1
|
Langlais T, Skalli W, du Cluzel X, Mainard N, George S, Gajny L, Vialle R, Dubousset J, Vergari C. Spinal axial torque assessment after surgical correction in adolescent idiopathic scoliosis: a new approach to 3D barycentremetry and mass distribution based on biplanar radiographs. Spine Deform 2024; 12:689-697. [PMID: 38347377 DOI: 10.1007/s43390-023-00816-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/23/2023] [Indexed: 05/04/2024]
Abstract
PURPOSE Barycentremetry in adolescent idiopathic scoliosis (AIS) allows the distribution of masses and their loading of the spine to be studied. In particular, the axial torque on the spine has been studied in AIS, but not after surgical correction. Spinal axial torque was studied in AIS before and after surgery. METHODS All AIS (Lenke 1 and 3) who underwent posterior spinal fusion surgery at our center in 2019 were included retrospectively. AIS underwent frontal and sagittal biplanar radiographs in the free-standing position before surgery, 4 months after surgery, and at the last follow-up. Their spine and external envelope were reconstructed with validated methods. Spinal axial torque at the apex and the upper and lower end vertebra was calculated. Finally, the preoperative and postoperative values were compared to a previously published reference corridor for asymptomatic subjects. RESULTS Twenty-nine patients were included (54 ± 11° Cobb angle, 15 ± 2 years old at surgery). The surgical procedure decreased the Cobb angle by 36° ± 11° and decreased the spinal axial torque at the upper end vertebra by 2.5 N/m (95% CI = [1.9; 3]; p < 0.001), at the apex by 0.6 N/m (95% CI = [0.4; 1]; p = 0.004), at the lower end vertebra by 2 N/m (95% CI = [1.5; 2.8]; p < 0.001). Compared to 95th percentile of torque, which was previously evaluated in asymptomatic subjects, more than 90% of patients had higher values at the upper and lower end vertebrae before surgery. Postoperatively, 62% of patients still had higher torque at the upper end vertebra than asymptomatic subjects, while only 38% patients showed abnormal values at the lower junction. CONCLUSION Results of this study confirm that AIS patients show abnormally high spinal axial torque, especially at the end vertebrae, and that this parameter is normalized postoperatively for only a small number of patients.
Collapse
Affiliation(s)
- Tristan Langlais
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France.
- Service Orthopédie et Traumatologie, Hôpital des Enfants, CHU Purpan, Toulouse Université, Toulouse, France.
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| | - Xavier du Cluzel
- Service Orthopédie et Traumatologie, CHU Necker Enfants Malades, Paris Cité Université, APHP, Paris, France
| | - Nicolas Mainard
- Service Orthopédie et Traumatologie, CHU Armand Trousseau, APHP, Sorbonne Université, Paris, France
| | - Samuel George
- Service Orthopédie et Traumatologie, CHU Necker Enfants Malades, Paris Cité Université, APHP, Paris, France
| | - Laurent Gajny
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| | - Raphael Vialle
- Service Orthopédie et Traumatologie, CHU Armand Trousseau, APHP, Sorbonne Université, Paris, France
| | - Jean Dubousset
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| |
Collapse
|
2
|
Langlais T, Vergari C, Rougereau G, Gaume M, Gajny L, Abelin-Genevois K, Bernard JC, Hu Z, Cheng JCY, Chu WCW, Assi A, Karam M, Ghanem I, Bassani T, Galbusera F, Sconfienza LM, Brayda-Bruno M, Courtois I, Ebermeyer E, Vialle R, Dubousset J, Skalli W. Assessment of malalignment at early stage in adolescent idiopathic scoliosis: a longitudinal cohort study. Eur Spine J 2024; 33:1665-1674. [PMID: 38407613 DOI: 10.1007/s00586-024-08178-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Our objective was to assess abnormalities of the odontoid-hip axis (OD-HA) angle in a mild scoliotic population to determine whether screening for malalignment would help predict the distinction between progressive and stable adolescent idiopathic scoliosis (AIS) at early stage. MATERIALS AND METHODS All patients (non-scoliotic and AIS) underwent a biplanar X-ray between 2013 and 2020. In AIS, inclusion criteria were Cobb angle between 10° and 25°; Risser sign lower than 3; age higher than 10 years; and no previous treatment. A 3D spine reconstruction was performed, and the OD-HA was computed automatically. A reference corridor for OD-HA values in non-scoliotic subjects was calculated as the range [5th-95th percentiles]. A severity index, helping to distinguish stable and progressive AIS, was calculated and weighted according to the OD-HA value. RESULTS Eighty-three non-scoliotic and 205 AIS were included. The mean coronal and sagittal OD-HA angles in the non-scoliotic group were 0.2° and -2.5°, whereas in AIS values were 0.3° and -0.8°, respectively. For coronal and sagittal OD-HA, 27.5% and 26.8% of AIS were outside the reference corridor compared with 10.8% in non-scoliotic (OR = 3.1 and 3). Adding to the severity index a weighting factor based on coronal OD-HA, for thoracic scoliosis, improved the positive predictive value by 9% and the specificity by 13%. CONCLUSION Analysis of OD-HA suggests that AIS patients are almost three times more likely to have malalignment compared with a non-scoliotic population. Furthermore, analysis of coronal OD-HA is promising to help the clinician distinguish between stable and progressive thoracic scoliosis.
Collapse
Affiliation(s)
- Tristan Langlais
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France.
- Service Orthopédie et Traumatologie, Hôpital des Enfants, Purpan, Toulouse Université, Toulouse, France.
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| | - Gregoire Rougereau
- Service Orthopédie et Traumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, APHP, Paris, France
| | - Mathilde Gaume
- Service Orthopédie et Traumatologie, Hôpital Necker Enfants Malades, Paris cité Université, APHP, Paris, France
| | - Laurent Gajny
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| | - Kariman Abelin-Genevois
- Department of Orthopaedic Surgery and Children Conservative Treatment, Croix-Rouge Française. Centre Médico-Chirurgical Et de Réadaptation Des Massues, Lyon, France
| | - Jean Claude Bernard
- Department of Orthopaedic Surgery and Children Conservative Treatment, Croix-Rouge Française. Centre Médico-Chirurgical Et de Réadaptation Des Massues, Lyon, France
| | - Zongshan Hu
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jack Chun Yiu Cheng
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ayman Assi
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Joseph University of Beirut, SaintBeirut, Lebanon
| | - Mohamad Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Joseph University of Beirut, SaintBeirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Joseph University of Beirut, SaintBeirut, Lebanon
- Department of Orthopedic Surgery, Hotel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy
| | | | | | - Eric Ebermeyer
- Unite Rachis, CHU - Hopital Bellevue, Saint-Etienne, France
| | - Raphael Vialle
- Sorbonne Université, Service Orthopédie et Traumatologie, Hôpital A. Trousseau, APHP, Paris, France
| | - Jean Dubousset
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, HESAM Université, Paris, France
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Gaume M, Gerard P, Khouri N, Glorion C, Dubousset J, Miladi L. Long-term outcomes of ilio-sacral screws in minimally invasive bipolar fusionless technique for neuromuscular scoliosis: a retrospective study in 167 patients. Arch Orthop Trauma Surg 2023; 143:1761-1767. [PMID: 35041079 DOI: 10.1007/s00402-021-04332-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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/21/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Pelvic fixation in patients with neuromuscular scoliosis is difficult, due to their fragile general condition and poor bone quality. Many techniques have been described, associated with high rates of mechanical complications. The objective of this work was to evaluate the mechanical complications and long-term radiological results of ilio-sacral screw pelvic fixation. MATERIALS AND METHODS 167 consecutive patients with neuromuscular scoliosis who underwent minimally invasive bipolar fixation with ilio-sacral screw pelvic fixation were retrospectively reviewed. The instrumentation consisted in a bilateral sliding rods construct extended from T1 to the sacrum, anchored proximally by double-hook claws and distally by ilio-sacral screws through a minimally invasive approach. Mechanical complications and radiographic measurements (angle of the major coronal curve, pelvic obliquity, lumbar lordosis) were evaluated preoperatively, postoperatively, and at the last follow-up. RESULTS Mean operative age was 12 ± 3 years, and follow-up 6.4 years (3.0-10.4 years). Pelvic obliquity decreased from 20° preoperatively to 5° (77% correction) at last follow-up, Angle of the major coronal curve from 75° to 36° (52% correction), and lumbar lordosis from 28° to 38°. 16 mechanical complications in nine patients occurred: screw prominence (n = 1), connector failure (n = 4), screw malposition (n = 11). Unplanned surgery was required in seven cases, two were managed during rod lengthening, seven did not require treatment. CONCLUSION In this series of neuromuscular patients operated by ilio-sacral screws as pelvic fixation, the results were stable with a mean follow-up of more than 6 years and the complication rate was reduced comparatively to the literature. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Mathilde Gaume
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France
| | - Pierre Gerard
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France
| | - Nejib Khouri
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France
| | - Christophe Glorion
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France
| | | | - Lotfi Miladi
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France.
| |
Collapse
|
5
|
Gaume M, Gerard P, Khouri N, Glorion C, Dubousset J, Miladi L. Correction to: Long-term outcomes of ilio-sacral screws in minimally invasive bipolar fusionless technique for neuromuscular scoliosis: a retrospective study in 167 patients. Arch Orthop Trauma Surg 2023; 143:1769. [PMID: 35138430 DOI: 10.1007/s00402-022-04379-4] [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] [Indexed: 11/02/2022]
Affiliation(s)
- Mathilde Gaume
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France
| | - Philippe Gerard
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France
| | - Nejib Khouri
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France
| | - Christophe Glorion
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France
| | | | - Lotfi Miladi
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France.
| |
Collapse
|
6
|
Hasegawa K, Hatsushikano S, Watanabe K, Ohashi M, Dubousset J. Scoliosis Research Society-22r score is affected by standing whole body sagittal alignment, age, and sex, but not by standing balance or skeletal muscle mass in healthy volunteers. Eur Spine J 2022; 31:3000-3012. [PMID: 36053322 DOI: 10.1007/s00586-022-07360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 08/01/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Aging and spinal disease impair standing whole body sagittal alignment (WBS alignment), which leads to stooping. When WBS alignment deteriorates, compensatory mechanisms are activated to maintain standing posture. Increase of the compensation impairs health-related quality of life (HRQOL). The purpose of this research was to determine whether postural factors, age, and sex affect HRQOL. METHODS This cross-sectional study evaluated the influence of WBS alignment, standing body sway (balance), skeletal muscle mass (SMM), aging, and sex on HRQOL in healthy volunteers (n = 150; mean age 40.9 years [20-76], 96 women). Age, sex, weight, height, and body mass index (BMI) were obtained. HRQOL was assessed with Scoliosis Research Society-22 (SRS-22r). WBS alignment and balance were measured by EOS imaging with simultaneous force plate measurement. SMM was measured using a medical body composition analyzer. Based on the bivariate analysis between the SRS-22r subtotal and all parameters, selected ten parameters were used for multivariate logistic regression analysis to identify affecting factors to SRS-22r. RESULTS Men had significantly higher weight, height, BMI, and SRS-22r score in all domains. The L4-S1 lumbar lordosis angle was greater in men, and pelvic tilt and knee hyperextension were greater in women. Women had a more stable standing posture, whereas men had significantly higher SMM values. Multivariate logistic regression analysis revealed that age, sex, and TPA were identified as significant factors affecting SRS-22r. CONCLUSIONS In healthy volunteers, SRS-22r is affected by aging, sex (woman had a lower score), and sagittal malalignment. Neither Standing balance nor SMM, however, affect SRS-22r.4.
Collapse
Affiliation(s)
- Kazuhiro Hasegawa
- Niigata Spine Surgery Center, 2-5-22 Nishi-machi, Niigata City, 950-0165, Japan.
| | - Shun Hatsushikano
- Niigata Spine Surgery Center, 2-5-22 Nishi-machi, Niigata City, 950-0165, Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Masayuki Ohashi
- Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Jean Dubousset
- Académie Nationale de Médecine, 16 Rue Bonaparte, 75006, Paris, France
| |
Collapse
|
7
|
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]
|
8
|
Hasegawa K, Amabile C, Nesme M, Dubousset J. Gravity center estimation for evaluation of standing whole body compensation using virtual barycentremetry based on biplanar slot-scanning stereoradiography - validation by simultaneous force plate measurement. BMC Musculoskelet Disord 2022; 23:22. [PMID: 34980054 PMCID: PMC8725375 DOI: 10.1186/s12891-021-04948-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/08/2021] [Indexed: 02/08/2023] Open
Abstract
Background Whole body standing alignment (WBSA) in terms of biomechanics can be evaluated accurately only by referring the gravity line (GL) which lies on the gravity center (GC). Here, we introduce a method for estimating GL and simultaneous WBSA measurement using the EOS® imaging system and report on the reproducibility and reliability of the method. Methods A 3-dimensional (3D) avatar to estimate GC was created following three steps: 3D reconstruction of the bone based on EOS images; deformation into a generic morphotype (MakeHuman statistical model) before density integration with 3D rasterization of the full body into 1-mm3 voxels (the content of each voxel is considered homogeneous); computation of the density of all the voxels provides the center of mass, which can be projected onto the floor as the GC of the full body, providing the GL in relation to the WBSA. The repeatability, reproducibility, and accuracy of the estimated GC and body weight of the avatar were compared with clinical estimation using a force plate in healthy volunteers and patients with degenerative and deformative diseases. Results Statistical analyses of the data revealed that the repeatability and reproducibility of the estimation was high with intra-rater and inter-rater intraclass correlation coefficient. ≥0.999. The coordinate values of the GC and body weight estimation did not differ significantly between the avatar and force plate measurements, demonstrating the high accuracy of the method. Conclusion This new method of estimating GC and WBSA is reliable and accurate. Application of this method could allow clinicians to quickly and qualitatively evaluate WBSA with GL with various spinal malalignment pathologies.
Collapse
Affiliation(s)
- Kazuhiro Hasegawa
- Niigata Spine Surgery Center, 2-5-22 Nishi-machi, Niigata City, 950-0165, Japan.
| | | | - Matthieu Nesme
- AnatoScope, Montpellier Headquarter, Cap-Omega Rond-Point Benjamin ranklin, 34960, Montpellier, France
| | - Jean Dubousset
- Académie Nationale de Médecine, 16 Rue Bonaparte, 75006, Paris, France
| |
Collapse
|
9
|
Dubousset J, Diebo BG. Proximal Junctional Kyphosis in Modern Spine Surgery: Why is it so Common? Spine Surg Relat Res 2022; 7:120-128. [PMID: 37041876 PMCID: PMC10083082 DOI: 10.22603/ssrr.2022-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/30/2022] [Indexed: 11/05/2022] Open
Abstract
In the past few decades, proximal junctional kyphosis (PJK) has emerged as a new complication after instrumented spinal fusion in adult and pediatric spinal deformities. This phenomenon has occurred concomitantly with the rise of robust instrumentation techniques and enhancement of our abilities to obtain greater spinal deformity correction. The goal of this paper is to review the mechanical and biological causes of PJK and recommend prevention strategies.
Collapse
Affiliation(s)
| | - Bassel G. Diebo
- Department of Orthopaedic Surgery, State University of New York, Downstate Medical Center
| |
Collapse
|
10
|
Assi A, Karam M, Skalli W, Vergari C, Vialle R, Pietton R, Bizdikian AJ, Kharrat K, Dubousset J, Ghanem I. A Novel Classification of 3D Rib Cage Deformity in Subjects With Adolescent Idiopathic Scoliosis. Clin Spine Surg 2021; 34:331-341. [PMID: 33591022 DOI: 10.1097/bsd.0000000000001139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a multicentric cross-sectional descriptive study. OBJECTIVE To analyze patterns of 3D rib cage deformity in subjects with adolescent idiopathic scoliosis (AIS) and their relationship with the spinal deformity. SUMMARY OF BACKGROUND DATA Subjects with AIS present with rib cage deformity that can affect respiratory functions. The 3D rib cage deformities in AIS and their relationship to the spinal deformity are still unelucidated. METHODS A total of 200 AIS and 71 controls underwent low-dose biplanar x-rays and had their spine and rib cage reconstructed in 3-dimensional (D). Classic spinopelvic parameters were calculated in 3D and: rib cage gibbosity, thickness, width, volume and volumetric spinal penetration index (VSPI). Subjects with AIS were classified as: group I with mild rib cage deformity (n=88), group II with severe rib cage deformity (n=112) subgrouped into IIa (high gibbosity, n=48), IIb (high VSPI, n=48), and IIc (both high gibbosity and VSPI, n=16). RESULTS Groups IIa and IIb had a higher Cobb angle (33 vs. 54 degrees and 46 degrees, respectively) and torsion index (11 vs. 14 degrees and 13 degrees, respectively) than group I. Group IIb showed more severe hypokyphosis (IIb=21 degrees; IIa=33 degrees; I=36 degrees; control=42 degrees) with a reduced rib cage volume (IIb=4731 cm3; IIa=4985 cm3; I=5257 cm3; control=5254 cm3) and thickness (IIb=135 mm; IIa=148 mm; I=144 mm; control=144 mm). Group IIa showed an increasingly large local gibbosity descending from proximal to distal levels and did not follow the axial rotation of the spine. Group IIc showed characteristics of both groups IIa and IIb. CONCLUSIONS This new classification of 3D rib cage deformity in AIS shows that the management of cases with high VSPI (groups IIb and IIc) should focus on restoring as much kyphosis as possible to avoid respiratory repercussions. Treatment indications in groups I and IIa would follow the consensual basic principles reported in the literature regarding bracing and surgery.
Collapse
Affiliation(s)
- Ayman Assi
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech
| | - Mohamad Karam
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech
| | - Raphael Vialle
- Department of Pediatric Orthopedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Raphael Pietton
- Department of Pediatric Orthopedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Aren J Bizdikian
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Khalil Kharrat
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Jean Dubousset
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech
| | - Ismat Ghanem
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| |
Collapse
|
11
|
Dubousset J, Gaume M, Miladi L. Ilio-sacral screw pelvic fixation when correcting spinal deformities with or without pelvic obliquity: our experience over 40 years. Spine Deform 2021; 9:665-670. [PMID: 33403658 DOI: 10.1007/s43390-020-00263-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
Ilio-sacral screw fixation for treatment of spinal deformities with pelvic obliquity was used from more than 40 years in our department of pediatric orthopedics. Despite trying all the other systems published in the literature, the authors came back to iliosacral screw to address the pelvic fixation. Keeping the same anatomical and biomechanical principles, with no damage of the SI joint, they improve the technology over time, to allow an easy use. The fear about the precise insertion necessary to prevent any root irritation is now greatly reduced thanks to the modern navigation. The history of the establishment and the advantages of this technique are explained based on more than 250 cumulative cases with an excellent correction of the pelvic obliquity, without any case of complete pull out of the ilio-sacral screw. A very low rate of nonunion thanks to the 3D adaptation of the balance in erect standing or sitting posture of the patient, thanks to the motion of the intact SI joint, and the small sagittal motion existing in the linkage screw/connector. All this comparing favorably to the other techniques published in the current literature.
Collapse
Affiliation(s)
| | - Mathilde Gaume
- Pediatric Orthopedic Department, Assistance Publique Hôpitaux de Paris, Necker Hospital, Paris Descartes University, 149 rue de Sèvres, 75015, Paris, France
| | - Lotfi Miladi
- Pediatric Orthopedic Department, Assistance Publique Hôpitaux de Paris, Necker Hospital, Paris Descartes University, 149 rue de Sèvres, 75015, Paris, France.
| |
Collapse
|
12
|
Dubousset J. [Deterioration of the spine with aging]. Rev Prat 2021; 71:495-496. [PMID: 34553526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
|
13
|
Dubousset J. [Preventive measures against aging of the spine]. Rev Prat 2021; 71:514-518. [PMID: 34553530] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Mesures préventives du vieillissement de la colonne vertébrale. More than 20% of the general population have a normal ageing spine without any pathologies. Because ageing touch more or less quickly, more or less deeply all of the constitutive tissues of the spine bones, joints as muscle and ligaments, prevention measures will be started relatively early around the 50ths and turned toward physical as well as neurosensory exercises in conjunction with cognitive development. If pain, walking difficulties or deformity appears it is necessary to obtain the opinion of a geriatric specialized team including neurologist, nutritional specialist, physical therapist people as well as trained spine surgeon for elderly people in case of the seldom but sometimes mandatory surgical indications.
Collapse
|
14
|
Dubousset J. [Spine aging]. Rev Prat 2021; 71:535-538. [PMID: 34553533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
|
15
|
Vergari C, Skalli W, Abelin-Genevois K, Bernard JC, Hu Z, Cheng JCY, Chu WCW, Assi A, Karam M, Ghanem I, Bassani T, Galbusera F, Sconfienza LM, Brayda-Bruno M, Courtois I, Ebermeyer E, Vialle R, Langlais T, Dubousset J. Effect of curve location on the severity index for adolescent idiopathic scoliosis: a longitudinal cohort study. Eur Radiol 2021; 31:8488-8497. [PMID: 33884474 DOI: 10.1007/s00330-021-07944-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/08/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Adolescent idiopathic scoliosis (AIS) is the most common spinal disorder in children. A severity index was recently proposed to identify the stable from the progressive scoliosis at the first standardized biplanar radiographic exam. The aim of this work was to extend the validation of the severity index and to determine if curve location influences its predictive capabilities. METHODS AIS patients with Cobb angle between 10° and 25°, Risser 0-2, and no previous treatment were included. They underwent standing biplanar radiography and 3D reconstruction of the spine and pelvis, which allowed to calculate their severity index. Patients were grouped by curve location (thoracic, thoracolumbar, lumbar). Patients were followed up until skeletal maturity (Risser ≥ 3) or brace prescription. Their outcome was compared to the prediction made by the severity index. RESULTS In total, 205 AIS patients were included; 82% of them (155/189, 95% confidence interval [74-90%]) were correctly classified by the index, while 16 patients were unclassified. Positive predictive ratio was 78% and negative predictive ratio was 86%. Specificity (78%) was not significantly affected by curve location, while patients with thoracic and lumbar curves showed higher sensitivity (≥ 89%) than those with thoracolumbar curves (74%). CONCLUSIONS In this multicentric cohort of 205 patients, the severity index was used to predict the risk of progression from mild to moderate scoliosis, with similar results of typical major curve types. This index represents a novel tool to aid the clinician and the patient in the modulation of the follow-up and, for progressive patients, their decision for brace treatment. KEY POINTS • The severity index of adolescent idiopathic scoliosis has the potential to detect patients with progressive scoliosis as early as the first exam. • Out of 205 patients, 82% were correctly classified as either stable or progressive by the severity index. • The location of the main curve had small effect on the predictive capability of the index.
Collapse
Affiliation(s)
- Claudio Vergari
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 151 bd de l'Hôpital, F-75013, Paris, France.
| | - Wafa Skalli
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 151 bd de l'Hôpital, F-75013, Paris, France
| | - Kariman Abelin-Genevois
- Department of Orthopaedic Surgery and Children Conservative Treatment, Croix-Rouge française, Centre Médico-Chirurgical et de Réadaptation des Massues, Lyon, France
| | - Jean Claude Bernard
- Department of Orthopaedic Surgery and Children Conservative Treatment, Croix-Rouge française, Centre Médico-Chirurgical et de Réadaptation des Massues, Lyon, France
| | - Zongshan Hu
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Jack Chun Yiu Cheng
- SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Mohammad Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | | | - Eric Ebermeyer
- Unite Rachis, CHU - Hopital Bellevue, Saint-Etienne, France
| | - Raphael Vialle
- Sorbonne Université, Department of Pediatric Orthopaedics, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Tristan Langlais
- Sorbonne Université, Department of Pediatric Orthopaedics, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean Dubousset
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, 151 bd de l'Hôpital, F-75013, Paris, France
| |
Collapse
|
16
|
Hasegawa K, Okamoto M, Hatsushikano S, Watanabe K, Ohashi M, Vital JM, Dubousset J. Compensation for standing posture by whole-body sagittal alignment in relation to health-related quality of life. Bone Joint J 2020; 102-B:1359-1367. [DOI: 10.1302/0301-620x.102b10.bjj-2019-1581.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study is to test the hypothesis that three grades of sagittal compensation for standing posture (normal, compensated, and decompensated) correlate with health-related quality of life measurements (HRQOL). Methods A total of 50 healthy volunteers (normal), 100 patients with single-level lumbar degenerative spondylolisthesis (LDS), and 70 patients with adult to elderly spinal deformity (deformity) were enrolled. Following collection of demographic data and HRQOL measured by the Scoliosis Research Society-22r (SRS-22r), radiological measurement by the biplanar slot-scanning full body stereoradiography (EOS) system was performed simultaneously with force-plate measurements to obtain whole body sagittal alignment parameters. These parameters included the offset between the centre of the acoustic meatus and the gravity line (CAM-GL), saggital vertical axis (SVA), T1 pelvic angle (TPA), McGregor slope, C2-7 lordosis, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PI-LL, sacral slope (SS), pelvic tilt (PT), and knee flexion. Whole spine MRI examination was also performed. Cluster analysis of the SRS-22r scores in the pooled data was performed to classify the subjects into three groups according to the HRQOL, and alignment parameters were then compared among the three cluster groups. Results On the basis of cluster analysis of the SRS-22r subscores, the pooled subjects were divided into three HRQOL groups as follows: almost normal (mean 4.24 (SD 0.32)), mildly disabled (mean 3.32 (SD 0.24)), and severely disabled (mean 2.31 (SD 0.35)). Except for CAM-GL, all the alignment parameters differed significantly among the cluster groups. The threshold values of key alignment parameters for severe disability were TPA > 30°, C2-7 lordosis > 13°, PI-LL > 30°, PT > 28°, and knee flexion > 8°. Lumbar spinal stenosis was found to be associated with the symptom severity. Conclusion This study provides evidence that the three grades of sagittal compensation in whole body alignment correlate with HRQOL scores. The compensation grades depend on the clinical diagnosis, whole body sagittal alignment, and lumbar spinal stenosis. The threshold values of key alignment parameters may be an indication for treatment. Cite this article: Bone Joint J 2020;102-B(10):1359–1367.
Collapse
Affiliation(s)
| | | | | | - Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University Hospital, Niigata, Japan
| | - Masayuki Ohashi
- Department of Orthopaedic Surgery, Niigata University Hospital, Niigata, Japan
| | | | | |
Collapse
|
17
|
Castelein RM, Pasha S, Cheng JC, Dubousset J. Idiopathic Scoliosis as a Rotatory Decompensation of the Spine. J Bone Miner Res 2020; 35:1850-1857. [PMID: 32697856 DOI: 10.1002/jbmr.4137] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 01/02/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 11/11/2022]
Abstract
Many years of dedicated research into the etiology of idiopathic scoliosis have not led to one unified theory. We propose that scoliosis is a mechanical, rotatory decompensation of the human spine that starts in the transverse, or horizontal, plane. The human spine is prone to this type of decompensation because of its unique and individually different, fully upright sagittal shape with some preexistent transverse plane rotation. Spinal stability depends on the integrity of a delicate system of stabilizers, in which intervertebral disc stiffness is crucial. There are two phases in life when important changes occur in the precarious balance between spinal loading and the disc's stabilizing properties: (i) during puberty, when loads and moment arms increase rapidly, while the disc's "anchor," the ring apophysis, matures from purely cartilaginous to mineralized to ultimately fused to the vertebral body, and (ii) in older age, when the torsional stiffness of the spinal segments decreases, due to disc degeneration and subsequent laxity of the fibers of the annulus fibrosus. During these crucial periods, transverse plane vertebral rotation can increase during a relatively brief window in time, either as adolescent idiopathic or degenerative de novo scoliosis. Much more is known of the biomechanical changes that occur during disc aging and degeneration than of the changing properties of the disc during maturation. © 2020 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saba Pasha
- Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jack Cy Cheng
- Department of Orthopaedics and Traumatology, S. H. Ho Scoliosis Research Laboratory, The Chinese University of Hong Kong, Shatin, Hong Kong.,Joint Scoliosis Research Center of The Chinese University of Hong Kong-Nanjing University, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | |
Collapse
|
18
|
Bao H, Moal B, Vira S, Bronsard N, Amabile C, Errico T, Schwab F, Skalli W, Dubousset J, Lafage V. Spino-femoral muscles affect sagittal alignment and compensatory recruitment: a new look into soft tissues in adult spinal deformity. Eur Spine J 2020; 29:2998-3005. [PMID: 32529524 DOI: 10.1007/s00586-020-06488-3] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/09/2020] [Accepted: 05/31/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To quantify muscle characteristics (volumes and fat infiltration) and identify their relationship to sagittal malalignment and compensatory mechanism recruitment. METHODS Female adult spinal deformity patients underwent T1-weighted MRI with a 2-point Dixon protocol from the proximal tibia up to the T12 vertebra. 3D reconstructions of 17 muscles, including extensors and flexors of spine, hip and knee, were obtained. Muscle volume standardized by bone volume and percentage of fat infiltration (Pfat) were calculated. Correlations and regressions were performed. RESULTS A total of 22 patients were included. Significant correlations were observed between sagittal alignment and muscle parameters. Fat infiltration of the hip and knee flexors and extensors correlated with larger C7-S1 SVA. Smaller spinal flexor/extensor volumes correlated with greater PI-LL mismatch (r = - 0.45 and - 0.51). Linear regression identified volume of biceps femoris as only predictor for PT (R2 = 0.34, p = 0.005) and Pfat of gluteus minimus as only predictor for SVA (R2 = 0.45, p = 0.001). Sagittally malaligned patients with larger PT (26.8° vs. 17.2°) had significantly smaller volume and larger Pfat of gluteus medius, gluteus minimus and biceps femoris, but similar values for gluteus maximus, the hip extensor. CONCLUSION This study is the first to quantify the relationship between degeneration of spino-femoral muscles and sagittal malalignment. This pathoanatomical study identifies the close relationship between gluteal, hamstring muscles and PT, SVA, which deepens our understanding of the underlying etiology that contributes to adult spinal deformity.
Collapse
Affiliation(s)
- Hongda Bao
- Hospital for Special Surgery, 535 East 70th Street, New York, 10021, USA.,Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Bertrand Moal
- Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Shaleen Vira
- Hospital for Joint Diseases at NYU Langone Medical Center, New York, USA
| | - Nicolas Bronsard
- Institut Universitaire de l'Appareil Locomoteur et du Sport, University Hospital of Nice, Nice, France
| | - Celia Amabile
- Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Thomas Errico
- Hospital for Joint Diseases at NYU Langone Medical Center, New York, USA
| | - Frank Schwab
- Hospital for Special Surgery, 535 East 70th Street, New York, 10021, USA
| | - Wafa Skalli
- Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Jean Dubousset
- Académie Nationale de Médecine, 16 rue Bonaparte, Paris, France
| | - Virginie Lafage
- Hospital for Special Surgery, 535 East 70th Street, New York, 10021, USA.
| |
Collapse
|
19
|
Abstract
According the almost 55 years of experience in Pediatric Spinal surgery it was easy for me to describe the evolution during the past of the surgical techniques as well as the indications for spinal deformities done first without any instrumentation (still useful from time to time nowadays), as from the back as on the front, post-operative immobilization achieved thanks to casting. The real instrumentation appeared successively with Harrington, Luque, and simultaneously the introduction of pedicle screw thanks Raymond Roy Camille. It was necessary to wait another 20 years to get the segmental 3D strategy of the CD instrumentation still the basis of modern spinal surgeries techniques whatever using Hooks Screws, Universal clamps or Hybrid constructs. For present & future, Early surgery is still indicated for localized lesion generally secondary to congenital malformations with or without spinal cord decompression. But for extended lesions especially involving the thoracic area cast and brace is still the good choice whatever the etiology with or without pelvic obliquity. When this treatment fails many attempts with various techniques were used with some success for spinal growth without disturbances about the respiratory function. But it was also demonstrated that the number of complications were still high, with in many cases the necessity to perform a final surgical fusion. It is why the development of the bipolar minimal invasive technique appeared, with very promising results, including the fact that a substantial number of patients get a spontaneous fusion, excluding final surgery. For the older or adolescent patients, the evolution toward a race to obtain the maximum correction of the Cobb angle become more and more disputable as is was demonstrated that the most important for the future regarding the spinal function is the 3D dynamic balance of the discs spaces left free below and above the fused area.
Collapse
Affiliation(s)
- Jean Dubousset
- Académie Nationale de Médecine, rue Bonaparte, Paris, France
| |
Collapse
|
20
|
Abstract
STUDY DESIGN/METHODS Review article. OBJECTIVES This article will provide an overview regarding measurement of radiation exposure and effects on patients with spinal deformity. SUMMARY OF BACKGROUND DATA/RESULTS Pediatric and adult spinal deformity patients are frequently exposed to diagnostic studies exposing them to ionizing radiation. There is a concern that medical radiation can result in increased cancer risk, particularly in children who will live for a long period of time in which cancer may develop and who have rapidly dividing cells that may be more susceptible to DNA damage. CT imaging imparts 10-100 times higher radiation dosing than standard radiographs. Usage of CT imaging studies is growing in the United States and represents 50% of medical imaging exposure. In addition to the 3 millisieverts (mSv) mean natural background exposure, in the United States, the average American experiences an additional 3 mSv of exposure primarily due to medical diagnostic imaging. Early-onset scoliosis patients are at risk of high cumulative radiation exposure given the young age at diagnosis and frequency of multiorgan system involvement in the case of neuromuscular, congenital, and syndromic patients. Biplanar slot scanning reduces patient radiation exposure, and overall levels of exposure from radiographic imaging is quite low compared with CT imaging or historic radiographs. Specialized pediatric CT dosing protocols result in lower patient absorbed dose. Surgeon and team intraoperative exposure to radiation should always be a concern. Appropriate shielding with a lead apron and minimizing radiation exposure are appropriate strategies. CONCLUSIONS This article will help guide surgeons to make appropriate decisions regarding the need for imaging studies and advocate for low-dose imaging protocols within their facilities. LEVEL OF EVIDENCE V.
Collapse
Affiliation(s)
- A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| | - Beth A Schueler
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Jean Dubousset
- Académie National de Médicine, 16 Rue Bonaparte, Paris 75006, France
| |
Collapse
|
21
|
Mikhaylovskiy MV, Dubousset J, Novikov VV, Vasyura AS, Udalova IG, Sadovoi MA. STUDY DESIGN: CASE SERIES OF 19 PATIENTS OPERATED FOR SEVERE SCOLIOSIS AND DIASTEMATOMYELIA. Coluna/Columna 2019. [DOI: 10.1590/s1808-185120191801201849] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: Diastematomyelia is a rare congenital spine and spinal cord malformation in which the spinal cord is divided into two parts by the osseous or fibrous septum. The incidence of diastematomyelia in patients with the most severe forms of congenital scoliosis is much higher than its general incidence in the population. When performing surgeries to correct scoliotic deformities, the question arises regarding the choice of a strategy for managing the septum. An unambiguous answer to this question does not exist, since the disease is very rare and heterogeneous. The aim was to summarize the data on different surgical strategies for detecting diastematomyelia. Methods: Literature review and retrospective analysis of our own clinical data. Results: We present our own experience of treating 19 patients with diastematomyelia and severe congenital scoliosis. Posture disorder was corrected in all cases; the septum was removed in none of the cases. Significant correction was achieved for all patients, and no neurological complications were observed in the short- and long-term follow-up. Conclusions: Surgical nonremoval of the spur enables compensation to be achieved, without neurological complications either in the immediate postoperative period or in the long-term (more than 2 years) follow-up. Level of Evidence IV; Case seriesh.
Collapse
Affiliation(s)
| | - Jean Dubousset
- Tsiv'yan Novosibirsk Research Institute of Traumatology and Orthopedics, Russia
| | | | | | | | | |
Collapse
|
22
|
Dubousset J, Chopin D, Seringe R. Reply to the Letter by Federico Solla, Virginie Rampal. Orthop Traumatol Surg Res 2019; 105:193. [PMID: 30591418 DOI: 10.1016/j.otsr.2018.11.006] [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: 10/17/2018] [Accepted: 11/19/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Jean Dubousset
- Académie nationale de médecine, 23, bis rue des Cordelières, 75013 Paris, France.
| | - Dominique Chopin
- Académie nationale de médecine, 23, bis rue des Cordelières, 75013 Paris, France
| | - Raphaël Seringe
- Académie nationale de médecine, 23, bis rue des Cordelières, 75013 Paris, France
| |
Collapse
|
23
|
Dubousset J, Chopin D, Seringe R. Have we made true progress in surgical indications and determining the limitations of spinal fusion in patients with idiopathic scoliosis? Orthop Traumatol Surg Res 2018; 104:555-556. [PMID: 30017859 DOI: 10.1016/j.otsr.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/08/2018] [Accepted: 07/10/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Jean Dubousset
- Académie nationale de médecine, 23 bis, rue des Cordelières, 75013 Paris, France.
| | - Daniel Chopin
- Académie nationale de médecine, 23 bis, rue des Cordelières, 75013 Paris, France
| | - Raphaël Seringe
- Académie nationale de médecine, 23 bis, rue des Cordelières, 75013 Paris, France
| |
Collapse
|
24
|
Pascal-Moussellard H, Ferrero E, Dubousset J, Miladi L. Expert's comment concerning Grand Rounds case entitled "Intraspinal canal rod migration causing late-onset paraparesis 8 years after scoliosis surgery" (I. Obeid et al. Eur Spine J; 2014, DOI 10.1007/s00586-014-3367-y). Eur Spine J 2015; 25:2102-7. [PMID: 26676370 DOI: 10.1007/s00586-015-4346-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 11/26/2022]
Affiliation(s)
- H Pascal-Moussellard
- Service de chirurgie orthopédique et de traumatologie, Pavillon Gaston Cordier, CHU Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - E Ferrero
- Service de chirurgie orthopédique et de traumatologie, Pavillon Gaston Cordier, CHU Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | | | - L Miladi
- Service orthopédie pédiatrique, CHU Necker Enfants Malades, APHP, Faculté de Médecine, 149 Rue des Sèvres, 75743, Paris Cedex 15, France
| |
Collapse
|
25
|
Abstract
PURPOSE To access the long-term outcomes for patients with arthrogryposis multiplex congenita at adult age. MATERIALS AND METHODS The cases were traced for most of them thanks to direct contact maintained from child hood, from colleagues interested from other parts of the country, and from the list from Alliance arthrogryposis association (parents and patients). The methods used were: mostly direct clinical examination, some phone calls or email. All answered a questionnaire for general life and mainly for function. One of these questions was: what is the function you missed most during your life? RESULTS 65 patients( 41 females and 24 males) were reviewed at adult age from 22 to 65 years. For the personal life: 38 are married and had 34 children with only 4 having arthrogryposis. Only 27 (15 F/12 M) were living alone. Self-sufficiency was observed in 35, partial in 20, total dependence in 10 people. 38 reached university level, 20 had secondary school level, 10 had primary school level. Ambulation was made possible with wheelchair: permanent for 18, partial for 9 ambulating at home only, 8 ambulating outside with crutches and 29 were free walkers. 36 patients out of 65 were driving a car sometimes modified with special equipment. The involvement of spine was seen in 26 patients requiring surgical treatment sometimes complex combining anterior and posterior approach in 14 cases. Surgery of the lower limbs (hips, knee, feet) was very often repeated, with almost always stability, pain free and function. The most important finding was that 52 patients had more or less severe involvement of the upper limbs which was considered by the majority of the patients to be the most disabling, more than the absence of walking! CONCLUSION Finally, it appeared that for the care of these patients, priority goes to the upper limbs function, because majority of these patients have a high level of intelligence. A remarkable fact is that many of these patients had to spend a lot of time during infancy and childhood in rehabilitation centers with education adapted for schools and teachers. Finally, they are grateful for that, telling often that it would have been much more difficult if not impossible to have such a treatment and education at home.
Collapse
Affiliation(s)
| | - Michel Guillaumat
- />Orthopedic department, Hopital Saint Joseph, Rue Raymond Losserand, 75014 Paris, France
| |
Collapse
|
26
|
Vergari C, Dubois G, Vialle R, Gennisson JL, Tanter M, Dubousset J, Rouch P, Skalli W. Lumbar annulus fibrosus biomechanical characterization in healthy children by ultrasound shear wave elastography. Eur Radiol 2015. [PMID: 26198667 DOI: 10.1007/s00330-015-3911-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Intervertebral disc (IVD) is key to spine biomechanics, and it is often involved in the cascade leading to spinal deformities such as idiopathic scoliosis, especially during the growth spurt. Recent progress in elastography techniques allows access to non-invasive measurement of cervical IVD in adults; the aim of this study was to determine the feasibility and reliability of shear wave elastography in healthy children lumbar IVD. METHODS Elastography measurements were performed in 31 healthy children (6-17 years old), in the annulus fibrosus and in the transverse plane of L5-S1 or L4-L5 IVD. Reliability was determined by three experienced operators repeating measurements. RESULTS Average shear wave speed in IVD was 2.9 ± 0.5 m/s; no significant correlations were observed with sex, age or body morphology. Intra-operator repeatability was 5.0 % while inter-operator reproducibility was 6.2 %. Intraclass correlation coefficient was higher than 0.9 for each operator. CONCLUSIONS Feasibility and reliability of IVD shear wave elastography were demonstrated. The measurement protocol is compatible with clinical routine and the results show the method's potential to give an insight into spine deformity progression and early detection. KEY POINTS • Intervertebral disc mechanical properties are key to spine biomechanics • Feasibility of shear wave elastography in children lumbar disc was assessed • Measurement was fast and reliable • Elastography could represent a novel biomarker for spine pathologies.
Collapse
Affiliation(s)
- Claudio Vergari
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013, Paris, France.
| | - Guillaume Dubois
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013, Paris, France
| | - Raphael Vialle
- Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, 75571, Paris, France
| | - Jean-Luc Gennisson
- Institut Langevin, Ondes et Images, ESPCI ParisTech, CNRS UMR7587, INSERM U979, Paris, France
| | - Mickael Tanter
- Institut Langevin, Ondes et Images, ESPCI ParisTech, CNRS UMR7587, INSERM U979, Paris, France
| | - Jean Dubousset
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013, Paris, France
| | - Philippe Rouch
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013, Paris, France
| | - Wafa Skalli
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013, Paris, France
| |
Collapse
|
27
|
Canavese F, Botnari A, Dimeglio A, Samba A, Pereira B, Gerst A, Granier M, Rousset M, Dubousset J. Serial elongation, derotation and flexion (EDF) casting under general anesthesia and neuromuscular blocking drugs improve outcome in patients with juvenile scoliosis: preliminary results. Eur Spine J 2015; 25:487-94. [PMID: 26160689 DOI: 10.1007/s00586-015-4100-1] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Juvenile scoliosis (JS), among different types of spinal deformity, remains still a challenge for orthopedic surgeons. Elongation, derotation and flexion (EDF) casting technique is a custom-made thoracolumbar cast based on a three-dimensional correction concept. The primary objective of the present study was to measure changes on plain radiographs of patients with JS treated with EDF plaster technique. The second aim was to evaluate the effectiveness of the EDF plaster technique realized under general anesthesia (GA) and neuromuscular blocking drugs, i.e. curare, on the radiological curve correction. METHODS A retrospective comparative case series study was performed in which were included forty-four skeletally immature patients. Three patient groups were selected. Group 1: EDF cast applied with patients awaken and no anesthesia; Group 2: EDF cast applied under GA without neuromuscular blocking drugs; Group 3: EDF cast applied under GA with neuromuscular blocking drugs. All the patients were treated with two serial EDF casts by 2 months and a half each. All measurements were taken from the radiographic exams. Cobb's angle; RVAD and Nash and Moe grade of rotation were assessed before and after applying the cast. Thirty-four (77.3 %) patients were followed up at least 24 months after removal of last EDF cast. RESULTS Eighteen patients (3 males, 15 females) were included in Group 1, 12 (2 males, 10 females) in Group 2 and 14 (5 males, 9 females) in Group 3. Serial EDF casting was more effective at initial curve reduction and in preventing curve progression when applied under GA with neuromuscular blocking drugs, i.e. curare. RVAD and Nash and Moe score improved significantly in all groups of patients treated according to principles of EDF technique. During follow-up period, six patients required surgery in Group 1 (6/18; 33.3 %), 3 patients required surgery in Group 2 (3/12; 25 %) and 2 patients underwent surgery in Group 3 (2/14; 15 %). CONCLUSIONS Preliminary results show EDF casting is effective in controlling the curve in both frontal (Cobb's angle) and transverse plane (rib vertebral angle and apical vertebral rotation degree).
Collapse
Affiliation(s)
- Federico Canavese
- Department of Pediatric Surgery, CHU Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France.
| | - Alexei Botnari
- Department of Pediatric Surgery, CHU Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France
| | - Alain Dimeglio
- Faculty of Medicine, University of Montpellier, 2 Rue de l'Ecole de Médecine, 34000, Montpellier, France
| | - Antoine Samba
- Department of Pediatric Surgery, CHU Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France
| | - Bruno Pereira
- Biostatistics unit, DRCI, CHU Clermont-Ferrand, 58 rue Montalambert, 63000, Clermont Ferrand, France
| | - Adeline Gerst
- Department of Anesthesia and Reanimation, CHU Clermont-Ferrand, 58 rue Montalambert, 63000, Clermont Ferrand, France
| | - Marie Granier
- Department of Anesthesia and Reanimation, CHU Clermont-Ferrand, 58 rue Montalambert, 63000, Clermont Ferrand, France
| | - Marie Rousset
- Department of Pediatric Surgery, CHU Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont Ferrand, France
| | - Jean Dubousset
- Académie Nationale de Médecine, 16 rue Bonaparte, 75006, Paris, France
| |
Collapse
|
28
|
Dubousset J. [Not Available]. Bull Acad Natl Med 2015; 199:381-382. [PMID: 27476316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
29
|
Vergari C, Rouch P, Dubois G, Bonneau D, Dubousset J, Tanter M, Gennisson JL, Skalli W. In vivo cervical intervertebral disc characterisation by elastography. Comput Methods Biomech Biomed Engin 2014; 17 Suppl 1:120-1. [PMID: 25074194 DOI: 10.1080/10255842.2014.931515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- C Vergari
- a Arts et Métiers ParisTech, LBM, 151 bd de l'hôpital , 75013 , Paris , France
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Vergari C, Rouch P, Dubois G, Bonneau D, Dubousset J, Tanter M, Gennisson JL, Skalli W. Intervertebral disc characterization by shear wave elastography: An in vitro preliminary study. Proc Inst Mech Eng H 2014; 228:607-615. [DOI: 10.1177/0954411914540279] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patient-specific numerical simulation of the spine is a useful tool both in clinic and research. While geometrical personalization of the spine is no more an issue, thanks to recent technological advances, non-invasive personalization of soft tissue’s mechanical properties remains a challenge. Ultrasound elastography is a relatively recent measurement technique allowing the evaluation of soft tissue’s elastic modulus through the measurement of shear wave speed. The aim of this study was to determine the feasibility of elastographic measurements in intervertebral disc. An in vitro approach was chosen to test the hypothesis that shear wave speed can be used to evaluate intervertebral disc mechanical properties and to assess measurement repeatability. In total, 11 oxtail intervertebral discs were tested in compression to determine their stiffness and apparent elastic modulus at rest and at 400 N. Elastographic measurements were performed in these two conditions and compared to these mechanical parameters. The protocol was repeated six times to determine elastographic measurement repeatability. Average shear wave speed over all samples was 5.3 ± 1.0 m/s, with a repeatability of 7% at rest and 4.6% at 400 N; stiffness and apparent elastic modulus were 266.3 ± 70.5 N/mm and 5.4 ± 1.1 MPa at rest, respectively, while at 400 N they were 781.0 ± 153.8 N/mm and 13.2 ± 2.4 MPa, respectively. Correlations were found between elastographic measurements and intervertebral disc mechanical properties; these preliminary results are promising for further in vivo application.
Collapse
Affiliation(s)
| | | | | | | | | | - Mickael Tanter
- Institut Langevin, Ondes et Images, ESPCI ParisTech, CNRS UMR7587, INSERM U979, Paris, France
| | - Jean-Luc Gennisson
- Institut Langevin, Ondes et Images, ESPCI ParisTech, CNRS UMR7587, INSERM U979, Paris, France
| | - Wafa Skalli
- Arts et Métiers ParisTech, LBM, Paris, France
| |
Collapse
|
31
|
Dubousset J. [Can falls be prevented?]. Bull Acad Natl Med 2014; 198:1055-1066. [PMID: 26983186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Most recommendations and measures intended to prevent falls focus on the elderly (see HAS guideline of April 2009) but, in our opinion, this isfar too late: prevention must begin much earlier, not only by identifying persons at risk, but also by providing personalized lifestyle advice adapted to each individual's biomechanical, somatic, neurological and biological characteristics. The first preventive measure is to identify a possible deterioration of balance, starting with a physical examination at the age of 45 and repeated regularly throughout life. Extrinsic preventive measures focusing on the domestic and external environments are clearly necessary. But what is most important is to detect and, if necessary, correct any degradation of intrinsic (intracorporeal or somatic) factors starting at the age of 45 years; these include vision, vestibular function and balance, proprioception, and psychological and neurological status. Chronic illnesses and their treatments must also be taken into account: treatment must be limited to indispensable drugs; sedative psychotropics must be avoided if possible; and polymedication must be tightly controlled, as it is a major risk factor for falls. Prevention also requires a diet sufficiently rich in protein, calcium and vitamin D3 (to prevent osteoporosis), and regular daily exercise adapted to the individual, if possible associated with a simultaneous cognitive task. The last key point is the absolute need for thorough functional rehabilitation after any accidental or medical trauma, regardless of age, with the aim of restoring functional status to that existing prior to the accident.
Collapse
|
32
|
Dubousset J, Ilharreborde B, Le Huec JC. Use of EOS imaging for the assessment of scoliosis deformities: application to postoperative 3D quantitative analysis of the trunk. Eur Spine J 2014; 23 Suppl 4:S397-405. [DOI: 10.1007/s00586-014-3334-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 11/30/2022]
|
33
|
Abstract
The authors have designed a new method of instrumentation aimed at obtaining surgical fixation of the scoliotic curve without any postoperative external immobilisation. It is particularly strong and rigid and allows adequate reduction of the curve. This technique avoids the sublaminar space and thus prevents excessive blood loss and diminishes the danger of cord damage. The instrumentation is made of two parallel rough cylindrical rods inserted independently in the convexity and concavity of the curve. If necessary, they can be bent pre-operatively. They are attached to hooks placed on the laminae or pedicles, which are locked by bolts, thus allowing progressive straightening of the curve. They are joined by two transverse bars, one above and one below, to provide better rigidity to the device and to allow correction of rotation. The parts of the vertebrae left free by the device are denuded to allow the addition of grafts. Laboratory tests have demonstrated that this type of fixator is more rigid than the Harrington or Luque rods. Fifteen patients, either idiopathic or paralytic cases, were operated on without any neurological impairment. No loss of correction was observed since the hooks have been locked.
Collapse
Affiliation(s)
- Y Cotrel
- Orthopédie infantile, hôpital Saint-Vincent-de-Paul, 74, avenue Denfert-Rochereau, 75014 Paris, France
| | - J Dubousset
- Orthopédie infantile, hôpital Saint-Vincent-de-Paul, 74, avenue Denfert-Rochereau, 75014 Paris, France.
| |
Collapse
|
34
|
Ilharreborde B, Dubousset J, Skalli W, Mazda K. Spinal penetration index assessment in adolescent idiopathic scoliosis using EOS low-dose biplanar stereoradiography. Eur Spine J 2013; 22:2438-44. [PMID: 23836300 DOI: 10.1007/s00586-013-2892-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 03/10/2013] [Accepted: 07/03/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE The spinal penetration index (SPI) quantifies the portion of the rib cage occupied by vertebrae. When measured by computed tomography (CT) or magnetic resonance imaging, SPI can only be determined in the reclining position, which modifies spinal and thoracic morphology. CT results in high radiation exposure. The authors studied rib cage and spinal morphology using low-dose biplanar stereoradiography and their impact on respiratory function in adolescent idiopathic scoliosis (AIS). METHODS In eighty thoracic AIS patients, a slot-scanning radiologic device allowing simultaneous acquisition of orthogonal images and 3D reconstructions with low exposure to radiation (EOS) was used to determine thoracic volume, mean spinal penetration index (SPIm), apical spinal penetration index (SPIa), main thoracic (MT) curve Cobb angle, T4-T12 kyphosis, and apical vertebral rotation (AVR). RESULTS Thoracic volume was correlated with thoracic kyphosis (r = 0.31, p = 0.006), but not with SPI, MT Cobb angle, or AVR. SPIm and SPIa were negatively correlated with thoracic kyphosis. Forced vital capacity and forced expiratory volume in 1 s were significantly lower in the hypokyphotic patients (p = 0.04, p = 0.03, respectively) and correlated with thoracic volume and T4-T12 kyphosis. No correlation was found between spinal penetration indices and pulmonary function tests, but SPIm was significantly greater in patients with obstructive syndrome (p = 0.01). CONCLUSIONS With little radiation exposure, EOS biplanar stereoradiography permits routine imaging is a functional standing position. Hypokyphotic patients had significantly decreased FEV1 and FVC. SPIm was significantly higher in patients with obstructive syndrome.
Collapse
Affiliation(s)
- Brice Ilharreborde
- Pediatric Orthopaedic Department, Robert Debré Hospital, AP-HP, Paris Diderot University, 48 Bd Sérurier, 75019, Paris, France,
| | | | | | | |
Collapse
|
35
|
Courvoisier A, Drevelle X, Vialle R, Dubousset J, Skalli W. 3D analysis of brace treatment in idiopathic scoliosis. Eur Spine J 2013; 22:2449-55. [PMID: 23812685 DOI: 10.1007/s00586-013-2881-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 04/21/2013] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE We have evaluated the effect of bracing in scoliosis on coronal alignment in a cohort of patients. Current literature has not described the specific effect of bracing on the 3D shape of the scoliotic curves. The purpose of this study was to analyze the variability of the 3D effect of bracing on idiopathic scoliosis. MATERIALS AND METHODS The spines of 30 patients with adolescent idiopathic scoliosis were reconstructed using biplanar stereoradiography with and without the brace. The Cobb angle, sagittal and pelvic parameters and transverse plane parameters were calculated. The variability and the mean values of each parameter, with and without a brace, were analyzed and compared using a student t test. RESULTS The Cobb angle improved in 50% of patients but remained unchanged in 50% cases. In 90% of the cases lordosis was decreased. The thoracic kyphosis was decreased in 26% cases, unchanged in 57% of cases and increased in 17% cases. The AVR was improved (>5°) in 26% cases, worsened in 23% and unchanged in 50%. Only the differences of Cobb angle and the lordosis were statistically significant. CONCLUSIONS Global statistics of this study concur with the literature. The Cobb angle was significantly improved. It also showed a significant hypolordotic effect. However, the results showed a high variability of the brace treatment effect in almost every parameter. Analysis of this variability by means of 3D reconstructions instead of global statistics should help characterize the mechanisms of correction of brace treatment.
Collapse
Affiliation(s)
- Aurélien Courvoisier
- Laboratoire de Biomécanique, Arts et Métiers, ParisTech., 151 Boulevard de l'hôpital, 75013, Paris, France,
| | | | | | | | | |
Collapse
|
36
|
Dubousset J, Charpak G, Skalli W, Deguise J, Kalifa G. EOS: A NEW IMAGING SYSTEM WITH LOW DOSE RADIATION IN STANDING POSITION FOR SPINE AND BONE & JOINT DISORDERS. ACTA ACUST UNITED AC 2011. [DOI: 10.1142/s0218957710002430] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Very precise combined work between multidisciplinary partners (radiation engineers in physics, engineers in biomechanics, medical radiologists and orthopedic pediatric surgeons) has led to the concept and development of a new low-dose radiation device named EOS. This device has three main advantages: (1) Thanks to the invention of Georges Charpak who designed gaseous detectors for X-rays, the reduction of dose necessary to obtain a good image of skeletal system was 8 to 10 times less for 2D imaging; compared to the dose necessary to obtain a 3D reconstruction from CT scan cuts, the reduction factor was 800 to 1000. (2) The accuracy of 3D reconstruction obtained is better than that of 3D reconstruction from CT scan cuts. (3) The patient in addition gets imaged in a standing functional position, thanks to the AP and lateral X-rays obtained from head to feet simultaneously. This is a big advantage compared to CT scans which are used only in lying position. From the simultaneous AP and lateral X-rays of the whole body obtained via the 3D bone external envelop technique, the biomechanics engineers obtain 3D reconstruction of every level of osteo-articular system, especially for spine, in standing position with an acceptable period of time for reconstruction. This (in spite of the evolution of standing MRI) allows more precise bone reconstruction in orthopedics, especially at the level of the entire skeleton, including the head, spine, pelvis, lower limbs, giving new consideration for physiology, physiopathology and therapeutics.
Collapse
Affiliation(s)
- Jean Dubousset
- Membre de l'Académie Nationale de Médecine et Hôpital, ST VINCENT DE PAUL, Service de Chirurgie, Orthopédique, Paris, France
| | | | - Wafa Skalli
- Ecole Nationale Supérieure des Arts et Métiers, 154 Bld de l'Hôpital Paris, France
| | - Jacques Deguise
- Laboratoire de Recherche en Imagerie, Orthopédique, Montréal, Canada
| | - Gabriel Kalifa
- Hôpital ST VINCENT DE PAUL, Service de Radiologie, France
| |
Collapse
|
37
|
Dubousset J, Lavaste F, Skalli W, Lafage V. [Modeling the spine and spinal cord]. Bull Acad Natl Med 2011; 195:1831-1842. [PMID: 22844745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
3D reconstruction of the spine may cover morphological, mechanical and functional aspects, among others. Since the computer era, rapid progress has been made in the development of practical applications, as well in the analysis of spinal pathophysiology during growth and aging. This technology is particularly usefulfor the planning, simulation and execution of corrective surgery, invention of new procedures, and therapeutic follow-up.
Collapse
|
38
|
|
39
|
Abstract
The Cotrel-Dubousset (CD) scoliosis surgery was simulated for 10 patients with idiopathic scoliosis using a 3D finite element model (FEM) of the patient's entire spine. The geometry of the FEM was extracted from a 3D stereo-radiographic reconstruction, and mechanical properties were personalized using lateral bending films. Finally, each step of the CD correction was simulated and results were compared with the post-operative 3D stereo-radiographic reconstruction. The whole procedure was applied for 10 patients, and quantitative comparison was performed between post-operative spine configuration and predicted configuration. For all patients, mean differences between post-operative measurements and predicted values of vertebral rotation were estimated at 5 degrees (max: 13 degrees) and those for linear position at 6 mm (max: 12 mm). Furthermore, intermediate steps of surgery simulation were consistent with the literature. Then, for one scoliotic patient, the model was used to investigate three alternative surgical strategies. It was found that a one-level change in the instrumentation limit may have a significant effect on spine alignment and correction.
Collapse
Affiliation(s)
- V Lafage
- Laboratoire de BioMécanique, ENSAM-CNRS, Paris, France.
| | | | | | | |
Collapse
|
40
|
Steffen JS, Obeid I, Aurouer N, Hauger O, Vital JM, Dubousset J, Skalli W. 3D postural balance with regard to gravity line: an evaluation in the transversal plane on 93 patients and 23 asymptomatic volunteers. Eur Spine J 2009; 19:760-7. [PMID: 20035359 DOI: 10.1007/s00586-009-1249-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 12/09/2009] [Indexed: 10/20/2022]
Abstract
Relevance of posture assessment has been reported in case of spine disorders. This study explores the interest in quantifying posture using 3D reconstruction from biplanar X-rays in free standing position and a force plate. 93 patients consulting for spine disorders were divided ('3D deformity', 'sagittal imbalance' and 'mild deformity') and compared with 23 asymptomatic volunteers. Registration of the gravity line (GL) in reconstruction yielded transversal position of the center of acoustic meati (CAM) T1, T4, T9, L3, S1 and hip axis (HA) with regard to GL. Transversal position of CAM and L3 appeared as relevant parameters to discriminate patients from volunteers. Sagittal inclination of the axis linking the CAM to HA was correlated with position of the CAM to GL (r = 0.92 for patients). In conclusion, observing posture in 3D with regard to GL provides clinical relevant information. CAM-HA inclination may improve postural evaluation without force plate.
Collapse
Affiliation(s)
- Jean-Sebastien Steffen
- Laboratoire de Biomecanique Arts et Metiers ParisTech CNRS, 151 Boulevard de l'Hopital, 75013, Paris, France.
| | | | | | | | | | | | | |
Collapse
|
41
|
Fassier A, Wicart P, Dubousset J, Seringe R. Arthrogryposis multiplex congenita. Long-term follow-up from birth until skeletal maturity. J Child Orthop 2009; 3:383-90. [PMID: 19669823 PMCID: PMC2758174 DOI: 10.1007/s11832-009-0187-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [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: 10/30/2008] [Accepted: 06/12/2009] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of this retrospective long-term study was to review and present the effects of treatment for 11 children with arthrogryposis multiplex congenital, or amyoplasia, followed from birth until skeletal maturity. METHODS We evaluated walking ability, age of beginning to walk, required ambulatory devices, age of independent walking and muscle strength. RESULTS Our series showed babies with severe limb involvements without spine abnormalities. Despite the initial severity of involvement, nine patients finally became ambulators with flexion contracture of less than 20 degrees on hips and 15 degrees on knees, and six were independent walkers before the age of 2.5 years. The two non-ambulators presented severe scoliosis at skeletal maturity, which needed spinal fusion. CONCLUSION We conclude that long-term ambulatory status at skeletal maturity is not correlated with the severity of condition at birth. A prognosis for ambulation at skeletal maturity will be done before 2.5 years of age. We believe that early aggressive management of children with severe arthrogryposis is warranted and justified.
Collapse
Affiliation(s)
- Alice Fassier
- />Université de Lyon, Faculté Laennec, Hôpital Femme-Mère-Enfant, 59, Boulevard Pinel, 69677 Bron Cedex, France
| | - Philippe Wicart
- />Hôpital Saint Vincent de Paul, Université René Descartes, 74–82, Avenue Denfert-Rochereau, 75674 Paris Cedex 14, France
| | - Jean Dubousset
- />Hôpital Saint Vincent de Paul, Université René Descartes, 74–82, Avenue Denfert-Rochereau, 75674 Paris Cedex 14, France
| | - Raphaël Seringe
- />Hôpital Saint Vincent de Paul, Université René Descartes, 74–82, Avenue Denfert-Rochereau, 75674 Paris Cedex 14, France
| |
Collapse
|
42
|
Humbert L, De Guise J, Godbout B, Cresson T, Aubert B, Branchaud D, Chav R, Gravel P, Parent S, Dubousset J, Skalli W. Fast 3D reconstruction of the spine from biplanar radiography: a diagnosis tool for routine scoliosis diagnosis and research in biomechanics. Comput Methods Biomech Biomed Engin 2009; 12:151-63. [DOI: 10.1080/10255840903081222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
43
|
Lavigne F, Mascard E, Laurian C, Dubousset J, Wicart P. Delayed-iatrogenic injury of the thoracic aorta by an anterior spinal instrumentation. Eur Spine J 2009; 18 Suppl 2:265-8. [PMID: 19381694 DOI: 10.1007/s00586-009-0974-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 03/21/2009] [Accepted: 03/28/2009] [Indexed: 11/24/2022]
Abstract
We present a case of a 15-year-old girl who presented to us with an unusual low back pain. About 7 years ago, this patient had corrective surgery for her idiopathic left thoracolumbar scoliosis. Recent surgery revealed a laceration of the posterior wall of the thoracic aorta by an impending screw thread. This injury was repaired by the vascular surgeons and, subsequently, the patient had full recovery without any complications.
Collapse
Affiliation(s)
- François Lavigne
- Department of Paediatric Surgery, Saint Vincent de Paul Hospital, 74-82 avenue Denfert Rochereau, Paris, France.
| | | | | | | | | |
Collapse
|
44
|
Abstract
The correlation of serum melatonin levels and curve progression in adolescent idiopathic scoliosis, and the effects of melatonin therapy in scoliotic patients with reduced levels of endogenous melatonin were studied in 40 adolescent patients with moderate to severe idiopathic scoliosis. Of the scoliotic subjects, 28 had stable scoliosis and 12 had progressive scoliosis. Normal melatonin levels were derived from 25 age-matched control patients. Serum melatonin levels were monitored yearly in scoloiotic patients for a period ranging from 3 to 6 yr, revealing a diurnal pattern with low values during the day and high at night. Scoliotic patients with normal levels were not treated or were treated with a brace, and all but two patients with low endogenous melatonin were treated with oral supplements of the indole. Of the 22 patients with a normal melatonin level, 16 had stable scoliosis and six had progressive scoliosis. Of the 16 patients treated for a low melatonin level, 12 had stable scoliosis and four had a progressive course. The two untreated cases had a progressive course. Of the 12 patients who had progressive scoliosis, nine had >35 degrees of curve at initial examination. These findings suggest that melatonin deficiency plays a role in the prognosis of idiopathic scoliosis. Therefore, melatonin supplements may prevent the progression of scoliosis, especially in mild cases with less than a 35 degrees curve.
Collapse
Affiliation(s)
- Masafumi Machida
- National Institute of Musculo-Skeletal Disorders, Murayama Medical Center, Tokyo, Japan.
| | | | | | | |
Collapse
|
45
|
Thaunat M, Mascard E, Wicart P, Missenard G, Dubousset J. [Surgical treatment of stiff massive knee endoprosthesis for bone tumors in children and adolescents]. ACTA ACUST UNITED AC 2008; 94:268-72. [PMID: 18456062 DOI: 10.1016/j.rco.2007.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2007] [Indexed: 11/17/2022]
Abstract
PURPOSE OF THE STUDY Improved oncologic outcome and technical advances in limb salvage surgery have made limb salvage therapy a feasible and valuable treatment option. Nevertheless, resection of a bone tumor followed by a reconstruction knee endoprosthesis can create gait abnormalities, of which one of the most frequent is knee stiffness. The aim of this retrospective study was to assess the outcomes of revision surgery for a stiff knee following reconstruction of a segmental long bone defect. PATIENTS AND METHODS Between 1983 and 2005, 19 patients who had undergone wide resection of a tumor close to the knee followed by reconstruction with a massive endoprosthesis were revised for a diagnosis of stiffness. RESULTS The mean age of the patients was 12 years (range: 7-19 years). Patients were followed for a mean five years (range: 1-21 years). Three patients were not assessed at the last follow up (two patients died, one patient was amputated for a local recurrence). The mean range of motion improved 80+/-24 degrees preoperatively to postoperatively. The Enneking score improved from 15+/-0.5 to 23+/-3 points at three months follow-up, and to 22+/-5 at last follow-up. Recurrent stiffness occurred three times and required a second operative release with a good final result. DISCUSSION Outcome depends on the cause of the stiffness of the reconstruction knee arthroplasty. Stiffness can be caused by complications (trauma, implant failure, infection), and patient-related factors (lack of physiotherapy). Open arthrolysis is indicated for chronic stiffness in a motivated patient with an identified cause because failure to identify the cause of stiffness may result in recurrence of the problem.
Collapse
Affiliation(s)
- M Thaunat
- Service de chirurgie orthopédique pédiatrique, hôpital Saint-Vincent-de-Paul, université Paris-Descartes, 74, avenue Denfert-Rochereau, 75674 Paris cedex 14, France.
| | | | | | | | | |
Collapse
|
46
|
Drevelle X, Dubousset J, Lafon Y, Ebermeyer E, Skalli W. Analysis of the mechanisms of idiopathic scoliosis progression using finite element simulation. Comput Methods Biomech Biomed Engin 2008. [DOI: 10.1080/10255840802297267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
47
|
Drevelle X, Dubousset J, Lafon Y, Ebermeyer E, Skalli W. Analysis of the mechanisms of idiopathic scoliosis progression using finite element simulation. Stud Health Technol Inform 2008; 140:85-89. [PMID: 18810005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The mechanisms of idiopathic scoliosis progression are still not fully understood. The aim of this study is to explore, using finite element simulation, effect of the combination of gravity and anterior spinal overgrowth on scoliosis progression. 14 adolescents (10 girls, 4 boys) with an average age of 10.8 years [range 9; 13] were divided in three groups: thoraco-lumbar scoliosis (TL), lumbar scoliosis (L), asymptomatic patients (A). Accurate 3D reconstructions of the spine have been built using bi-planar X-rays. A patient specific validated finite element model has been used. Simulations have been launched with simulation of the combined effect of gravity and growth. The progression during the simulation was defined by a maximal axial rotation movement greater or equal than 4 degrees and a maximal lateral displacement greater or equal than 5 mm ("first order progression" for one criterion, "second order" for the both criteria). In the group TL, we notice an aggravation for 4 patients (Cobb angle increase at least by 4 degrees , mean at 5.9 degrees ). Only three patients of the group L show a progression with a smaller Cobb angle increase (mean 3.9 degrees ). For the group A, no progression is found for 3 and a progression is found for 1. An anterior spinal overgrowth combined with gravity and a pre-existent curve in the spine could lead to a progression of scoliosis. It seems necessary to consider differently lumbar curves from other curves. Numerical simulation with a patient specific model appears as a useful tool to investigate mechanisms of scoliosis aggravation.
Collapse
Affiliation(s)
- X Drevelle
- Laboratoire de Biomécanique, Arts & Métiers ParisTech - CNRS UMR 8005, Paris, France.
| | | | | | | | | |
Collapse
|
48
|
Humbert L, De Guise J, Godbout B, Parent S, Dubousset J, Skalli W. Comparative study of scoliotic spines using a fast 3D reconstruction method from biplanar X-rays. Comput Methods Biomech Biomed Engin 2008. [DOI: 10.1080/10255840802297028] [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: 10/21/2022]
|
49
|
Bonnet F, Pavy B, Beaudoin S, Dubousset J, Mitrofanoff M. Treatment of a large defect of the chest wall in a child using a negative pressure wound dressing. ACTA ACUST UNITED AC 2007; 41:143-5. [PMID: 17486521 DOI: 10.1080/02844310600699499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Vacuum-assisted closure(VAC) is a simple wound healing tool in plastic surgery. We report a large thoracic defect in a child, in which the VAC was used to cover an exposed polytetrafluoroethylene prosthesis. The VAC saved the prosthesis and induced complete granulation of the wound, which healed completely in five weeks.
Collapse
Affiliation(s)
- Florent Bonnet
- Department of Plastic and Reconstructive Surgery, Hôpital Saint-Vincent-de-Paul, Paris, France.
| | | | | | | | | |
Collapse
|
50
|
Dubousset J. Comment on "Comparison between constrained and non-constrained Cobb techniques for the assessment of thoracic kyphosis and lumbar lordosis" (J.-M. Mac-Thiong et al.). Eur Spine J 2007; 16:1333. [PMID: 17387525 PMCID: PMC2200736 DOI: 10.1007/s00586-007-0315-0] [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] [Accepted: 01/11/2007] [Indexed: 11/26/2022]
Affiliation(s)
- J Dubousset
- Président du G.I.C.D., Hôpital Saint Vincent de Paul, 82, Avenue Denfert-Rochereau, 75674 Paris, France.
| |
Collapse
|