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Nassim N, Mekhael E, Rachkidi RE, Saadé M, Ayoub E, Rteil A, Jaber E, Chaaya C, Rehayem R, Abi Nahed J, Karam M, Ghanem I, Massaad A, Assi A. Global Sagittal Angle and T9-tilt seem to be the most clinically and functionally relevant global alignment parameters in patients with Adult Spinal Deformity. Brain Spine 2024; 4:102805. [PMID: 38646427 PMCID: PMC11033086 DOI: 10.1016/j.bas.2024.102805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/06/2024] [Accepted: 04/04/2024] [Indexed: 04/23/2024]
Abstract
Introduction Radiographic analysis is necessary for the assessment and the surgical planning in adults with spinal deformity (ASD). Restoration of global alignment is key to improving patient's quality of life. However, the large number of existing global alignment parameters can be confusing for surgeons. Research question To determine the most clinically and functionally relevant global alignment parameters in ASD. Material and methods ASD and controls underwent full body biplanar X-ray to calculate global alignment parameters: odontoid to hip axis angle (OD-HA), global sagittal angle (GSA), global tilt (GT), SVA, center of auditory meatus to hip axis (CAM-HA), SSA, T1-tilt and T9-tilt. All subjects filled HRQoL questionnaires: ODI, SF-36, VAS for pain and BDI (Beck's Depression Inventory). 3D gait analysis was performed to calculate kinematic and spatio-temporal parameters. A machine learning model predicted gait parameters and HRQoL scores from global alignment parameters. Results 124 primary ASD and 47 controls were enrolled. T9 tilt predicted the most BDI (31%), hip flexion/extension during gait (36%), and double support time (39%). GSA predicted the most ODI (26%), thorax flexion/extension during gait (33%), and cadence (36%). Discussion and conclusion Among all global alignment parameters, GSA, evaluating both trunk shift and knee flexion, and T9 tilt, evaluating the shift of the center of mass, were the best predictors for most of HRQoL scores and gait kinematics. Therefore, we recommend using GSA and T9 tilt in clinical practice when evaluating ASD because they represent the most quality of life and functional kinematic of these patients.
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Affiliation(s)
- Nabil Nassim
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Elio Mekhael
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Rami El Rachkidi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Maria Saadé
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Elma Ayoub
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Ali Rteil
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Elena Jaber
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Celine Chaaya
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Rami Rehayem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Julien Abi Nahed
- Technology Innovation Unit, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France
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Abi Karam K, El Rachkidi R, Semaan K, Saad E, Fakhoury M, Saade M, Ayoub E, Rteil A, Jaber E, Mekhael E, Nassim N, Massaad A, Ghanem I, Assi A. Kinematic adaptations from self-selected to fast speed walking in patients with adult spinal deformity. Spine Deform 2024; 12:423-431. [PMID: 38200215 DOI: 10.1007/s43390-023-00799-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/25/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To investigate kinematic adaptations from self-selected to fast speed walking in ASD patients. METHODS 115 primary ASD and 66 controls underwent biplanar radiographic X-rays and 3D gait analysis to calculate trunk, segmental spine and lower limb kinematics during self-selected and fast speed walking. Kinematic adaptation was calculated as the difference (Δ) between fast and self-selected speed walking. ASD with 7 or more limited kinematic adaptation parameters were classified as ASD-limited-KA, while those with less than 7 limited kinematic adaptation parameters were classified as ASD-mild-KA. RESULTS 25 patients were classified as ASD-limited-KA and 90 as ASD-mild-KA. ASD-limited-KA patients walked with a lesser increase of pelvic rotation (Δ = 1.7 vs 5.5°), sagittal hip movement (Δ = 3.1 vs 7.4°) and shoulder-pelvis axial rotation (Δ = 3.4 vs 6.4°) compared to controls (all p < 0.05). ASD-limited-KA had an increased SVA (60.6 vs - 5.7 mm), PT (23.7 vs 11.9°), PI-LL (9.7 vs - 11.7°), knee flexion (9.2 vs - 0.4°) and a decreased LL (44.0 vs 61.4°) compared to controls (all p < 0.05). Kinematic and radiographic alterations were less pronounced in ASD-mild-KA. The limited increase of walking speed was correlated to the deteriorated physical component summary score of SF-36 (r = 0.37). DISCUSSION Kinematic limitations during adaptation from self-selected to fast speed walking highlight an alteration of a daily life activity in ASD patients. ASD with limited kinematic adaptations showed more severe sagittal malalignment with an increased SVA, PT, PI-LL, and knee flexion, a decreased LL and the most deteriorated quality of life. This highlights the importance of 3D movement analysis in the evaluation of ASD.
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Affiliation(s)
- Krystel Abi Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Rami El Rachkidi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Karl Semaan
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Eddy Saad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Marc Fakhoury
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Maria Saade
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Elma Ayoub
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Ali Rteil
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Elena Jaber
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Elio Mekhael
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Nabil Nassim
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon.
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France.
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Bizdikian AJ, Assi A, Semaan K, Otayek J, Karam M, Massaad A, Jaber E, Ghanem I, El Rachkidi R. Role of bilateral staged hip arthroplasty in Hip-spine syndrome: A case report. Medicine (Baltimore) 2023; 102:e36296. [PMID: 38065850 PMCID: PMC10713155 DOI: 10.1097/md.0000000000036296] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/03/2023] [Indexed: 12/18/2023] Open
Abstract
RATIONALE Hip-spine syndrome is a frequent finding in patients presenting with symptoms both at the level of the hip and spine. PATIENT CONCERNS Patient previously operated of lumbar laminectomy for supposed spinal stenosis presenting with persistent pain and disability. DIAGNOSES Clinical examination and imaging showed severe bilateral hip osteoarthritis. Full body standing and sitting biplanar radiographs showed an associated severe sagittal malalignment. 3D motion analysis and health-related quality of life (HRQOL) questionnaires showed a severe functional impact. INTERVENTIONS He was operated of a staged bilateral total hip arthroplasty using the direct anterior approach. OUTCOMES Spinopelvic and sagittal alignment parameters, as well as 3D motion analysis and HRQOL scores showed significant improvement after the first, then the second total hip arthroplasty. LESSONS Comprehensive functional diagnostic testing, including full body standing and seated radiographs, 3D gait analysis and HRQOL questionnaires may provide important information for future management.
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Affiliation(s)
- Aren Joe Bizdikian
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph of Beirut, Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph of Beirut, Beirut, Lebanon
| | - Karl Semaan
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph of Beirut, Beirut, Lebanon
| | - Joeffroy Otayek
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph of Beirut, Beirut, Lebanon
| | - Mohamad Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph of Beirut, Beirut, Lebanon
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph of Beirut, Beirut, Lebanon
| | - Elena Jaber
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph of Beirut, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph of Beirut, Beirut, Lebanon
| | - Rami El Rachkidi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph of Beirut, Beirut, Lebanon
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Mekhael E, El Rachkidi R, Saliby RM, Nassim N, Semaan K, Massaad A, Karam M, Saade M, Ayoub E, Rteil A, Jaber E, Chaaya C, Abi Nahed J, Ghanem I, Assi A. Functional assessment using 3D movement analysis can better predict health-related quality of life outcomes in patients with adult spinal deformity: a machine learning approach. Front Surg 2023; 10:1166734. [PMID: 37206356 PMCID: PMC10189154 DOI: 10.3389/fsurg.2023.1166734] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction Adult spinal deformity (ASD) is classically evaluated by health-related quality of life (HRQoL) questionnaires and static radiographic spino-pelvic and global alignment parameters. Recently, 3D movement analysis (3DMA) was used for functional assessment of ASD to objectively quantify patient's independence during daily life activities. The aim of this study was to determine the role of both static and functional assessments in the prediction of HRQoL outcomes using machine learning methods. Methods ASD patients and controls underwent full-body biplanar low-dose x-rays with 3D reconstruction of skeletal segment as well as 3DMA of gait and filled HRQoL questionnaires: SF-36 physical and mental components (PCS&MCS), Oswestry Disability Index (ODI), Beck's Depression Inventory (BDI), and visual analog scale (VAS) for pain. A random forest machine learning (ML) model was used to predict HRQoL outcomes based on three simulations: (1) radiographic, (2) kinematic, (3) both radiographic and kinematic parameters. Accuracy of prediction and RMSE of the model were evaluated using 10-fold cross validation in each simulation and compared between simulations. The model was also used to investigate the possibility of predicting HRQoL outcomes in ASD after treatment. Results In total, 173 primary ASD and 57 controls were enrolled; 30 ASD were followed-up after surgical or medical treatment. The first ML simulation had a median accuracy of 83.4%. The second simulation had a median accuracy of 84.7%. The third simulation had a median accuracy of 87%. Simulations 2 and 3 had comparable accuracies of prediction for all HRQoL outcomes and higher predictions compared to Simulation 1 (i.e., accuracy for PCS = 85 ± 5 vs. 88.4 ± 4 and 89.7% ± 4%, for MCS = 83.7 ± 8.3 vs. 86.3 ± 5.6 and 87.7% ± 6.8% for simulations 1, 2 and 3 resp., p < 0.05). Similar results were reported when the 3 simulations were tested on ASD after treatment. Discussion This study showed that kinematic parameters can better predict HRQoL outcomes than stand-alone classical radiographic parameters, not only for physical but also for mental scores. Moreover, 3DMA was shown to be a good predictive of HRQoL outcomes for ASD follow-up after medical or surgical treatment. Thus, the assessment of ASD patients should no longer rely on radiographs alone but on movement analysis as well.
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Affiliation(s)
- Elio Mekhael
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Rami El Rachkidi
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | | | - Nabil Nassim
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Karl Semaan
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Abir Massaad
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Mohamad Karam
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Maria Saade
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Elma Ayoub
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Ali Rteil
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Elena Jaber
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Celine Chaaya
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Julien Abi Nahed
- Technology Innovation Unit, Hamad Medical Corporation, Doha, Qatar
| | - Ismat Ghanem
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Ayman Assi
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Angers, France
- Correspondence: Ayman Assi
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Semaan K, Rachkidi R, Saad E, Massaad A, Kawkabani G, Saliby RM, Mekhael M, Abi Karam K, Fakhoury M, Jaber E, Ghanem I, Skalli W, Lafage V, Assi A. Alterations of gait kinematics depend on the deformity type in the setting of adult spinal deformity. Eur Spine J 2022; 31:3069-3080. [PMID: 36028589 DOI: 10.1007/s00586-022-07348-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 07/13/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate 3D kinematic alterations during gait in Adult Spinal Deformity (ASD) subjects with different deformity presentations. METHODS One hundred nineteen primary ASD (51 ± 19y, 90F), age and sex-matched to 60 controls, underwent 3D gait analysis with subsequent calculation of 3D lower limb, trunk and segmental spine kinematics as well as the gait deviation index (GDI). ASD were classified into three groups: 51 with sagittal malalignment (ASD-Sag: SVA > 50 mm, PT > 25°, and/or PI-LL > 10°), 28 with only frontal deformity (ASD-Front: Cobb > 20°) and 40 with only hyperkyphosis (ASD-HyperTK: TK > 60°). Kinematics were compared between groups. RESULTS ASD-Sag had a decreased pelvic mobility compared to controls with a decreased ROM of hips (38 vs. 45°) and knees (51 vs. 61°). Furthermore, ASD-Sag exhibited a decreased walking speed (0.8 vs. 1.2 m/s) and GDI (80 vs. 95, all p < 0.05) making them more prone to falls. ASD-HyperTK showed similar patterns but in a less pronounced way. ASD-Front had normal walking patterns. GDI, knee flex/extension and walking speed were significantly associated with SVA and PT (r = 0.30-0.65). CONCLUSION Sagittal spinal malalignment seems to be the driver of gait alterations in ASD. Patients with higher GT, SVA, PT or PI-LL tended to walk slower, with shorter steps in order to maintain stability with a limited flexibility in the pelvis, hips and knees. These changes were found to a lesser extent in ASD with only hyperkyphosis but not in those with only frontal deformity. 3D gait analysis is an objective tool to evaluate functionality in ASD patients depending on their type of spinal deformity. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Affiliation(s)
- Karl Semaan
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Rami Rachkidi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Eddy Saad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Georges Kawkabani
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Renée Maria Saliby
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Mario Mekhael
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Krystel Abi Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Marc Fakhoury
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Elena Jaber
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts Et Métiers, Paris, France
| | | | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
- Institut de Biomécanique Humaine Georges Charpak, Arts Et Métiers, Paris, France.
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Saad E, Semaan K, Kawkabani G, Massaad A, Salibv RM, Mekhael M, Fakhoury M, Karam KA, Jaber E, Ghanem I, Lafage V, Skalli W, Rachkidi R, Assi A. Alteration of the Sitting and Standing Movement in Adult Spinal Deformity. Front Bioeng Biotechnol 2022; 9:751193. [PMID: 35096787 PMCID: PMC8792509 DOI: 10.3389/fbioe.2021.751193] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/03/2021] [Indexed: 12/03/2022] Open
Abstract
Adults with spinal deformity (ASD) are known to have spinal malalignment affecting their quality of life and daily life activities. While walking kinematics were shown to be altered in ASD, other functional activities are yet to be evaluated such as sitting and standing, which are essential for patients’ autonomy and quality of life perception. In this cross-sectional study, 93 ASD subjects (50 ± 20 years; 71 F) age and sex matched to 31 controls (45 ± 15 years; 18 F) underwent biplanar radiographic imaging with subsequent calculation of standing radiographic spinopelvic parameters. All subjects filled HRQOL questionnaires such as SF36 and ODI. ASD were further divided into 34 ASD-sag (with PT > 25° and/or SVA >5 cm and/or PI-LL >10°), 32 ASD-hyperTK (with only TK >60°), and 27 ASD-front (with only frontal malalignment: Cobb >20°). All subjects underwent 3D motion analysis during the sit-to-stand and stand-to-sit movements. The range of motion (ROM) and mean values of pelvis, lower limbs, thorax, head, and spinal segments were calculated on the kinematic waveforms. Kinematics were compared between groups and correlations to radiographic and HRQOL scores were computed. During sit-to-stand and stand-to-sit movements, ASD-sag had decreased pelvic anteversion (12.2 vs 15.2°), hip flexion (53.0 vs 62.2°), sagittal mobility in knees (87.1 vs 93.9°), and lumbar mobility (L1L3-L3L5: −9.1 vs −6.8°, all p < 0.05) compared with controls. ASD-hyperTK showed increased dynamic lordosis (L1L3–L3L5: −9.1 vs −6.8°), segmental thoracic kyphosis (T2T10–T10L1: 32.0 vs 17.2°, C7T2–T2T10: 30.4 vs 17.7°), and thoracolumbar extension (T10L1–L1L3: −12.4 vs −5.5°, all p < 0.05) compared with controls. They also had increased mobility at the thoracolumbar and upper-thoracic spine. Both ASD-sag and ASD-hyperTK maintained a flexed trunk, an extended head along with an increased trunk and head sagittal ROM. Kinematic alterations were correlated to radiographic parameters and HRQOL scores. Even after controlling for demographic factors, dynamic trunk flexion was determined by TK and PI-LL mismatch (adj. R2 = 0.44). Lumbar sagittal ROM was determined by PI-LL mismatch (adj. R2 = 0.13). In conclusion, the type of spinal deformity in ASD seems to determine the strategy used for sitting and standing. Future studies should evaluate whether surgical correction of the deformity could restore sitting and standing kinematics and ultimately improve quality of life.
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Affiliation(s)
- Eddy Saad
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Karl Semaan
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | | | - Abir Massaad
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | | | - Mario Mekhael
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Marc Fakhoury
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | | | - Elena Jaber
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Ismat Ghanem
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Virginie Lafage
- Orthopaedics Surgery, Lenox Hill Hospital, New York, NY, United States
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France
| | - Rami Rachkidi
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Ayman Assi
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France
- *Correspondence: Ayman Assi,
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Mekhael M, Kawkabani G, Saliby RM, Skalli W, Saad E, Jaber E, Rachkidi R, Kharrat K, Kreichati G, Ghanem I, Lafage V, Assi A. Toward understanding the underlying mechanisms of pelvic tilt reserve in adult spinal deformity: the role of the 3D hip orientation. Eur Spine J 2021; 30:2495-2503. [PMID: 33638719 DOI: 10.1007/s00586-021-06778-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/05/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore 3D hip orientation in standing position in subjects with adult spinal deformity (ASD) presenting with different levels of compensatory mechanisms. METHODS Subjects with ASD (n = 159) and controls (n = 68) underwent full-body biplanar X-rays with the calculation of 3D spinopelvic, postural and hip parameters. ASD subjects were grouped as ASD with knee flexion (ASD-KF) if they compensated by flexing their knees (knee flexion ≥ 5°), and ASD with knee extension (ASD-KE) otherwise (knee flexion < 5°). Spinopelvic, postural and hip parameters were compared between the three groups. Univariate and multivariate analyses were then computed between spinopelvic and hip parameters. RESULTS ASD-KF had higher SVA (67 ± 66 mm vs. 2 ± 33 mm and 11 ± 21 mm), PT (27 ± 14° vs. 18 ± 9° and 11 ± 7°) and PI-LL mismatch (20 ± 26° vs - 1 ± 18° and - 13 ± 10°) when compared to ASD-KE and controls (all p < 0.05). ASD-KF also had a more tilted (34 ± 11° vs. 28 ± 9° and 26 ± 7°), anteverted (24 ± 6° vs. 20 ± 5° and 18 ± 4°) and abducted (59 ± 6° vs. 57 ± 4° and 56 ± 4°) acetabulum, with a higher posterior coverage (100 ± 6° vs. 97 ± 7° for ASD-KE) when compared to ASD-KE and controls (all p < 0.05). The main determinants of acetabular tilt, acetabular abduction and anterior acetabular coverage were PT, SVA and LL (adjusted R2 [0.12; 0.5]). CONCLUSIONS ASD subjects compensating with knee flexion have altered hip orientation, characterized by increased posterior coverage (acetabular anteversion, tilt and posterior coverage) and decreased anterior coverage which can together lead to posterior femoro-acetabular impingement, thus limiting pelvic retroversion. This underlying mechanism could be potentially involved in the hip-spine syndrome.
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Affiliation(s)
- Mario Mekhael
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Georges Kawkabani
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Renée Maria Saliby
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Eddy Saad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Elena Jaber
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Rami Rachkidi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Khalil Kharrat
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Gaby Kreichati
- 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
| | - Virginie Lafage
- Department of Orthopedic surgery, Hospital for Special Surgery, New York, USA
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon. .,Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
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