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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] [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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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] [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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张 伟, 柴 子, 崔 西, 王 康, 张 旭, 李 海, 翟 云, 于 海. [Back-forward bending CT in simulated surgical position to evaluate the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:457-462. [PMID: 37070314 PMCID: PMC10110746 DOI: 10.7507/1002-1892.202211107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 03/12/2023] [Indexed: 04/19/2023]
Abstract
Objective To introduce a scout view scanning technique of back-forward bending CT (BFB-CT) in simulated surgical position for evaluating the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture. Methods A total of 28 patients with thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture who met the selection criteria between June 2018 and December 2021 were included in the study. There were 6 males and 22 females with an average age of 69.5 years (range, 56-92 years). The injured vertebra were located at T 10-L 2, including 11 cases of single thoracic fracture, 11 cases of single lumbar fracture, and 6 cases of multiple thoracolumbar fractures. The disease duration ranged from 3 weeks to 36 months, with a median of 5 months. All patients received examinations of BFB-CT and standing lateral full-spine X-ray (SLFSX). The thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), local kyphosis of injured vertebra (LKIV), lumbar lordosis (LL), and the sagittal vertical axis (SVA) were measured. Referring to the calculation method of scoliosis flexibility, the kyphosis flexibility of thoracic, thoracolumbar, and injured vertebra were calculated respectively. The sagittal parameters measured by the two methods were compared, and the correlation of the parameters measured by the two methods was analyzed by Pearson correlation. Results Except LL ( P>0.05), TK, TLK, LKIV, and SVA measured by BFB-CT were significantly lower than those measured by SLFSX ( P<0.05). The flexibilities of thoracic, thoracolumbar, and injured vertebra were 34.1%±18.8%, 36.2%±13.8%, and 39.3%±18.6%, respectively. Correlation analysis showed that the sagittal parameters measured by the two methods were positively correlated ( P<0.001), and the correlation coefficients of TK, TLK, LKIV, and SVA were 0.900, 0.730, 0.700, and 0.680, respectively. Conclusion Thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture shows an excellent flexibility and BFB-CT in simulated surgical position can obtain the remaining real angle which need to be corrected surgically.
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Affiliation(s)
- 伟 张
- 阜阳市人民医院骨科 安徽省脊柱畸形临床医学研究中心(安徽阜阳 236000)Department of Orthopaedics, Fuyang People’s Hospital, Clinical Research Center for Spine Deformity of Anhui Province, Fuyang Anhui, 236000, P. R. China
| | - 子豪 柴
- 阜阳市人民医院骨科 安徽省脊柱畸形临床医学研究中心(安徽阜阳 236000)Department of Orthopaedics, Fuyang People’s Hospital, Clinical Research Center for Spine Deformity of Anhui Province, Fuyang Anhui, 236000, P. R. China
| | - 西龙 崔
- 阜阳市人民医院骨科 安徽省脊柱畸形临床医学研究中心(安徽阜阳 236000)Department of Orthopaedics, Fuyang People’s Hospital, Clinical Research Center for Spine Deformity of Anhui Province, Fuyang Anhui, 236000, P. R. China
| | - 康康 王
- 阜阳市人民医院骨科 安徽省脊柱畸形临床医学研究中心(安徽阜阳 236000)Department of Orthopaedics, Fuyang People’s Hospital, Clinical Research Center for Spine Deformity of Anhui Province, Fuyang Anhui, 236000, P. R. China
| | - 旭 张
- 阜阳市人民医院骨科 安徽省脊柱畸形临床医学研究中心(安徽阜阳 236000)Department of Orthopaedics, Fuyang People’s Hospital, Clinical Research Center for Spine Deformity of Anhui Province, Fuyang Anhui, 236000, P. R. China
| | - 海江 李
- 阜阳市人民医院骨科 安徽省脊柱畸形临床医学研究中心(安徽阜阳 236000)Department of Orthopaedics, Fuyang People’s Hospital, Clinical Research Center for Spine Deformity of Anhui Province, Fuyang Anhui, 236000, P. R. China
| | - 云雷 翟
- 阜阳市人民医院骨科 安徽省脊柱畸形临床医学研究中心(安徽阜阳 236000)Department of Orthopaedics, Fuyang People’s Hospital, Clinical Research Center for Spine Deformity of Anhui Province, Fuyang Anhui, 236000, P. R. China
| | - 海洋 于
- 阜阳市人民医院骨科 安徽省脊柱畸形临床医学研究中心(安徽阜阳 236000)Department of Orthopaedics, Fuyang People’s Hospital, Clinical Research Center for Spine Deformity of Anhui Province, Fuyang Anhui, 236000, P. R. China
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Turan K, Kara GK, Camurcu Y, Kizilay YO, Uysal Y, Sahin E, Aydinli U. Cervical and thoracic/lumbar motion and muscle strength in surgically treated adolescent idiopathic scoliosis patients. J Back Musculoskelet Rehabil 2022; 35:1337-1343. [PMID: 35723086 DOI: 10.3233/bmr-210303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND To date, only one study assessed the spinal mobility and muscle strength of patients who were treated either with fusion or brace treatment. OBJECTIVE The aim of this retrospective study was to evaluate the range of motion (ROM) and strength of the cervical and thoracic/lumbar spine in patients who underwent spinal fusion for the treatment of adolescent idiopathic scoliosis (AIS) in comparison to healthy individuals. METHODS Patients (n= 28) who were treated surgically for AIS were included in the study. An age and gender matched control group (n= 22) was included that consisted of healthy individuals. DAVID® Lumbar/Thoracic Extension, Lumbar/Thoracic Rotation, and Cervical Extension/Lateral Flexion devices were used to measure cervical and lumbar/thoracic ROM as well as muscle strength. RESULTS Significant differences were observed between groups in all ROM measurements except thoracic/lumbar sagittal flexion ROM measurement (p= 0.198). There were significant differences between groups in terms of muscle strength, except thoracic lumbar left rotation strength (p= 0.081). CONCLUSIONS The findings of the current study demonstrated that cervical and thoracic/lumbar range of motion, as well as muscle strength, were significantly decreased in surgically treated adolescent idiopathic scoliosis patients compared to healthy counterparts. However, trunk (thoracic/lumbar) flexion range of motion and trunk left rotation muscle strength were not significantly different.
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Affiliation(s)
- Kayhan Turan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Atlas University, Istanbul, Turkey
| | - Gokhan Kursat Kara
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Yalkin Camurcu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Atlas University, Istanbul, Turkey
| | - Yusuf Onur Kizilay
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Atlas University, Istanbul, Turkey
| | - Yunus Uysal
- Department of Orthopaedics and Traumatology, Aritmi Osmangazi Hospital, Bursa, Turkey
| | - Ecem Sahin
- Verom Spine and Tumor Center, Bursa, Turkey
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