMPLE The database inclusion criteria were adults (>18 years old) presenting any of the following radiographic parameters: scoliosis (Cobb ≥20°), SVA ≥5 cm, thoracic kyphosis ≥60° or PT ≥25°. All patients with complete data at baseline were included. OUTCOME MEASURES Health-related quality of life scores, demographic variables (DVs), and radiographic parameters were collected at baseline. METHODS Differences in HRQLs among groups of each DV were assessed with analyses of variance. Correlations between radiographic variables and HRQLs were assessed using the Spearman rank correlation. Multivariate linear regression models were fitted for each of the HRQLs (Oswestry Disability Index [ODI], Scoliosis Research Society-22 subtotal score, or physical component summaries) with sagittal parameters and covariants as independent variables. A p<.05 value was considered statistically significant. RESULTS Among a total of 755 included patients (mean age, 52.1 years), 431 were non-surgical candidates and 324 were surgical candidates. Global tilt and LLI significantly correlated with HRQLs (r=0.4 and -0.3, respectively) for univariate analysis. Demographic variables such as age, gender, body mass index, past surgery, and surgical or non-surgical candidate were significant predictors of ODI score. The likelihood ratio tests for the addition of the sagittal parameters showed that SVA, GT, T1 sagittal tilt, PI-LL, and LLI were statistically significant predictors for ODI score even adjusted for covariates. The differences of R2 values from Model 1 were 1.5% at maximum, indicating that the addition of sagittal parameters to the reference model increased only 1.5% of the variance of ODI explained by the models. CONCLUSION GT and LLI appear to be independent radiographic parameters impacting ODI variance. If most of the parameters described in the literature are correlated with ODI, the impact of these radiographic parameters is less than 2% of ODI variance, whereas 40% are explained by DVs. The importance of radiographic parameters lies more on their purpose to describe and understand the malalignment mechanisms than their univariate correlation with HRQLs.
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Affiliation(s)
- Louis Boissière
- Spine Unit 1, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076 Bordeaux, France.
| | - Mitsuru Takemoto
- Spine Unit 1, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076 Bordeaux, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, King Abdul Aziz Rd, Ar Rabi, Riyadh 13316, Saudi Arabia
| | - Jean-Marc Vital
- Spine Unit 1, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076 Bordeaux, France
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Vall d'Hebron, Passeig Vall Hebron 119-129, Barcelona 08035, Spain
| | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Büyükdere Cd. No:40 Maslak, 34457, İstanbul, Turkey
| | - Caglar Yilgor
- Spine Surgery Unit, Acibadem Maslak Hospital, Büyükdere Cd. No:40 Maslak, 34457, İstanbul, Turkey
| | - Emre Acaroglu
- Ankara Spine Center, İran Caddesi 45/2 Kavaklıder, 06450, Ankara, Turkey
| | | | - Frank Kleinstück
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zürich, Switzerland
| | - Ibrahim Obeid
- Spine Unit 1, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076 Bordeaux, France
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Bourghli A, Boissiere L, Larrieu D, Vital JM, Yilgor C, Pellisé F, Alanay A, Acaroglu E, Perez-Grueso FJ, Kleinstück F, Obeid I. Lack of improvement in health-related quality of life (HRQOL) scores 6 months after surgery for adult spinal deformity (ASD) predicts high revision rate in the second postoperative year. Eur Spine J 2017; 26:2160-2166. [PMID: 28361369 DOI: 10.1007/s00586-017-5068-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 03/05/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE ASD is assessed radiologically with the spinopelvic parameters and clinically with HRQOL scores. The revision rate after ASD surgery is high and usually occurs during the first or second postoperative year. The aim of this study is to find clinical or radiological factors that could predict revision surgery in the second postoperative year. MATERIALS AND METHODS Inclusion criterion: ASD patients operated on by instrumented posterior fusion with more than 2 years follow-up were enrolled prospectively. Additional criterion was no revision surgery during the first postoperative year. From a multicenter database of 560 operated ASD patients, 164 patients met these criteria. The patients were divided into two groups depending on the need of revision surgery during the second postoperative year. Preoperative, 6-month, 1-year and 2-year data were collected and compared for both groups. RESULTS A total of 22 patients needed revision surgery and 142 did not. All revisions were for mechanical complications (non-fusion and implant related). Preoperatively, there was a significant difference between the groups (no revision vs. revision) for age (48 vs. 60 years), ODI (37 vs. 53), and SVA (29 vs. 76 mm), respectively. At 6 months, a significant difference in sagittal alignment was found, though HRQOL scores were similar. At 1 year, the no revision group scores improved, whereas the revision group scores remained stable or worsened. At 2 years, the no revision group scores remained stable. Comparing 6- and 12-month data, patients with improved, stable and worsened HRQOL scores had 8, 15 and 28% revision rates, respectively. CONCLUSION The revision rate at the second-year post-surgery (13.4%) remains high and demonstrated that a 2-year follow-up is mandatory. In addition to usual risk factors for mechanical complications in ASD surgery, stabilization or worsening of the HRQOL scores between the 6th and 12th month postop was highly predictive of revision rate. This observation is beneficial for ASD patient follow-up as clinical symptoms clearly precede mechanical failure.
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Affiliation(s)
- Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O. Box 84400, Riyadh, 11671, Saudi Arabia.
| | - Louis Boissiere
- Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
| | - Daniel Larrieu
- Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
| | - Jean-Marc Vital
- Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
| | - Caglar Yilgor
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | | | | | | | - Ibrahim Obeid
- Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France
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Bourghli A, Vital JM, Boissière L, Obeid I. TWO ADJACENT LEVELS DISLOCATION OF THE CERVICAL SPINE MANAGED VIAAN ANTERIOR ONLY APPROACH. A Case Report. J Med Liban 2016; 64:181-185. [PMID: 28850208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report the rare case of a 52-year-old man who presented an incomplete tetraplegia after a hang gliding accident. Computed tomography revealed a complete bilateral facet fracture-dislocation at the C4C5 level, with a unilateral facet fracture-dislocation on the left side at the C3C4 level; there was also a sagittal fracture of the fifth cervical vertebra extending through the middle of its body with a second fracture through the posterior arch. The patient was taken urgently to the operating room and closed reduction maneuvers were performed under general anesthesia, followed by an anterior prevascular approach for C3 to C5 fusion with two iliac crest grafts and a plate. Patient’s muscle strength was 3/5 on all four limbs on discharge and between 4/5 and 5/5 at one year. He stopped self-catheterization nine months after the accident. At two years follow-up, X-rays and CT scan showed a stable construct with satisfactory fusion. This is the first paper, in the literature, to describe double level contiguous cervical dislocation with a sagittal split fracture, and managed via an anterior only approach.
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Obeid I, Boissière L, Yilgor C, Larrieu D, Pellisé F, Alanay A, Acaroglu E, Perez-Grueso FJ, Kleinstück F, Vital JM, Bourghli A. Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning. Eur Spine J 2016; 25:3644-3649. [PMID: 27323962 DOI: 10.1007/s00586-016-4649-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 01/06/2023]
Abstract
PURPOSE Regarding the close interaction between the spinal alignment and the pelvis orientation, no parameter is routinely used to describe and to evaluate the global spinopelvic balance, taking into account simultaneously the spinal part and the pelvic part of the global alignment. We described the global tilt (GT) that could analyze malalignment considering the spine and the pelvis simultaneously. From a geometrical point of view, the global tilt is the sum of the pelvic tilt (PT) and the C7 vertical tilt (angular value of sagittal vertical axis). The aim of this study is to evaluate the global tilt with comparison to PT and sagittal vertical axis (SVA), with the hypothesis that GT would be the least sensitive to positional changes. METHODS A cohort of 22 patients with sagittal malalignment was identified from a multicentric database of adult spinal deformities (ASD). Inclusion criteria were age >30 years, SVA > 40 mm and/or PT > 20°. All patients had full spine EOS radiographs in positions 1 and 2 (P1 and P2), in which the patient was asked to stand and put his hands on his shoulders without any effort (P1), or to make an effort to be as straight as possible (P2). PT, SVA and GT were measured in both positions and changes between P1 and P2 were calculated and compared using Student's t test with significance level at p < 0.05. RESULTS No significant changes were observed for GT; SVA and PT were significantly influenced by patient positioning. SVA decreased and PT increased for all cases in P2 whereas the changes in GT were in either direction. The average increase in PT was 7.1° (±5.4) or 30.8 % (±24.9); decrease in SVA was 45.1 mm (±25.6) or 60.0 % (±44.2) while the change in GT was 4.4° (±3.3) or 12.6 % (±9.3). DISCUSSION GT appears to be less affected by the patient's position compared to SVA and PT. This seems logical because GT contains both spinal alignment and pelvic compensation; it is not affected by their changes in opposing directions. CONCLUSION GT appears to be the most reliable single sagittal plane parameter in ASD. It is the least affected by patient position and incorporates both the pelvic and the spinal alignment within one measure.
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Affiliation(s)
- I Obeid
- Spine Unit 1, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - L Boissière
- Spine Unit 1, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France.
| | - C Yilgor
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - D Larrieu
- Spine Unit 1, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - F Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | - A Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - E Acaroglu
- Ankara Acibadem Spine Center, Ankara, Turkey
| | - F J Perez-Grueso
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - F Kleinstück
- Spine Center, Schulthess Klinik, Zurich, Switzerland
| | - J M Vital
- Spine Unit 1, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - A Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
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Bourghli A, Boissière L, Vital JM, Bourghli MA, Almusrea K, Khoury G, Obeid I. Modified closing-opening wedge osteotomy for the treatment of sagittal malalignment in thoracolumbar fractures malunion. Spine J 2015; 15:2574-82. [PMID: 26341464 DOI: 10.1016/j.spinee.2015.08.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/26/2015] [Accepted: 08/27/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Many techniques have been described for the surgical treatment of rigid posttraumatic thoracolumbar kyphosis, but none is well adapted to the modified shape of the wedged vertebra. PURPOSE The study aimed to describe the modified closing-opening wedge osteotomy (MCOWO), a new osteotomy technique that adapts to the triangular shape of the wedged apical vertebra of the deformity. STUDY DESIGN A retrospective assessment of the degree of correction before and after the MCOWO was carried out. PATIENT SAMPLE Ten patients presenting rigid posttraumatic thoracolumbar kyphosis were enrolled in this study. OUTCOME MEASURES We used preoperative and postoperative whole spine radiographs to assess the sagittal plane parameters, and computed tomography scan for measurement of the vertebral segment height at the osteotomy level, spinal cord length, aorta length, and fusion rate. METHODS Ten patients underwent the MCOWO at T12 or L1. The procedure involves removing the postero-superior triangular corner of the wedged vertebra and transforming it to a shape similar to a trapezoid. RESULTS The patients' mean age was 36.6±7.5 years, the mean time between the fracture and the surgery was 12.2±5.6 months, and the mean follow-up was 30.6±5 months. In all patients, statistically significant improvement was observed in the sagittal plane after surgery. The thoracolumbar angle improved from 52±6° preoperatively to 7.1±5.7° at the last follow-up. Mean osteotomy angle was 38.1±2.6°, mean spinal cord shortening was 1.2±0.2 cm, and mean aorta lengthening was 2.3±0.4 cm. All the patients showed complete fusion at 2 years, and none required revision surgery. Two patients presented a temporary unilateral weakness that recovered completely within 3 months after the surgery. CONCLUSIONS The MCOWO is an interesting procedure for patients with posttraumatic thoracolumbar kyphosis. The modified osteotomy is adapted to the modified shape of the compressed vertebra. Spinal cord shortening and aorta lengthening were well tolerated in all patients.
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Affiliation(s)
- Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, 11671 Pobox 84400 Saudi Arabia.
| | - Louis Boissière
- Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital,Place Amélie Raba-Léon 33076 Bordeaux cedex, France
| | - Jean-Marc Vital
- Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital,Place Amélie Raba-Léon 33076 Bordeaux cedex, France
| | - Mohamed Aiman Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, 11671 Pobox 84400 Saudi Arabia
| | - Khaled Almusrea
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, 11671 Pobox 84400 Saudi Arabia
| | - Ghassan Khoury
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, 11671 Pobox 84400 Saudi Arabia
| | - Ibrahim Obeid
- Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital,Place Amélie Raba-Léon 33076 Bordeaux cedex, France
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Obeid I, Laouissat F, Bourghli A, Boissière L, Vital JM. One-stage posterior spinal shortening by L5 partial spondylectomy for spondyloptosis or L5-S1 high-grade spondylolisthesis management. Eur Spine J 2015; 25:664-70. [PMID: 26272371 DOI: 10.1007/s00586-015-4174-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 08/01/2015] [Accepted: 08/01/2015] [Indexed: 10/23/2022]
Abstract
STUDY DESIGN A case series of seven consecutive patients with L5-S1 spondyloptosis (SPP) and Meyerding IV spondylolisthesis (HGSPL) treated consecutively by a new surgical technique with partial reduction and fixation after spinal shortening. OBJECTIVE To report clinical and radiological outcomes of a spinal shortening procedure by a single posterior approach in seven patients with HGSPL and SPP. BACKGROUND DATA The surgical treatment of L5-S1 SPP and HGSPL remains challenging, and numbers of surgical treatment options have been described with several principles. We reported a new surgical technique achieving partial reduction and fixation of L5-S1 SPP and HGSPL and highlighted its clinical and radiological outcomes. METHODS Seven patients with Meyerding Grade IV (2), and Grade V (5) were operated consecutively between 2004 and 2011 for HGSPL and SPP. Surgery time, blood loss and complications were collected for all patients. The slip angle or Dubousset lumbo-sacral Angle (Dub-LSA), L5 slip percentage (%slip), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK) and C7-tilt were measured pre and postoperatively. All patients underwent posterior one-stage decompression with sacral dome osteotomy, L5 vertebrectomy with L5-S1 discectomy, and partial reduction and instrumented fusion in a single posterior approach. RESULTS The mean age and follow-up were, respectively, 20 years and 65 months. The mean preoperative %slip was 115 %, which improved to 63 % postoperatively. The mean preoperative Dub-LSA, PT, LL, TK, and C7-tilt were 37°, 31°, -74°, 30°, and 6°, respectively, which improved to 94°, 25°, -44°, 42° and -0.14° postoperatively. No implant failure or pseudarthrosis were reported at last follow-up. CONCLUSION This novel and efficient one-stage shortening technique offers the possibility to manage lumbosacral kyphosis and spinal local malalignment in L5-S1 SPP.
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Affiliation(s)
- Ibrahim Obeid
- Spine Unit 1, Orthopedic Surgery Department, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Féthi Laouissat
- CMCR Massues, Croix Rouge Française, 92, rue Edmond Locard, 69005, Lyon, France.
| | - Anouar Bourghli
- Spine Unit 1, Orthopedic Surgery Department, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Louis Boissière
- Spine Unit 1, Orthopedic Surgery Department, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Jean-Marc Vital
- Spine Unit 1, Orthopedic Surgery Department, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
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Vital JM, Boissière L, Bourghli A, Castelain JE, Challier V, Obeid I. Osteotomies through a fusion mass in the lumbar spine. Eur Spine J 2014; 24 Suppl 1:S107-11. [PMID: 25416167 DOI: 10.1007/s00586-014-3657-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/01/2014] [Accepted: 11/01/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Flat-back syndrome is one of the main causes of surgical failure after lumbar fusion and can lead to a revision surgery to correct it. Three-column pedicle subtraction osteotomy is an efficient technique to restore lumbar lordosis (LL) for fixed sagittal malalignment. The fusion mass stemming from the past surgeries makes the procedure demanding as most anatomical landmarks are missing. MATERIAL AND METHODS This review article will focus on the correction of this lack of LL through the fusion mass. We will successively review the preoperative management, the surgical specificities, and various types of clinical cases that can be encountered in flat-back syndromes. CONCLUSION PSO in the fixed fusion mass is technically demanding. Preoperative CT-scan and preoperative navigation allow us to push the limits when anatomical landmarks disappear. Bleeding and neurologic are the two major complications feared by the surgeon. The best way to avoid these revision surgeries is to restore a proper lumbar lordosis at the time of initial surgery by considering lumbo-pelvic indexes.
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Affiliation(s)
- Jean-Marc Vital
- Orthopedic Department, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
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Obeid I, Boissière L, Vital JM, Bourghli A. Osteotomy of the spine for multifocal deformities. Eur Spine J 2014; 24 Suppl 1:S83-92. [PMID: 25391623 DOI: 10.1007/s00586-014-3660-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/01/2014] [Accepted: 11/01/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION When a deformity involves more than one area of the spine, it becomes a multifocal deformity; such a deformity could either be extending on two adjacent segments, or be two separated deformities on two non-adjacent segments. MATERIALS AND METHODS The surgical management of multifocal spinal deformities is challenging and must be done through a thorough preoperative planning where spinal and pelvic parameters should accurately be determined. Different strategies should be applied depending on the type of the multifocal deformity, the area involved, the angulation and stiffness of the spine in that area, and the presence of either a pure sagittal malalignment or a combined coronal and sagittal malalignment. This paper discusses these strategies and gives guidelines regarding the use of the different osteotomy techniques depending on each different situation that the deformity spine surgeon may encounter. For instance, where is the ideal level to perform a pedicle subtraction osteotomy (PSO) in a multifocal deformity? How does one take advantage of the remaining high discs to increase the correction without the need for a second PSO? When and where does one perform an asymmetrical PSO? When and where does one perform two PSOs? How does navigation help the spine surgeon to push the surgical limits further in these complex cases? CONCLUSION All these questions about the management of multifocal deformities will be discussed and answered with technical details and concrete examples of the different situations that may be encountered.
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Affiliation(s)
- Ibrahim Obeid
- Spine Unit, Bordeaux University Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France,
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Bourghli A, Luc S, Obeid I, Guérin P, Gille O, Vital JM, Boissière L, Pointillart V. Management of a major atlanto-axial instability secondary to a lytic lesion of C2. Eur Spine J 2014; 24:180-4. [DOI: 10.1007/s00586-014-3513-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/04/2014] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
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