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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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Assi A, Rebeyrat G, El Rachkidi R, Semaan K, Saad E, Mekhael E, Nassim N, Massaad A, Lafage V, Ghanem I, Pillet H, Skalli W. ASD with high pelvic retroversion develop changes in their acetabular orientation during walking. Brain Spine 2023; 3:101752. [PMID: 37383434 PMCID: PMC10293306 DOI: 10.1016/j.bas.2023.101752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/10/2023] [Accepted: 05/02/2023] [Indexed: 06/30/2023]
Abstract
Introduction It was hypothesized that pelvic retroversion in Adult Spinal Deformity (ASD) can be related to an increased hip loading explaining the occurrence of hip-spine syndrome. Research question How pelvic retroversion can modify acetabular orientation in ASD during walking? Methods 89 primary ASD and 37 controls underwent 3D gait analysis and full-body biplanar X-rays. Classic spinopelvic parameters were calculated from 3D skeletal reconstructions in addition to acetabular anteversion, abduction, tilt, and coverage. Then, 3D bones were registered on each gait frame to compute the dynamic value of the radiographic parameters during walking. ASD patients having a high PT were grouped as ASD-highPT, otherwise as ASD-normPT. Control group was divided in: C-aged and C-young, age matched to ASD-hightPT and ASD-normPT respectively. Results 25/89 patients were classified as ASD-highPT having a radiographic PT of 31° (vs 12° in other groups, p < 0.001). On static radiograph, ASD-highPT showed more severe postural malalignment than the other groups: ODHA = 5°, L1L5 = 17°, SVA = 57.4 mm (vs 2°, 48° and 5 mm resp. in other groups,all p < 0.001). During gait, ASD-highPT presented a higher dynamic pelvic retroversion of 30° (vs 15° in C-aged), along with a higher acetabular anteversion of 24° (vs 20°), external coverage of 38° (vs 29°) and a lower anterior coverage of 52° (vs 58°,all p < 0.05). Conclusion ASD patients with severe pelvic retroversion showed an increased acetabular anteversion, external coverage and lower anterior coverage during gait. These changes in acetabular orientation, computed during walking, were shown to be related to hip osteoarthritis.
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Affiliation(s)
- 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
| | - Guillaume Rebeyrat
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France
| | - 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
| | - 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
| | - Hélène Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France
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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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El Rachkidi R, Massaad A, Saad E, Kawkabani G, Semaan K, Abi Nahed J, Ghanem I, Lafage V, Skalli W, Assi A. Spinopelvic Adaptations in Standing and Sitting Positions in Patients With Adult Spinal Deformity. Cureus 2022; 14:e28113. [PMID: 36134075 PMCID: PMC9481204 DOI: 10.7759/cureus.28113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose To describe spinopelvic adaptations in the standing and sitting positions in patients with adult spinal deformity (ASD). Methods Ninety-five patients with ASD and 32 controls completed health-related quality of life (HRQOL) questionnaires: short form 36 (SF36), Oswestry Disability Index (ODI), and visual analog scale (VAS) for pain. They underwent biplanar radiography in both standing and sitting positions. Patients with ASD were divided into ASD-front (frontal deformity Cobb > 20°, n = 24), ASD-sag (sagittal vertical axis (SVA) > 50 mm, pelvic tilt (PT) > 25°, or pelvic incidence (PI)-lumbar lordosis (LL) > 10°, n = 40), and ASD-hyper thoracic kyphosis (TK >60°, n = 31) groups. Flexibility was defined as the difference (Δ) in radiographic parameters between the standing and sitting positions. The radiographic parameters were compared between the groups. Correlations between HRQOL scores were evaluated. Results All participants increased their SVA from standing to sitting (ΔSVA<0), except for patients with ASD-sag, who tended to decrease their SVA (78-62 mm) and maximize their pelvic retroversion (27-40° vs 10-34° in controls, p<0.001). They also showed reduced thoracic and lumbar flexibility (ΔLL = 3.4 vs 37.1°; ΔTK = −1.7 vs 9.4° in controls, p<0.001). ASD-hyperTK showed a decreased PT while sitting (28.9 vs 34.4° in controls, p<0.001); they tended to decrease their LL and TK but could not reach values for controls (ΔLL = 22.8 vs 37.1° and ΔTK = 5.2 vs 9.4°, p<0.001). The ASD-front had normal standing and sitting postures. ΔSVA and ΔLL were negatively correlated with the physical component scale (PCS of SF36) and ODI (r = −0.39 and r = −0.46, respectively). Conclusion Patients with ASD present with different spinopelvic postures and adaptations from standing to sitting positions, with those having sagittal malalignment most affected. In addition, changes in standing and sitting postures were related to HRQOL outcomes. Therefore, surgeons should consider patient sitting adaptations in surgical planning and spinal fusion. Future studies on ASD should evaluate whether physical therapy or spinal surgery can improve sitting posture and QOL, especially for those with high SVA or PT.
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Bizdikian AJ, El Rachkidi R. Posterior Ligamentous Complex Injuries of the Thoracolumbar Spine: Importance and Surgical Implications. Cureus 2021; 13:e18774. [PMID: 34796064 PMCID: PMC8590454 DOI: 10.7759/cureus.18774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/05/2022] Open
Abstract
The soft tissues surrounding the spine play a primordial role in its stability, the most important of which are located posteriorly and are deemed the posterior ligamentous complex (PLC). Injuries to the PLC in the setting of thoracolumbar trauma are often dreaded and little attention has been given to them in the management protocols of thoracolumbar trauma. This review aims to summarize and contextualize current concepts in PLC injuries of the thoracolumbar spine with the aim to provide a clear guide for clinical management. Injuries to the PLC may be suspected on the clinical exam but are often missed, leading to serious complications, including instability and neurological compromise. The diagnosis is often made indirectly by spinal radiographs and CT-scanning or by direct visualization of soft tissues via magnetic resonance imaging. The latter remains the standard imaging modality and is mandatory for patients with a high suspicion of PLC injury. PLC injuries are associated with vertebral fractures and follow a progressive pattern of severity, depending on the mechanism of injury and extent of trauma. Surgical management is warranted, as PLC damage renders the spine unstable. Although fusion was once the standard of care and remains applicable for certain patients, recent endeavors of temporary spinal fixation without fusion are increasingly gaining traction in patients with PLC injuries. In conclusion, PLC injuries are challenging as they are often missed, poorly understood, and are not easily managed. Proper diagnosis and management are crucial to avoid long-standing complications such as spinal instability. Considering the paucity of available data on such an important topic in thoracolumbar trauma, this review article aims to contextualize current concepts in PLC injuries in order to demystify this sparsely covered subject.
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Affiliation(s)
- Aren Joe Bizdikian
- Department of Orthopaedics and Traumatology, Hotel-Dieu de France Hospital, Beirut, LBN
| | - Rami El Rachkidi
- Department of Orthopaedics and Traumatology, Hotel-Dieu de France Hospital, Beirut, LBN
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Sebaaly A, El Rachkidi R, Grobost P, Burnier M, Labelle H, Roussouly P. L5 incidence: an important parameter for spinopelvic balance evaluation in high-grade spondylolisthesis. Spine J 2018; 18:1417-1423. [PMID: 29360579 DOI: 10.1016/j.spinee.2018.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/28/2017] [Accepted: 01/11/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND In high-grade spondylolisthesis (HGSPL), the pelvic incidence (PI) is not a reliable measurement because of doming of the sacrum. Measurement of L5 incidence (L5I) was described as a tool to measure pelvic morphology in HGSPL and for surgical follow-up. OBJECTIVE We aimed to evaluate L5I in HGSPL and its relationship to other spinopelvic parameters. STUDY DESIGN A retrospective study of a cohort of 184 patients with HGSPL was carried out. METHODS Whole spine radiographs were analyzed for PI, pelvic tilt (PT), sacral slope, lumbar lordosis (LL), L5I, L5 tilt (L5T), L5 slope, lumbosacral kyphosis, and slip percentage. Statistical analysis and correlation were made (Pearson correlation test; p<.05). In accordance to Cohen, statically significant correlation were considered strong if R>0.5, moderate if 0.3<R<0.5, and small if R<0.3. RESULTS A total of 184 cases were analyzed, with a female-to-male ratio of 2.35 and a mean age of 20.1 years. Sacral doming was present in 73% of the cases. Mean L5I incidence was 65.2° and strongly correlated to other sagittal parameters, especially PT (R=0.7), LL (R=0.7), L5T (R=0.77), and L5 slope (R=0.83). There was less but still strong correlation to Dubousset lumbosacral kyphosis (Dub-LSK) angle (R=-0.63) and percentage of slippage (R=0.56). L5 tilt showed nearly perfect correlation to PT (R=0.95). Forty-four percent of the cases were balanced HGSPL, whereas 56% of the cases were unbalanced HGSPL. L5 incidence was found to be a good predictor of local imbalance with a cutoff of L5I=61. CONCLUSION This paper describes L5I, which is a positional parameter in HGSPL. L5 incidence is a simple and reliable measure in the preoperative setting in HGSPL. Its correlation with spinal sagittal parameters (especially PT and LL) is strong and was found to be better than Dub-LSK. There is also a good correlation between L5I and HGSPL pelvic parameters (slip percentage and lumbosacral kyphosis). We recommend its use for evaluation of surgical correction and recommend the value of 60° as cutoff value to define spinopelvic balance in HGSPL.
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Affiliation(s)
- Amer Sebaaly
- Department of Orthopedic Surgery, Clinique médico-chirurgicale des Massues, 92 Rue Edmond Locard, 69005 Lyon, France; Faculty of Medicine, Saint Joseph University, Damascus Rd, 1107 2180, Beirut, Lebanon.
| | - Rami El Rachkidi
- Faculty of Medicine, Saint Joseph University, Damascus Rd, 1107 2180, Beirut, Lebanon; Department of Orthopedic Surgery, Hotel Dieu de France, Alfred Naccache St, 166830, Achrafieh, Beirut, Lebanon
| | - Pierre Grobost
- Department of Orthopedic Surgery, Clinique médico-chirurgicale des Massues, 92 Rue Edmond Locard, 69005 Lyon, France
| | - Marion Burnier
- Department of Orthopedic Surgery, Clinique médico-chirurgicale des Massues, 92 Rue Edmond Locard, 69005 Lyon, France
| | - Hubert Labelle
- Sainte-Justine University Hospital Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C5, Canada
| | - Pierre Roussouly
- Department of Orthopedic Surgery, Clinique médico-chirurgicale des Massues, 92 Rue Edmond Locard, 69005 Lyon, France
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Abstract
PURPOSE In 1992, Georges Charpak invented a new type of X-ray detector, which in turn led to the development of the EOS(®) 2D/3D imaging system. This system takes simultaneous anteroposterior and lateral 2D images of the whole body and can be utilized to perform 3D reconstruction based on statistical models. The purpose of this review is to present the state of the art for this EOS(®) imaging technique, to report recent developments and advances in the technique, and to stress its benefits while also noting its limitations. METHODS The review was based on a thorough literature search on the subject as well as personal experience gained from many years of using the EOS(®) system. RESULTS While EOS(®) imaging could be proposed for many applications, it is most useful in relation to scoliosis and sagittal balance, due to its ability to take simultaneous orthogonal images while the patient is standing, to perform 3D reconstruction, and to determine various relationships among adjacent segments (cervical spine, pelvis, and lower limbs). The technique has also been validated for the study of pelvic and lower-limb deformity and pathology in adult and pediatric populations; in such a study it has the advantage of allowing the measurement of torsional deformity, which classically requires a CT scan. CONCLUSIONS The major advantages of EOS(®) are the relatively low dose of radiation (50-80 % less than conventional X-rays) that the patient receives and the possibility of obtaining a 3D reconstruction of the bones. However, this 3D reconstruction is not created automatically; a well-trained operator is required to generate it. The EOS(®) imaging technique has proven itself to be a very useful research and diagnostic tool.
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Affiliation(s)
- Elias Melhem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
| | - Rami El Rachkidi
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon
| | - Ismat Ghanem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon ,Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
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Pillet H, Sangeux M, Hausselle J, El Rachkidi R, Skalli W. A reference method for the evaluation of femoral head joint center location technique based on external markers. Gait Posture 2013; 39:655-8. [PMID: 24055179 DOI: 10.1016/j.gaitpost.2013.08.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/24/2013] [Accepted: 08/25/2013] [Indexed: 02/02/2023]
Abstract
Accurate localization of joint centers is essential in movement analysis. However, joint centers cannot be directly palpated and alternative methods must be used. To assess the relative merits of these methods, a medical image based reference should be used. The EOS(®) system, a new low dose bi-planar X-rays imaging technique may be considered. The aim of this study was to evaluate the accuracy of hip joint center (HJC) localization using the EOS(®) system. Seventeen healthy young adults participated in the study. Femoral heads and pelvic external markers were localized using the EOS(®) system and the HJCs were expressed in the movement analysis coordinate system. Results showed that external marker localization was reliable within 0.15 mm for trained assessors. Mean accuracy for HJC localization was 2.9 mm (SD: 1.3, max: 6.2). The EOS based method therefore appeared reliable and may be used for femoral head localization or as a reference to assess the accuracy of other methods for HJC localization.
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Affiliation(s)
- Hélène Pillet
- Arts et Metiers ParisTech, LBM, 151 bd de l'hopital, 75013 Paris, France.
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