1
|
Langlais T, Skalli W, du Cluzel X, Mainard N, George S, Gajny L, Vialle R, Dubousset J, Vergari C. Spinal axial torque assessment after surgical correction in adolescent idiopathic scoliosis: a new approach to 3D barycentremetry and mass distribution based on biplanar radiographs. Spine Deform 2024; 12:689-697. [PMID: 38347377 DOI: 10.1007/s43390-023-00816-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/23/2023] [Indexed: 05/04/2024]
Abstract
PURPOSE Barycentremetry in adolescent idiopathic scoliosis (AIS) allows the distribution of masses and their loading of the spine to be studied. In particular, the axial torque on the spine has been studied in AIS, but not after surgical correction. Spinal axial torque was studied in AIS before and after surgery. METHODS All AIS (Lenke 1 and 3) who underwent posterior spinal fusion surgery at our center in 2019 were included retrospectively. AIS underwent frontal and sagittal biplanar radiographs in the free-standing position before surgery, 4 months after surgery, and at the last follow-up. Their spine and external envelope were reconstructed with validated methods. Spinal axial torque at the apex and the upper and lower end vertebra was calculated. Finally, the preoperative and postoperative values were compared to a previously published reference corridor for asymptomatic subjects. RESULTS Twenty-nine patients were included (54 ± 11° Cobb angle, 15 ± 2 years old at surgery). The surgical procedure decreased the Cobb angle by 36° ± 11° and decreased the spinal axial torque at the upper end vertebra by 2.5 N/m (95% CI = [1.9; 3]; p < 0.001), at the apex by 0.6 N/m (95% CI = [0.4; 1]; p = 0.004), at the lower end vertebra by 2 N/m (95% CI = [1.5; 2.8]; p < 0.001). Compared to 95th percentile of torque, which was previously evaluated in asymptomatic subjects, more than 90% of patients had higher values at the upper and lower end vertebrae before surgery. Postoperatively, 62% of patients still had higher torque at the upper end vertebra than asymptomatic subjects, while only 38% patients showed abnormal values at the lower junction. CONCLUSION Results of this study confirm that AIS patients show abnormally high spinal axial torque, especially at the end vertebrae, and that this parameter is normalized postoperatively for only a small number of patients.
Collapse
Affiliation(s)
- Tristan Langlais
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France.
- Service Orthopédie et Traumatologie, Hôpital des Enfants, CHU Purpan, Toulouse Université, Toulouse, France.
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| | - Xavier du Cluzel
- Service Orthopédie et Traumatologie, CHU Necker Enfants Malades, Paris Cité Université, APHP, Paris, France
| | - Nicolas Mainard
- Service Orthopédie et Traumatologie, CHU Armand Trousseau, APHP, Sorbonne Université, Paris, France
| | - Samuel George
- Service Orthopédie et Traumatologie, CHU Necker Enfants Malades, Paris Cité Université, APHP, Paris, France
| | - Laurent Gajny
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| | - Raphael Vialle
- Service Orthopédie et Traumatologie, CHU Armand Trousseau, APHP, Sorbonne Université, Paris, France
| | - Jean Dubousset
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| |
Collapse
|
2
|
Khalifé M, Vergari C, Assi A, Guigui P, Attali V, Valentin R, Vafadar S, Ferrero E, Skalli W. Full-body Postural Alignment Analysis Through Barycentremetry. Spine (Phila Pa 1976) 2024:00007632-990000000-00630. [PMID: 38571297 DOI: 10.1097/brs.0000000000005001] [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: 12/30/2023] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
STUDY DESIGN Multicentric retrospective. OBJECTIVE The study of center of mass (COM) locations (i.e. barycentremetry) can help us understand postural alignment. This study goal was to determine relationships between COM locations and global postural alignment X-ray parameters in healthy subjects. The second objective was to determine the impact on spinopelvic alignment of increased distance between anterior body envelope and spine at lumbar apex level. SUMMARY OF BACKGROUND DATA Unexplored relationship between COM location and spinopelvic parameters. METHODS This study included healthy volunteers with full-body biplanar radiograph including body envelope reconstruction, allowing the estimation of COM location. The following parameters were analyzed: lumbar lordosis (LL), thoracic kyphosis (TK), cervical lordosis (CL), pelvic tilt (PT), Sacro-femoral angle (SFA), Knee flexion angle (KFA), sagittal odontoid-hip axis angle (ODHA). The following COM in the sagittal plane were located: whole body, at thoracolumbar inflexion point, and body segment above TK apex. The body envelope reconstruction also provided the distance between anterior skin and the LL apex vertebral body center ("SV-L distance"). RESULTS This study included 124 volunteers, with a mean age of 44±19.3. Multivariate analysis confirmed posterior translation of COM above TK apex with increasing LL (P=0.002) through its proximal component, and posterior shift of COM at inflexion point with increasing TK (P=0.008). Increased SV-L distance was associated with greater ODHA (r=0.4) and more anterior body COM (r=0.8), caused by increased TK (r=0.2) and decreased proximal and distal LL (both r=0.3), resulting in an augmentation in SFA (r=0.3) (all P<0.01). CONCLUSIONS Barycentremetry showed that greater LL was associated with posterior shift of COM above thoracic apex while greater TK was correlated with more posterior COM at inflexion point. Whole-body COM was strongly correlated with ODHA. This study also exhibited significant alignment disruption associated with increased abdominal volume, with compensatory hip extension. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Marc Khalifé
- Orthopaedic Surgery Department, Spine Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
- Université Paris-Cité, Paris, France
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013 Paris, France
| | - Claudio Vergari
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013 Paris, France
| | - Ayman Assi
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013 Paris, France
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Pierre Guigui
- Orthopaedic Surgery Department, Spine Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
- Université Paris-Cité, Paris, France
| | - Valérie Attali
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013 Paris, France
- Service des Pathologies du Sommeil (Département "R3S"), Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
| | - Rémi Valentin
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013 Paris, France
- Service des Pathologies du Sommeil (Département "R3S"), Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
| | - Saman Vafadar
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013 Paris, France
| | - Emmanuelle Ferrero
- Orthopaedic Surgery Department, Spine Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
- Université Paris-Cité, Paris, France
| | - Wafa Skalli
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013 Paris, France
| |
Collapse
|
3
|
Langlais T, Vergari C, Rougereau G, Gaume M, Gajny L, Abelin-Genevois K, Bernard JC, Hu Z, Cheng JCY, Chu WCW, Assi A, Karam M, Ghanem I, Bassani T, Galbusera F, Sconfienza LM, Brayda-Bruno M, Courtois I, Ebermeyer E, Vialle R, Dubousset J, Skalli W. Assessment of malalignment at early stage in adolescent idiopathic scoliosis: a longitudinal cohort study. Eur Spine J 2024; 33:1665-1674. [PMID: 38407613 DOI: 10.1007/s00586-024-08178-w] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Our objective was to assess abnormalities of the odontoid-hip axis (OD-HA) angle in a mild scoliotic population to determine whether screening for malalignment would help predict the distinction between progressive and stable adolescent idiopathic scoliosis (AIS) at early stage. MATERIALS AND METHODS All patients (non-scoliotic and AIS) underwent a biplanar X-ray between 2013 and 2020. In AIS, inclusion criteria were Cobb angle between 10° and 25°; Risser sign lower than 3; age higher than 10 years; and no previous treatment. A 3D spine reconstruction was performed, and the OD-HA was computed automatically. A reference corridor for OD-HA values in non-scoliotic subjects was calculated as the range [5th-95th percentiles]. A severity index, helping to distinguish stable and progressive AIS, was calculated and weighted according to the OD-HA value. RESULTS Eighty-three non-scoliotic and 205 AIS were included. The mean coronal and sagittal OD-HA angles in the non-scoliotic group were 0.2° and -2.5°, whereas in AIS values were 0.3° and -0.8°, respectively. For coronal and sagittal OD-HA, 27.5% and 26.8% of AIS were outside the reference corridor compared with 10.8% in non-scoliotic (OR = 3.1 and 3). Adding to the severity index a weighting factor based on coronal OD-HA, for thoracic scoliosis, improved the positive predictive value by 9% and the specificity by 13%. CONCLUSION Analysis of OD-HA suggests that AIS patients are almost three times more likely to have malalignment compared with a non-scoliotic population. Furthermore, analysis of coronal OD-HA is promising to help the clinician distinguish between stable and progressive thoracic scoliosis.
Collapse
Affiliation(s)
- Tristan Langlais
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France.
- Service Orthopédie et Traumatologie, Hôpital des Enfants, Purpan, Toulouse Université, Toulouse, France.
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| | - Gregoire Rougereau
- Service Orthopédie et Traumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, APHP, Paris, France
| | - Mathilde Gaume
- Service Orthopédie et Traumatologie, Hôpital Necker Enfants Malades, Paris cité Université, APHP, Paris, France
| | - Laurent Gajny
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| | - Kariman Abelin-Genevois
- Department of Orthopaedic Surgery and Children Conservative Treatment, Croix-Rouge Française. Centre Médico-Chirurgical Et de Réadaptation Des Massues, Lyon, France
| | - Jean Claude Bernard
- Department of Orthopaedic Surgery and Children Conservative Treatment, Croix-Rouge Française. Centre Médico-Chirurgical Et de Réadaptation Des Massues, Lyon, France
| | - Zongshan Hu
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jack Chun Yiu Cheng
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ayman Assi
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Joseph University of Beirut, SaintBeirut, Lebanon
| | - Mohamad Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Joseph University of Beirut, SaintBeirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Joseph University of Beirut, SaintBeirut, Lebanon
- Department of Orthopedic Surgery, Hotel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
| | | | | | - Eric Ebermeyer
- Unite Rachis, CHU - Hopital Bellevue, Saint-Etienne, France
| | - Raphael Vialle
- Sorbonne Université, Service Orthopédie et Traumatologie, Hôpital A. Trousseau, APHP, Paris, France
| | - Jean Dubousset
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| |
Collapse
|
4
|
Gaume M, Loiselet K, Chekir H, Langlais T, Boddaert N, Stricker S, Pannier S, Skalli W, Miladi L, Vergari C. Evidence of spinal stiffening following fusionless bipolar fixation for neuromuscular scoliosis: a shear wave elastography assessment of lumbar annulus fibrosus. Eur Spine J 2024; 33:1617-1623. [PMID: 37924389 DOI: 10.1007/s00586-023-08013-8] [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: 06/09/2023] [Revised: 09/12/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES There are no established criteria for stiffness after fusionless surgery for neuromuscular scoliosis (NMS). As a result, there is no consensus regarding the surgical strategy to propose at long-term follow-up. This study reports the first use of shear wave elastography for assessing the mechanical response of lumbar intervertebral discs (IVDs) after fusionless bipolar fixation (FBF) for NMS and compares them with healthy controls. The aim was to acquire evidence from the stiffness of the spine following FBF. PATIENTS AND METHODS Nineteen NMS operated on with FBF (18 ± 2y at last follow-up, 6 ± 1 y after surgery) were included prospectively. Preoperative Cobb was 89 ± 20° and 35 ± 1° at latest follow-up. All patients had reached skeletal maturity. Eighteen healthy patients (20 ± 4 y) were also included. Shear wave speed (SWS) was measured in the annulus fibrosus of L3L4, L4L5 and L5S1 IVDs and compared between the two groups. A measurement reliability was performed. RESULTS In healthy subjects, average SWS (all disc levels pooled) was 7.5 ± 2.6 m/s. In NMS patients, SWS was significantly higher at 9.9 ± 1.4 m/s (p < 0.05). Differences were significant between L3L4 (9.3 ± 1.8 m/s vs. 7.0 ± 2.5 m/s, p = 0.004) and L4L5 (10.3 ± 2.3 m/s vs. 7.1 ± 1.1 m/s, p = 0.0006). No difference was observed for L5S1 (p = 0.2). No correlation was found with age at surgery, Cobb angle correction and age at the SWE measurement. CONCLUSIONS This study shows a significant increase in disc stiffness at the end of growth for NMS patients treated by FBF. These findings are a useful adjunct to CT-scan in assessing stiffness of the spine allowing the avoidance of surgical final fusion at skeletal maturity.
Collapse
Affiliation(s)
- Mathilde Gaume
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France.
- Arts Et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France.
- Necker Hospital, 149 Rue de Sevres, 75015, Paris, France.
| | - Klervie Loiselet
- Pediatric Radiology Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Hedi Chekir
- Pediatric Radiology Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Tristan Langlais
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
- Arts Et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Sarah Stricker
- Neurosurgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Stéphanie Pannier
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Wafa Skalli
- Arts Et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - Lotfi Miladi
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Claudio Vergari
- Arts Et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| |
Collapse
|
5
|
Vergari C, Kim Y, Takemoto M, Tokuyasu H, Shimizu Y, Tanaka C, Fukae S, Fujibayashi S, Matsuda S. The relationship between spino-pelvic-hip mobility and quality of life before and after total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:1379-1387. [PMID: 37847287 DOI: 10.1007/s00402-023-05094-4] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/30/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Total hip arthroplasty (THA) can significantly improve quality of life (QOL) in patients with hip osteoarthritis. A relationship exists between activity levels and postoperative QOL, but its determinants are not well known. The aim of this work was to investigate the relationship between hip, pelvis and lumbar spine mobility and alignment before and after THA with QOL. MATERIAL AND METHODS Consecutive patients with hip arthrosis and an indication for THA were included prospectively between July 2019 and December 2020, and they underwent lateral radiographs in free-standing, extension, relaxed- and flexed-seated position. Spinopelvic and hip parameters were measured, as well as their changes between positions to assess hip, pelvis and lumbar spine mobility. Patients were also administered QOL questionnaires. Data were collected preoperatively and 6 and 12 months postoperatively. RESULTS Seventy patients were included; QOL significantly increased 6 months after THA (from 18 [10; 27] to 61 [48; 72], p < 0.001). QOL further increased by 10 points or more after 6 months in 18% of patients, while it decreased in 16%. The latter showed higher pelvic range of motion (between flexion and extension) than the former. CONCLUSIONS This study confirmed that QOL is significantly improved by THA, and that spinopelvic alignment and function can play a role. Future work should elucidate how to better predict postoperative QOL from preoperative patient characteristics to improve patient treatment and establish early postoperative physical therapy for patients who could benefit from postoperative improvement of activity-related QOL.
Collapse
Affiliation(s)
- Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, 151 Bd de L'Hôpital, 75013, Paris, France.
| | - Youngwoo Kim
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Mitsuru Takemoto
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | | | - Yu Shimizu
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Chiaki Tanaka
- Department of Orthopaedic Surgery, Gakkentoshi Hospital, Kyoto, Japan
| | - Shunya Fukae
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| |
Collapse
|
6
|
Bouloussa H, Durand Z, Gibon E, Chen AF, Grant M, Saleh-Mghir A, Mirza M, Stutzman B, Vergari C, Yue J, Anzala N, Bonnot D, Albac S, Bouloussa O, Croisier D. A novel antibacterial compound decreases MRSA biofilm formation without the use of antibiotics in a murine model. J Orthop Res 2024; 42:202-211. [PMID: 37283215 DOI: 10.1002/jor.25638] [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: 03/02/2023] [Revised: 05/04/2023] [Accepted: 05/30/2023] [Indexed: 06/08/2023]
Abstract
Despite significant advancements in material science, surgical site infection (SSI) rates remain high and prevention is key. This study aimed to demonstrate the in vivo safety and antibacterial efficacy of titanium implants treated with a novel broad-spectrum biocidal compound (DBG21) against methicillin-resistant Staphylococcus aureus (MRSA). Titanium (Ti) discs were covalently bound with DBG21. Untreated Ti discs were used as controls. All discs were implanted either untreated for 44 control mice or DBG21-treated for 44 treated mice. After implantation, 1 × 107 colony forming units (CFU) of MRSA were injected into the operating site. Mice were killed at 7 and 14 days to determine the number of adherent bacteria (biofilm) on implants and in the peri-implant surrounding tissues. Systemic and local toxicity were assessed. At both 7 and 14 days, DBG21-treated implants yielded a significant decrease in MRSA biofilm (3.6 median log10 CFU [99.97%] reduction [p < 0.001] and 1.9 median log10 CFU [98.7%] reduction [p = 0.037], respectively) and peri-implant surrounding tissues (2.7 median log10 CFU/g [99.8%] reduction [p < 0.001] and 5.6 median log10 CFU/g [99.9997%] reduction [p < 0.001], respectively). There were no significant differences between control and treated mice in terms of systemic and local toxicity. DBG-21 demonstrated a significant decrease in the number of biofilm bacteria without associated toxicity in a small animal implant model of SSI. Preventing biofilm formation has been recognized as a key element of preventing implant-related infections.
Collapse
Affiliation(s)
| | - Zoe Durand
- DeBogy Molecular Inc., Farmington, Connecticut, USA
| | | | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Grant
- Section of Infectious Diseases, New Haven, Connecticut, USA
| | - Azzam Saleh-Mghir
- UVSQ-Inserm, UMR 1173 Infection and Inflammation, Montigny-le-Bretonneux, France
| | - Mohsin Mirza
- DeBogy Molecular Inc., Farmington, Connecticut, USA
| | | | - Claudio Vergari
- Arts et Métiers Sciences et Technologie, Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - James Yue
- CT Orthopaedic Specialists, Department of Surgery, Frank H Netter School of Medicine Quinnipiac University, North Haven, Connecticut, USA
| | | | | | | | | | | |
Collapse
|
7
|
Vergari C, Persohn S, Rohan PY. The effect of breathing on the in vivo mechanical characterization of linea alba by ultrasound shearwave elastography. Comput Biol Med 2023; 167:107637. [PMID: 37897961 DOI: 10.1016/j.compbiomed.2023.107637] [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] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/09/2023] [Accepted: 10/24/2023] [Indexed: 10/30/2023]
Abstract
The most common surgical repair of abdominal wall hernia consists in implanting a mesh to reinforce hernia defects during the healing phase. Ultrasound shearwave elastography (SWE) is a promising non-invasive method to estimate soft tissue mechanical properties at bedside through shear wave speed (SWS) measurement. Combined with conventional ultrasonography, it could help the clinician plan surgery. In this work, a novel protocol is proposed to reliably assess the stiffness of the linea alba, and to evaluate the effect of breathing and of inflating the abdomen on SWS. Fifteen healthy adults were included. SWS was measured in the linea alba, in the longitudinal and transverse direction, during several breathing cycle and during active abdominal inflation. SWS during normal breathing was 2.3 [2.0; 2.5] m/s in longitudinal direction and 2.2 [1.9; 2.7] m/s in the transversal. Inflating the abdomen increased SWS both in longitudinal and transversal direction (3.5 [2.8; 5.8] m/s and 5.2 [3.0; 6.0] m/s, respectively). The novel protocol significantly improved the reproducibility relative to the literature (8% in the longitudinal direction and 14% in the transverse one). Breathing had a mild effect on SWS, and accounting for it only marginally improved the reproducibility. This study proved the feasibility of the method, and its potential clinical interest. Further studies on larger cohort should focus on improving our understanding of the relationship between abdominal wall properties and clinical outcomes, but also provide a cartography of the abdominal wall, beyond the linea alba.
Collapse
Affiliation(s)
- Claudio Vergari
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France.
| | - Sylvain Persohn
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - Pierre-Yves Rohan
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| |
Collapse
|
8
|
Galinié P, Eyssartier C, Sauret C, Tordjman M, Pissonier ML, Carlier R, Skalli W, Vergari C. In-vivo characterization of the lumbar annulus fibrosus in adults with ultrasonography and shear wave elastography. Med Eng Phys 2023; 120:104044. [PMID: 37838398 DOI: 10.1016/j.medengphy.2023.104044] [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] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/05/2023] [Accepted: 08/25/2023] [Indexed: 10/16/2023]
Abstract
In vivo characterization of intervertebral disc (IVD) mechanical properties and microstructure could give an insight into the onset and progression of disc pathologies. Ultrasound shearwave elastography provided promising results in children, but feasibility in adult lumbar discs, which are deep in the abdomen, was never proved. The aim of this work was to determine the feasibility and reliability of ultrasound assessment of lumbar IVD in adults. Thirty asymptomatic adults were included (22 to 67 years old). Subjects were lying supine, and the annulus fibrosus of the L3-L4 IVD was imaged by conventional ultrasonography and shearwave elastography. Shear wave speed (SWS) and lamellar thickness were measured. Reliability was determined through repeated measurements acquired by three operators. Average SWS in AF at the L3L4 level was 4.0 ± 0.9 m/s, with an inter-operator uncertainty of 8.7%, while lamellar thickness was 255 ± 27 µm with an uncertainty of 9.6%. Measurement was not feasible in one out of four subjects with BMI > 24 kg/m² (overweight). Ultrasound assessment of annulus fibrosus revealed feasible, within certain limitations, and reproducible. This method gives an insight into disc microstructure and mechanical properties, and it could be applied for the early detection or follow-up of disc pathologies.
Collapse
Affiliation(s)
- Priscilla Galinié
- Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France
| | - Camille Eyssartier
- Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France; Fédération Française de Gymnastique, Paris, France
| | - Christophe Sauret
- Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France; Centre d'Etudes et de Recherche sur l'Appareillage des Handicapés, Institution Nationale des Invalides, France
| | - Mickael Tordjman
- Medical Imaging Department, Raymond Poincaré Hospital, 104 bd Raymond Poincaré, 92380, GARCHES, France
| | - Marie-Line Pissonier
- Medical Imaging Department, Raymond Poincaré Hospital, 104 bd Raymond Poincaré, 92380, GARCHES, France
| | - Robert Carlier
- Medical Imaging Department, Raymond Poincaré Hospital, 104 bd Raymond Poincaré, 92380, GARCHES, France
| | - Wafa Skalli
- Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France
| | - Claudio Vergari
- Arts et Métiers Sciences et Technologies, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France.
| |
Collapse
|
9
|
Langlais T, Bouy A, Eloy G, Mainard N, Skalli W, Vergari C, Vialle R. Sagittal plane assessment of manual concave rod bending for posterior correction in adolescents with idiopathic thoracic scoliosis (Lenke 1 and 3). Orthop Traumatol Surg Res 2023; 109:103654. [PMID: 37399990 DOI: 10.1016/j.otsr.2023.103654] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 07/05/2023]
Abstract
OBJECTIVES The objectives of this study were to evaluate the repeatability and reproducibility of a method for measuring freehand rod bending and to analyze the relationship between the rod's bend and the resulting sagittal correction. MATERIALS AND METHODS All the children who underwent correction by posterior translation using pedicle screws at all levels were included prospectively in 2018 and 2019. The rod's sagittal parameters were measured retrospectively by three independent surgeons on two separate occasions using the same protocol. After the rods were bent but before they were inserted, the surgeon traced the contours of the rods on a sheet of paper that was later scanned and analyzed semiautomatically. The spinal parameters were calculated based on biplanar radiographs taken preoperatively, postoperatively and at the final follow-up visit. Patients who had less than 10° thoracic kyphosis (T5-T12) made up the "Lenke N-" subgroup. RESULTS Thirty patients were included (14 of whom were Lenke N-) who had a Cobb angle of 59.2±11.3° preoperatively and 13.3±8.4° postoperatively (p<0.00001). The inter- and intrarater ICC for the rod measurements were>0.9 (excellent). The mean kyphosis of the concave rod was 48.4±5.7° (38.3-60.9°). The mean change in T5-T12 kyphosis was 9.7±10.8° (-14.3-30.8°) (p<0.0001) in the entire population, while it was 17.7±7.1° (5.5-30.8°) (p<0.0001) in the Lenke N- subgroup. The change in thoracic kyphosis was positively correlated with the kyphosis of the concave rod (rho=0.52; p=0.003). CONCLUSION This study found excellent reproducibility and repeatability of measuring freehand rod bending. The kyphosis applied to the concave rod is positively correlated to the change in the resulting kyphosis and made it possible to restore satisfactory thoracic kyphosis. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Tristan Langlais
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France; Institut de Biomécanique Humaine Georges Charpak-IBHGC, Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, HESAM Université, 75013 Paris, France; Service d'orthopédie pédiatrique, hôpital des Enfants, Purpan, Toulouse université, Toulouse, France.
| | - Alois Bouy
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Gauthier Eloy
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Nicolas Mainard
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak-IBHGC, Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, HESAM Université, 75013 Paris, France
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak-IBHGC, Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, HESAM Université, 75013 Paris, France
| | - Raphaël Vialle
- Service d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| |
Collapse
|
10
|
Khalifé M, Vergari C, Rebeyrat G, Ferrero E, Guigui P, Assi A, Skalli W. Femoral neck version in the spinopelvic and lower limb 3D alignment: a full-body EOS ® study in 400 healthy subjects. Eur Spine J 2023:10.1007/s00586-023-07915-x. [PMID: 37697058 DOI: 10.1007/s00586-023-07915-x] [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: 05/04/2023] [Revised: 07/19/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND The goal of this study was to better understand the variation of femoral neck version according to spinopelvic and lower limb 3D alignment using biplanar X-rays in standing position. METHODS This multicentric study retrospectively included healthy subjects from previous studies who had free-standing position biplanar radiographs. Subjects were excluded if they presented spinal or any musculo-skeletal deformity, and reported pain in the spine, hip or knee. Age, sex, and the following 3D-reconstructed parameters were collected: spinal curvatures, pelvic parameters, sagittal vertical axis (SVA), T1 pelvic angle (TPA), spino-sacral angle (SSA), femoral torsion angle (FTA), sacro-femoral angle (SFA), knee flexion angle (KA), ankle angle (AA), pelvic shift (PS) and ankle distance. Femoral neck version angle (FVA) was calculated between horizontal plane projection of the bi-coxo-femoral axis and the line passing through the femoral neck barycenter and femoral head center. Analysis according to age subsets was performed. RESULTS A total of 400 subjects were included (219 females); mean age was 29 ± 18 years (range: 4-83). Subjects with high pelvic tilt values presented significantly higher FVA than average and low-PT individuals, respectively, 7.8 ± 7.1°, 2 ± 9° and 2.1 ± 9.5° (p < 0.001). These subjects also presented lower lumbar lordosis values and higher acetabulum anteversion in the horizontal plane than the two other groups. SVA correlation with FVA was weaker (r = 0.1, p = 0.03) than SSA and TPA (r = - 0.3 and r = 0.3, respectively, p < 0.001). A strong correlation was found with femoral torsion (r = 0.5, p < 0.001). SFA (r = - 0.3, p < 0.001), pelvic shift (r = 0.2, p < 0.001) and ankle distance (r = 0.3, p < 0.001) were also significantly correlated. Multivariate analysis confirmed significant association of age, pelvic tilt, lumbar lordosis, pelvic shift, ankle distance and femoral torsion with FVA. CONCLUSION Patients with lower lumbar lordosis present pelvic retroversion which induces a higher femoral neck version. This finding may help positioning implants in total hip replacement procedures. Higher pelvic shift, age, male gender and increased femoral torsion were also correlated with higher FVA. LEVEL OF EVIDENCE II (Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding).
Collapse
Affiliation(s)
- Marc Khalifé
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015, Paris, France.
- Université Paris-Cité, Paris, France.
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France.
| | - Claudio Vergari
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France
| | - Guillaume Rebeyrat
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France
| | - Emmanuelle Ferrero
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015, Paris, France
- Université Paris-Cité, Paris, France
| | - Pierre Guigui
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015, Paris, France
- Université Paris-Cité, Paris, France
| | - Ayman Assi
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Wafa Skalli
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France
| |
Collapse
|
11
|
Gaume M, Langlais T, Loiselet K, Pannier S, Skalli W, Vergari C, Miladi L. Spontaneous induced bone fusion in minimally invasive fusionless bipolar fixation in neuromuscular scoliosis: a computed tomography analysis. Eur Spine J 2023; 32:2550-2557. [PMID: 37133763 DOI: 10.1007/s00586-023-07745-x] [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: 01/17/2023] [Revised: 04/11/2023] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE Posterior spinal fusion (PSF) at skeletal maturity is still the gold standard in children with neuromuscular scoliosis (NMS) who underwent fusionless surgery. The aim of this computed tomography (CT) study was to quantify the spontaneous bone fusion at the end of a lengthening program by minimally invasive fusionless bipolar fixation (MIFBF), that could avoid PSF. METHODS NMS operated on with MIFBF from T1 to the pelvis and at final lengthening program were included. CT was performed at least five years postoperatively. The autofusion was classified as completely or not fused at the facets joint (on both coronal and sagittal plane, right and left side, from T1 to L5), and around the rods (axial plane, right and left side, from T5 to L5). Vertebral body heights were assessed. RESULTS Ten patients were included (10.7y ± 2 at initial surgery). Mean Cobb angle was 82 ± 20 preoperatively and 37 ± 13 at last follow-up. CT were performed on average 6.7y ± 1.7 after initial surgery. Mean preoperative and last follow-up thoracic vertebrae height were respectively 13.5 mm ± 1.7 and 17.4 mm ± 1.7 (p < 0.001). 93% facets joints were fused (out of 320 analyzed joints), corresponding to 15/16 vertebral levels. Ossification around the rods was observed in 6.5±2.4 levels out of 13 in the convex side, and 4.2 ± 2.2 in the concave side (p = 0.04). CONCLUSIONS This first computed quantitative study showed MIFBF in NMS preserved spinal growth, while it induced 93% of facet joints fusion. This could be is an additional argument when questionning the real need for PSF at skeletal maturity.
Collapse
Affiliation(s)
- M Gaume
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, 149 rue de Sevres, 75015, Paris, France.
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France.
| | - T Langlais
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, 149 rue de Sevres, 75015, Paris, France
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - K Loiselet
- Pediatric Radiology Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - S Pannier
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, 149 rue de Sevres, 75015, Paris, France
| | - W Skalli
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - C Vergari
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - L Miladi
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, 149 rue de Sevres, 75015, Paris, France
| |
Collapse
|
12
|
Vergari C, Skalli W, Abelin-Genevois K, Bernard JC, Hu Z, Cheng JCY, Chu WCW, Assi A, Karam M, Ghanem I, Bassani T, Galbusera F, Sconfienza LM, Brayda-Bruno M, Courtois I, Ebermeyer E, Vialle R, Langlais T, Dubousset J. Spine slenderness is not an early sign of progression in adolescent idiopathic scoliosis. Med Eng Phys 2022; 108:103879. [DOI: 10.1016/j.medengphy.2022.103879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 10/15/2022]
|
13
|
Vergari C, Kim Y, Takemoto M, Shimizu Y, Tanaka C, Fukae S, Fujibayashi S, Matsuda S. Sagittal alignment in patients with flexion contracture of the hip before and after total hip arthroplasty. Arch Orthop Trauma Surg 2022; 143:3587-3596. [PMID: 36085380 DOI: 10.1007/s00402-022-04606-y] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In hip osteoarthritis, hip flexion contracture can severely alter the patient's alignment, and, therefore, affect the patient's quality of life (QOL). Hip contracture is not well-studied, partly because of the difficulties of its diagnosis. The aim of this study was to propose a quantitative definition of hip flexion contracture, and to analyse sagittal alignment in these patients compared to non-contracture ones, before and 12 months after total hip arthroplasty (THA). MATERIALS AND METHODS Consecutive patients with hip arthrosis and an indication for THA were included (N = 123). Sagittal full-body radiographs were acquired in free standing position and in extension. QOL questionnaires were administered before and after surgery. Spinopelvic parameters were measured, including the pelvic-femur angle (PFA). Patients with low pelvic incidence (< 45°) were included in the hip contracture group if PFA > 5°, or PFA > -5° when pelvic incidence ≥ 45°. RESULTS 29% of patients were in the hip flexion contracture group, and they showed lower pelvic tilt than the no-contracture group (p < 0.001), larger lumbar lordosis (LL) and smaller PI-LL (p < 0.001), as well as a forward position of the head. 16% of patients still had hip contracture 12-months postop. Contracture patients showed higher QOL scores after surgery. CONCLUSIONS The proposed method to diagnose hip contracture group allowed to define a group of patients who showed a specific pattern of sagittal spinopelvic alignment. These patients improved their alignment and quality of life postoperatively, but their hip mobility was not always restored. Diagnosing these patients is a first step toward the development of more specific surgical approaches, aiming to improve their surgical outcome.
Collapse
Affiliation(s)
- Claudio Vergari
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, 151 Bd de l'Hôpital, 75013, Paris, France. .,International Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.
| | - Youngwoo Kim
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Mitsuru Takemoto
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Yu Shimizu
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Chiaki Tanaka
- Department of Orthopaedic Surgery, Gakkentoshi Hospital, Kyoto, Japan
| | - Shunya Fukae
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| |
Collapse
|
14
|
Khalifé M, Vergari C, Ferrero E, Attali V, Heidsieck C, Assi A, Skalli W. The rib cage: a new element in the spinopelvic chain. Eur Spine J 2022; 31:1457-1467. [PMID: 35501578 DOI: 10.1007/s00586-022-07216-9] [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: 10/16/2021] [Revised: 03/03/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION This study analyzes anatomical variations of the thoracic cage (TC) according to spinopelvic alignment, age and gender using stereoradiography in erect position. METHODS This retrospective multicentric study analyzed computed parameters collected from free-standing position bi-planar radiographs, among healthy subjects. Collected data were: age, gender, pelvic parameters (Pelvic Incidence, Pelvic Tilt (PT) and Sacral Slope), T1-T12 Kyphosis (TK), L1-S1 Lordosis (LL), curvilinear spinal length, global TC parameters (maximum thickness and width, rib cage volume, mean Spinal Penetration Index (SPI)), 1st-10th rib parameters (absolute and relative (to the corresponding vertebra) sagittal angles). RESULTS Totally, 256 subjects were included (140 females). Mean age was 34 (range: 8-83). Significant correlations were found between TK and TC thickness (0.3, p < 0.001) and with TC Volume (0.3, p = 0.04), as well as rib absolute sagittal angle for upper and middle ribs (0.2, p = 0.02). Conversely, a -0.3 correlation has been exhibited between SPI and TK. Similar correlations were found with LL. PT significantly correlated with TC thickness (0.4, p = 0.003), SPI (-0.3, p = 0.03), and all rib relative sagittal angles. Among global TC parameters, only thickness and SPI significantly changed after 20 years (respectively, 0.39 and -0.52, p < 0.001). Ribs relative sagittal angle showed negative correlation with age in skeletally mature subjects (p < 0.001). CONCLUSION This study demonstrates the correlation between TC anatomy and spinopelvic parameters, confirming its part of the spinopelvic chain of balance. Indeed, higher spinal curvatures were associated with lower SPI and higher TC thickness, TC volume and rib absolute sagittal angles.
Collapse
Affiliation(s)
- Marc Khalifé
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015, Paris, France. .,Université Paris Cité, Paris, France. .,Arts Et Métiers Institute of Technology, Université Sorbonne Paris Nord, Villetaneuse, France. .,IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France.
| | - Claudio Vergari
- Arts Et Métiers Institute of Technology, Université Sorbonne Paris Nord, Villetaneuse, France.,IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France
| | - Emmanuelle Ferrero
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015, Paris, France.,Université Paris Cité, Paris, France
| | - Valérie Attali
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Université, Paris, France.,Service Des Pathologies du Sommeil (Département "R3S"), Assistance Publique Hôpitaux de Paris (APHP), Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Cécile Heidsieck
- Arts Et Métiers Institute of Technology, Université Sorbonne Paris Nord, Villetaneuse, France.,IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France
| | - Ayman Assi
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Wafa Skalli
- Arts Et Métiers Institute of Technology, Université Sorbonne Paris Nord, Villetaneuse, France.,IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 75013, Paris, France
| |
Collapse
|
15
|
Dukan R, Vergari C, Boyer P, Skalli W. Contribution of shear wave elastography in evaluation of the deltoid in reverse shoulder arthroplasty: reproducibility study and preliminary results. Med Ultrason 2022; 24:174-179. [PMID: 34762727 DOI: 10.11152/mu-3249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIMS The current difficulty of reverse shoulder arthroplasty (RSA) is soft tissue management, and adequate deltoid tension and at present there is no consensus and available tools (X-ray, MRI, EMG) remain difficult to apply in clinical follow-up. The objective of this study was (1) to determine reliability and feasibility of deltoid elasticity assessment using ultrasound elastographyand (2) to assess the change of deltoid stiffness after RSA by comparing shear wave speed (SWS) between healthy and RSA shoulders. MATERIAL AND METHODS Twenty-six healthy (native shoulder, painless and complete range of motion) subjects and twelve patients with RSA were included. Two independent investigators performed 3 measurements on each segment. Measurements were bilateral. Anterior segment was also evaluated at 45° and 60° of passive abduction. Reliability and feasibility have been assessed (ISO5725-standard). RESULTS Coefficient of measurements variation was less than 6.1% and 0.13 m/s. In the healthy group, SWS was not significantly different between anterior and middle segments; however, the SWS of the posterior segment was significantly lower than others (p<0.0001). In abduction position, compared to the rest position, SWS of the anterior segment decreased at 45° abduction (p=0.0003) and increased at 60° abduction (p<0.0001). Variability of measurement was higher in the RSA group. No significant difference was found between the SWS measurement of the operated and non-operated side. SWS measurements of the operated side of the anterior and middle segment were significantly higher compared to the healthy group. In abduction position, compared to rest position, no difference in SWS of the anterior segment was found at 45° abduction (p=0.71) and nor at 60° abduction (p=0.75). CONCLUSION This study demonstrated feasibility and reliability of shoulder assessment with shear wave elastography. Reference values for asymptomatic patients can already be used in future studies on shoulder pathology and surgery.
Collapse
Affiliation(s)
- Ruben Dukan
- Université Paris Diderot, Bichat Hospital, service d'orthopédie, 46 rue Henri Huchard 75018 Paris, France, +336 50 04 82 77, Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paristech, 151 Boulevard de l'Hôpital, 75013 Paris, France..
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paristech, 151 Boulevard de l'Hôpital, 75013 Paris, France , .
| | - Patrick Boyer
- Université Paris Diderot, Hôpital Bichât, service d'orthopédie, 46 rue Henri Huchard 75018 Paris, France, Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paristech, 151 Boulevard de l'Hôpital, 75013 Paris, France..
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paristech, 151 Boulevard de l'Hôpital, 75013 Paris, France, .
| |
Collapse
|
16
|
Vergari C, Skalli W, Clavel L, Demuynck M, Valentin R, Sandoz B, Similowski T, Attali V. Functional analysis of the human rib cage over the vital capacity range in standing position using biplanar X-ray imaging. Comput Biol Med 2022; 144:105343. [DOI: 10.1016/j.compbiomed.2022.105343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022]
|
17
|
Hu Z, Vergari C, Gajny L, Man GCW, Yeung KH, Liu Z, Lam TP, Zhu Z, Qiu Y, Chu WCW, Cheng JCY, Skalli W. An analysis on the determinants of head to pelvic balance in a Chinese adult population. Quant Imaging Med Surg 2022; 12:2311-2320. [DOI: 10.21037/qims-21-718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 12/16/2021] [Indexed: 11/06/2022]
|
18
|
Pietton R, Vialle R, Laurent R, Skalli W, Vergari C, Langlais T. Changes in quantitative elastography assessment of the adjacent lumbar disc after segmental fixation of the spine: a case description of a burst fracture of L4. Quant Imaging Med Surg 2022; 12:2184-2188. [DOI: 10.21037/qims-21-666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/25/2021] [Indexed: 11/06/2022]
|
19
|
Karam M, Ghanem I, Vergari C, Khalil N, Saadé M, Chaaya C, Rteil A, Ayoub E, Saad E, Kharrat K, Skalli W, Assi A. Global malalignment in adolescent idiopathic scoliosis: the axial deformity is the main driver. Eur Spine J 2022; 31:2326-2338. [PMID: 34985548 DOI: 10.1007/s00586-021-07101-x] [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: 07/02/2021] [Revised: 11/16/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the global alignment of non-operated subjects with adolescent idiopathic scoliosis. METHOD A total of 254 subjects with AIS and 64 controls underwent low dose biplanar X-rays and had their spine, pelvis, and rib cage reconstructed in 3D. Global alignment was measured in the sagittal and frontal planes by calculating the OD-HA angle (between C2 dens to hip axis with the vertical). Subjects with AIS were classified as malaligned if the OD-HA was > 95th percentile relative to controls. RESULTS The sagittal OD-HA in AIS remained within the normal ranges. In the frontal plane, 182 AIS were normally aligned (Group 1, OD-HA = 0.9°) but 72 were malaligned (Group 2, OD-HA = 2.9°). Group 2 had a more severe spinal deformity in the frontal and horizontal planes compared to Group 1 (Cobb: 42 ± 16° vs. 30 ± 18°; apical vertebral rotation AVR: 19 ± 10° vs. 12 ± 7°, all p < 0.05). Group 2 subjects were mainly classified as Lenke 5 or 6. 19/72 malaligned subjects had a mild deformity (Cobb < 30°) but a progressive scoliosis (severity index ≥ 0.6). The frontal OD-HA angle was found to be mainly determined (adjusted-R2 = 0.22) by the apical vertebral rotation and secondarily by the Lenke type. CONCLUSIONS This study showed that frontal malalignment is more common in distal major structural scoliosis and its main driver is the apical vertebral rotation. This highlights the importance of monitoring the axial plane deformity in order to avoid worsening of the frontal global alignment.
Collapse
Affiliation(s)
- Mohamad Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Nour Khalil
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Maria Saadé
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Céline Chaaya
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Ali Rteil
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Elma Ayoub
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Eddy Saad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Khalil Kharrat
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon. .,Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France.
| |
Collapse
|
20
|
Pietton R, Bouloussa H, Langlais T, Taytard J, Beydon N, Skalli W, Vergari C, Vialle R. Estimating pulmonary function after surgery for adolescent idiopathic scoliosis using biplanar radiographs of the chest with 3D reconstruction. Bone Joint J 2022; 104-B:112-119. [PMID: 34969276 DOI: 10.1302/0301-620x.104b1.bjj-2021-0337.r2] [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] [Indexed: 11/05/2022]
Abstract
AIMS This study addressed two questions: first, does surgical correction of an idiopathic scoliosis increase the volume of the rib cage, and second, is it possible to evaluate the change in lung function after corrective surgery for adolescent idiopathic scoliosis (AIS) using biplanar radiographs of the ribcage with 3D reconstruction? METHODS A total of 45 patients with a thoracic AIS which needed surgical correction and fusion were included in a prospective study. All patients underwent pulmonary function testing (PFT) and low-dose biplanar radiographs both preoperatively and one year after surgery. The following measurements were recorded: forced vital capacity (FVC), slow vital capacity (SVC), and total lung capacity (TLC). Rib cage volume (RCV), maximum rib hump, main thoracic curve Cobb angle (MCCA), medial-lateral and anteroposterior diameter, and T4-T12 kyphosis were calculated from 3D reconstructions of the biplanar radiographs. RESULTS All spinal and thoracic measurements improved significantly after surgery (p < 0.001). RCV increased from 4.9 l (SD 1) preoperatively to 5.3 l (SD 0.9) (p < 0.001) while TLC increased from 4.1 l (SD 0.9) preoperatively to 4.3 l (SD 0.8) (p < 0.001). RCV was correlated with all functional indexes before and after correction of the deformity. Improvement in RCV was weakly correlated with correction of the mean thoracic Cobb angle (p = 0.006). The difference in TLC was significantly correlated with changes in RCV (p = 0.041). It was possible to predict postoperative TLC from the postoperative RCV. CONCLUSION 3D rib cage assessment from biplanar radiographs could be a minimally invasive method of estimating pulmonary function before and after spinal fusion in patients with an AIS. The 3D RCV reflects virtual chest capacity and hence pulmonary function in this group of patients. Cite this article: Bone Joint J 2022;104-B(1):112-119.
Collapse
Affiliation(s)
- Raphaël Pietton
- Department of Paediatric Orthopaedics, Sorbonne Université, Paris, France.,Arts et Métiers Paris Tech, Institut de Biomécanique Humaine Georges Charpak/IBHCG, Paris, France
| | - Houssam Bouloussa
- Department of Paediatric Orthopaedics, Sorbonne Université, Paris, France
| | - Tristan Langlais
- Department of Paediatric Orthopaedics, Sorbonne Université, Paris, France
| | - Jessica Taytard
- Department of Pediatric Pulmonology, Sorbonne Université, Armand Trousseau Hospital, Paris, France
| | - Nicole Beydon
- Department of Pulmonary Function Test and Sleep Center, Sorbonne Université, Armand Trousseau Hospital, Paris, France
| | - Wafa Skalli
- Arts et Métiers Paris Tech, Institut de Biomécanique Humaine Georges Charpak/IBHCG, Paris, France
| | - Claudio Vergari
- Arts et Métiers Paris Tech, Institut de Biomécanique Humaine Georges Charpak/IBHCG, Paris, France
| | - Raphaël Vialle
- Department of Paediatric Orthopaedics, Sorbonne Université, Paris, France
| |
Collapse
|
21
|
Gaume M, Vergari C, Khouri N, Skalli W, Glorion C, Miladi L. Minimally Invasive Surgery for Neuromuscular Scoliosis: Results and Complications at a Minimal Follow-up of 5 Years. Spine (Phila Pa 1976) 2021; 46:1696-1704. [PMID: 33907082 DOI: 10.1097/brs.0000000000004082] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study. OBJECTIVE The aim of this study was to report the results of an alternative technique to growing rods (GR) for neuromuscular scoliosis using a minimally invasive fusionless surgery with a minimum of 5 years' follow-up. SUMMARY OF BACKGROUND DATA Conservative treatment is not effective in progressive neuromuscular scoliosis. Early surgery using GR is increasingly advocated to control the deformity while preserving spinal and thoracic growth before arthrodesis. These techniques still provide a high rate of complications. METHODS The technique relies on a bilateral double rod sliding instrumentation anchored proximally by four hooks claws and distally to the pelvis by iliosacral screws through a minimally invasive approach. The clinical and radiological outcomes of 100 consecutive patients with neuromuscular scoliosis who underwent this fusionless surgery with a minimum follow-up of 5 years were reviewed. RESULTS 6.5 ± 0.7 years after initial surgery, six patients were lost of follow-up and 11 died of unrelated raison. Of the 83 remaining patients at latest follow-up, mean Cobb angle was stable to 35.0° which correspond to 61% correction of the initial deformation. Mean pelvic obliquity was 29.6° (0.3°-80.0°) preoperatively and 7.2 (0.2°-23.5°) at latest follow-up. Correction of the hyper kyphosis remained stable. Skeletal maturitywas reached in 42 of 83 patients (50.6%). None of these patients has required spinal fusion. The global complication rate was 31.3%. CONCLUSION The outcomes of this minimally invasive fusionless technique at 5 years follow-up showed a stable correction of spinal deformities and pelvic obliquity over time, with a reduced rate of complication. The arthrodesis was not required for all patients at skeletal maturity. This technique could be a good alternative to arthrodesis for neuromuscular scoliosis.Level of Evidence: 3.
Collapse
Affiliation(s)
- Mathilde Gaume
- Pediatrics Orthopedics Department, Necker Hospital, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
- Arts et Métiers ParisTech, LBM/lnstitut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Claudio Vergari
- Arts et Métiers ParisTech, LBM/lnstitut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Nejib Khouri
- Pediatrics Orthopedics Department, Necker Hospital, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Wafa Skalli
- Arts et Métiers ParisTech, LBM/lnstitut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Christophe Glorion
- Pediatrics Orthopedics Department, Necker Hospital, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lotfi Miladi
- Pediatrics Orthopedics Department, Necker Hospital, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| |
Collapse
|
22
|
Assi A, Karam M, Skalli W, Vergari C, Vialle R, Pietton R, Bizdikian AJ, Kharrat K, Dubousset J, Ghanem I. A Novel Classification of 3D Rib Cage Deformity in Subjects With Adolescent Idiopathic Scoliosis. Clin Spine Surg 2021; 34:331-341. [PMID: 33591022 DOI: 10.1097/bsd.0000000000001139] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a multicentric cross-sectional descriptive study. OBJECTIVE To analyze patterns of 3D rib cage deformity in subjects with adolescent idiopathic scoliosis (AIS) and their relationship with the spinal deformity. SUMMARY OF BACKGROUND DATA Subjects with AIS present with rib cage deformity that can affect respiratory functions. The 3D rib cage deformities in AIS and their relationship to the spinal deformity are still unelucidated. METHODS A total of 200 AIS and 71 controls underwent low-dose biplanar x-rays and had their spine and rib cage reconstructed in 3-dimensional (D). Classic spinopelvic parameters were calculated in 3D and: rib cage gibbosity, thickness, width, volume and volumetric spinal penetration index (VSPI). Subjects with AIS were classified as: group I with mild rib cage deformity (n=88), group II with severe rib cage deformity (n=112) subgrouped into IIa (high gibbosity, n=48), IIb (high VSPI, n=48), and IIc (both high gibbosity and VSPI, n=16). RESULTS Groups IIa and IIb had a higher Cobb angle (33 vs. 54 degrees and 46 degrees, respectively) and torsion index (11 vs. 14 degrees and 13 degrees, respectively) than group I. Group IIb showed more severe hypokyphosis (IIb=21 degrees; IIa=33 degrees; I=36 degrees; control=42 degrees) with a reduced rib cage volume (IIb=4731 cm3; IIa=4985 cm3; I=5257 cm3; control=5254 cm3) and thickness (IIb=135 mm; IIa=148 mm; I=144 mm; control=144 mm). Group IIa showed an increasingly large local gibbosity descending from proximal to distal levels and did not follow the axial rotation of the spine. Group IIc showed characteristics of both groups IIa and IIb. CONCLUSIONS This new classification of 3D rib cage deformity in AIS shows that the management of cases with high VSPI (groups IIb and IIc) should focus on restoring as much kyphosis as possible to avoid respiratory repercussions. Treatment indications in groups I and IIa would follow the consensual basic principles reported in the literature regarding bracing and surgery.
Collapse
Affiliation(s)
- Ayman Assi
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech
| | - Mohamad Karam
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech
| | - Raphael Vialle
- Department of Pediatric Orthopedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Raphael Pietton
- Department of Pediatric Orthopedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Aren J Bizdikian
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Khalil Kharrat
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Jean Dubousset
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech
| | - Ismat Ghanem
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| |
Collapse
|
23
|
Hisaund A, Pietton R, Vialle R, Skalli W, Vergari C. Feasibility of Rib Kinematics and Intercostal-Space Biomechanical Characterization by Ultrasound in Adolescent Idiopathic Scoliosis. Ultrasound Med Biol 2021; 47:1957-1963. [PMID: 33926755 DOI: 10.1016/j.ultrasmedbio.2021.03.017] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
The aim of this work was to determine the feasibility of combined ultrasonography and elastography measurement to characterize the mechanical properties of the intercostal space during breathing. Eighteen asymptomatic participants (ages 13 ± 2 y) and six participants with adolescent idiopathic scoliosis (AIS) were included (Cobb angle 60° ± 12°). Ultrasonographic and elastographic clips were acquired of T8-T9 ribs and the intercostal space. The two adjacent ribs were tracked to infer the breathing cycle. Shear-wave speed (SWS) was measured in the intercostal space at different stages of the breathing cycle. SWS was symmetric in the control group, during both expiration and inspiration. In AIS, the SWS during inspiration was higher in the convex side than in the concave one (p = 0.02). Furthermore, SWS was higher during inspiration than expiration in the control group and in the AIS convex side, but not in the AIS concave side (p > 0.05). This new method combining echography and shear-wave elastography allowed measurement of the mechanical characteristics of the intercostal space at different phases of the breathing cycle and highlighted differences between the AIS and control groups. This approach opens the way to further analyses of the biomechanical characteristics of breathing in severe AIS.
Collapse
Affiliation(s)
- Alisa Hisaund
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France
| | - Raphaël Pietton
- Department of Pediatric Orthopaedics, Sorbonne Université, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Raphaël Vialle
- Department of Pediatric Orthopaedics, Sorbonne Université, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Wafa Skalli
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France
| | - Claudio Vergari
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France.
| |
Collapse
|
24
|
Crawford-Manning F, Vardaki MZ, Green E, Meakin JR, Vergari C, Stone N, Winlove CP. Multiphoton imaging and Raman spectroscopy of the bovine vertebral endplate. Analyst 2021; 146:4242-4253. [PMID: 34096935 DOI: 10.1039/d1an00702e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The interface between the intervertebral disc and the vertebral body is important to the discs' biomechanics and physiology, and is widely implicated in its pathology. This study aimed to explore biochemically and structurally the bony endplate, cartilage endplate and intervertebral disc, below the nucleus and below the annulus in healthy bovine tails. Multiphoton imaging and spontaneous Raman spectroscopy were employed. Raman spectroscopy provided relative quantification of mineral and matrix components across the vertebral endplate and its adjacent areas with microscopic spatial resolution. Microscopy utilising second-harmonic generation (SHG) and two-photon fluorescence (TPF) allowed for the structural identification of distinct endplate regions. The cartilage endplate was revealed as structurally distinct from both the bone and disc, supporting its biomechanical function as a transition zone between the soft and hard tissue components. The collagen fibres were continuous across the tidemark which defines the interface between the mineralised and non-mineralised regions of the endplate. Raman spectroscopy revealed gradients in phosphate and carbonate content through the depth of the endplate and also differences beneath the nucleus and annulus consistent with a higher rate of remodelling under the annulus.
Collapse
Affiliation(s)
- Fay Crawford-Manning
- School of Physics and Astronomy, University of Exeter, Exeter, UK. and School of Primary, Community and Social Care, Keele University & Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK
| | - Martha Z Vardaki
- School of Physics and Astronomy, University of Exeter, Exeter, UK. and Department of Medical Physics, School of Health Sciences, University of Ioannina, Ioannina, 45110, Greece
| | - Ellen Green
- School of Physics and Astronomy, University of Exeter, Exeter, UK.
| | - Judith R Meakin
- School of Physics and Astronomy, University of Exeter, Exeter, UK.
| | - Claudio Vergari
- School of Physics and Astronomy, University of Exeter, Exeter, UK. and Arts et Metiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France
| | - Nick Stone
- School of Physics and Astronomy, University of Exeter, Exeter, UK.
| | - C Peter Winlove
- School of Physics and Astronomy, University of Exeter, Exeter, UK.
| |
Collapse
|
25
|
Vergari C, Skalli W, Abelin-Genevois K, Bernard JC, Hu Z, Cheng JCY, Chu WCW, Assi A, Karam M, Ghanem I, Bassani T, Galbusera F, Sconfienza LM, Brayda-Bruno M, Courtois I, Ebermeyer E, Vialle R, Langlais T, Dubousset J. Effect of curve location on the severity index for adolescent idiopathic scoliosis: a longitudinal cohort study. Eur Radiol 2021; 31:8488-8497. [PMID: 33884474 DOI: 10.1007/s00330-021-07944-4] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/08/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Adolescent idiopathic scoliosis (AIS) is the most common spinal disorder in children. A severity index was recently proposed to identify the stable from the progressive scoliosis at the first standardized biplanar radiographic exam. The aim of this work was to extend the validation of the severity index and to determine if curve location influences its predictive capabilities. METHODS AIS patients with Cobb angle between 10° and 25°, Risser 0-2, and no previous treatment were included. They underwent standing biplanar radiography and 3D reconstruction of the spine and pelvis, which allowed to calculate their severity index. Patients were grouped by curve location (thoracic, thoracolumbar, lumbar). Patients were followed up until skeletal maturity (Risser ≥ 3) or brace prescription. Their outcome was compared to the prediction made by the severity index. RESULTS In total, 205 AIS patients were included; 82% of them (155/189, 95% confidence interval [74-90%]) were correctly classified by the index, while 16 patients were unclassified. Positive predictive ratio was 78% and negative predictive ratio was 86%. Specificity (78%) was not significantly affected by curve location, while patients with thoracic and lumbar curves showed higher sensitivity (≥ 89%) than those with thoracolumbar curves (74%). CONCLUSIONS In this multicentric cohort of 205 patients, the severity index was used to predict the risk of progression from mild to moderate scoliosis, with similar results of typical major curve types. This index represents a novel tool to aid the clinician and the patient in the modulation of the follow-up and, for progressive patients, their decision for brace treatment. KEY POINTS • The severity index of adolescent idiopathic scoliosis has the potential to detect patients with progressive scoliosis as early as the first exam. • Out of 205 patients, 82% were correctly classified as either stable or progressive by the severity index. • The location of the main curve had small effect on the predictive capability of the index.
Collapse
Affiliation(s)
- Claudio Vergari
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 151 bd de l'Hôpital, F-75013, Paris, France.
| | - Wafa Skalli
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 151 bd de l'Hôpital, F-75013, Paris, France
| | - Kariman Abelin-Genevois
- Department of Orthopaedic Surgery and Children Conservative Treatment, Croix-Rouge française, Centre Médico-Chirurgical et de Réadaptation des Massues, Lyon, France
| | - Jean Claude Bernard
- Department of Orthopaedic Surgery and Children Conservative Treatment, Croix-Rouge française, Centre Médico-Chirurgical et de Réadaptation des Massues, Lyon, France
| | - Zongshan Hu
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Jack Chun Yiu Cheng
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Mohammad Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | | | - Eric Ebermeyer
- Unite Rachis, CHU - Hopital Bellevue, Saint-Etienne, France
| | - Raphael Vialle
- Sorbonne Université, Department of Pediatric Orthopaedics, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Tristan Langlais
- Sorbonne Université, Department of Pediatric Orthopaedics, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean Dubousset
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 151 bd de l'Hôpital, F-75013, Paris, France
| |
Collapse
|
26
|
Yeung KH, Man GCW, Skalli W, Hu Z, Hung VWY, Hung ALH, Lam TP, Ng BKW, Cheng JCY, Vergari C, Chu WCW. Global sagittal alignment after surgery of right thoracic idiopathic scoliosis in adolescents and adults with and without thoracic hypokyphosis. Sci Rep 2021; 11:6294. [PMID: 33737666 PMCID: PMC7973511 DOI: 10.1038/s41598-021-85782-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/04/2021] [Indexed: 11/09/2022] Open
Abstract
This study aimed to characterize global sagittal alignment in adolescent idiopathic scoliosis (AIS) with normal kyphosis (NTK, kyphosis > 10°) and with thoracic hypokyphosis (THK, kyphosis < 10°), before and after posterior spinal fusion, and compare them with asymptomatic controls. 27 AIS girls and young adults with right thoracic curves were included (seventeen with age ≤ 18 years, then age > 21). Biplanar radiographies were acquired at baseline, immediate post-operatively, 1-year and 2-year follow-up, and 3D reconstruction of the spine and pelvis was performed. NTK and THK showed different global sagittal alignment, as well as differences compared to controls. AIS with THK at baseline had higher SVA/SFD (2.0 ± 2.9 vs - 0.4 ± 1.9; P < 0.05) and OD-HA (0.2 ± 1.4° vs - 1.3 ± 1.6°; P < 0.05) than controls, indicating that THK had compensated balance with unusual forward leaning posture. Immediately post-operation, SVA/SFD remained high (1.3 ± 3.0) while OD-HA reversed (- 1.2 ± 1.7°), indicating that THK patients had found partially compensated balance. After 2-yeas, both SVA/SFD (- 1.3 ± 2.1) and OD-HA (- 1.4 ± 0.9°) were normalized. The changes in global sagittal alignment and mechanism of balance are different in AIS with or without THK. As the head plays a critical role on balance during immediate and delayed post-operation, OD-HA can be complementary parameter for assessing global balance during post-operative follow-up of AIS patients with THK.
Collapse
Affiliation(s)
- Kwong Hang Yeung
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Gene Chi Wai Man
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wafa Skalli
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, Arts et Metiers ParisTech, 151, boulevard de l'hopital, 75013, Paris, France
| | - Zongshan Hu
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Vivian Wing Yin Hung
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Alec Lik Hang Hung
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Tsz Ping Lam
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Bobby Kin Wah Ng
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jack Chun Yiu Cheng
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Claudio Vergari
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, Arts et Metiers ParisTech, 151, boulevard de l'hopital, 75013, Paris, France.
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| |
Collapse
|
27
|
Wang JY, Mansfield JC, Brasselet S, Vergari C, Meakin JR, Winlove CP. Micro-mechanical damage of needle puncture on bovine annulus fibrosus fibrils studied using polarization-resolved Second Harmonic Generation(P-SHG) microscopy. J Mech Behav Biomed Mater 2021; 118:104458. [PMID: 33761373 DOI: 10.1016/j.jmbbm.2021.104458] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/28/2021] [Accepted: 03/10/2021] [Indexed: 11/24/2022]
Abstract
Needle injection has been widely used in spinal therapeutic or diagnostic processes, such as discography. The use of needles has been suspected in causing mild disc degeneration which can lead to long-term back pain. However, the localised microscopic damage caused by needles has not been well studied. The local progressive damage on a microscopic level caused by needle punctures on the surface of bovine annulus fibrosus was investigated. Four different sizes of needle were used for the puncture and twenty-nine bovine intervertebral discs were studied. Polarization-resolved second harmonic generation and fluorescent microscopy were used to study the local microscopic structural changes in collagen and cell nuclei due to needle damage. Repeated 70 cyclic loadings at ±5% of axial strain were applied after the needle puncture in order to assess progressive damage caused by the needle. Puncture damage on annulus fibrosus were observed either collagen fibre bundles being pushed aside, being cut through or combination of both with part being lift or pushed in. The progressive damage was found less relevant to the needle size and more progressive damage was only observed using the larger needle. Two distinct populations of collagen, in which one was relatively more organised than the other population, were observed especially after the puncture from skewed distribution of polarization-SHG analysis. Cell shape was found rounder near the puncture site where collagen fibres were damaged.
Collapse
Affiliation(s)
- J-Y Wang
- College of Engineering, Mathematics & Physical Sciences, Physics Building, Stocker Road, Exeter, EX4 4QL, UK.
| | - J C Mansfield
- College of Engineering, Mathematics & Physical Sciences, Physics Building, Stocker Road, Exeter, EX4 4QL, UK
| | - S Brasselet
- Aix Marseille Univ, CNRS, Centrale Marseille, Institut Fresnel, F-13013, Marseille, France
| | - C Vergari
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris
| | - J R Meakin
- College of Engineering, Mathematics & Physical Sciences, Physics Building, Stocker Road, Exeter, EX4 4QL, UK
| | - C P Winlove
- College of Engineering, Mathematics & Physical Sciences, Physics Building, Stocker Road, Exeter, EX4 4QL, UK
| |
Collapse
|
28
|
Pietton R, David M, Hisaund A, Langlais T, Skalli W, Vialle R, Vergari C. Biomechanical Evaluation of Intercostal Muscles in Healthy Children and Adolescent Idiopathic Scoliosis: A Preliminary Study. Ultrasound Med Biol 2021; 47:51-57. [PMID: 33077337 DOI: 10.1016/j.ultrasmedbio.2020.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 04/18/2020] [Revised: 07/27/2020] [Accepted: 09/07/2020] [Indexed: 05/24/2023]
Abstract
Spine deformity during adolescent idiopathic scoliosis can induce a rib-cage deformity. This bone deformity can have direct consequences on the chest-wall muscles, including intercostal muscles, leading to respiratory impairments in individuals with severe cases. The aim of this study was to determine whether shear-wave elastography can be used to measure intercostal-muscle shear-wave speed (SWS) in healthy children and those with adolescent idiopathic scoliosis (AIS). Nineteen healthy participants and 16 with AIS took part. SWS measurements were taken by three operators, twice each. Average SWS was 2.3 ± 0.4 m/s, and inter-operator reproducibility was 0.2 m/s. SWS was significantly higher during apnea than in normal breathing (p < 0.01) in both groups. No significant difference was observed between groups in apnea or in normal breathing. Characterization of the intercostal muscles by ultrasound elastography is therefore feasible and reliable for children and adolescents with and without scoliosis.
Collapse
Affiliation(s)
- Raphaël Pietton
- Sorbonne Université, Department of Paediatric Orthopaedics, Armand Trousseau Hospital, APHP, Paris, France; Sorbonne Université, Hospital-University Department for Innovative Therapies in Musculoskeletal Diseases DHU-MAMUTH, APHP, Paris, France.
| | - Mercedes David
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Alisa Hisaund
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Tristan Langlais
- Sorbonne Université, Department of Paediatric Orthopaedics, Armand Trousseau Hospital, APHP, Paris, France; Sorbonne Université, Hospital-University Department for Innovative Therapies in Musculoskeletal Diseases DHU-MAMUTH, APHP, Paris, France
| | - Wafa Skalli
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Raphaël Vialle
- Sorbonne Université, Department of Paediatric Orthopaedics, Armand Trousseau Hospital, APHP, Paris, France; Sorbonne Université, Hospital-University Department for Innovative Therapies in Musculoskeletal Diseases DHU-MAMUTH, APHP, Paris, France
| | - Claudio Vergari
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, Paris, France
| |
Collapse
|
29
|
Vergari C, Chen Z, Robichon L, Courtois I, Ebermeyer E, Vialle R, Langlais T, Pietton R, Skalli W. Towards a predictive simulation of brace action in adolescent idiopathic scoliosis. Comput Methods Biomech Biomed Engin 2020; 24:874-882. [PMID: 33295806 DOI: 10.1080/10255842.2020.1856373] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 10/22/2022]
Abstract
Bracing is the most common treatment to stop the progression of adolescent idiopathic scoliosis. Finite element modeling could help improve brace design, but model validation is still a challenge. In this work, the clinical relevance of a predictive and subject-specific model for bracing was evaluated in forty-six AIS patients. The model reproduces brace action and the patient's spinopelvic adjustments to keep balance. The model simulated 70% or more patients with geometrical parameters within a preselected tolerance level. Although the model simulation of the sagittal plane could be improved, the approach is promising for a realistic and predictive simulation of brace action.
Collapse
Affiliation(s)
- Claudio Vergari
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris
| | - Zhuowei Chen
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris
| | - Léopold Robichon
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris
| | | | - Eric Ebermeyer
- CHU - Hôpital Bellevue, Unité Rachis, Saint-Etienne, France
| | - Raphaël Vialle
- Department of Pediatric Orthopaedics, Sorbonne Université, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Tristan Langlais
- Department of Pediatric Orthopaedics, Sorbonne Université, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Raphaël Pietton
- Department of Pediatric Orthopaedics, Sorbonne Université, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Wafa Skalli
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris
| |
Collapse
|
30
|
Langlais T, Verdun S, Compagnon R, Ursu C, Vergari C, Barret H, Morin C. Prediction of clinical height gain from surgical posterior correction of idiopathic scoliosis. J Neurosurg Spine 2020; 33:1-6. [PMID: 32470942 DOI: 10.3171/2020.3.spine191541] [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] [Received: 12/23/2019] [Accepted: 03/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The best predictors of height gain due to surgical correction are the number of fused vertebrae and the degrees of the corrected Cobb angle. Existing studies of predictive models measured the radiographic spinal height and did not report the clinical height gain. The aims of this study were to determine the best predictive factors of clinical height gain before surgical correction, construct a predictive model using patient population data for machine learning, and test the performance of this model on a validation population. METHODS The authors reviewed 145 medical records of consecutive patients who underwent surgery that included placement of posterior spinal instrumentation and fusion for idiopathic scoliosis between 2012 and 2016. Standing and sitting clinical heights were measured before and after surgery in patients who had been surgically treated under similar conditions. Multivariate analysis was then performed and the results were used to develop a predictive model for height gain after surgery. The data from the included patients were randomly assigned to a learning set or a test set. RESULTS In total, 116 patients were included in the analysis, for whom the average postoperative clinical height gain in a standing position was 4.2 ± 1.8 cm (range 0-11 cm). The best prediction model was calculated as follows: standing clinical height gain (cm) = 1 - 0.023 × sitting clinical height (cm) - 0.19 × Risser stage + 0.058 × Cobb preoperative angle (°) + 0.021 × T5-12 kyphosis (°) + 0.14 × number of levels fused. In the validation cohort, 91% of the predicted values had an error of less than one-half of the actual height gain. CONCLUSIONS This predictive model formula for calculating the potential postoperative height gain after surgical treatment can be used preoperatively to inform idiopathic scoliosis patients of what outcomes they may expect from posterior spinal instrumentation and fusion (taking into account the model's uncertainty).
Collapse
Affiliation(s)
- Tristan Langlais
- 1Pediatric Orthopaedics Department, Institut Calot, Berck-sur-Mer
- 2Institut de Biomécanique Humaine Georges Charpak, Arts et Metiers ParisTech, Laboratoire de Biomécanique, Paris
- 4Pediatric Orthopaedics Department, Children's Hospital Purpan, Toulouse; and
| | - Stephane Verdun
- 3Biostatistics Department-Delegations for Clinical Research and Innovation, Lille Catholic Hospitals, Lille
| | - Roxane Compagnon
- 4Pediatric Orthopaedics Department, Children's Hospital Purpan, Toulouse; and
| | - Catalin Ursu
- 1Pediatric Orthopaedics Department, Institut Calot, Berck-sur-Mer
| | - Claudio Vergari
- 2Institut de Biomécanique Humaine Georges Charpak, Arts et Metiers ParisTech, Laboratoire de Biomécanique, Paris
| | - Hugo Barret
- 5Orthopedic Department, Cannes Hospital, Cannes, France
| | - Christian Morin
- 1Pediatric Orthopaedics Department, Institut Calot, Berck-sur-Mer
| |
Collapse
|
31
|
Vergari C, Skalli W, Gajny L. A convolutional neural network to detect scoliosis treatment in radiographs. Int J Comput Assist Radiol Surg 2020; 15:1069-1074. [PMID: 32337647 DOI: 10.1007/s11548-020-02173-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/16/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this work is to propose a classification algorithm to automatically detect treatment for scoliosis (brace, implant or no treatment) in postero-anterior radiographs. Such automatic labelling of radiographs could represent a step towards global automatic radiological analysis. METHODS Seven hundred and ninety-six frontal radiographies of adolescents were collected (84 patients wearing a brace, 325 with a spinal implant and 387 reference images with no treatment). The dataset was augmented to a total of 2096 images. A classification model was built, composed by a forward convolutional neural network (CNN) followed by a discriminant analysis; the output was a probability for a given image to contain a brace, a spinal implant or none. The model was validated with a stratified tenfold cross-validation procedure. Performance was estimated by calculating the average accuracy. RESULTS 98.3% of the radiographs were correctly classified as either reference, brace or implant, excluding 2.0% unclassified images. 99.7% of brace radiographs were correctly detected, while most of the errors occurred in the reference group (i.e. 2.1% of reference images were wrongly classified). CONCLUSION The proposed classification model, the originality of which is the coupling of a CNN with discriminant analysis, can be used to automatically label radiographs for the presence of scoliosis treatment. This information is usually missing from DICOM metadata, so such method could facilitate the use of large databases. Furthermore, the same model architecture could potentially be applied for other radiograph classifications, such as sex and presence of scoliotic deformity.
Collapse
Affiliation(s)
- Claudio Vergari
- Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France
| | - Wafa Skalli
- Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France
| | - Laurent Gajny
- Arts et Métiers, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France.
| |
Collapse
|
32
|
Gaume M, Persohn S, Vergari C, Glorion C, Skalli W, Miladi L. Biomechanical cadaver study of proximal fixation in a minimally invasive bipolar construct. Spine Deform 2020; 8:33-38. [PMID: 31925759 DOI: 10.1007/s43390-019-00014-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/06/2019] [Accepted: 09/14/2019] [Indexed: 12/27/2022]
Abstract
STUDY DESIGN Biomechanical human cadaver study. OBJECTIVE To determine the three-dimensional intervertebral ranges of motion (ROMs) of intact and hook-instrumented thoracic spine specimens subjected to physiological loads, using an in vitro experimental protocol with EOS biplane radiography. Pedicle screws are commonly used in thoracic instrumentation constructs, and their biomechanical properties have been widely studied. Promising clinical results have been reported using a T1-T5 thoracic hook-claw construct for proximal rod anchoring. Instrumentation stability is a crucial factor in minimizing mechanical complications rates but had not been assessed for this construct in a biomechanical study. METHODS Six fresh-frozen human cadaver C6-T7 thoracic spines were studied. The first thoracic vertebrae were instrumented using two claws of supra-laminar and pedicle hooks, each fixed on two adjacent vertebrae, on either side of a single free vertebra. Quasi-static pure-moment loads up to 5 Nm were applied to each specimen before and after instrumentation, in flexion-extension, right and left bending, and axial rotation. Five steel beads impacted in each vertebra allowed 3D tracking of vertebral movements on EOS biplanar radiographs acquired after each loading step. The relative ranges of motion (ROMs) of each pair of vertebras were computed. RESULTS Mean ROMs with the intact specimens were 17° in flexion-extension, 27.9° in lateral bending, and 29.5° in axial rotation. Corresponding values with the instrumented specimens were 0.9°, 2.6°, and 7.3°, respectively. Instrumentation significantly (P < 0.05) decreased flexion-extension (by 92-98%), lateral bending (by 87-96%), and axial rotation (by 68-84%). CONCLUSION This study establishes the biomechanical stability of a double claw-hook construct in the upper thoracic spine, which may well explain the low mechanical complication rate in previous clinical studies. LEVEL OF EVIDENCE Not applicable, experimental cadaver study.
Collapse
Affiliation(s)
- M Gaume
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 Bd. de l'Hôpital, 75013, Paris, France. .,Pediatrics Orthopedics Department, Necker Hospital, Paris Descartes University, Assistance Publique Hôpitaux de Paris, Paris, France.
| | - S Persohn
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 Bd. de l'Hôpital, 75013, Paris, France
| | - C Vergari
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 Bd. de l'Hôpital, 75013, Paris, France
| | - C Glorion
- Pediatrics Orthopedics Department, Necker Hospital, Paris Descartes University, Assistance Publique Hôpitaux de Paris, Paris, France
| | - W Skalli
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 Bd. de l'Hôpital, 75013, Paris, France
| | - L Miladi
- Pediatrics Orthopedics Department, Necker Hospital, Paris Descartes University, Assistance Publique Hôpitaux de Paris, Paris, France
| |
Collapse
|
33
|
Pietton R, Bouloussa H, Vergari C, Skalli W, Vialle R. Rib Cage Measurement Reproducibility Using Biplanar Stereoradiographic 3D Reconstructions in Adolescent Idiopathic Scoliosis. J Pediatr Orthop 2020; 40:36-41. [PMID: 31815860 DOI: 10.1097/bpo.0000000000001095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A reproducibility study of preoperative rib cage three-dimensional (3D) measurements was conducted for patients with Adolescent Idiopathic Scoliosis (AIS). No prior reliability study has been performed for preoperative 3D reconstructions of the rib cage by using stereoradiography in patients with preoperative AIS. Our objective was to assess the reliability of rib cage 3D reconstructions using biplanar stereoradiography in patients with AIS before surgery. METHODS This series includes 21 patients with Lenke 1 or 2 scoliosis (74±20 degrees). All patients underwent low-dose standing biplanar radiographs. Two operators performed reconstructions twice each. Intraoperator repeatability, interoperator reproducibility, and intraclass coefficients (ICC) were calculated and compared between groups. RESULTS The average rib cage volume was 4.71 L (SD±0.75 L). Two SD was 0.19 L with a coefficient of variation of 4.1%; ICC was 0.968. The thoracic index was 0.6 (SD±0.1). Two SD was 0.03 with a coefficient of variation of 4.7% and a ICC of 0.820. As for the Spinal Penetration Index (6.4%; SD±2.4), 2SD was 0.9% with a coefficient of variation of 14.3% and a ICC of 0.901. The 3D rib hump 2SD (average 27±8 degrees) was 1.4 degrees. The coefficient of variation and ICC were respectively 5.1% and 0.991. CONCLUSIONS Three-dimensional reconstruction of the rib cage using biplanar stereoradiography is a reliable method to estimate preoperative thoracic parameters in patients with AIS. LEVEL OF EVIDENCE Level IV-diagnostic study.
Collapse
Affiliation(s)
- Raphael Pietton
- Department of Pediatric Orthopedic, Armand Trousseau Hospital, Paris 6 University, France
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, Paris, France
| | - Houssam Bouloussa
- Department of Pediatric Orthopedic, Armand Trousseau Hospital, Paris 6 University, France
| | - Claudio Vergari
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, Paris, France
- School of Physics and Astronomy, University of Exeter, Exeter, UK
| | - Wafa Skalli
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, Paris, France
| | - Raphael Vialle
- Department of Pediatric Orthopedic, Armand Trousseau Hospital, Paris 6 University, France
| |
Collapse
|
34
|
Vergari C, Chanteux L, Pietton R, Langlais T, Vialle R, Skalli W. Shear wave elastography of lumbar annulus fibrosus in adolescent idiopathic scoliosis before and after surgical intervention. Eur Radiol 2019; 30:1980-1985. [PMID: 31834510 DOI: 10.1007/s00330-019-06563-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/05/2019] [Revised: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To determine lumbar intervertebral disc properties with shear wave elastography in adolescent idiopathic scoliotic (AIS) patients before and after surgery, and compare them with asymptomatic controls. METHODS Twenty-five severe AIS patients with an indication for fusion surgery (15 ± 1.5 years old, the Cobb angle ranging between 40 and 93°) and fifty-nine asymptomatic adolescents (13 ± 2 years old) were included prospectively. Shear wave speed (SWS) was measured in the annulus fibrosus of L3-L4, L4-L5, and L5-S1 discs of each subject. In AIS patients, measurements took place before surgery, and 3 months (N = 13) or 1 year after (N = 12). RESULTS No difference was observed between disc levels in any group. When pooling disc levels, SWS was significantly higher in preop AIS patients (4.0 ± 0.5 m/s) than in asymptomatic subjects (3.1 ± 0.5 m/s, p < 0.0001). SWS decreased 3 months postop (3.5 ± 0.3 m/s), and it decreased further towards normal values 1 year after (3.3 ± 0.4 m/s). SWS in preop AIS patients tended to decrease with the Cobb angle (Spearman's rho = - 0.4, p = 0.05). CONCLUSION Shear wave elastography measurements showed that discs in AIS patients were altered relative to asymptomatic ones, and this alteration tended to normalize 1 year post fusion surgery. Further studies should aim at determining if bracing of mild scoliosis has an effect on disc properties. KEY POINTS • Shear wave elastography shows alteration of annulus fibrosus in adolescent idiopathic scoliosis. • Disc elastography tends to normalize 1 year after surgery.
Collapse
Affiliation(s)
- Claudio Vergari
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France.
| | - Lucas Chanteux
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France.,Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, 75571, Paris, France
| | - Raphael Pietton
- Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, 75571, Paris, France
| | - Tristan Langlais
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France.,Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, 75571, Paris, France
| | - Raphael Vialle
- Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, 75571, Paris, France
| | - Wafa Skalli
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
| |
Collapse
|
35
|
Vergari C, Bocahut N, Hernandez T, Assi A, Skalli W, Ilharreborde B. Trunk Growth in Early-Onset Idiopathic Scoliosis Measured With Biplanar Radiography. Spine Deform 2019; 7:962-970. [PMID: 31732009 DOI: 10.1016/j.jspd.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/27/2018] [Revised: 02/20/2019] [Accepted: 04/05/2019] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Cross-sectional and longitudinal retrospective study. OBJECTIVES To measure thoracic dimensions and volume during growth in early-onset idiopathic scoliosis (EOIS) patients and to compare them to a population of asymptomatic adults and to the previous literature. SUMMARY OF BACKGROUND DATA Data on trunk growth for scoliotic children between 6 and 14 years of age is sparse in the literature. METHODS Thirty-six patients (29 girls and 7 boys, between 3 and 14 years old, average Cobb angle 33°±15°) were included, all with a minimum two-year follow-up. Sixty-one asymptomatic girls and 54 asymptomatic adults were included as control groups. All subjects underwent biplanar radiography and 3D reconstruction of the spine, pelvis, and rib cage. EOIS patients repeated their radiologic examination every six months. Cobb angle, rib cage volume, anteroposterior and transverse diameters, thoracic index, thoracic perimeter, pelvic incidence, and T1-T12 and T1-S1 distance were calculated. Reproducibility of measurement was assessed. RESULTS Measurement reliability in such young patients was comparable to previous studies in adolescents and adults. Geometrical parameters of EOIS patients increased linearly with age. For instance, rib cage volume in girls with EOIS increased from 2200 cm3 at six to seven years of age to 4100 cm3 at 13-14 years (65% of adult values, 294 cm3/y). Comparison with asymptomatic girls showed that EOIS could affect growth spurt. Longitudinal analysis on a cohort of six girls who had a follow-up of six years confirmed the cross-sectional data. CONCLUSIONS In this longitudinal and cross-sectional study, trunk growth between 3 and 14 years of age was characterized, for the first time, with biplanar radiography and 3D reconstruction. The results can be useful to estimate patient growth and thus have potential application in the surgical planning of EOIS patients. LEVEL OF EVIDENCE Level II, retrospective study.
Collapse
Affiliation(s)
- Claudio Vergari
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hopital 75013 Paris, France.
| | - Nicolas Bocahut
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hopital 75013 Paris, France; Department of Pediatric Orthopaedics, Robert Debré Hospital, Paris 7 University, 48 boulevard Sérurier 75019 Paris, France
| | - Thibault Hernandez
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hopital 75013 Paris, France; Department of Pediatric Orthopaedics, Armand Trousseau Hospital, Sorbonne University, 26, avenue du Docteur Arnold-Netter, 75012 Paris, France
| | - Ayman Assi
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hopital 75013 Paris, France; Faculty of Medicine, University of Saint-Joseph, Damascus street, BP 17-5208 - Mar Mekhaël, Beirut, Lebanon
| | - Wafa Skalli
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hopital 75013 Paris, France
| | - Brice Ilharreborde
- Department of Pediatric Orthopaedics, Robert Debré Hospital, Paris 7 University, 48 boulevard Sérurier 75019 Paris, France
| |
Collapse
|
36
|
Ebrahimi S, Gajny L, Vergari C, Angelini ED, Skalli W. Vertebral rotation estimation from frontal X-rays using a quasi-automated pedicle detection method. Eur Spine J 2019; 28:3026-3034. [PMID: 31584120 DOI: 10.1007/s00586-019-06158-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 07/19/2019] [Accepted: 09/16/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Measurement of vertebral axial rotation (VAR) is relevant for the assessment of scoliosis. Stokes method allows estimating VAR in frontal X-rays from the relative position of the pedicles and the vertebral body. This method requires identifying these landmarks for each vertebral level, which is time-consuming. In this work, a quasi-automated method for pedicle detection and VAR estimation was proposed. METHOD A total of 149 healthy and adolescent idiopathic scoliotic (AIS) subjects were included in this retrospective study. Their frontal X-rays were collected from multiple sites and manually annotated to identify the spinal midline and pedicle positions. Then, an automated pedicle detector was developed based on image analysis, machine learning and fast manual identification of a few landmarks. VARs were calculated using the Stokes method in a validation dataset of 11 healthy (age 6-33 years) and 46 AIS subjects (age 6-16 years, Cobb 10°-46°), both from detected pedicles and those manually annotated to compare them. Sensitivity of pedicle location to the manual inputs was quantified on 20 scoliotic subjects, using 10 perturbed versions of the manual inputs. RESULTS Pedicles centers were localized with a precision of 84% and mean difference of 1.2 ± 1.2 mm, when comparing with manual identification. Comparison of VAR values between automated and manual pedicle localization yielded a signed difference of - 0.2 ± 3.4°. The uncertainty on pedicle location was smaller than 2 mm along each image axis. CONCLUSION The proposed method allowed calculating VAR values in frontal radiographs with minimal user intervention and robust quasi-automated pedicle localization. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- Shahin Ebrahimi
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Laurent Gajny
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France.
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Elsa D Angelini
- LTCI, Department Image-Data-Signal, Telecom ParisTech, Paris, France.,ITMAT Data Science Group, NIHR Imperial BRC, Imperial College London, London, UK
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| |
Collapse
|
37
|
Kim Y, Vergari C, Girinon F, Lazennec JY, Skalli W. Stand-to-Sit Kinematics of the Pelvis Is Not Always as Expected: Hip and Spine Pathologies Can Have an Impact. J Arthroplasty 2019; 34:2118-2123. [PMID: 31138502 DOI: 10.1016/j.arth.2019.04.059] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/10/2019] [Accepted: 04/25/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Stand-to-sit pelvis kinematics is commonly considered as a rotation around the bicoxofemoral axis. However, abnormal kinematics could occur for patients with musculoskeletal disorders, affecting the hip-spine complex. The aim of this study is to perform a quantitative analysis of the stand-to-sit pelvis kinematics using 3D reconstruction from biplanar x-rays. METHODS Thirty volunteers as a control group (C), 30 patients with hip pathology (Hip), and 30 patients with spine pathology (Spine) were evaluated. All subjects underwent standing and sitting full-body biplanar x-rays. Three-dimensional reconstruction was performed in each configuration and then translated such as the middle of the line joining the center of each acetabulum corresponds to the origin. Rigid registration quantified the finite helical axis (FHA) describing the transition between standing and sitting with two specific parameters. The orientation angle (OA) is the signed 3D angle between FHA and bicoxofemoral axis, and the rotation angle (RA) represents the signed angle around FHA. RESULTS The mean OA was -1.8° for the C group, 0.3° for Hip group, and -2.4° for Spine group. There was no significant difference in mean OA between groups. However, variability was higher for the Spine group with a standard deviation (SD) of 15.9° compared with 10.8° in the C group and 12.3° in the Hip group. The mean RA in the C group was 18.1° (SD, 9.0°). There was significant difference in RA between the Hip and Spine groups (21.1° [SD, 8.0°] and 16.4° [SD, 10.8°], respectively) (P = .04). CONCLUSION Hip and spine pathologies affect stand-to-sit pelvic kinematics.
Collapse
Affiliation(s)
- Youngwoo Kim
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paris Tech, Paris, France, Paris, France; Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, France; Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paris Tech, Paris, France, Paris, France
| | - François Girinon
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paris Tech, Paris, France, Paris, France
| | - Jean Yves Lazennec
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, France; Anatomy Department Faculté Pitié-Salpêtrière, Médecine Sorbonne Université, Paris, France, Paris, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paris Tech, Paris, France, Paris, France
| |
Collapse
|
38
|
Vergari C, Courtois I, Ebermeyer E, Pietton R, Bouloussa H, Vialle R, Skalli W. Answer to the Letter to the Editor of Weiss HR et al. concerning "Head to pelvis alignment of adolescent idiopathic scoliosis patients both in and out of brace" by Vergari C, Courtois I, Ebermeyer E, Pietton R, Bouloussa H, Vialle R, Skalli W (Eur Spine J; 2019: https://doi.org/10.1007/s00586-019-05981-8). Eur Spine J 2019; 28:2226. [PMID: 31321543 DOI: 10.1007/s00586-019-06070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Claudio Vergari
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Isabelle Courtois
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
| | - Eric Ebermeyer
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
| | - Raphael Pietton
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
| | - Houssam Bouloussa
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
| | - Raphael Vialle
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
| | - Wafa Skalli
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
| |
Collapse
|
39
|
Bouloussa H, Pietton R, Vergari C, Haen TX, Skalli W, Vialle R. Biplanar stereoradiography predicts pulmonary function tests in adolescent idiopathic scoliosis: a cross-sectional study. Eur Spine J 2019; 28:1962-1969. [DOI: 10.1007/s00586-019-05940-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/02/2019] [Indexed: 11/25/2022]
|
40
|
Alzakri A, Vergari C, Van den Abbeele M, Gille O, Skalli W, Obeid I. Global Sagittal Alignment and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis. Spine Deform 2019; 7:236-244. [PMID: 30660217 DOI: 10.1016/j.jspd.2018.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 02/22/2018] [Revised: 05/23/2018] [Accepted: 06/24/2018] [Indexed: 11/18/2022]
Abstract
STUDY DESIGN Case-control study. OBJECTIVES To analyse global sagittal alignment including the cranial center of mass (CCOM) and proximal junctional kyphosis (PJK) in adolescent idiopathic scoliosis (AIS) patients treated with posterior instrumentation. SUMMARY OF BACKGROUND DATA PJK plays an important role in the global sagittal alignment in AIS patients. Maintaining the head above the pelvis allows for a minimization of energy expense in ambulation and upright posture. Numerous studies have been performed to understand the PJK phenomena in AIS patients. However, to our knowledge, no study performed on AIS patients included the head in the analysis of global sagittal alignment and PJK. METHODS This study included 85 AIS patients and 51 asymptomatic adolescents. Low-dose bi-planar radiographs were acquired for each subject preoperatively and at the two-year follow-up. Two global sagittal alignment parameters were calculated, that is, the angle between the vertical and the line joining the center of the bi-coxofemoral axis (HA) and either the most superior point of the dentiform apophysis of C2 (OD) or the cranial center of mass (CCOM). RESULTS Among normal adolescents, the average OD-HA and CCOM-HA angles were -2.3° ± 2° and -1.5° ± 1.8°, respectively. Among AIS patients, the average OD-HA and CCOM-HA angles were, respectively, -2.3° ± 1.9° and -1.3° ± 1.8° preoperatively and -2.8° ± 1.7° and -1.9° ± 1.7° at the last follow-up. Overall, 13% of the patients developed PJK postoperatively. Case-by-case analysis showed that adjusting the thoracic kyphosis and the compensations required to maintain this constant could provide explanatory elements. CONCLUSIONS OD-HA and CCOM-HA angles remain almost constant among the normal group and patients, pre- and postoperatively, whether PJK or non-PJK. Five patients without PJK and only one patient with PJK produced abnormal values relative to the asymptomatic subjects. Therefore, it could be concluded that PJK is a compensation mechanism, which allows for CCOM-HA and, to a lesser extent, OD-HA to remain invariant. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Abdulmajeed Alzakri
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013 Paris, France; Bordeaux University Hospital, Department of Spinal Surgery, Unit 1, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France; Orthopedic Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Claudio Vergari
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013 Paris, France
| | - M Van den Abbeele
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013 Paris, France
| | - Olivier Gille
- Bordeaux University Hospital, Department of Spinal Surgery, Unit 1, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Wafa Skalli
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013 Paris, France
| | - Ibrahim Obeid
- Bordeaux University Hospital, Department of Spinal Surgery, Unit 1, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
| |
Collapse
|
41
|
Ghailane S, Bouloussa H, Challier V, Vergari C, Yoshida G, Obeid I, Boissière L, Vital JM, Mazas S, Coudert P, Gille O. Radiographic Classification for Degenerative Spondylolisthesis of the Lumbar Spine Based on Sagittal Balance: A Reliability Study. Spine Deform 2019; 6:358-365. [PMID: 29886905 DOI: 10.1016/j.jspd.2017.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/28/2017] [Revised: 11/28/2017] [Accepted: 12/01/2017] [Indexed: 10/14/2022]
Abstract
STUDY DESIGN Inter- and intraobserver reliability study. OBJECT To assess the reliability of a new radiographic classification of degenerative spondylolisthesis of the lumbar spine (DSLS). SUMMARY OF BACKGROUND DATA DSLS is a common cause of chronic low back and leg pain in adults. To this date, there is no consensus for a comprehensive analysis of DSLS. The reliability of a new DSLS classification system based on sagittal alignment was assessed. METHODS Ninety-nine patients admitted to our spinal surgery department for surgical treatment of DSLS between January 2012 and December 2015 were included. Three observers measured sagittal alignment parameters with validated software: segmental lordosis (SL), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Full body low-dose lateral view radiographs were analyzed and classified according to three main types: Type 1A: preserved LL and SL; Type 1B: preserved LL and reduced SL (≤5°); Type 2A: PI-LL ≥10° without pelvic compensation (PT <25°); Type 2B: PI-LL ≥10° with pelvic compensation (PT ≥25°); Type 3: global sagittal malalignment (SVA ≥40 mm). The three observers classified radiographs twice with a 3-week interval for intraobserver reproducibility. Interobserver reproducibility was calculated using Fleiss κ and intra-class coefficient. Intraobserver reproducibility was calculated using Cohen κ. RESULTS Mean age was 68.8 ± 9.8 years. Mean sagittal alignment parameters values were the following: PI: 60.1° ± 12.7°; PI-LL was 12.2° ± 13.9°, PT: 24.7° ± 8.5°; SVA: 44.9 mm ± 44.6 mm; SL: 16.6° ± 8.4°. Intraobserver repeatability showed an almost perfect agreement (ICC > 0.92 and Cohen κ > 0.89 for each observer). Fleiss κ value for interobserver reproducibility was 0.82, with percentage agreement among observers between 88% and 89%. CONCLUSION This new classification showed an excellent inter- and intraobserver reliability. This simple method could be an additional sagittal balance tool helping surgeons improve their preoperative DSLS analysis.
Collapse
Affiliation(s)
- Soufiane Ghailane
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France.
| | - Houssam Bouloussa
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Vincent Challier
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Claudio Vergari
- University of Exeter, School of Physics and Astronomy, Exeter, United Kingdom
| | - Go Yoshida
- 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
| | - 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
| | - 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
| | - Simon Mazas
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Pierre Coudert
- 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
| |
Collapse
|
42
|
Vergari C, Aubert B, Lallemant-Dudek P, Haen TX, Skalli W. A novel method of anatomical landmark selection for rib cage 3D reconstruction from biplanar radiography. Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization 2018. [DOI: 10.1080/21681163.2018.1537860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Claudio Vergari
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - Benjamin Aubert
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | | | - Thomas-Xavier Haen
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, Paris, France
- Ramsay Générale de Santé, Clinique Jouvenet, Paris, France
| | - Wafa Skalli
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, Paris, France
| |
Collapse
|
43
|
Hernandez T, Thenard T, Vergari C, Robichon L, Skalli W, Vialle R. Coronal trunk imbalance in idiopathic scoliosis: Does gravity line localisation confirm the physical findings? Orthop Traumatol Surg Res 2018; 104:617-622. [PMID: 29908357 DOI: 10.1016/j.otsr.2018.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 12/21/2017] [Revised: 03/27/2018] [Accepted: 04/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) can require surgical procedures that have major consequences. Coronal imbalance as assessed clinically using a plumb line is a key criterion for selecting patients to surgery. Nevertheless, the reference standard for assessing postural balance of the trunk is gravity line localisation within a validated frame of reference. Recent studies have established that the gravity line can be localised after body contour reconstruction from biplanar radiographs. The objective of this study was to validate a gravity line localisation method based on biplanar radiographs in a population with AIS then to validate gravity line position versus plumb line position. HYPOTHESIS Plumb line and gravity line assessments of coronal balance correlate with each other. MATERIAL AND METHODS A gravity line localisation method based on biplanar radiography was validated in 14 patients with AIS versus force platform as the method of reference. Normal plumb line and gravity line positions were determined in 27 asymptomatic adolescents using biplanar radiography. The results of the two methods were then compared in 53 patients with AIS. RESULTS The reliability of gravity line localisation in the coronal plane based on biplanar radiography was 2.4mm (95% confidence interval). The distance between the gravity line and the middle of the line connecting the centres of the two femoral heads (HA) showed a strongly significant association with plumb line position computed as the distance from the vertical line through the middle of T1 and the centre of the S1 endplate (T1V/S): r=0.71, p<0.0001. Of the 20 patients with plumb line results indicating coronal imbalance, 11 (55%) had a normal gravity line-to-HA distance. Of the 33 patients with normal plumb line results, 7 (21%) had an abnormal gravity line-to-HA distance. CONCLUSION The results of this study validate gravity line determination from biplanar radiographs in a population with AIS. Plumb line position correlated significantly with gravity line position but was less accurate for guiding surgical decisions. LEVEL OF EVIDENCE IV, retrospective study.
Collapse
Affiliation(s)
- Thibault Hernandez
- Service de chirurgie orthopédique et réparatrice de l'enfant, hôpital Armand-Trousseau, 26, avenue du Dr-Netter, 75012 Paris, France; Arts et metiers ParisTech, LBM/Institut de biomécanique humaine Georges-Charpak, 151, boulevard de l'Hôpital, 75013 Paris, France.
| | - Thomas Thenard
- Arts et metiers ParisTech, LBM/Institut de biomécanique humaine Georges-Charpak, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - Claudio Vergari
- Arts et metiers ParisTech, LBM/Institut de biomécanique humaine Georges-Charpak, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - Leopold Robichon
- Arts et metiers ParisTech, LBM/Institut de biomécanique humaine Georges-Charpak, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - Wafa Skalli
- Arts et metiers ParisTech, LBM/Institut de biomécanique humaine Georges-Charpak, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - Raphaël Vialle
- Service de chirurgie orthopédique et réparatrice de l'enfant, hôpital Armand-Trousseau, 26, avenue du Dr-Netter, 75012 Paris, France; Département hospitalo-universitaire, maladies musculo-squelettiques et innovations thérapeutiques, DHU-MAMUTH, hôpital Armand-Trousseau, 26, avenue du Dr-Netter, 75012 Paris, France
| |
Collapse
|
44
|
Doridam J, Macron A, Vergari C, Verney A, Rohan PY, Pillet H. Feasibility of sub-dermal soft tissue deformation assessment using B-mode ultrasound for pressure ulcer prevention. J Tissue Viability 2018; 27:238-243. [PMID: 30195464 DOI: 10.1016/j.jtv.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/19/2018] [Revised: 07/15/2018] [Accepted: 08/10/2018] [Indexed: 10/28/2022]
Abstract
Pressure Ulcer (PU) prevention remains a main public health issue. The physio-pathology of this injury is not fully understood, and a satisfactory therapy is currently not available. Recently, several works suggested that mechanical strains are responsible of deformation-induced damage involved in the initiation of Deep Tissue Injury (DTI). A better assessment of the internal behavior could allow to enhance the modeling of the transmission of loads into the different structures composing the buttock. A few studies focused on the experimental in vivo buttock deformation quantification using Magnetic Resonance Imaging (MRI), but its use has important drawbacks. In clinical practice, ultrasound imaging is an accessible, low cost, and real-time technic to study the soft tissue. The objective of the present work was to show the feasibility of using B-mode ultrasound imaging for the quantification of localised soft-tissue strains of buttock tissues during sitting. An original protocol was designed, and the intra-operator reliability of the method was assessed. Digital Image Correlation was used to compute the displacement field of the soft tissue of the buttock during a full realistic loading while sitting. Reference data of the strains in the frontal and sagittal planes under the ischium were reported for a population of 7 healthy subjects. The average of shear strains over the region of interest in the fat layer reached levels up to 117% higher than the damage thresholds previously quantified for the muscular tissue in rats. In addition, the observation of the muscles displacements seems to confirm previous results which already reported the absence of muscular tissue under the ischium in the seated position, questioning the assumption commonly made in Finite Element modeling that deep tissue injury initiates in the muscle underlying the bone.
Collapse
Affiliation(s)
- J Doridam
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France; Department of Anatomy, University Paris XIII, UFR Santé Médecine Biologie Humaine, Bobigny, France.
| | - A Macron
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France; CEA, LIST, Interactive Robotics Laboratory, F-91191, Gif-sur-Yvette, France
| | - C Vergari
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France
| | - A Verney
- CEA, LIST, Interactive Robotics Laboratory, F-91191, Gif-sur-Yvette, France
| | - P-Y Rohan
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France
| | - H Pillet
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France
| |
Collapse
|
45
|
Hardy A, Rodaix C, Vergari C, Vialle R. Normal Range of Patellar Tendon Elasticity Using the Sharewave Elastography Technique: An In Vivo Study in Normal Volunteers. Surg Technol Int 2017; 31:227-230. [PMID: 29301166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In-vivo investigation of tendon mechanical properties in healthy subjects using Shear Wave Elastography (SWE) techniques is a relatively new field of study. This work aims to evaluate the elastic properties of the patellar tendon in various knee range of flexion. Twenty healthy adult subjects were enrolled in the study. Shear wave speed (SWS) in the patellar tendon was measured in three different positions: Knee extended, knee semi-flexed (30°), and knee flexed (90°). Mean shear modulus was 50.9 +- 33.1 kPa in knee extension position, 137.5 +- 50.7 kPa in 30° flexion position, and 226.5 +- 60.3 kPa in 90° flexion position. The lowest shear modulus was obtained at rest with the knee in a fully extended position. These results are in agreement with those previously reported on Achilles tendon and triceps muscles. Shear modulus values obtained in our study could be considered as baseline values for further investigations in adults.
Collapse
Affiliation(s)
- Alexandre Hardy
- Department of Pediatric Orthopaedics, Universite Pierre et Marie Curie Paris, Armand Trousseau Hospital, Paris, France
| | - Camille Rodaix
- Department of Pediatric Orthopaedics, Universite Pierre et Marie Curie Paris, Armand Trousseau Hospital, Paris, France
| | - Claudio Vergari
- Arts et Metiers, Paristech, Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - Raphael Vialle
- Hospital-University Department for Innovative Therapies in Musculoskeletal Diseases, The MAMUTH-DHU, Armand Trousseau Hospital, Pierre and Marie Curie University, Paris, Franc
| |
Collapse
|
46
|
Vergari C, Mansfield JC, Chan D, Clarke A, Meakin JR, Winlove PC. The effects of needle damage on annulus fibrosus micromechanics. Acta Biomater 2017; 63:274-282. [PMID: 28917706 DOI: 10.1016/j.actbio.2017.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/23/2017] [Accepted: 09/13/2017] [Indexed: 01/07/2023]
Abstract
Needle puncture of the intervertebral disc can initiate a mechanical and biochemical cascade leading to disc degeneration. Puncture's mechanical effects have been shown near the puncture site, mechanical effects should be observed far, relative to needle size, from the puncture site, given the disc-wide damage induced by the stab. The aim of this work was to quantify these far-field effects, and to observe the local structural damage provoked by the needle. Strips of cow tail annulus fibrosus underwent two consecutive mechanical loadings to 5% tensile strain; fifteen samples were punctured in a radial direction with a randomly assigned needle between the two loadings (needle gauges between 19 and 23). Ten samples (control group) were not punctured. During loading, the tissue strains were imaged using second harmonic generation microscopy in a <600×800µm region about 4.4mm from the puncture site. After mechanical testing, the puncture site was imaged in 3D. Puncture had no significant effect on annulus elastic modulus. Imaging showed a modest change in the shearing between fibre bundles however, the linear strain between bundles, intra-bundle shear and linear strain were not significantly affected. At the puncture site, detached lumps of tissue were present. These results suggest that the mechanical effects observed in intact discs are due to the depressurization of the disc, rather than the local damage to the annulus. Needle profiles could be designed, aiming at separating fibre bundles rather than cutting through them, to avoid leaving dying tissue behind. STATEMENT OF SIGNIFICANCE Needle puncture of the intervertebral disc can initiate a mechanical and biochemical cascade leading to disc degeneration, but the link between the local damage of the puncture and the disc-wide effects is not well understood. This work aimed at determining the micro-mechanical effects of the puncture far from its site, and to observe the damage induced by the puncture with high resolution imaging. Results show that the puncture had modest effect far from the puncture, but lumps of tissue were left by the needle, detached from the disc; these could cause further damage through friction and inflammation of the surrounding tissues. This suggests that the cascade leading to degeneration is probably driven by a biochemical response rather than disc-wide mechanical effects.
Collapse
|
47
|
Pedersen PH, Xavier F, Vergari C, Skalli W, Eiskjær SP, Vialle R. Paper #9: Nano-Dose Protocol for 3D Reconstruction of the Spine in Early Onset Scoliosis: Preliminary Results of a Phantom Based and Clinically Validated Study using Stereo-Radiography. Spine Deform 2017; 5:444. [PMID: 31997201 DOI: 10.1016/j.jspd.2017.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This is a prospective study validating the reproducibility of 3D reconstruction of the spine using a new reduced micro-dose protocol. A pilot group of children with scoliosis underwent micro-dose- and additional reduced micro-dose (nano-dose) full-spine imaging. 3D reconstructions of both protocols were evaluated.
Collapse
|
48
|
Gille O, Bouloussa H, Mazas S, Vergari C, Challier V, Vital JM, Coudert P, Ghailane S. A new classification system for degenerative spondylolisthesis of the lumbar spine. Eur Spine J 2017; 26:3096-3105. [PMID: 28836019 DOI: 10.1007/s00586-017-5275-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 08/17/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE There is no consensus for a comprehensive analysis of degenerative spondylolisthesis of the lumbar spine (DSLS). A new classification system for DSLS based on sagittal alignment was proposed. Its clinical relevance was explored. METHODS Health-related quality-of-life scales (HRQOLs) and clinical parameters were collected: SF-12, ODI, and low back and leg pain visual analog scales (BP-VAS, LP-VAS). Radiographic analysis included Meyerding grading and sagittal parameters: segmental lordosis (SL), L1-S1 lumbar lordosis (LL), T1-T12 thoracic kyphosis (TK), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Patients were classified according to three main types-1A: preserved LL and SL; 1B: preserved LL and reduced SL (≤5°); 2A: PI-LL ≥10° without pelvic compensation (PT < 25°); 2B: PI-LL ≥10° with pelvic compensation (PT ≥ 25°); type 3: global sagittal malalignment (SVA ≥40 mm). RESULTS 166 patients (119 F: 47 M) suffering from DSLS were included. Mean age was 67.1 ± 11 years. DSLS demographics were, respectively: type 1A: 73 patients, type 1B: 3, type 2A: 8, type 2B: 22, and type 3: 60. Meyerding grading was: grade 1 (n = 124); grade 2 (n = 24). Affected levels were: L4-L5 (n = 121), L3-L4 (n = 34), L2-L3 (n = 6), and L5-S1 (n = 5). Mean sagittal parameter values were: PI: 59.3° ± 11.9°; PT: 24.3° ± 7.6°; SVA: 29.1 ± 42.2 mm; SL: 18.2° ± 8.1°. DSLS types were correlated with age, ODI and SF-12 PCS (ρ = 0.34, p < 0.05; ρ = 0.33, p < 0.05; ρ = -0.20, and p = 0.01, respectively). CONCLUSION This classification was consistent with age and HRQOLs and could be a preoperative assessment tool. Its therapeutic impact has yet to be validated. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Olivier Gille
- Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Bordeaux University Hospital, Université de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Houssam Bouloussa
- Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Bordeaux University Hospital, Université de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Simon Mazas
- Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Bordeaux University Hospital, Université de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Claudio Vergari
- School of Physics and Astronomy, University of Exeter, Exeter, UK
| | - Vincent Challier
- Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Bordeaux University Hospital, Université de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Jean-Marc Vital
- Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Bordeaux University Hospital, Université de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Pierre Coudert
- Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Bordeaux University Hospital, Université de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Soufiane Ghailane
- Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Bordeaux University Hospital, Université de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France.
| |
Collapse
|
49
|
Bouloussa H, Alzakri A, Ghailane S, Vergari C, Mazas S, Vital JM, Coudert P, Gille O. Is it safe to perform lumbar spine surgery on patients over eighty five? Int Orthop 2017; 41:2091-2096. [PMID: 28748381 DOI: 10.1007/s00264-017-3555-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 03/27/2017] [Accepted: 06/23/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and tolerance of lumbar spine surgery in patients over 85. MATERIALS AND METHODS Patients over 85 years of age with LSS who underwent decompression surgery with or without fusion between February 2011 and July 2014 were included. Comorbidities, autonomy (Activities of Daily Life and Braden scales), surgical parameters and complications (Clavien-Dindo classification) were collected. A telephone survey was performed to assess survival and patients' satisfaction at last follow-up. RESULTS Mean follow-up was 27.4 ± 7.6 months (range, 18-65). Mean age was 87.5 ± 2.7 years (range, 85-97). Mean ADLs and Braden scores were, respectively, 4.3 ± 1.2 and 20.2 ± 1.4. Fifteen patients had associated spondylolisthesis. Nineteen minor complications (grade I and II, 38.7%), five moderate complications (grade III, 10.2%) and six major complications (grade IV and V, 12.2%) occurred. The perioperative mortality rate was 0.02%. At last follow-up, 41 patients were very satisfied (83.7%), five patients were satisfied (10.2%) and three patients were not satisfied (6.1%). Fusion did not affect the incidence of complications (p = 0.3) nor the average number of complications per patient (p = 0.2). CONCLUSION Advanced age should not be a contraindication to lumbar spine surgery provided careful preoperative selection is performed. This study reported a high satisfaction rate and a low mortality rate at the price of a high number of complications, most of which being minor.
Collapse
Affiliation(s)
- Houssam Bouloussa
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France.
| | - Abdulmajeed Alzakri
- Orthopaedic Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Soufiane Ghailane
- Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Claudio Vergari
- University of Exeter, School of Physics and Astronomy, Exeter, UK
| | - Simon Mazas
- 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
| | - Pierre Coudert
- 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
| |
Collapse
|
50
|
Vergari C, Chan D, Clarke A, Mansfield JC, Meakin JR, Winlove PC. Bovine and degenerated human annulus fibrosus: a microstructural and micromechanical comparison. Biomech Model Mechanobiol 2017; 16:1475-1484. [PMID: 28378119 PMCID: PMC5511600 DOI: 10.1007/s10237-017-0900-z] [Citation(s) in RCA: 21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 03/15/2017] [Indexed: 01/03/2023]
Abstract
The complex structure of the annulus fibrosus is strongly related to its mechanical properties. Recent work showed that it is possible to observe the relative movement of fibre bundles in loaded cow tail annulus; the aim of this work was to describe and quantify annulus fibrosus micromechanics in degenerated human disc, and compare it with cow tail annulus, an animal model often used in the literature. Second harmonic generation was used to image the collagen matrix in twenty strips of annulus fibrosus harvested from intervertebral disc of seven patients undergoing surgery. Samples were loaded to 6% tensile strain in 1% steps. Elastic modulus was calculated from loading curves, and micromechanical strains were calculated from the images using custom software. The same protocol was applied to twenty strips of annulus harvested from cow tail discs. Significant morphological differences were found between human and cow tail samples, the most striking being the lack of collagen fibre crimp in the former. Fibres were also observed bending and running from one lamella to the other, forming a strong flexible interface. Interdigitation of fibre bundles was also present at this interface. Quantitative results show complex patterns of inter-bundle and inter-lamellar behaviour, with inter-bundle sliding being the main strain mechanism. Elastic modulus was similar between species, and it was not affected by the degree of degeneration. This work gives an insight into the complex structure and mechanical function of the annulus fibrosus, which should be accounted for in disc numerical modelling.
Collapse
Affiliation(s)
- Claudio Vergari
- School of Physics and Astronomy, University of Exeter, Physics Building, Stocker Road, Exeter, EX4 4QL, UK.
| | - Daniel Chan
- Peninsula Spine Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK
| | - Andrew Clarke
- Peninsula Spine Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK
| | - Jessica C Mansfield
- School of Physics and Astronomy, University of Exeter, Physics Building, Stocker Road, Exeter, EX4 4QL, UK
| | - Judith R Meakin
- School of Physics and Astronomy, University of Exeter, Physics Building, Stocker Road, Exeter, EX4 4QL, UK
| | - Peter C Winlove
- School of Physics and Astronomy, University of Exeter, Physics Building, Stocker Road, Exeter, EX4 4QL, UK
| |
Collapse
|