Validation of a new computer-assisted tool to measure spino-pelvic parameters

Lafage, Renaud; Ferrero, Emmanuelle; Henry, Jensen K.; Challier, Vincent; Diebo, Bassel G.; Liabaud, Barthélemy; Lafage, Virginie; Schwab, Frank J.

doi:10.1016/j.spinee.2015.08.067

Cited by 184 publications

(115 citation statements)

References 29 publications

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“…Full-body lateral radiographs were analyzed using a dedicated and validated software 31 . The following sagittal radiographic parameters were evaluated.…”

Section: Methodsmentioning

confidence: 99%

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Predicting Cervical Alignment Required to Maintain Horizontal Gaze Based on Global Spinal Alignment

Diebo

Challier²,

Henry

et al. 2016

Spine

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Study Design-Retrospective cohortObjective-To investigate the cervical alignment necessary for the maintenance of horizontal gaze depends on underlying thoracolumbar alignment Summary of Background Data-Cervical curvature (CC) is affected by thoracic and global alignment. Recent studies suggest large variability in normative CC ranging from lordotic to kyphotic alignment. No previous studies have assessed the effect of global spinal alignment on CC in maintenance of horizontal gaze.Methods-Patients without previous history of spinal surgery and were able to maintain their horizontal gaze while undergoing full body imaging were included. Patients were stratified based on thoracic kyphosis (TK) into (<30, 30-40, 40-50 and >50) then by SRS-Schwab sagittal vertical axis (SVA) modifier into (posterior alignment SVA<0, aligned 0-50 and malaligned >50mm). Cervical alignment was assessed among SVA grade in TK groups. Stepwise linear regression analysis was applied on random selection of 60% of the population. A simplified formula was developed and validated on the remaining 40%. each TK group (n=118, 137, 125, 197), lower cervical curvature (C2-C7) was significantly more lordotic by increased Schwab SVA grade. T1 slope and cervical SVA significantly increased with increased thoracolumbar (C7-S1) SVA. Upper cervical curvature (C0-C2) and mismatch between T1 slope and cervical curvature (T1-CL) were similar. Regression analysis revealed LL minus TK (LL-TK) as an independent predictor (r=0.640, r2=0.410) with formula: CC = 10 -(LL-TK)/2. Validation revealed that the absolute difference between the Results-In

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“…Full-body lateral radiographs were analyzed using a dedicated and validated software 31 . The following sagittal radiographic parameters were evaluated.…”

Section: Methodsmentioning

confidence: 99%

“…For validation, the percentage of patients with predicted CC within 10° of their actual CC was investigated. ISO (International Organization of Standardization) reproducibility of lower CC used in this software was 5.87° 31 . Level of significance was set at p < 0.05.…”

Section: Methodsmentioning

confidence: 99%

Predicting Cervical Alignment Required to Maintain Horizontal Gaze Based on Global Spinal Alignment

Diebo

Challier²,

Henry

et al. 2016

Spine

Self Cite

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“…Standing films were analyzed for sagittal parameters in a standardized fashion by using validated software (Surgimap). 19 Primary radiographic outcome measures included pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), PI-LL mismatch, and sagittal vertical axis (SVA). In addition, measurements of the disc height at the posterior vertebral body, segmental angle, and sagittal angle and of the amount of listhesis (measured by the offset of posterior vertebral body wall in millimeters) were also collected.…”

Section: Clinical and Radiographic Assessmentmentioning

confidence: 99%

Assessment of radiographic and clinical outcomes of an articulating expandable interbody cage in minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis

Massie¹,

Zakaria²,

Schultz

et al. 2018

Neurosurgical Focus

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OBJECTIVEThe inability to significantly improve sagittal parameters has been a limitation of minimally invasive surgery for transforaminal lumbar interbody fusion (MIS TLIF). Traditional cages have a limited capacity to restore lordosis. This study evaluates the use of a crescent-shaped articulating expandable cage (Altera) for MIS TLIF.METHODSThis is a retrospective review of 1- and 2-level MIS TLIF. Radiographic outcomes included differences in segmental and lumbar lordosis, disc height, evidence of fusion, and any endplate violations. Clinical outcomes included the numeric rating scale for leg and back pain and the Oswestry Disability Index (ODI) for low-back pain.RESULTSThirty-nine patients underwent single-level MIS TLIF, and 5 underwent 2-level MIS TLIF. The mean age was 63.1 years, with 64% women. On average, spondylolisthesis was corrected by 4.3 mm (preoperative = 6.69 mm, postoperative = 2.39 mm, p < 0.001), the segmental angle was improved by 4.94° (preoperative = 5.63°, postoperative = 10.58°, p < 0.001), and segmental height increased by 3.1 mm (preoperative = 5.09 mm, postoperative = 8.19 mm, p < 0.001). At 90 days after surgery the authors observed the following: a smaller postoperative sagittal vertical axis was associated with larger changes in back pain at 90 days (r = −0.558, p = 0.013); a larger decrease in spondylolisthesis was associated with greater improvements in ODI and back pain scores (r = −0.425, p = 0.043, and r = −0.43, p = 0.031, respectively); and a larger decrease in pelvic tilt (PT) was associated with greater improvements in back pain (r = −0.548, p = 0.043). For the 1-year PROs, the relationship between the change in PT and changes in ODI and numeric rating scale back pain were significant (r = 0.612, p = 0.009, and r = −0.803, p = 0.001, respectively) with larger decreases in PT associated with larger improvements in ODI and back pain. Overall for this study there was a 96% fusion rate.Fourteen patients were noted to have endplate violation on intraoperative fluoroscopy during placement of the cage. Only 3 of these had progression of their subsidence, with an overall subsidence rate of 6% (3 of 49) visible on postoperative CT.CONCLUSIONSThe use of this expandable, articulating, lordotic, or hyperlordotic interbody cage for MIS TLIF provides a significant restoration of segmental height and segmental lordosis, with associated improvements in sagittal balance parameters. Patients treated with this technique had acceptable levels of fusion and significant reductions in pain and disability.

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“…All measurements were done with SurgiMap Version 1.2.1.70 [11]. On standing lateral radiographs, all single level angles were measured from the superior endplate of the upper vertebra to the inferior endplate of the lower vertebra (L1 / L2, L2 / L3, L3 / L4, L4 / L5).…”

Section: Radiographic Measurementsmentioning

confidence: 99%

Comparison of Lumbar Lordosis in Lateral Radiographs in Standing Position with supine MR Imaging in consideration of the Sacral Slope

Benditz¹,

Boluki²,

Weber³

et al. 2016

Fortschr Röntgenstr

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ZUSAMMENFASSUNGZiel Ziel dieser retrospektiven Studie war es, den Einfluss des "Sacral Slope" auf den Zusammenhang zwischen der gemessenen lumbalen Lordose in lateralen Röntgenaufnahmen der Wirbelsäule im Stehen und liegenden MRT Aufnahmen zu untersuchen. Dieser Zusammenhang ist in der Literatur weitgehend unbekannt. Bisherige Studien haben Zusammenhänge für die thorakale Wirbelsäule gezeigt, jedoch nicht für die lumbalen Anteile. Methods MR images and standing lateral radiographs of 63 patients without actual low back pain or radiographic pathologies of the lumbar spine were analyzed. Standing radiographic measurements included the sagittal parameters pelvic incidence (PI) pelvic tilt (PT), and sacral slope (SS); MR images were used to additionally measure lumbar L1-S1 lordosis and single level lordosis. Differences between radiographic and MRI measurements were analyzed and divided into 4 subgroups of different sacral slope according to Roussouly's classification.Results Global lumbar lordosis (L1-S1) was 44.99°(± 10 754) on radiographs and 47.91°(± 9.170) on MRI, yielding a clinically relevant correlation (r = 0.61, p < 0.01). Measurements of single level lordosis only showed minor differences. At all levels except for L5 / S1, lordosis measured by means of standing Musculoskeletal System 233Benditz A et al.

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Validation of a new computer-assisted tool to measure spino-pelvic parameters

Cited by 184 publications

References 29 publications

Predicting Cervical Alignment Required to Maintain Horizontal Gaze Based on Global Spinal Alignment

Predicting Cervical Alignment Required to Maintain Horizontal Gaze Based on Global Spinal Alignment

Assessment of radiographic and clinical outcomes of an articulating expandable interbody cage in minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis

Comparison of Lumbar Lordosis in Lateral Radiographs in Standing Position with supine MR Imaging in consideration of the Sacral Slope

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