Variation of Global Sagittal Alignment Parameters According to Gender, Pelvic Incidence, and Age.

Study Design: Retrospective cross-sectional study.

Objective: The aim was to describe existing global sagittal alignment parameters across ages and to analyze differences according to gender and pelvic incidence (PI).

Summary Of Background Data: Variability with age has been reported.

Revision after spinal stenosis surgery.

Purpose: To make a literature review on spinal stenosis recurrence after a first surgery and edit rules to avoid this complication.

Methods: We conducted two separate PUBMED searches to evaluate the revision post-stenosis and degenerative scoliosis surgery using the terms: lumbar vertebrae/surgery, spinal stenosis, spine, scoliosis and reoperation. The resulting papers were categorized into three groups: (1) those that evaluated reoperation post-simple decompression; (2) those that evaluated spinal decompression and fusion for short (3 levels or less) or long (more than 3 levels) segment spinal fusion; and (3) those diagnosing the stenosis during the surgery.

Analysis of cervical sagittal alignment variations after lumbar pedicle subtraction osteotomy for severe imbalance: study of 59 cases.

Objective: To evaluate postoperative changes within the cervical alignment following surgical lumbar correction by pedicle subtraction osteotomy (PSO) in patients affected with sagittal global malalignment disease.

Methods: This was a monocentric, radiographic, and prospective study. 79 patients, who underwent sagittal correction by PSO, performed an EOS imaging pre- and postoperatively between January 2008 and December 2013 at the University Hospital of Bordeaux.

Which parameters are relevant in sagittal balance analysis of the cervical spine? A literature review.

Introduction: Cervical spine is part of the spine with the most mobility in the sagittal plane. It is important for surgeons to have reliable, simple and reproducible parameters to analyse the cervical.

Material And Method: This study is a systematic review and a critique of current parameters to help improve the study of cervical spinal balance.

Malignant triton tumor: Grand Round presentation of a rare aggressive case thoracolumbar spine tumor.

Introduction: We report a rare and aggressive case of malignant triton tumor (MTT) at the thoracolumbar junction with foraminal extension mistreated as schwannoma.

Materials And Methods: A 70-year-old man with a 2-year history of lower back pain and left L4 radiculopathy with no history of neurofibromatosis.

Results: Pre-operative MRI suggested a typical schwannoma.

Maverick total disc arthroplasty performs well at 10 years follow-up: a prospective study with HRQL and balance analysis.

Purpose: The treatment of low back pain associated to Disc Degenerative Disease (DDD) is still controversial. Segmental Fusion is the gold standard, but many studies have reported that motion-preserving devices bring substantial clinical benefits to patients. Concerns on the associated complications and on the long-term clinical effectiveness of such instrumentations are still present and have led recently to a decrease of the number of Lumbar Total Disk Replacements (TDR).

Normative 3D acetabular orientation measurements by the low-dose EOS imaging system in 102 asymptomatic subjects in standing position: Analyses by side, gender, pelvic incidence and reproducibility.

Background: Three-dimensional (3D) acetabular orientation is a fundamental topic in orthopedic surgery. Computed tomography (CT) allows 3D measurement of native acetabular orientation, but with a substantial radiation dose. The EOS imaging system was developed to perform this kind of evaluation, but has not been validated in this indication with specific attention to the acetabulum.

Normative spino-pelvic parameters in patients with the lumbarization of S1 compared to a normal asymptomatic population.

Introduction: Normal spino-pelvic values for patients with lumbarization of S1 have not been described in the literature. Presented are the normal values for this population group, the prevalence of S1 lumbarization, and the correlation between pelvic incidence (PI) and lumbar lordosis (LL) in this group.

Methods: Two databases of asymptomatic patients were combined to identify 11 patients with the lumbarization of S1.

Normative values for the spine shape parameters using 3D standing analysis from a database of 268 asymptomatic Caucasian and Japanese subjects.

Purpose: Sagittal balance analysis has gained importance and the measure of the radiographic spinopelvic parameters is now a routine part of many interventions of spine surgery. Indeed, surgical correction of lumbar lordosis must be proportional to the pelvic incidence (PI). The compensatory mechanisms [pelvic retroversion with increased pelvic tilt (PT) and decreased thoracic kyphosis] spontaneously reverse after successful surgery.

Normative values for the L5 incidence in a subgroup of transitional anomalies extracted from 147 asymptomatic subjects.

Purpose: Pelvic incidence angle is not always measurable due to lumbosacral transitional vertebrae (LSV). The fifth lumbar vertebra (L5) is rarely abnormal. The purpose of this study was to quantify from full-body standing X-rays, the L5 incidence angle (L5I) in a normal asymptomatic population and to correlate it with standard spino-pelvic parameters taking the sacrum (S1) as a reference.

Lumbar scoliosis associated with spinal stenosis in idiopathic and degenerative cases.

Unlabelled: Degenerative de novo scoliosis is commonly present in older adult patients. The degenerative process including disc bulging, facet arthritis, and ligamentum flavum hypertrophy contributes to the appearance of symptoms of spinal stenosis. Idiopathic scoliosis has also degenerative changes that can lead to spinal stenosis.

Bone morphogenetic protein use in spine surgery-complications and outcomes: a systematic review.

Purpose: Because of significant complications related to the use of autologous bone grafts in spinal fusion surgery, bone substitutes and growth factors such as bone morphogenetic protein (BMP) have been developed. One of them, recombinant human (rh) BMP-2, has been approved by the Food and Drug Administration (FDA) for use under precise conditions. However, rhBMP-2-related side effects have been reported, used in FDA-approved procedures, but also in off-label use.

Clinical and radiological outcomes of lumbar posterior subtraction osteotomies are correlated to pelvic incidence and FBI index : Prospective series of 63 cases.

Purpose: Pedicle subtraction osteotomy (PSO) is one of the surgical options for treating alignment disorders of the fused spine (due to post-surgical fusion or related to arthritis). It enables satisfactory sagittal realignment and improved function due to economic sagittal balance. The aim of this study was to analyze clinical and radiological results of PSO after a minimum follow-up of 2 years and demonstrate the benefit of sub-group analysis as a function of pelvic incidence (PI).

Prospective study using anterior approach did not show association between Modic 1 changes and low grade infection in lumbar spine.

Introduction: The modern literature is producing a rapidly growing number of articles which highlight the relationship between infection and lumbar disc degeneration. However, the means by which samples are collected is questionable. Posterior approach surgery is not free from skin contamination.

Single-use instrumentation in posterior lumbar fusion could decrease incidence of surgical site infection: a prospective bi-centric study.

Purpose: Single-use surgical instruments were recently introduced to improve OR efficiency and reduce infection risks. This study aimed to investigate clinical results 1 year after instrumented lumbar fusion, with the aid of single-use surgical instruments, with particular attention to surgical site infection and Oswestry Disability Index (ODI).

Method: This prospective bi-centric study included 21 men and 28 women, aged 61.

Role of a collagen membrane in adhesion prevention strategy for complex spinal surgeries.

Purpose: Following lumbar spine surgery, postoperative complications can appear, including epidural adhesions. The formation of fibrosis around the dura mater can, on the one hand, lead to compression of the nerve roots with recurrent radicular pain and, on the other hand, can increase the risks of specific complications at spinal re-intervention (haematomas and dural breaches). The aim of this prospective monocentric study was to assess the safety of a new collagen antiadhesion membrane in vertebral osteotomy surgery where scar tissue and adhesions are important.

Insufficient restoration of lumbar lordosis and FBI index following pedicle subtraction osteotomy is an indicator of likely mechanical complication.

Purpose: Pedicle subtraction osteotomies (PSO) enable correction of spinal deformities but remain difficult and are associated with high complication rates. This study aimed to prospectively review different post-operative complications and mechanical problems in patients who underwent PSO as treatment for sagittal imbalance as sequelae of degenerative disc disease or previous spinal fusion.

Method: This was a descriptive prospective single center study of 63 patients who underwent sagittal imbalance correction by PSO.

Sagittal parameters of global cervical balance using EOS imaging: normative values from a prospective cohort of asymptomatic volunteers.

Objective: To define reference parameters for analyzing sagittal balance of the cervical spine in asymptomatic volunteers.

Methods: Prospective study after Bioethics Committee approval. Imaging performed using a low-dose radiographic system (EOS Imaging, Paris, France).

Thoracic osteotomy for Gorham-Stout disease of the spine: a case report and literature review.

Introduction: Gorham-Stout syndrome is an aggressive, non-heritable skeletal disease characterized by osteolysis following minor trauma. The primary involvement of the spine is less common (10 %) and has been described in only about 20 cases; there is no consensus about the best way to treat this condition.

Purpose Of The Study: To report a case of Gorham-Stout syndrome involving the thoracic spine and to review the literature to suggest a post-operative treatment to prevent osteolysis.

Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review.

The measure of radiographic pelvic and spinal parameters for sagittal balance analysis has gained importance in reconstructive surgery of the spine and particularly in degenerative spinal diseases (DSD). Fusion in the lumbar spine may result in loss of lumbar lordosis (LL), with possible compensatory mechanisms: decreased sacral slope (SS), increased pelvic tilt (PT) and decreased thoracic kyphosis (TK). An increase in PT after surgery is correlated with postoperative back pain.

Pelvic parameters: origin and significance.

Introduction: The adoption by humans of an upright position resulted in broadening and verticalisation of the pelvis together with the appearance of characteristic spinal curves, has profoundly modified the structure of the muscles supporting the spine.

Material: In order to characterise the sagittal balance of the pelvis, it is necessary to define parameters based on notable biomechanical forces involved in the transmission of constraints. The angle of incidence was constructed to enable reproducible analysis of the anatomical characteristics of the pelvis in the sagittal plane.