Emmanuelle Ferrero1,2, Wafa Skalli3, Virginie Lafage4, Cédric Maillot3, Robert Carlier5, Antoie Feydy6, Adrien Felter5, Marc Khalifé7, Pierre Guigui7. 1. Department of Orthopaedic Surgery, Hopital Européen Georges Pompidou, APHP, Paris V University, 20 Rue Leblanc, 75015, Paris, France. emmanuelle.ferrero@aphp.fr. 2. Laboratoire de biomécanique Georges Charpak, Ecole Nationale supérieure Des Arts Et métiers, 75013, Paris, France. emmanuelle.ferrero@aphp.fr. 3. Laboratoire de biomécanique Georges Charpak, Ecole Nationale supérieure Des Arts Et métiers, 75013, Paris, France. 4. SpineLab, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. 5. Department of Radiology, Hopital de Garches, APHP, Garches, France. 6. Department of Radiology, Hopital Cochin, APHP, Paris V University, Paris, France. 7. Department of Orthopaedic Surgery, Hopital Européen Georges Pompidou, APHP, Paris V University, 20 Rue Leblanc, 75015, Paris, France.
Abstract
INTRODUCTION: While the clinical impact of coronal and sagittal alignment in adult spinal deformity (ASD) patients (pts) is established, there is a paucity of data in terms of axial plane deformity and potential association between muscle degeneration and 3D deformity. The purpose of this study was to analyze spinopelvic muscles characteristics in association with the 3D deformity of ASD patients. METHODS: This is a prospective cohort study; primary lumbar scoliosis patients (Cobb > 20°) were enrolled and sustained a low-dose X-rays with 3D spinal reconstructions and a fat/water separation MRI (from C7 to the knee). Volumetric 3D reconstructions and fat infiltration (FI) of 6 muscles groups were performed. Relationships between muscular data, radiographic parameters and health-related quality of life were investigated. Patients were stratified and compared based on the SRS classification, the odontoid-hip axis (ODHA) angle (> or < 6.1°) and occurrence of rotatory subluxation. RESULTS AND DISCUSSION: Twenty-eight patients were enrolled with a mean age of 60 ± 16yo and mean body mass index of 26 ± 4 kg/m2 without differences between groups. There were a moderate sagittal malalignment and a Cobb angle of 45 ± 11° (table). Muscular volume was smaller in patients with more severe deformity (p > 0.05). Pts with ODHA > 6.1° or pelvic incidence minus lumbar lordosis > 10° had significantly higher FI for the 6 muscular groups, patients with pelvic tilt > 20° had significantly higher FI for erector spinae, hip flexors and extensors (p < 0.05). SF36-PCS significantly correlated with the muscular volume; SRS and Oswestry disability index correlated with the erectors spinae volume (p < 0.05). CONCLUSION: This study analyzed for the first time the relationship between 3D radiographic parameters and muscular characteristics in ASD. Sagittal malalignment is associated with increased FI and decreased muscle volumes with poor outcomes. These slides can be retrieved under Electronic Supplementary Material.
INTRODUCTION: While the clinical impact of coronal and sagittal alignment in adult spinal deformity (ASD) patients (pts) is established, there is a paucity of data in terms of axial plane deformity and potential association between muscle degeneration and 3D deformity. The purpose of this study was to analyze spinopelvic muscles characteristics in association with the 3D deformity of ASD patients. METHODS: This is a prospective cohort study; primary lumbar scoliosispatients (Cobb > 20°) were enrolled and sustained a low-dose X-rays with 3D spinal reconstructions and a fat/water separation MRI (from C7 to the knee). Volumetric 3D reconstructions and fat infiltration (FI) of 6 muscles groups were performed. Relationships between muscular data, radiographic parameters and health-related quality of life were investigated. Patients were stratified and compared based on the SRS classification, the odontoid-hip axis (ODHA) angle (> or < 6.1°) and occurrence of rotatory subluxation. RESULTS AND DISCUSSION: Twenty-eight patients were enrolled with a mean age of 60 ± 16yo and mean body mass index of 26 ± 4 kg/m2 without differences between groups. There were a moderate sagittal malalignment and a Cobb angle of 45 ± 11° (table). Muscular volume was smaller in patients with more severe deformity (p > 0.05). Pts with ODHA > 6.1° or pelvic incidence minus lumbar lordosis > 10° had significantly higher FI for the 6 muscular groups, patients with pelvic tilt > 20° had significantly higher FI for erector spinae, hip flexors and extensors (p < 0.05). SF36-PCS significantly correlated with the muscular volume; SRS and Oswestry disability index correlated with the erectors spinae volume (p < 0.05). CONCLUSION: This study analyzed for the first time the relationship between 3D radiographic parameters and muscular characteristics in ASD. Sagittal malalignment is associated with increased FI and decreased muscle volumes with poor outcomes. These slides can be retrieved under Electronic Supplementary Material.
Authors: Jonathan Charles Elysee; Francis Lovecchio; Renaud Lafage; Bryan Ang; Alex Huang; Mathieu Bannwarth; Han Jo Kim; Frank Schwab; Virginie Lafage Journal: Eur Spine J Date: 2021-02-20 Impact factor: 3.134