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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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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.
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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
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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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Ghanem D, Ghoul A, Assi A, Ghanem I. Towards a better understanding of knee angular deformities: discrepancies between clinical examination and 2D/3D assessments. Arch Orthop Trauma Surg 2024; 144:1005-1011. [PMID: 38070015 DOI: 10.1007/s00402-023-05153-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/20/2023] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Discrepancy between the clinical examination and the 2D/3D radiographs is a common concern in patients with angular or rotational deformities of the lower limbs, as it may alter clinical judgment and subsequent treatment. The aim was to identify such discrepancies and assess determinants that may contribute to their existence. MATERIALS AND METHODS A retrospective chart review was conducted on 329 consecutive patients (658 lower limbs) who underwent physical examination and long-leg biplanar radiographs in our institution between 2013 and 2018 for limb length discrepancy or angular deformity of the knees (varus/valgus). Eleven parameters were measured on 2D and 3D images. 3D measurements were based on standing biplanar X-rays and their 3D reconstructions and were considered the gold standard. Contingency tables and multiple linear regression were used to assess discrepancies between the three modalities and their determinants respectively. RESULTS Significant mismatches were found between physical examination and 2D images (1% in varus and 1% in valgus), between physical examination and 3D assessment (1% in varus and 4.6% in valgus) as well as between 2 and 3D assessments (1.9% in varus and 7.6% in valgus). The significant determinants of the mismatch between 2 and 3D modalities were frontal pelvic obliquity, neck shaft angle, knee flexion, femoral torsion, and tibial mechanical angle. CONCLUSION In the presence of positional and/or morphological deformities, physical examination and 2D assessment of knee alignment could be biased due to axes projection errors. A better understanding of 3D alignment of the knee as part of the entire lower limb from pelvis to toes, may lead to a better diagnosis and subsequently a better treatment of knee angular deformities.
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Affiliation(s)
- Diane Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon.
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
| | - Ali Ghoul
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
- Hôtel-Dieu de France Hospital, 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
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
- Hôtel-Dieu de France Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
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Tarchichi J, Daher M, Sakr I, Ghoul A, Zalaket J, Ghanem I, Mansour T. Anterior hip dislocation: A current concepts review and proposal of management algorithm. Injury 2024; 55:111252. [PMID: 38043144 DOI: 10.1016/j.injury.2023.111252] [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: 05/20/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
Anterior hip dislocations as compared to posterior, rarely occurs. Nevertheless, it is important to be prepared to manage it. Physical examination and imaging are crucial in detecting this type of dislocation and ruling out any associated fractures. The most important thing is not delaying reduction which is done in a closed manner preferably in the operating room and under general anesthesia. Post-operative complications should be monitored. As for rehabilitation it is still debated and no consensus was reached.
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Affiliation(s)
- Jean Tarchichi
- Orthopedics Department, Hotel Dieu de France, Beirut, Lebanon.
| | - Mohammad Daher
- Orthopedics Department, Hotel Dieu de France, Beirut, Lebanon
| | - Itala Sakr
- Orthopedics Department, Hotel Dieu de France, Beirut, Lebanon
| | - Ali Ghoul
- Orthopedics Department, Hotel Dieu de France, Beirut, Lebanon
| | - Jad Zalaket
- Orthopedics Department, Hotel Dieu de France, Beirut, Lebanon
| | - Ismat Ghanem
- Orthopedics Department, Hotel Dieu de France, Beirut, Lebanon
| | - Toni Mansour
- Orthopedics Department, Hotel Dieu de France, Beirut, Lebanon
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Rassi J, Ghanem D, Bizdikian AJ, Daher M, Kreichati G, Ghanem I. Acute unexplained T1-T2 fracture-dislocation following posterior instrumentation and fusion for paralytic scoliosis. Int J Surg Case Rep 2024; 114:109099. [PMID: 38041890 PMCID: PMC10731219 DOI: 10.1016/j.ijscr.2023.109099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Upper thoracic fracture-dislocation following posterior instrumentation and fusion is rare, with potentially devastating neurologic consequences. The recommended treatment is an open reduction, spinal cord decompression, and a proximal extension of spinal instrumentation. To report the diagnosis and management of an acute non-traumatic T1-T2 fracture-dislocation, occurring in the early postoperative course of a posterior instrumentation and fusion for neurogenic scoliosis. CASE REPORT A 12-year-old spastic quadriplegic cerebral palsy (CP) male patient, who underwent an uneventful T2-S1 instrumentation for scoliosis, presented to the emergency department (ED) 2 weeks later, with mild fever, urinary retention, fecaloma and hypotonia of the 4 limbs, of few days duration. His parents reported no history of trauma and denied epileptic seizures. Atypical cervicothoracic spastic movements the night preceding his symptoms were the only relevant events of the patient's history. CT and MRI were both suggestive of a complete T1-T2 fracture-dislocation and spinal cord compromise. CLINICAL DISCUSSION The patient underwent immediate posterior decompression with wide lamino-arthrectomy, open reduction and proximal extension of his posterior instrumentation to C5. One year following surgery, there was only mild sensorimotor and bladder and bowel function recovery. CONCLUSION To our knowledge, this is the first report of an acute non-traumatic unexplained T1-T2 fracture-dislocation following posterior instrumentation and fusion. Despite a proper management, only very mild recovery was observed one year following surgery.
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Affiliation(s)
- Joe Rassi
- Department of Orthopaedic Surgery, Hotel-Dieu de France Hospital, Beirut, Lebanon.
| | - Diane Ghanem
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Aren Joe Bizdikian
- Department of Orthopaedic Surgery, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Mohammad Daher
- Department of Orthopaedic Surgery, Brown University, Providence, RI, USA
| | - Gaby Kreichati
- Department of Orthopaedic Surgery, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Ismat Ghanem
- Department of Orthopaedic Surgery, Hotel-Dieu de France Hospital, Beirut, Lebanon
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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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Ghanem I, Saliba I, Ghanem D, Assi A, Dubousset J, Bernstein S, Tolo V, Bassett G, Miladi L. Kyphectomy in myelomeningocele revisited: risk factors for failure. Eur Spine J 2023; 32:4128-4144. [PMID: 37698696 DOI: 10.1007/s00586-023-07924-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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/09/2023] [Accepted: 08/27/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Lumbar kyphosis occurs in approximately 8-20% of patients with myelomeningocele (MMC). The purpose of this article is to analyze the risks and benefits of vertebrectomy and spinal stabilization in MMC children with severe lumbar kyphosis and to establish treatment guidelines. METHODS This is an IRB-approved retrospective analysis of 59 patients with MMC who underwent kyphectomy and posterior instrumentation in three centers. Average age at surgery was 7.9 years (2 weeks-17 years). Sitting trunk position, skin status, kyphosis angle, and thoracic lordosis were analyzed preoperatively, postoperatively, and at an average follow-up of 8.2 years (range 2.5-16). The correction was maintained by applying a short posterior instrumentation in 6 patients, and extending to the pelvis in 53 cases. Pelvic fixation was achieved using the Warner and Fackler technique in 24 patients, the Dunn-McCarthy in 8, Luque-Galveston in 8, sacral screws in 2, and ilio-sacral screws in 11. RESULTS Sitting position improved postoperatively in 47 of the 53 patients who underwent pelvic fixation and only in one patient with short instrumentation. All 6 patients with long instrumentation and poor postoperative sitting balance were in the Dunn-McCarthy fixation group. Skin sores at the apex of the deformity disappeared postoperatively in all patients but recurred in two patients with short instrumentations. Kyphosis angle improved from 109° (45°-170°) preoperatively to 10° (0°-45°) postoperatively and 21° (0°-55°) at last follow-up. The best results were seen in cases where a cross-k-wire fixation of the kyphectomy site was used, augmented with a long thoraco-pelvic instrumentation consisting of Luque sublaminar wires in the thoracic region and a Warner-Fackler type of pelvic fixation. Good results were also found with the bipolar technique and ilio-sacral screw fixation. Six over 24 patients with the Warner and Fackler technique showed gradual dislodgment or hardware failure, with subsequent nonunion of the kyphectomy site in four. Infection, with or without wound dehiscence and/or hardware exposure, occurred in 17 cases, necessitating hardware removal in 9 patients. CONCLUSION Lumbar kyphosis in MMC children is best managed by resection of enough vertebrae from the apex to produce a flat lumbar spine, with perfect bone-to-bone contact and long thoraco-pelvic instrumentation using the Warner and Fackler technique through the S1 foramina or the bipolar technique with ilio-sacral screw fixation. Additional local fixation of the osteotomy site using cross-wires with or without cerclage increases the stability of the construct. The majority of complications occurred in patients with short instrumentations or where residual kyphosis persisted postoperatively regardless of the type of pelvic fixation or hardware density. The Dunn-McCarthy technique for pelvic fixation following kyphectomy in MMC was less successful in producing stable pelvic fixation and should not be considered in this patient category.
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Affiliation(s)
- Ismat Ghanem
- Division of Orthopedics, Hotel-Dieu de France Hospital, St Joseph University, Beirut, Lebanon
| | - Ibrahim Saliba
- Division of Orthopedics, Hotel-Dieu de France Hospital, St Joseph University, Beirut, Lebanon.
| | - Diane Ghanem
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ayman Assi
- Division of Orthopedics, Hotel-Dieu de France Hospital, St Joseph University, Beirut, Lebanon
| | - Jean Dubousset
- Saint Vincent de Paul Hospital, Université Paris Descartes, Paris, France
| | - Saul Bernstein
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Vernon Tolo
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - George Bassett
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Lotfi Miladi
- Saint Vincent de Paul Hospital, Université Paris Descartes, Paris, France
- Hopital d'Enfants Malades Necker, Paris, France
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Karam M, Bizdikian AJ, Ghanem I, Assi A. Answer to the Letter to the Editor of T. Sugita et al. concerning "Alterations of 3D acetabular and lower limb parameters in adolescent idiopathic scoliosis" by Karam M, et al. (Eur Spine J [2020]; 29(8):2010-2017): Does windswept deformity of the knee exist in 274 participants with adolescent idiopathic scoliosis? Eur Spine J 2023; 32:4074-4075. [PMID: 37548753 DOI: 10.1007/s00586-023-07863-6] [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: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Mohamad Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Aren Joe Bizdikian
- 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
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon.
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Daher M, Zalaquett Z, Mekhael E, Aoun M, Chalhoub R, Abdo M, Aoude M, Farraj SA, Ghoul A, Tarchichi J, Rassi J, Sebaaly A, Trak-Smayra V, Kesrouani C, Kourie HR, Ghanem I. Epidemiology of bone tumors in Lebanon: a retrospective study from 2000 to 2022 at a tertiary center. Future Sci OA 2023; 9:FSO886. [PMID: 37752923 PMCID: PMC10518824 DOI: 10.2144/fsoa-2023-0102] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 09/28/2023] Open
Abstract
Aim Bone tumors are rare and have an uneven geographic distribution. Methods 730 patients diagnosed with bone tumors were included in this retrospective analysis. Results With a 64% rate of malignancy, the most common tumors were metastasis (40%) mostly in the axial skeleton, Osteosarcoma (9%) mostly in the femur, Osteochondroma (8%) mostly in the femur, giant cell tumors (7%) mostly in the knee, and Ewing's sarcoma (6%) mostly in the axial skeleton. Conclusion Even though a some of the tumors have a predilection for certain localizations in the human body, they may differ in the middle-eastern population. One must also pay attention to the higher rates of malignancies as compared with other cohorts.
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Affiliation(s)
- Mohammad Daher
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | - Ziad Zalaquett
- Hôtel Dieu de France, Hematology-Oncology Department, Beirut, Lebanon
| | - Elio Mekhael
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | - Marven Aoun
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | - Ralph Chalhoub
- Hôtel Dieu de France, Hematology-Oncology Department, Beirut, Lebanon
| | - Majd Abdo
- Hôtel Dieu de France, Hematology-Oncology Department, Beirut, Lebanon
| | - Marc Aoude
- Hôtel Dieu de France, Hematology-Oncology Department, Beirut, Lebanon
| | - Sami Abi Farraj
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | - Ali Ghoul
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | - Jean Tarchichi
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | - Joe Rassi
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | - Amer Sebaaly
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | | | | | | | - Ismat Ghanem
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
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11
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Mehanna J, Massaad A, Assi A, Rassi J, Atallah A, Ghanem I. Risk Factors for Failure of Calcaneal Lengthening Osteotomy in Children and Adolescents With Planovalgus Foot Deformity: A Retrospective Study. Cureus 2023; 15:e43157. [PMID: 37692710 PMCID: PMC10484500 DOI: 10.7759/cureus.43157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION The calcaneal lengthening procedure (CLP) is a well-known surgical technique used for the correction of symptomatic planovalgus foot deformities. Literature shows a significant rate of relapse and undercorrection of the foot post-operatively. Factors determining the failure or success of CLP are still not well understood. The purpose of this retrospective study was to assess the most significant factors related to the failure of this procedure. METHODS A case-control retrospective study was conducted on 50 patients (80 feet) aged 12.4±2.5 years who underwent CLP. A clinical (demographic parameters, etiology, Gross Motor Function Classification System (GMFCS) level) and radiological evaluation were assessed preoperatively and repeated postoperatively at 56.5±32.5 months. Two methods of osteotomy bone fixation were studied: K-wires vs. eight-plate. Standing anteroposterior (AP) and lateral (L) radiographs were done, and the following radiographic parameters were measured: calcaneocuboid (CC) joint subluxation classified into normal, moderate, and severe (L); AP and L talo-first metatarsal (T1MT) angle; AP talonavicular (TN) coverage angle; AP and L talocalcaneal (TC) angle; calcaneal pitch (CP) angle; and L talo-horizontal (TH) angle. Mosca's criteria were used for clinical and radiological assessments. The association between demographic data, clinical and radiological results, and the variation between preoperative and postoperative angles were studied. The main risk factors affecting clinical results and CC joint subluxation were investigated (logistic regression and analysis of covariance (ANCOVA)). RESULTS Satisfactory clinical results were associated with satisfactory radiological ones on Mosca's criteria (p<0.001). The use of an eight-plate for osteotomy fixation gave better results than K-wires (79% vs. 59%). Radiological angles were improved in both techniques postoperatively (increase of CP and L-TC and decrease of AP-T1MT, AP-TC, AP-TN, and L-T1MT, all p<0.05). Non-satisfactory clinical results were associated with a high GMFCS level, a low preoperative AP-TN coverage angle, and a low preoperative CP angle (R2=0.45). Both a young age and a low CP angle preoperatively were associated with CC subluxation (R2=0.31). CONCLUSION The neurological status and the severity of the planovalgus foot deformity preoperatively were the main risk factors affecting clinical outcomes after CLP. However, young age and the severity of the deformity preoperatively were the main risk factors behind CC joint subluxation affecting CLP outcomes.
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Affiliation(s)
- Joe Mehanna
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Joe Rassi
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Alexis Atallah
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
- Orthopedic Surgery, Hôtel-Dieu de France Hospital, Beirut, LBN
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Yared F, Massaad A, Bakouny Z, Otayek J, Bizdikian AJ, Ghanimeh J, Labaki C, Ghanem D, Ghanem I, Skalli W, Assi A. Differences in Kinematic Changes From Self-Selected to Fast Speed Gait in Asymptomatic Adults With Radiological Signs of Femoro-Acetabular Impingement. Cureus 2023; 15:e43733. [PMID: 37727201 PMCID: PMC10505836 DOI: 10.7759/cureus.43733] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Femoro-acetabular impingement (FAI) may present as alterations in the skeletal morphology of the hip. Repercussions of FAI can be witnessed in self-selected speed walking as well as physical exercise such as running or fast speed walking. The aim of this study was to investigate changes in kinematics at different gait speeds in subjects presenting with radiological findings invoking FAI. One hundred thirty asymptomatic adults underwent biplanar X-rays with a calculation of 3D hip parameters: acetabular anteversion, abduction and tilt, vertical center edge angle (VCE), femoral anteversion, neck-shaft angle, acetabular coverage of the femoral head, femoral head diameter and neck length. Parameters were classified according to FAI clinical thresholds. Two groups were created: Control group (63 subjects having up to one subnormal hip parameter in favour of FAI) and Radiographic FAI group (67 subjects having ≥2 subnormal hip parameters that might cause FAI). All subjects underwent 3D gait analysis at self-selected and fast speed, from which kinematic parameters were generated. Arithmetic differences between fast and self-selected speed gait were considered as gait changes. Subjects in the Radiographic FAI group had decreased acetabular tilt (24 vs. 19˚), anteversion (19 vs. 16˚), abduction (55 vs. 53˚), femoral anteversion (18 vs. 14˚) and increased VCE (29 vs. 33˚, all p<0.05), compared to controls. Changes from self-selected to fast speed showed that subjects in the Radiographic FAI group had lower range of motion (ROM) pelvic rotation (7 vs. 4˚) and ROM hip flexion/extension (10 vs. 7˚), reduced hip extension (-4 vs. -2˚) and step length (16 vs. 13 cm; all p<0.05). The Radiographic FAI group had decreased acetabular abduction, anteversion and femoral anteversion in favour of FAI. When adapting from self-selected to fast speed gait, the Radiographic FAI group seemed to limit pelvic rotation and hip flexion/extension resulting in a decrease in step length. These kinematic limitations were previously reported in subjects with symptomatic FAI. Gait analysis could be considered as a functional diagnostic tool to assess FAI along with radiological assessment.
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Affiliation(s)
- Fares Yared
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Ziad Bakouny
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Joeffroy Otayek
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Aren-Joe Bizdikian
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Joe Ghanimeh
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Chris Labaki
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Diane Ghanem
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, FRA
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
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Ghanem I, Ghanem D, Rassi J, Saliba I. Achilles tenotomy during Ponseti's clubfoot treatment: better early than late. J Pediatr Orthop B 2023:01202412-990000000-00132. [PMID: 37401473 DOI: 10.1097/bpb.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
To evaluate the outcome of Achilles tenotomy at first cast in neonates with stiff clubfoot undergoing Ponseti's method of treatment. One hundred forty stiff clubfeet (Dimeglio grades III and IV) scheduled for Ponseti's method were prospectively randomized into two groups of 70 each: (1) early, tenotomy at first cast; (2) late, tenotomy at fourth to sixth casts (conventional). The procedure was performed under local lidocaine spray in an office setting using a needle. The results were assessed at an average follow-up of 12.4 years. Technical difficulties and short and long-term complications were recorded. At last follow-up, the results were rated excellent, good, fair, and poor in 70, 18, 9, and 3% of patients in the late group, respectively, and 82, 13, 4, and 1% in the early group (P = 0.048). Technical difficulties were encountered in 38% of the late group and 3% in the early group (P < 0.0001). Flattening of the talar dome of mild to moderate severity was found in 16% of the late group and 4% in the early group (P < 0.001). Early Achilles tenotomy seems to give better results than the conventional late tenotomy, with less short and long-term complications. This may be explained by the greater ease to palpate the Achilles tendon on a previously untreated foot, and the less amount of compressive forces across the tibiotalar and subtalar joints produced by early release of the posterior tether.
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Affiliation(s)
- Ismat Ghanem
- Orthopaedic Department, Hôtel-Dieu de France Hospital, Saint Joseph University
| | - Diane Ghanem
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Joe Rassi
- Orthopaedic Department, Hôtel-Dieu de France Hospital, Saint Joseph University
| | - Ibrahim Saliba
- Orthopaedic Department, Hôtel-Dieu de France Hospital, Saint Joseph University
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Daher M, Zalaquett Z, Chalhoub R, Abi Farraj S, Abdo M, Sebaaly A, Kourie HR, Ghanem I. Molecular and biologic biomarkers of Ewing sarcoma: A systematic review. J Bone Oncol 2023; 40:100482. [PMID: 37180735 PMCID: PMC10173001 DOI: 10.1016/j.jbo.2023.100482] [Citation(s) in RCA: 3] [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: 03/31/2023] [Revised: 04/23/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023] Open
Abstract
With an annual incidence of less than 1%, Ewing sarcoma mainly occurs in children and young adults. It is not a frequent tumor but is the second most common bone malignancy in children. It has a 5-year survival rate of 65-75%; however, it has a poor prognosis when it relapses in patients. A genomic profile of this tumor can potentially help identify poor prognosis patients earlier and guide their treatment. A systematic review of the articles concerning genetic biomarkers in Ewing sarcoma was conducted using the Google Scholar, Cochrane, and PubMed database. There were 71 articles discovered. Numerous diagnostic, prognostic, and predictive biomarkers were found. However, more research is necessary to confirm the role of some of the mentioned biomarkers. .
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Affiliation(s)
- Mohammad Daher
- Orthopedic Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
- Corresponding author at: Hotel Dieu de France, Beirut, Lebanon.
| | - Ziad Zalaquett
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
| | - Ralph Chalhoub
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
| | - Sami Abi Farraj
- Orthopedic Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
| | - Majd Abdo
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
| | - Amer Sebaaly
- Orthopedic Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
| | - Hampig-Raphaël Kourie
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
| | - Ismat Ghanem
- Orthopedic Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
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15
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Ghanem I, Karam G, Ghanem D, Saliba I. Femoral nerve palsy during Pavlik harness treatment for developmental dysplasia of the hip is not an indication for harness abandonment. J Child Orthop 2023; 17:205-211. [PMID: 37288053 PMCID: PMC10242367 DOI: 10.1177/18632521231172986] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/13/2023] [Indexed: 06/09/2023] Open
Abstract
Objectives The aim of this study was to report the incidence of femoral nerve palsy in developmental dysplasia of the hip children treated with Pavlik harness, to identify any possible associated risk factors, and to evaluate its outcome without any specific strap release. Methods A retrospective chart review was conducted on all cases of femoral nerve palsy in a consecutive series of children who underwent Pavlik harness treatment for developmental dysplasia of the hip. In unilateral cases, the developmental dysplasia of the hip was compared to the contralateral side. All hips with femoral nerve palsy were compared to the remaining hips of the series and any possible risk factor for paralysis was recorded. Results In total, 53 cases of femoral nerve palsy of various severity were identified from a group of 473 children with 527 hips treated for developmental dysplasia of the hip at an average age of 3.9 months. However, 93% occurred during the first 2 weeks of treatment. Femoral nerve palsy was more common in older and larger children with the most severe Tonnis type, and a hip flexion angle in the harness above 90° (p < 0.03 for all). All of them resolved spontaneously before completion of treatment without any specific measures. We found no correlation between the presence of femoral nerve palsy or the time taken for spontaneous resolution and treatment failure using the harness. Conclusion Femoral nerve palsy is most observed with higher Tonnis types and high hip flexion angles in the harness, but its presence by itself is not predictive of treatment failure. It resolves spontaneously before completion of treatment and does not require any strap release or harness discontinuation. Level of evidence Level III.
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Affiliation(s)
- Ismat Ghanem
- Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Geoffrey Karam
- Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Diane Ghanem
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ibrahim Saliba
- Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University, 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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Martinelli E, Cremolini C, Mazard T, Vidal J, Virchow I, Tougeron D, Cuyle PJ, Chibaudel B, Kim S, Ghanem I, Asselain B, Castagné C, Zkik A, Khan S, Arnold D. Real-world first-line treatment of patients with BRAF V600E-mutant metastatic colorectal cancer: the CAPSTAN CRC study. ESMO Open 2022; 7:100603. [PMID: 36368253 PMCID: PMC9832736 DOI: 10.1016/j.esmoop.2022.100603] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND BRAFV600E mutations occur in 8%-12% of metastatic colorectal cancer (mCRC) cases and are associated with poor survival. European guidelines recommend combination (doublet or triplet) chemotherapy plus bevacizumab in first line. However, an unmet need remains for more effective treatments for these patients. PATIENTS AND METHODS CAPSTAN CRC is a European, retrospective, multicenter, observational study evaluating real-world treatment practices for patients with BRAFV600E-mutant mCRC treated between 1 January 2016 and 31 January 2020. The primary objective was to describe first-line treatment patterns. Secondary objectives included describing baseline demographics, mutational testing procedures, treatment effectiveness, and safety. RESULTS In total, 255 patients (median age 66.0 years; 58.4% female) with BRAFV600E-mutant unresectable mCRC from seven countries were included. Most had right-sided tumors (52.5%) and presented with synchronous disease at diagnosis (66.4%). Chemotherapy plus targeted therapy (68.7%) was preferred at first line over chemotherapy alone (31.3%). The main first-line treatments were FOLFOX plus bevacizumab (27.1%) and FOLFOXIRI (folinic acid, 5-fluorouracil, oxaliplatin, irinotecan) with/without bevacizumab (27.1%/19.2%). Median duration of first-line treatment was 4.9 months. Overall, 52.5% received second-line treatment. Across all first-line regimens, progression-free survival (PFS) and overall survival were 6.0 [95% confidence interval (CI) 5.3-6.7] months and 12.9 (95% CI 11.6-14.1) months, respectively. Triplet plus targeted therapy was associated with more adverse events (75.0%) compared with triplet chemotherapy alone (50.0%) and doublet chemotherapy alone (36.1%). Multivariate analysis identified low body mass index and presence of three or more metastatic sites as significant prognostic factors for PFS. CONCLUSIONS This study is, to date, the largest real-world analysis of patients with BRAFV600E-mutant mCRC, providing valuable insights into routine first-line treatment practices for these patients. The data highlight the intrinsic aggressiveness of this disease subgroup, confirming results from previous real-world studies and clinical trials, and stressing the urgent need for more effective treatment options in this setting.
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Affiliation(s)
- E Martinelli
- Medical Oncology, Department of Precision Medicine, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy.
| | - C Cremolini
- Oncologia Medica, University of Pisa, Pisa, Italy
| | - T Mazard
- Institut de Recherche en Cancerologie de Montpellier, INSERM, Montpellier University, Institut du Cancer de Montpellier, Montpellier, France
| | - J Vidal
- Department of Medical Oncology, Hospital del Mar - IMIM, CIBERONC, Barcelona, Spain
| | - I Virchow
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - D Tougeron
- Department of Hepato-gastroenterology, Poitiers University Hospital and University of Poitiers, Poitiers, France
| | - P-J Cuyle
- Gastroenterology and Digestive Oncology Department, Imelda General Hospital, Bonheiden, Belgium
| | - B Chibaudel
- Department of Medical Oncology, Hôpital Franco-Britannique - Fondation Cognacq-Jay, Levallois-Perret, France
| | - S Kim
- Department of Medical Oncology, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France
| | - I Ghanem
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | | | - C Castagné
- Pierre Fabre, Boulogne-Billancourt, France
| | - A Zkik
- Pierre Fabre, Boulogne-Billancourt, France
| | - S Khan
- Pierre Fabre, Boulogne-Billancourt, France
| | - D Arnold
- Asklepios Tumorzentrum Hamburg AK Altona, Hamburg, Germany
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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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20
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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]
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21
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Rizkallah M, Assi A, El Abiad R, Adib S, Ghanem I. Comments on: "From statistical significance to clinical relevance: The contribution of new assessment instruments" of S Klouche, S Putman, E Cavaignac, X Bayle-Iniguez, J Murgier published in Orthop Traumatol Surg Res. 2021 May;107(3):102879. doi: 10.1016/j.otsr.2021.102879. From statistical significance to clinical relevance: What about the objective outcomes? Orthop Traumatol Surg Res 2022; 108:103334. [PMID: 35605935 DOI: 10.1016/j.otsr.2022.103334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/17/2022] [Indexed: 02/03/2023]
Affiliation(s)
| | - Ayman Assi
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Rami El Abiad
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon; Department of Orthopedic Surgery, Hôtel-Dieu de France University Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Salim Adib
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ismat Ghanem
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon; Department of Orthopedic Surgery, Hôtel-Dieu de France University Hospital, Saint-Joseph University, Beirut, Lebanon
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22
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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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23
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Ghanem I, Lora D, Herradón N, de Velasco G, Carretero-González A, Jiménez-Varas MÁ, Vázquez de Parga P, Feliu J. Neoadjuvant chemotherapy with or without radiotherapy versus upfront surgery for resectable pancreatic adenocarcinoma: a meta-analysis of randomized clinical trials. ESMO Open 2022; 7:100485. [PMID: 35580504 PMCID: PMC9117867 DOI: 10.1016/j.esmoop.2022.100485] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The role of neoadjuvant chemotherapy (NC) in resectable pancreatic cancer (RPC) has yet to be defined. This review aims to analyze the benefit of NC in RPC compared with upfront surgery (US) in terms of overall survival (OS) and disease-free survival (DFS). PATIENTS AND METHODS PubMed, CENTRAL (The Cochrane Library), and Embase were systematically reviewed until 3 November 2021. Abstract proceedings and virtual meeting presentations from the American Society of Clinical Oncology and the European Society of Medical Oncology conferences, reference articles of published clinical trials, and review articles were considered. Only randomized clinical trials (RCTs) comparing NC administration with or without radiotherapy previous with surgery (experimental arm) versus US followed by adjuvant chemotherapy with or without radiotherapy (control arm) for RPC were included. RESULTS A total of 1135 studies were screened. Of these, 1117 studies were primarily excluded. Of the remaining 18 studies, 5 were excluded because of no adequate trial design for this work and 7 others had no available results. Finally, 6 trials with 469 patients with pancreatic cancer randomized to NC (n = 212) or US (n = 257) were selected. Compared with US, NC significantly improved OS [hazard ratio (HR) 0.75; 95% confidence interval (CI) 0.58-0.98; P = 0.033] and DFS (HR 0.73; 95% CI 0.59-0.89; P = 0.002). While the NC approach was not significantly associated with lower resection rate [relative risk (RR) 0.92; 95% CI 0.84-1.01; P = 0.069], the R0 resection rate was significantly higher for NC than for US (RR 1.31; 95% CI 1.13-1.52; P = 0.0004). CONCLUSION This is the first meta-analysis of RCTs showing that NC improves OS for RPC compared with US followed by adjuvant therapy. Ongoing RCTs should confirm these findings with FOLFIRINOX to generalize the indication of NC.
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Affiliation(s)
- I Ghanem
- Department of Medical Oncology, Hospital Universitario La Paz (IdiPAZ), Madrid, Spain.
| | - D Lora
- Clinical Research Unit (imas12-CIBERESP), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - N Herradón
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G de Velasco
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Carretero-González
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, USA
| | | | - P Vázquez de Parga
- Department of Gastroenterology and Hepatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - J Feliu
- Department of Medical Oncology, Hospital Universitario La Paz (IdiPAZ), Madrid, Spain; Cátedra UAM-AMGEN, CIBERONC, Madrid, Spain
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24
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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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25
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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.
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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.
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26
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Salameh M, Bizdikian AJ, Saad E, Saliby RM, Nacouzi R, Khalil N, Ghanem I, Kreichati G, Assi A. Reliability assessment of cervical spine parameters measured on full-body radiographs in asymptomatic subjects and patients with spinal deformity. Orthop Traumatol Surg Res 2021; 107:103026. [PMID: 34329761 DOI: 10.1016/j.otsr.2021.103026] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/05/2020] [Accepted: 11/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cervical spinal alignment is usually assessed on full-body radiographs allowing for the concomitant evaluation of possible compensatory mechanisms that may occur at any level in the setting of postural malalignment. HYPOTHESIS Cervical parameters measured on full-body radiographs are reliable. PATIENTS AND METHODS A total of 70 subjects were included and divided in 3 groups: asymptomatic adults (n=21), adolescents with idiopathic scoliosis (n=20), and adults with spinal deformity (n=29), for whom full-body low-dose biplanar radiographs were obtained. Eighteen cervical parameters including gaze and cervical curvature, upper cervical spine, global cervical alignment, thoraco-cervical and cervico-pelvic parameters were measured by 4 operators, three times each. The intraclass correlation coefficient (ICC) and the 95% confidence interval (95% CI) where calculated for each parameter and compared between the 3 groups. RESULTS ICC and the 95% CI were similar between the 3 groups. The measured parameters showed a very high repeatability (ICC>0.8) except for C0-C2, which presented an average repeatability (ICC=0.57). The cSVA, CTPA, C2-SPi, cranial offset, T1-SPi, CBVA and cranial tilt had a 95% CI<2 (° or cm). The TIA, T1-CL and C0-C2 had a 95% CI>6°. DISCUSSION The poor visibility of the foramen magnum, hard palate, C7, T1, and the sternum on radiographs could explain why certain parameters showed a higher measurement error. The assessment of these error margins is essential for an accurate evaluation of cervical spinal deformities and a proper therapeutic approach. LEVEL OF EVIDENCE III; retrospective analysis of prospectively collected data.
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Affiliation(s)
- Michel Salameh
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Aren Joe Bizdikian
- 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
| | - Renée Maria Saliby
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Rhéa Nacouzi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Nour Khalil
- 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
| | - Gaby Kreichati
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon.
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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.
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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
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Megarbane A, Bizzari S, Deepthi A, Sabbagh S, Mansour H, Chouery E, Hmaimess G, Jabbour R, Mehawej C, Alame S, Hani A, Hasbini D, Ghanem I, Koussa S, Al-Ali MT, Obeid M, Talea DB, Lefranc G, Levy N, Leturcq F, El Hayek S, Delague V, Urtizberea A. A 20-year Clinical and Genetic Neuromuscular Cohort Analysis in Lebanon: An International Effort. J Neuromuscul Dis 2021; 9:193-210. [PMID: 34602496 PMCID: PMC8842757 DOI: 10.3233/jnd-210652] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Indexed: 11/03/2022]
Abstract
BACKGROUND Clinical and molecular data on the occurrence and frequency of inherited neuromuscular disorders (NMD) in the Lebanese population is scarce. OBJECTIVE This study aims to provide a retrospective overview of hereditary NMDs based on our clinical consultations in Lebanon. METHODS Clinical and molecular data of patients referred to a multi-disciplinary consultation for neuromuscular disorders over a 20-year period (1999-2019) was reviewed. RESULTS A total of 506 patients were diagnosed with 62 different disorders encompassing 10 classes of NMDs. 103 variants in 49 genes were identified. In this cohort, 81.4%of patients were diagnosed with motor neuron diseases and muscular dystrophies, with almost half of these described with spinal muscular atrophy (SMA) (40.3%of patients). We estimate a high SMA incidence of 1 in 7,500 births in Lebanon. Duchenne and Becker muscular dystrophy were the second most frequently diagnosed NMDs (17%of patients). The latter disorders were associated with the highest number of variants (39) identified in this study. A highly heterogeneous presentation of Limb Girdle Muscular Dystrophy and Charcot-Marie-Tooth disease was notably identified. The least common disorders (5.5%of patients) involved congenital, metabolic, and mitochondrial myopathies, congenital myasthenic syndromes, and myotonic dystrophies. A review of the literature for selected NMDs in Lebanon is provided. CONCLUSIONS Our study indicates a high prevalence and underreporting of heterogeneous forms of NMDs in Lebanon- a major challenge with many novel NMD treatments in the pipeline. This report calls for a regional NMD patient registry.
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Affiliation(s)
- Andre Megarbane
- Department of Human Genetics, Gilbert and Rose-Mary Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.,Institut Jérôme Lejeune, Paris, France
| | | | | | - Sandra Sabbagh
- Department of Pediatrics, Hôtel Dieu de France Hospital, Beirut, Lebanon
| | - Hicham Mansour
- Department of Pediatrics, Saint George Hospital, Balamand University, Beirut, Lebanon
| | - Eliane Chouery
- Department of Human Genetics, Gilbert and Rose-Mary Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Ghassan Hmaimess
- Department of Pediatrics, Saint George Hospital, Balamand University, Beirut, Lebanon
| | - Rosette Jabbour
- Department of Neurology, Saint George Hospital, Balamand University, Beirut, Lebanon
| | - Cybel Mehawej
- Department of Human Genetics, Gilbert and Rose-Mary Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Saada Alame
- Department of Neuropediatrics, Lebanese University, Beirut, Lebanon
| | - Abeer Hani
- Departments of Pediatrics and Neurology, Gilbert and Rose-Mary Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Dana Hasbini
- Department of Pediatric Neurology, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Ismat Ghanem
- Department of Orthopedics, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Salam Koussa
- Department of Neurology, Geitaoui Lebanese University Hospital, Beirut, Lebanon
| | | | - Marc Obeid
- Genetic laboratory, American University of Science and Technology, Lebanon
| | - Diana Bou Talea
- Genetic laboratory, American University of Science and Technology, Lebanon
| | - Gerard Lefranc
- Institut de Génétique Humaine, UMR 9002 CNRS-Université de Montpellier, France
| | - Nicolas Levy
- Aix Marseille Univ, Inserm, MMG, U 1251, Marseille, France
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Ghanem I, Rizkallah M. Clubfoot management in the Middle East: a survey-based review. Ann Transl Med 2021; 9:1106. [PMID: 34423018 PMCID: PMC8339851 DOI: 10.21037/atm-21-33] [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: 01/04/2021] [Accepted: 03/04/2021] [Indexed: 11/23/2022]
Abstract
Clubfoot is the most frequent congenital deformity involving the foot. Little is known about the management of this disease in the Middle East as sparse data is available in the literature. Through the last 5 decades, congenital clubfoot management in the Middle East went from manipulation through Kite’s technique in the late seventies, to early primary surgical intervention in the late eighties and early nineties of the previous century, and then back to manipulation with Ponseti’s technique and the French functional technique in the late nineties, with the latter falling out of favor with time. This is comparable to the evolution of management witnessed in the United States and in Europe, with 10 to 15 years of delay. The delay is getting shorter with time due to the easier access to published scientific data and the increasing number of fellows from Middle East travelling to referral centers in Europe and the USA. A survey was performed among pediatric orthopedic surgeons in the Middle East to assess their approach to clubfoot management. This is the first survey of its kind in the region. It showed a wide adoption (97.1%) of the Ponseti’s technique with serial manipulation and casting, Achilles tenotomy followed by abduction bracing. Divergent practices were found concerning the upper age limit for Ponseti treatment and the setting of the Achilles tenotomy. Nevertheless, these subjects are still a matter of debate in the literature and international conferences. All in all, pediatric orthopedic surgeons in the Middle East are offering their patients the gold standard of care. However, lot of work is to be done in raising awareness for this disease in the community, and among our colleagues as prenatal screening for clubfoot in the Middle East is practically nonexistent.
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Affiliation(s)
- Ismat Ghanem
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.,Hôtel-Dieu de France University Hospital, Saint-Joseph University, Beirut, Lebanon
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Kawkabani G, Saliby RM, Mekhael M, Rachkidi R, Massaad A, Ghanem I, Kharrat K, Kreichati G, Saad E, Lafage V, Lafage R, Skalli W, Assi A. Gait kinematic alterations in subjects with adult spinal deformity and their radiological determinants. Gait Posture 2021; 88:203-209. [PMID: 34118744 DOI: 10.1016/j.gaitpost.2021.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 09/28/2020] [Revised: 04/30/2021] [Accepted: 06/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adults with spinal deformity (ASD) are known to have postural malalignment affecting their quality of life. Classical evaluation and follow-up are usually based on full-body static radiographs and health related quality of life questionnaires. Despite being an essential daily life activity, formal gait assessment lacks in clinical practice. RESEARCH QUESTION What are the main alterations in gait kinematics of ASD and their radiological determinants? METHODS 52 ASD and 63 control subjects underwent full-body 3D gait analysis with calculation of joint kinematics and full-body biplanar X-rays with calculation of 3D postural parameters. Kinematics and postural parameters were compared between groups. Determinants of gait alterations among postural radiographic parameters were explored. RESULTS ASD had increased sagittal vertical axis (SVA:34 ± 59 vs -5 ± 20 mm), pelvic tilt (PT:19 ± 13 vs 11 ± 6°) and frontal Cobb (25 ± 21 vs 4 ± 6°) compared to controls (all p < 0.001). ASD displayed decrease walking speed (0.9 ± 0.3 vs 1.2 ± 0.2 m/s), step length (0.58 ± 0.11 vs 0.64 ± 0.07 m) and increased single support (0.45 ± 0.05 vs 0.42 ± 0.04 s). ASD walked with decreased hip extension in stance (-3 ± 10 vs -7 ± 8°), increased knee flexion at initial contact and in stance (10 ± 11 vs 5 ± 10° and 19 ± 7 vs 16 ± 8° respectively), and decreased knee flexion/extension ROM (55 ± 9 vs 59 ± 7°). ASD had increased trunk flexion (12 ± 12 vs 6 ± 11°) and reduced dynamic lumbar lordosis (-11 ± 12 vs -15 ± 7°, all p < 0.001). Sagittal knee ROM, walking speed and step length were negatively determined by SVA; lack of lumbar lordosis during gait was negatively determined by radiological lumbar lordosis. SIGNIFICANCE Static compensations in ASD persist during gait, where they exhibit a flexed attitude at the trunk, hips and knees, reduced hip and knee mobility and loss of dynamic lordosis. ASD walked at a slower pace with increased single and double support times that might contribute to their gait stability. These dynamic discrepancies were strongly related to static sagittal malalignment.
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Affiliation(s)
| | | | - Mario Mekhael
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Rami Rachkidi
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Abir Massaad
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Ismat Ghanem
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Khalil Kharrat
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Gaby Kreichati
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Eddy Saad
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | | | - Renaud Lafage
- Spine Service, Hospital for Special Surgery, New York, USA
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Ayman Assi
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
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El Helou A, Sebaaly A, El Rassi J, Taslakian B, Ghanem I, El Abyad R. Measurement of biceps tendon retraction after arthroscopic tenotomy. J Shoulder Elbow Surg 2021; 30:1369-1374. [PMID: 32919051 DOI: 10.1016/j.jse.2020.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND One of the treatment options for long head of the biceps tendon (LHBT) pathology is tenotomy. To our knowledge, no study in the literature has evaluated the degree of retraction after tenotomy. The goals of this study were to determine the distance of this retraction and to identify its relationship with patient characteristics. METHODS We conducted an observational prospective survey over a 3-month period among 30 patients operated on arthroscopically by the same surgeon between August 2018 and April 2019. A radiopaque device was introduced inside the LHBT before tenotomy. Radiographs were obtained to evaluate the distance of retraction on day 1, day 30, and day 90. RESULTS Thirty patients were included, of whom 63.3% (19) were women. Surgery was performed for a rotator cuff tear in 10 patients (33.3%) and for subacromial impingement in the remainder of patients (66.7%) after failure of conservative management. The mean retraction of the LHBT (distance between the glenoid and clip) increased from 1.9 cm (day 1) to 3.5 cm (day 90). Three radiographic measurements were performed, and all 3 showed significant increases from day 1 to day 90. According to the Student t test, the mean retraction in the subacromial impingement group was significantly higher than that in the rotator cuff tear group on day 1, day 30, and day 90. Body mass index, younger age, sex, and dominant hand did not show any relation with LHBT retraction (P > .05). The mean LHBT retraction was significantly higher on day 90 in patients presenting with a positive Popeye sign (P < .05). CONCLUSION At 3 months of follow-up, the mean LHBT retraction was 3.5 cm from the glenoid and 2.5 cm from the greater tuberosity. It dynamically increased from day 1 to day 90. The LHBT will retract and sit beyond the transverse humeral ligament in the bicipital groove. The LHBT retracts significantly more when early mobilization of the shoulder is allowed.
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Affiliation(s)
- Abdo El Helou
- Department of Orthopedic Surgery, Hotel-Dieu de France, Beirut, Lebanon.
| | - Amer Sebaaly
- Department of Orthopedic Surgery, Hotel-Dieu de France, Beirut, Lebanon; Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joe El Rassi
- Department of Orthopedic Surgery, Hotel-Dieu de France, Beirut, Lebanon
| | - Betty Taslakian
- Department of Orthopedic Surgery, Hotel-Dieu de France, Beirut, Lebanon
| | - Ismat Ghanem
- Department of Orthopedic Surgery, Hotel-Dieu de France, Beirut, Lebanon; Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Rami El Abyad
- Department of Orthopedic Surgery, Hotel-Dieu de France, Beirut, Lebanon; Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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32
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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.
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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
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Gutierrez-Sainz L, Viñal D, Villamayor J, Martinez-Perez D, Garcia-Cuesta JA, Ghanem I, Custodio A, Feliu J. Prognostic factors in advanced pancreatic ductal adenocarcinoma patients-receiving second-line treatment: a single institution experience. Clin Transl Oncol 2021; 23:1838-1846. [PMID: 33866520 DOI: 10.1007/s12094-021-02589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Second-line (2L) treatments for advanced pancreatic ductal adenocarcinoma (PDAC) achieve a modest benefit at the expense of potential toxicity. In the absence of predictive factors of response, the identification of prognostic factors could help in the therapeutic decisions-making. The purpose of this study was to assess the prognostic factors associated with shorter survival in patients with advanced PDAC who received 2L treatment. METHODS We conducted a single institution retrospective study, which included all patients with advanced PDAC who received 2L treatment between September 2006 and February 2020 at La Paz University Hospital, Madrid (Spain). Significant variables in the logistic regression model were used to create a prognostic score. RESULTS We included 108 patients. The median overall survival (OS) was 5.10 months (95%CI 4.02-6.17). In the multivariate analysis, time to progression (TTP) shorter than 4 months after first-line treatment (OR 4.53 [95%CI 1.28-16.00] p = 0.01), neutrophil-to-lymphocyte ratio (NLR) greater than 3 at the beginning of 2L (OR 9.07 [95%CI 1.82-45.16] p = 0.01) and CA-19.9 level higher than the upper limit of normal at the beginning of 2L (OR 7.83 [95%CI 1.30-49.97] p = 0.02) were independently associated with OS shorter than 3 months. The prognostic score classified patients into three prognostic groups (good, intermediate and poor) with significant differences in OS (p < 0.001). CONCLUSIONS TTP shorter than 4 months after first-line treatment, NLR greater than 3 and CA-19.9 level higher than the upper limit of normal at the beginning of 2L were associated with shorter overall survival. We developed a prognostic score that classifies patients with advanced PDAC into three prognostic groups after progression to the first-line. This score could help in the decision-making for 2L treatment.
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Affiliation(s)
- L Gutierrez-Sainz
- Medical Oncology Department, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - D Viñal
- Medical Oncology Department, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - J Villamayor
- Medical Oncology Department, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - D Martinez-Perez
- Medical Oncology Department, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - J A Garcia-Cuesta
- Medical Oncology Department, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - I Ghanem
- Medical Oncology Department, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - A Custodio
- Medical Oncology Department, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain.,Cátedra UAM-AMGEN, Madrid, Spain.,CIBERONC, Madrid, Spain
| | - J Feliu
- Medical Oncology Department, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain.,Cátedra UAM-AMGEN, Madrid, Spain.,CIBERONC, Madrid, Spain
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34
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Calderon C, Gomez D, Carmona-Bayonas A, Hernandez R, Ghanem I, Gil Raga M, Ostios Garcia L, Garcia Carrasco M, Lopez de Ceballos MH, Ferreira E, Jimenez-Fonseca P. Social support, coping strategies and sociodemographic factors in women with breast cancer. Clin Transl Oncol 2021; 23:1955-1960. [PMID: 33840046 DOI: 10.1007/s12094-021-02592-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/08/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The aim of this study was to analyze the associations between perceived social support and sociodemographic variables on coping strategies. METHODS A prospective, cross-sectional, multicenter study was conducted in 404 women with resected, non-metastatic breast cancer. Participants completed questionnaires: perceived social support (MSPSS), coping strategies (Mini-MAC), and psychological distress (BSI-18). RESULTS Sociodemographic factors as age, education, and partnership status were associated with coping strategies. As for maladaptive strategies, hopelessness was more frequent in older people and lower educational level; fatalism in older and single people, and cognitive avoidance was associated with lower educational level. Suppor t from family, friends, and partners was associated with a greater fighting spirit. In contrast, high psychological distress (anxiety and depression) was associated with greater use of maladaptive strategies. CONCLUSION Young people, a high level of education, having a partner, low psychological distress, and seeking social support were associated with the use of adaptive cancer coping strategies.
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Affiliation(s)
- C Calderon
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,University of Pais Vasco, Pais Vasco, Spain
| | - D Gomez
- University of Pais Vasco, Pais Vasco, Spain.,Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - A Carmona-Bayonas
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, UMU, IMI, Murcia, Spain
| | - R Hernandez
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | - I Ghanem
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - M Gil Raga
- Department of Medical Oncology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - L Ostios Garcia
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - M Garcia Carrasco
- Department of Medical Oncology, Hospital Quirónsalud Sagrado Corazón, Sevilla, Spain
| | - M H Lopez de Ceballos
- Department of Medical Oncology, Hospital San Pedro de Alcántara de Cáceres, Cáceres, Spain
| | - E Ferreira
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,University of Pais Vasco, Pais Vasco, Spain
| | - P Jimenez-Fonseca
- University of Pais Vasco, Pais Vasco, Spain. .,Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain.
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Jabbour H, Abou Haidar M, Jabbour K, Abi Lutfallah A, Abou Zeid H, Ghanem I, Naccache N, Ayoub E. Effect of prone position without volume expansion on pulse pressure variation in spinal surgery : a prospective observational study. Acta Anaest Belg 2021. [DOI: 10.56126/72.1.3] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background : Pulse pressure variation (PPV) is a predictor of fluid responsiveness in supine patients under mechanical ventilation. Its use has also been validated in the prone position. The aim of this study was to assess changes in PPV induced by prone position in patients undergoing spinal surgery.
Methods : Ninety-six patients aged 12 to 75 years, scheduled for elective spinal surgery were included. Patients were excluded if they had clinical signs related to any organ failure, or if they required vasoactive drugs and/or volume expansion during the early stages of anesthesia. Patients received a standardized anesthesia protocol. Fluid expansion was not allowed from induction until 10 minutes after positioning. Hemodynamic measurements recorded before the induction of anesthesia (T0) included : arterial pressure (systolic (SAP) diastolic (DAP) and mean (MAP)) and heart rate (HR). Radial artery was cannulated after intubation and measurements, as well as PPV, were noted in supine position (T1). Patients were then placed in prone position hemodynamics and PPV measurements were repeated (T2).
Results : Forty-eight patients completed the study. Anesthesia induction induced a significant decrease in SAP, DAP, and MAP with no effect on HR. Prone position did not induce any significant changes in SAP, MAP, DAP, and HR. A significant difference was found between PPV values in supine (Mean=10.5, SD=4.5) and prone positions (Mean=15.2, SD=7.1) ; t=-4.15 (p<0.001). The mean increase in PPV was 4.7%.
Conclusion : Prone position without prior volume expansion induces a significant increase in PPV prior to any modification in arterial blood pressure and heart rate.
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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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Mjaess G, Karam A, Labaki C, Karam M, Bakouny Z, Ghanimeh J, Saliby RM, Bizdikian AJ, Ghanem I, Assi A. What is the most reliable radiographic method to evaluate the longitudinal foot arch? Application in subjects with Adolescent Idiopathic Scoliosis. Orthop Traumatol Surg Res 2020; 106:1263-1268. [PMID: 32035816 DOI: 10.1016/j.otsr.2019.11.024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/05/2019] [Accepted: 11/19/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The foot arch is known to be altered in subjects with postural malalignment. Foot arch morphology can be studied simultaneously with body's balance by measuring foot radiographic parameters on full-body biplanar x-rays. There is no consensus on which is the most reliable method to use to draw the foot axes. The aim was to determine the most reliable methods to draw the main foot axes and apply these findings in order to study the difference of foot parameters between AIS and control subjects. HYPOTHESES (1) distant and clear anatomical landmarks are needed to draw the foot axes accurately; (2) foot longitudinal arch parameters differ between AIS and controls. METHODS Ninety AIS patients and 36 controls have undergone full body biplanar X-rays from which 3D spino-pelvic and postural parameters were collected for each patient. Six radiological foot angles were evaluated on the 2D lateral radiographs: calcaneal pitch (CPA), talar declination (TDA), first metatarsal declination (FMDA), talo-calcaneal (TCA), calcaneal first metatarsal (CFMA) and Meary. Angles were calculated based on three major axes of the foot: talar, calcaneal, and first metatarsal. Two to three methods were used to draw each axis and the reliability of each method was assessed (three operators, 2-times each). Then, differences of the foot parameters between AIS and controls, and determinants of these differences among 3D spino-pelvic and postural parameters were evaluated. RESULTS The most reliable methods for drawing the three axes of the foot were those using distant and clear anatomical landmarks on talus, calcaneum and first metatarsal and used for the subsequent analysis. The AIS group showed a significantly lower TDA (22° vs. 24°, p=0.014) and CFMA (141° vs. 144°, p=0.045), and higher FMDA (18° vs. 15°, p=0.008) and Meary's angle (-5° vs. -9°, p=0.005) when compared to controls. Differences were found to be determined mainly by the center of auditory meatus sagittal plumbline. DISCUSSION This is the first study to evaluate the most reliable method to draw foot axes on the lateral radiograph of biplanar X-rays in order to assess radiological foot arch parameters. AIS patients were shown to have more elevated foot arch compared to controls.
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Affiliation(s)
- Georges Mjaess
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Aya Karam
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Chris Labaki
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Mohammad Karam
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Ziad Bakouny
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Joe Ghanimeh
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | | | | | - Ismat Ghanem
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Ayman Assi
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon.
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Moussa MK, Bou Raad R, Ghanem I, Mansour O. Complete Extrusion of Talar Body Associated With Ipsilateral Floating Knee. Cureus 2020; 12:e10346. [PMID: 33062470 PMCID: PMC7549865 DOI: 10.7759/cureus.10346] [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] [Indexed: 11/08/2022] Open
Abstract
Talar injuries represent serious medico-surgical conditions because of the involvement of the talus in multiple articulations, such as the subtalar, the transverse talar, and the ankle joint complex. Its complete detachment from the surrounding ligaments and bone is known as talar extrusion, a very rare injury with a complicated treatment course. We report a case of a 43-year-old female patient presenting with a non-retrieved complete left talar body extrusion associated with a floating knee, manifested by left tibial shaft fracture and left supracondylar femoral fracture. The patient was treated with open reduction and internal fixation for the floating knee and a manually shaped talar cement spacer with staged tibiocalcaneal arthrodesis for the ankle. The patient was monitored over a six-year period. This case is reported for the extreme rarity of lost open talar body extrusion, and its problematic treatment in the absence of clear guidelines, especially with the presence of multiple concomitant ipsilateral fractures of the limb, such as floating knee, as in this case.
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Affiliation(s)
- Mohamad K Moussa
- Orthopedic Surgery, Lebanese University Faculty of Medical Sciences, Beirut, LBN
| | - Ryan Bou Raad
- Orthopedic Surgery, Lebanese University Faculty of Medical Sciences, Beirut, LBN
| | - Ismat Ghanem
- Pediatric Orthopedic Surgery, Hôtel Dieu de France Hospital, Beirut, LBN
| | - Oussama Mansour
- Orthopedics and Traumatology, Al-Zahraa Hospital University Medical Center, Beirut, LBN
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Karam M, Bizdikian AJ, Khalil N, Bakouny Z, Obeid I, Ghanimeh J, Labaki C, Mjaess G, Karam A, Skalli W, Kharrat K, Ghanem I, Assi A. Alterations of 3D acetabular and lower limb parameters in adolescent idiopathic scoliosis. Eur Spine J 2020; 29:2010-2017. [PMID: 32246232 DOI: 10.1007/s00586-020-06397-5] [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] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/11/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the 3D deformity of the acetabula and lower limbs in subjects with adolescent idiopathic scoliosis (AIS) and their relationship with spino-pelvic alignment. METHODS Two hundred and seventy-four subjects with AIS (frontal Cobb: 33.5° ± 18° [10°-110°]) and 84 controls were enrolled. All subjects underwent full-body biplanar X-rays with subsequent 3D reconstructions. Classic spino-pelvic and lower limb parameters were collected as well as acetabular parameters: acetabular orientation in the 3 planes (tilt, anteversion and abduction), center-edge angle (CEA) and anterior and posterior sector angles. Subjects with AIS were represented by both lower limb sides and classified by elevated (ES) or lowered (LS), depending on the frontal pelvic obliquity. Parameters were then compared between groups. Determinants of acetabular and lower limb alterations were investigated among spino-pelvic parameters. RESULTS Acetabular abduction was higher on the ES in AIS (59.2° ± 6°) when compared to both LS (55.6° ± 6°) and controls (57.5° ± 3.9°, p < 0.001). CEA and acetabular anteversion were higher on the LS in AIS (32° ± 6.1°, 20.5° ± 5.7°) when compared to both ES (28.7° ± 5.1°, 19.8° ± 5.1°) and controls (29.8° ± 4.8°, 19.1° ± 4°, respectively, p < 0.001). Anterior sector angle was lower on both ES and LS in AIS when compared to controls. CEA, acetabular abduction and acetabular anteversion were found to be mostly determined (adjusted R2: 0.08-0.32) by pelvic tilt and less by frontal pelvic obliquity, frontal Cobb and T1T12. CONCLUSIONS Subjects with AIS had a more abducted acetabulum at the lowered side, more anteverted acetabulum and a lack of anterior coverage of both acetabula. These alterations were strongly related to pelvic tilt.
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Affiliation(s)
- Mohammad Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Aren Joe Bizdikian
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Nour Khalil
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Ziad Bakouny
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | | | - Joe Ghanimeh
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Chris Labaki
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Georges Mjaess
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Aya Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Khalil Kharrat
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon.
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
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Mekhael M, Labaki C, Bizdikian AJ, Bakouny Z, Otayek J, Yared F, Massaad A, Skalli W, Ghanem I, Assi A. How do skeletal and postural parameters contribute to maintain balance during walking? Hum Mov Sci 2020; 72:102658. [DOI: 10.1016/j.humov.2020.102658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
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Borja IG, Irigoyen JF, Goñi S, Ghanem I, Amat I, Arrazubi V, Sanz JP, Hernandez-Garcia I, Vera R, Feliu J, Viudez A. P-252 Serial cytokines as potential predictive/prognosis biomarkers in potentially resectable pancreatic adenocarcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.334] [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] [Indexed: 10/23/2022] Open
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Abstract
Idiopathic scoliosis is a disease of the growing spine. Risk of progression and aggravation of disease are mainly dictated by the remaining growth and curve magnitude. Remaining growth can be estimated by repeated biometric measurements, tanner sign and bone age estimation. Puberty is the turning point in the natural history of this disease. The first two years following puberty are the turning point in the natural history of this disease since 90% of growth occurs during this period. Lateral olecranon radiograph is effective for estimating bone age during this phase. Growth acceleration is followed by a deceleration phase of three years where menarche occurs. Bone age during this phase is evaluated by hand X-rays and the Risser sign. Progression risk assessment of idiopathic scoliosis showed that a 30° curve at the beginning of puberty together with 20° to 30° curves with more than 10° of annual curve progression has a 100% risk of progression towards the 45° surgical threshold. In these patients, anticipation may be the key for effective treatment strategy. Treating these curves earlier than the surgical threshold before increased stiffness would lead to a better outcome.
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Affiliation(s)
- Ismat Ghanem
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.,Department of Orthopedic Surgery, Hôtel-Dieu de France University Hospital, Saint-Joseph University, Beirut, Lebanon
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Maestroni BM, Skerritt JH, Ferris IG, Ambrus A, Amin R, Bajet N, Dagher S, Genhai Y, Ghanem I, Guo J, Hock B, Jebakumar SRD, Maestroni B, Maqbool U, Matthews W, Merino R, Montoya A, Mukherjee PK, Prapamontol T, Skerritt J, Stanker L, Takyi E, Yücel Ü. Analysis of DDT Residues in Soil by ELISA: An International Interlaboratory Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/84.1.134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
An international interlaboratory study was conducted to determine the performance of a group of laboratories from developing and developed countries. The study used a commercial microwell ELISA on unknown samples spiked with different levels of DDT. The study design was based on Youden pairs and balanced replicates. Two soils, differing in particle size distributions, organic matter content, and cation-exchange capacities and thought to be DDT-free, were spiked at 5 DDT levels between 0.025 and 2 mg/kg. Nineteen laboratories in 17 countries took part in the collaborative trial; of these, the majority were modestly equipped laboratories in developing countries. Samples were analyzed without filtration or cleanup and using standards of pure DDT in methanol. Data were analyzed for repeatability and reproducibility, and average recoveries at the spike levels were calculated. Mean real recoveries for both soils were similar (103% for soil A and 100% for soil B), with values between 0.1 and 2 mg/kg DDT. Precision estimates were best in the linear working range of the assay (0.1–0.5 mg/kg DDT), with reproducibility relative standard deviations (RSDR) typically averaging about 38 and 46% near the upper and lower detection limits, respectively. Corresponding repeatability relative standard deviation (RSDr) values were 20–36% and 36–57%. Thus, even though much of the trial was performed under developing country conditions, performance statistics were similar to other reported results obtained with ELISAs on small molecules of agricultural importance, such as mycotoxins and pesticide and antibiotic residues.
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Affiliation(s)
- Britt M Maestroni
- Food and Agriculture Organization of the United Nations/International Atomic Energy Agency, Training and Reference Center for Food and Pesticide Control, Agriculture and Biotechnology Laboratory, A-2444 Seiberdorf, Austria
| | - John H Skerritt
- Australian Centre for International Agricultural Research, GPO Box 1571, Canberra ACT 2601, Australia
| | - Ian G Ferris
- Food and Agriculture Organization of the United Nations/International Atomic Energy Agency, Agriculture and Biotechnology Laboratory, A-2444 Seiberdorf, Austria
| | - Arpad Ambrus
- Food and Agriculture Organization of the United Nations/International Atomic Energy Agency, Agriculture and Biotechnology Laboratory, A-2444 Seiberdorf, Austria
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Labaki C, Otayek J, Massaad A, Bakouny Z, Karam M, Hanna C, Kassab A, Bizdikian AJ, Mjaess G, Karam A, Skalli W, Ghanem I, Assi A. Is the apical vertebra the most rotated vertebra in the scoliotic curve? J Neurosurg Spine 2019; 31:1-7. [PMID: 31443082 DOI: 10.3171/2019.6.spine19203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/19/2019] [Accepted: 06/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to determine if the apical vertebra (AV) in patients with adolescent idiopathic scoliosis (AIS) is the most rotated vertebra in the scoliotic segment. METHODS A total of 158 patients with AIS (Cobb angle range 20°-101°) underwent biplanar radiography with 3D reconstructions of the spine and calculation of vertebral axial rotations. The type of major curvature was recorded (thoracic, thoracolumbar, or lumbar), and both major and minor curvatures were included. The difference of levels (DL) between the level of maximal vertebral rotation (LMVR) and the AV was calculated as follows: DL = 0 if LMVR and AV were the same, DL = 1 if LMVR was directly above or below the AV, and DL = 2 if LMVR was separated by 1 vertebra or more from the AV. To investigate which factors explained the divergence of the LMVR from the AV, multinomial models were computed. RESULTS The distribution of the DL was as follows: for major curvatures, 143 were DL = 0, 11 were DL = 1, and 4 were DL = 2; and for minor curvatures, 53 were DL = 0, 9 were DL = 1, and 31 were DL = 2. The determinants of a DL = 2 (compared with DL = 0) were lumbar curvature (compared with thoracic; adjusted OR 0.094, p = 0.001), major curvature (compared with minor; adjusted OR 0.116, p = 0.001), and curvatures with increasing apical vertebral rotation (adjusted OR 0.788, p < 0.001). CONCLUSIONS This study showed that the AV is the most rotated vertebra in the majority of major curvatures, while in minor curvatures, the most rotated vertebra appears to be the junctional vertebra between major and minor curvatures in a significant proportion of cases.
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Affiliation(s)
- Chris Labaki
- 1Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; and
| | - Joeffroy Otayek
- 1Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; and
| | - Abir Massaad
- 1Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; and
| | - Ziad Bakouny
- 1Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; and
| | - Mohammad Karam
- 1Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; and
| | - Cyril Hanna
- 1Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; and
| | - Anthony Kassab
- 1Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; and
| | | | - Georges Mjaess
- 1Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; and
| | - Aya Karam
- 1Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; and
| | - Wafa Skalli
- 2Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Ismat Ghanem
- 1Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; and
| | - Ayman Assi
- 1Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; and
- 2Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
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Bakouny Z, Khalil N, Otayek J, Bizdikian AJ, Yared F, Salameh M, Bou Zeid N, Ghanem I, Kharrat K, Kreichati G, Lafage R, Lafage V, Assi A. Are the sagittal cervical radiographic modifiers of the Ames-ISSG classification specific to adult cervical deformity? J Neurosurg Spine 2019; 29:483-490. [PMID: 30052148 DOI: 10.3171/2018.2.spine171285] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/21/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe Ames-International Spine Study Group (ISSG) classification has recently been proposed as a tool for adult cervical deformity evaluation. This classification includes three radiographic cervical sagittal modifiers that have not been evaluated in asymptomatic adults. The aim of this study was to determine whether the sagittal radiographic modifiers described in the Ames-ISSG cervical classification are encountered in asymptomatic adults without alteration of health-related quality of life (HRQOL).METHODSThe authors conducted a cross-sectional study of subjects with an age ≥ 18 years and no cervical or back-related complaints or history of orthopedic surgery. All subjects underwent full-body biplanar radiographs with the measurement of cervical, segmental, and global alignment and completed the SF-36 HRQOL questionnaire. Subjects were classified according to the sagittal radiographic modifiers (chin-brow vertical angle [CBVA], mismatch between T1 slope and cervical lordosis [TS-CL], and C2-7 sagittal vertical axis [cSVA]) of the Ames-ISSG classification for cervical deformity, which also includes a qualitative descriptor of cervical deformity, the modified Japanese Orthopaedic Association (mJOA) myelopathy score, and the Scoliosis Research Society (SRS)-Schwab classification for spinal deformity assessment. Characteristics of the subjects classified by the different modifier grades were compared.RESULTSOne hundred forty-one asymptomatic subjects (ages 18-59 years, 71 females) were enrolled in the study. Twenty-seven (19.1%) and 61 (43.3%) subjects were classified as grade 1 in terms of the TS-CL and CBVA modifiers, respectively. Ninety-eight (69.5%) and 4 (2.8%) were grade 2 for these same respective modifiers. One hundred thirty-six (96.5%) subjects had at least one modifier at grade 1 or 2. There was a significant relationship between patient age and grades of TS-CL (p < 0.001, Cramer's V [CV] = 0.32) and CBVA (p = 0.04, CV = 0.22) modifiers. The HRQOL, global alignment, and segmental alignment parameters were similar among the subjects with different modifier grades (p > 0.05).CONCLUSIONSThe CBVA and TS-CL radiographic modifiers of the Ames-ISSG classification do not seem to be specific to subjects with cervical deformities and can occur in asymptomatic subjects without alteration in HRQOL.
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Affiliation(s)
| | | | | | | | | | | | | | - Ismat Ghanem
- 1Faculty of Medicine and.,2Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon; and
| | - Khalil Kharrat
- 1Faculty of Medicine and.,2Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon; and
| | - Gaby Kreichati
- 1Faculty of Medicine and.,2Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon; and
| | - Renaud Lafage
- 3Spine Division, Hospital for Special Surgery, New York, New York
| | - Virginie Lafage
- 3Spine Division, Hospital for Special Surgery, New York, New York
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Ghanem I, Trilla L, Gámez A, Mendiola M, Maurel J, Campos-Barros À, Peña C, Cuatrecasas M, G-Pastrián L, García Alfonso P, Feliu J, Fresno J. Whole-exome sequencing of non-metastatic anal squamous cell carcinoma: a prognostic genetic variants analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.162] [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] [Indexed: 11/14/2022] Open
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Trilla L, Ghanem I, Gámez A, Maurel J, Campos-Barros À, G-Pastrián L, Mendiola M, Peña C, Cuatrecasas M, García Alfonso P, Fresno J, Feliu J. Mutational profile of non-metastatic anal squamous cell carcinoma: a restrictive high impact genetic variants analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.010] [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] [Indexed: 11/13/2022] Open
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Melhem E, Bayoud W, Ghanem I. Bone healing is achievable despite extensive wound dehiscence and wide plate and screws exposure in children. Orthop Traumatol Surg Res 2019; 105:757-760. [PMID: 28336328 DOI: 10.1016/j.otsr.2017.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/24/2016] [Accepted: 01/06/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Extensive wound dehiscence and wide plate and screw exposure in the early weeks following orthopaedic surgery in children is usually managed either by extensive debridement, lavage and secondary closure or hardware removal and external fixation. PATIENTS Three children with LCP plate and screws exposure were managed by simple repetitive debridement and local wound care without any IV antibiotics, nor secondary closure or hardware removal. All three cases occurred in the tibia, one following tibial osteotomy in lateral hemimelia with a long history of previous surgeries, one following wide excision of a tibial Ewing sarcoma with chemo- and radiotherapy, and the third following wide excision of a 12cm necrotic tibial segment due to chronic osteomyelitis. Bone healing was uneventful in 2 cases and was in progress in the case with the Ewing sarcoma. Plate and screws were removed in all cases, following an obvious bone healing in 2 cases, and forced by the need for chemotherapy due to the presence of lung metastases in the third case. Spontaneous soft tissue healing occurred thereafter. CONCLUSION A stable fixation may lead to a good bone healing despite an extensive wound dehiscence and a wide plate and screws exposure with just a proper local wound care and without any major additional surgery. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- E Melhem
- Department of Orthopaedic Surgery, Hotel-Dieu de France Hospital, Saint Joseph University, 166830 Beirut, Lebanon.
| | - W Bayoud
- Department of Orthopaedic Surgery, Hotel-Dieu de France Hospital, Saint Joseph University, 166830 Beirut, Lebanon
| | - I Ghanem
- Department of Orthopaedic Surgery, Hotel-Dieu de France Hospital, Saint Joseph University, 166830 Beirut, Lebanon
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Ghanem I, Massaad A, Assi A, Rizkallah M, Bizdikian AJ, El Abiad R, Seringe R, Mosca V, Wicart P. Understanding the foot's functional anatomy in physiological and pathological conditions: the calcaneopedal unit concept. J Child Orthop 2019; 13:134-146. [PMID: 30996737 PMCID: PMC6442506 DOI: 10.1302/1863-2548.13.180022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A thorough review of the available orthopaedic literature shows significant controversies, inconsistencies and sparse data regarding the terminology used to describe foot deformities. This lack of consensus on terminology creates confusion in professional discussions of foot anatomy, pathoanatomy and treatment of deformities. The controversies apply to joint movements as well as static relationships between the bones. DESCRIPTION The calcaneopedal unit (CPU) is a specific anatomical and physiological entity, represented by the entire foot excepted the talus. The calcaneus, midfoot and forefoot are solidly bound by three strong ligaments that create a unit that articulates with the talus. The movement of the CPU is complex, as it rotates under the talus, around the axis of Henke that coincides with the talo-calcaneal ligament of Farabeuf.This calcaneopedal unit is deformable. It is compared with a twisted plate, able to adapt to many physiological situations in standing position, in order to acheive a plantigrade position.Moreover, the calcaneopedal unit and the talo-tibiofibular complex are interdependent; rotation of the latter produces morphologic modifications inside the former and vice versa. PURPOSE This paper is a review article of this concept and of its physiopathological applications.
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Affiliation(s)
- I. Ghanem
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon,Orthopedic Surgery Department, Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon, Correspondence should be sent to I. Ghanem, MD, Hôtel-Dieu de France Hospital, A. Naccache Avenue- Achrafieh, University of Saint-Joseph, Beirut, Lebanon. E-mail:
| | - A. Massaad
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - A. Assi
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - M. Rizkallah
- Orthopedic Surgery Department, Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon
| | - A. J. Bizdikian
- Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - R. El Abiad
- Orthopedic Surgery Department, Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon
| | - R. Seringe
- Orthopedic Surgery Department, Cochin University Hospital – University of Rene Descartes, Paris, France
| | - V. Mosca
- Department of Orthopedic Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - P. Wicart
- Orthopedic Surgery Department, Hôpital Necker-Enfants Malades, University of Paris Descartes, Paris, France
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Abstract
PURPOSE This study evaluates intraoperative disappearance of motor waveforms related to patient positioning in neurologically asymptomatic patients with spinal deformity. METHODS This is a retrospective review of 190 neurologically asymptomatic patients aged seven to 17 years planned for posterior instrumentation under neuromonitoring. There were 159 patients with adolescent idiopathic scoliosis and 31 patients with secondary scoliosis. Patients underwent surgery with transcranial electric stimulation motor evoked potentials (TES-MEPs). In case of abnormal findings, surgery was temporarily discontinued and necessary measures undertaken. In case of permanent signal disappearance surgery was definitively discontinued. RESULTS Six patients showed permanent loss of signal during early stages of surgery. These patients had a mean major curve of 64° Cobb angle and a mean thoracic kyphosis (D2 to D12) of 72°. The 184 remaining patients had a mean major curve of 50° Cobb angle and a thoracic kyphosis of 35°. A retrospective descriptive review of the patients' radiographs shows hyperkyphosis to be the common ground between the six secondary scoliosis cases. Gradual preoperative traction maintained during the surgery applied in two of these patients taken back to surgery six months later was associated with maintenance of TES-MEP signals throughout the surgery. CONCLUSION This study shows that positional permanent loss of neuromonitoring signals is more likely to occur in patients with secondary scoliosis and hyperkyphosis shown to have sharper spine deformity and suspected to have a more vulnerable spinal cord. Gradual skeletal traction performed in two of these patients and maintained during surgery showed promising results. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- M. Rizkallah
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon,Department of Orthopedic Surgery, Hôtel-Dieu de France University Hospital, Saint-Joseph University, Beirut, Lebanon, Correspondence should be sent to Maroun Rizkallah, M.D., Faculty of Medicine, Saint-Joseph University and Department of Orthopedic Surgery, Hôtel-Dieu de France University Hospital, Saint-Joseph University, Alfred Naccache Street, Achrafieh, Beirut, Lebanon. E-mail:
| | - R. El Abiad
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon,Department of Orthopedic Surgery, Hôtel-Dieu de France University Hospital, Saint-Joseph University, Beirut, Lebanon
| | - E. Badr
- Electrophysiology Department, Hôtel-Dieu de France University Hospital, Saint-Joseph University, Beirut, Lebanon
| | - I. Ghanem
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon,Department of Orthopedic Surgery, Hôtel-Dieu de France University Hospital, Saint-Joseph University, Beirut, Lebanon
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