RESUMEN
OBJECTIVES: Report the use of an optical technique for individual monitoring of the sagittal morphology of the spine in an upright position while avoid irradiation. SUBJECTS AND METHODS: The series consists of 15 asymptomatic subjects and 326 cases with spinal disorders. Sagittal analysis is expressed by the global trunk tilt (GTT), the intensity of the curves and their level of inflection. RESULTS: The confidence interval is 2 to 3° and 3 to 6mm according to the parameters. A significant correlation was observed for the global axis measured by optical or radiological techniques. Variations in intensity and proportion of thoracic and lumbar sagittal curves were observed according to the disease, as well as their evolution over a period of 5 to 30 months. Various "strategies" of adaptation have been observed during repeated examinations. DISCUSSION: This non-radiating technique allows to be repeated after initial X-rays, for regular monitoring of a disturbance or a therapeutic effect. Its understandable imaging allows the patient to be aware of his situation. CONCLUSION: This optical technique is reliable and safe for monitoring the sagittal balance while helping further therapeutic target.
Asunto(s)
Antropometría/métodos , Dispositivos Ópticos , Examen Físico/métodos , Curvaturas de la Columna Vertebral/diagnóstico , Traumatismos Vertebrales/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antropometría/instrumentación , Dolor de Espalda/etiología , Niño , Intervalos de Confianza , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Postura , Traumatismos por Radiación/prevención & control , Radiografía , Reproducibilidad de los Resultados , Curvaturas de la Columna Vertebral/diagnóstico por imagen , Curvaturas de la Columna Vertebral/fisiopatología , Fracturas de la Columna Vertebral/diagnóstico , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/fisiopatología , Traumatismos Vertebrales/diagnóstico por imagen , Traumatismos Vertebrales/fisiopatología , Adulto JovenRESUMEN
BACKGROUND: Three-dimensional (3D) reconstructions of the spine in the upright position are classically obtained using two-dimensional, non-simultaneous radiographic imaging. However, a subject's sway between exposures induces inaccuracy in the 3D reconstructions. PURPOSE: To evaluate the impact of patient sway between successive radiographic exposures, and to test if 3D reconstruction accuracy can be improved by a corrective method with simultaneous Moire-X-ray imaging. MATERIAL AND METHODS: Using a calibrated deformable phantom perceptible by both techniques (Moire and X-ray), the 3D positional and rotational vertebral data from 3D reconstructions with and without the corrective procedure were compared to the corresponding data of computed tomography (CT) scans, considered as a reference. All were expressed in the global axis system, as defined by the Scoliosis Research Society. RESULTS: When a sagittal sway of 10 degrees occurred between successive biplanar X-rays, the accuracy of the 3D reconstruction without correction was 8.8 mm for the anteroposterior vertebral locations and 6.4 degrees for the sagittal orientations. When the corrective method was applied, the accuracy was improved to 1.3 mm and 1.5 degrees , respectively. CONCLUSION: 3D accuracy improved significantly by using the corrective method, whatever the subject's sway. This technique is reliable for clinical appraisal of the spine, if the subject's sway does not exceed 10 degrees . For greater sway, improvement persists, but a risk of lack of accuracy exists.
Asunto(s)
Aumento de la Imagen/métodos , Imagenología Tridimensional/métodos , Movimiento , Columna Vertebral/diagnóstico por imagen , Humanos , Técnicas In Vitro , Fantasmas de Imagen , Postura , RadiografíaRESUMEN
PURPOSE OF THE STUDY: Implantation of total hip arthroplasties raises several important questions concerning the relationship between the orientation of the lumbosacral joint and the acetabular-femoral joint; in other words, between the position of the patients trunk and the orientation of the acetabula. To elucidate better these complex relationships, we conducted a morphometry study on a sample of 51 dry pelves: pelv 26 female and 25 male specimens. MATERIAL AND METHODS: Three-dimensional coordinates of 47 homologous points were recorded for each pelvis. Data were then processed with De-Visu, a graphic visualization software. Seven parameters were compared: sacral slope, sacral incidence, and five parameters quantifying the three-dimensional orientation of the acetabula. RESULTS: The graphic modelization enabled an integral 3-D visualization of each pelvis. The sagittal view enabled simultaneous visualization of the sacrum, the sacroiliac joints, the acetabula, and their alignments, as well as the variability of their spatial relation. The position reference chosen to simulate the upright position aligned the anterior iliac spines and the superior pubic point. This position was found pertinent because the mean value of the sacral slope (41.8) and the sacral incidence (54) were not different from published series. The sacral slope was the most strongly correlated with the acetabular parameters. It exhibited a positive correlation with sagittal acetabular slope (r=0.59) and acetabular inclination (r=0.59). It exhibited a negative correlation with acetabular anteversion (R=0.45). The correlation with the sagittal acetabular slope was very strong for anteversion (r=0.92), and rose with acetabular inclination (r=-0.66). The angle formed by the two acetabular axes was highly variable (37). The correlation between this angle and inclination was very high in males (r=-0.88) and non-significant in females. There was however a very strong correlation with anteversion in females (r=-0.74) which was non-significant in males. This contrasting finding was related to the wide spread of the inclination values in males and anteversion values in females. DISCUSSION: We demonstrated a new sagittal parameter: the acetabular incidence. The summit of this angle is the center of the acetabulum. The sides are the pelvic thickness and the acetabular axes. This parameter was negatively correlated with the sacral incidence. It account simultaneously for the sagittal position of the sacrum in relation to the acetabula and for the degree of acetabular anteversion and inclination. We have demonstrated that the geometric sum of these two angles, sacral incidence and acetabular incidence, is equivalent to the sacro-acetabular angle demonstrated by Lazennec and Saillant. These authors showed that the sacro-acetabular angle is the sum of two positional parameters, the sacral slope and the sagittal acetabular tilt (or slope). The three angles -- sacral incidence, acetabular incidence, sacro-acetabular angle -- are anatomic angles which do not vary with the pelvic position.
Asunto(s)
Acetábulo/anatomía & histología , Sacro/anatomía & histología , Cadáver , Femenino , Humanos , Masculino , MatemáticaRESUMEN
The sagittal morphology of the pelvis determines the amount of lordosis needed for each individual. The proper harmony of the sagittal spinal curves allows a stable balance, economical in terms of mechanical effects and muscular energy. A previous barycentremetrical laboratory study allowed us to demonstrate that the axis of gravity of the upper body segment was located behind the lumbar vertebrae and the femoral heads, thus ensuring economy and stability. The determination of the anatomical connection of the individual gravity is thus of primary importance for the evaluation of sagittal balance. Data for 42 patients without spinal pathology, previously evaluated by barycentremetry, were used to establish a predictive equation for the application point of the gravity at the level of the third lumbar vertebra (L3). This equation, using anthropometric and radiographic pelvic and spinal parameters, was integrated into a software program called Similibary. It was applied to the same 42 subjects. These results were compared in order to validate the method. No significant difference was observed between the two techniques. This easy-to-use tool allows a personalised evaluation of the sagittal balance of the spine, both through the evaluation of the harmonious relationship between the spinal curves and the pelvis, and through the location of gravity supported by the vertebral structures in L3.
Asunto(s)
Gravitación , Postura , Programas Informáticos , Columna Vertebral/anatomía & histología , Adolescente , Adulto , Fenómenos Biomecánicos , Femenino , Humanos , Masculino , Valores de Referencia , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVE: The line joining the two iliac crests is classically regarded as the anatomical landmark determining the inter-vertebral space L4-L5 for the spinal punctures. Its variability has been reported but never related to predictive clinical anatomic factors identifying patients groups in which there is increased risk of miscalculation of the spinal level. METHODS: Two sagittal pelvic anatomical angles, called 'pelvic incidence' and 'pelvic lordosis' were measured on lateral X-rays of the pelvis of 132 normal individuals and 49 spondylolysis patients. The values were compared with the sagittal projection of the intercrestal line on the disco-vertebral lumbar structures. RESULTS: A strict relation was observed between this projection of the intercrestal line and the sagittal pelvic anatomical angles. The greater the pelvic incidence, the higher the intercrestal line was projected, all the more in patients with spondylolysis with a listhesis or a disc narrowing. CONCLUSIONS: The relation between the pelvic sagittal angles and the intercrestal line projection explains the variability described for this anatomical landmark. It implies precautions minimizing neurological risk in the case of a puncture carried out more cranially than expected, particularly for high values of pelvic incidence occurring in spinal pathologies such as spondylolysis, in the elderly or in the obese patients. In these cases, we recommend the use of spinal imaging during the procedure to assist selection of the desired insertion level.
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Huesos Pélvicos/anatomía & histología , Espondilólisis/diagnóstico por imagen , Adolescente , Adulto , Anciano , Femenino , Humanos , Lordosis/diagnóstico por imagen , Masculino , Ilustración Médica , Persona de Mediana Edad , Huesos Pélvicos/diagnóstico por imagen , Radiografía , Valores de Referencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Espondilolistesis/diagnóstico por imagenRESUMEN
Pelvis and spinal curves were studied with an angular parameter typical of pelvis morphology: pelvic incidence. A significant chain of correlations between positional pelvic and spinal parameters and incidence is known. This study investigated standards of incidence and a predictive equation of lordosis from selective pelvic and spinal individual parameters. One hundred and forty nine (78 men and 71 women) healthy adults, aged 19-50 years, with no spinal disorders, were included and had a full-spine lateral X-ray in a standardised upright position. Computerised technology was used for the measurement of angular parameters. Mean-deviation section of each parameter and Pearson correlation test were calculated. A multivariate selection algorithm was running with the lordosis (predicted variable) and the other spinal and pelvic parameters (predictor variables), to determine the best sets of predictors to include in the model. A low incidence (<44 degrees ) decreased sacral-slope and the lordosis is flattened. A high incidence (>62 degrees ) increased sacral-slope and the lordosis is more pronounced. Lordosis predictive equation is based on incidence, kyphosis, sacral-slope and +/-T9 tilt. The confidence limits and the residuals (the difference between measured and predicted lordosis) assessed the predicted lordosis accuracy of the model: respectively, +/-1.65 and 2.41 degrees with the 4-item model; +/-1.73 and 3.62 degrees with the 3-item model. The ability of the functional spine-pelvis unit to search for a sagittal balance depended both on the incidence and on the variation section of the other positional parameters. Incidence gave an adaptation potential at two levels of positional compensation: overlying state (kyphosis, T9 tilt), underlying state (sacral slope, pelvic tilt). The biomechanical and clinical conditions of the standing posture (as in scoliosis, low back pain, spondylisthesis, spine surgery, obesity and postural impairments) can be studied by comparing the measured lordosis with the predicted lordosis.
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Huesos Pélvicos/anatomía & histología , Columna Vertebral/anatomía & histología , Adulto , Antropometría , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Biológicos , Huesos Pélvicos/diagnóstico por imagen , Postura , Radiografía , Reproducibilidad de los Resultados , Factores Sexuales , Columna Vertebral/diagnóstico por imagenRESUMEN
PURPOSE OF THE STUDY: The dynamic neutralization system (Dynesis) has been proposed for the treatment of symptomatic lumbar discopathy. This system preserves the mobility of the instrumented vertebral segment and restores discal height by posterior distraction on pedicular screws, stabilization being ensured by compression on a spacer. The potential kyphosing effect of this system and the impact on sagittal morphology of the spine were analyzed. MATERIAL AND METHODS: Twenty-six patients were studied. Lateral x-rays of the lumbar spine in the upright position were obtained before and after the surgical procedure and at mean 9.5 +/- 3.3 months follow-up. Comparisons were made between the pre- and postoperative presentation with measurement of the pelvic and spinal sagittal parameters described by Duval-Beaupère: inclination of the pelvic segment on the sacrum, lordosis, and disc wedge angles at each level (particularly the instrumented levels). Sagittal morphology was assessed pre- and postoperatively. RESULTS: Mean kyphosing effect was 6 +/- 1.4 degrees, induced by the posterior distraction system. This accentuated the initial lumbar hypolordosis related to the degenerative disease. Comparison of the pre- and postoperative films revealed four types of sagittal reaction of the lumbopelvic segment: no modification (type A), significant loss of lordosis without change at the pelvis level (type B) or with compensatory pelvic retroversion (type C), accentuation of the lordosis with pelvic anteversion (type D). CONCLUSION: The dynamic neutralization system (Dynesis) can stabilize degenerative discopathy and protect the adjacent levels. Posterior distraction perturbs the initial hypokyphosis and can lead to pelvic compensation to achieve better dynamic balance. This loss of lordosis is however a cause of excessive mechanical stress on the lumbar structures and can lead to long-term degradation. Future developments of this dynamic system should take into account the essential factor of sagittal balance.
Asunto(s)
Desplazamiento del Disco Intervertebral/cirugía , Cifosis/etiología , Osteogénesis por Distracción , Adulto , Tornillos Óseos , Femenino , Humanos , Vértebras Lumbares/patología , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
An inguinal arthrosynovial cyst of the hip joint developed after total hip arthroplasty leading to compression of the femoral vein. This complication occurred after implantation of a non-cemented prosthesis with a ceramic-on-ceramic interface inserted in a polyethylene sandwich. Multiple foreign bodies composed of both ceramic and polyethylene particles were visualized microscopically. Later, rupture of the joint interface required implant replacement. This cyst was a precursor sign of a deteriorating prosthesis surface.
Asunto(s)
Articulación de la Cadera , Prótesis de Cadera/efectos adversos , Quiste Sinovial/etiología , Cerámica , Humanos , Masculino , Persona de Mediana Edad , Diseño de PrótesisRESUMEN
The anatomic pelvic parameter "incidence" - the angle between the line perpendicular to the middle of the sacral plate and the line joining the middle of the sacral plate to the center of the bicoxo-femoral axis - has been shown to be strongly correlated with the sacral slope and lumbar lordosis, and ensures the individual an economical standing position. It is important for determining the sagittal curve of the spine. The angle of incidence has also been shown to depend partly on the sagittal anatomy of sacrum, which is established in childhood while learning to stand and walk. The purpose of this study was (1) to define the relationship between the sacrum and the angle of incidence, and (2) to compare these parameters in three populations: young adults, infants before walking, and patients with spondylolisthesis. Forty-four normal young adults, 32 infants not yet walking and 39 patients with spondylolisthesis due to isthmic spondylolysis underwent a sagittal full-spine radiography. A graphic table and the software for bidimensional study of the sacrum developed by J. Hecquet were used to determine various anatomic and positional parameters. Comparison tests of means, and multiple and partial correlation tests were used. A study of the reliability of the measurements using factorial plan methods was performed. The sagittal anatomic parameters of the sacrum were found to have a close relationship with the pelvic parameter of incidence angle, and therefore with the sagittal balance of the spine. The anatomy of the sacrum in spondylolisthesis patients is particular in that some features are much like those of young infants, but it is more curved and the incidence angle is significantly larger. There is a close relationship between angle of incidence and the slip of spondylolisthesis. All the parameters of young infants are significantly smaller than those of adults. It can be concluded that the sagittal anatomy of the sacrum plays a key role in spinal sagittal balance. The sacral bone is an integral a part of the pelvis and constitutes the undistorted part of the spinal curves. Organization of sagittal curves during growth can be followed up by looking at the sacrum. The sacrum in the spondylolisthesis group differs from the normal, and the greater angle of incidence and sacral slope in this group could predispose to vertebral slip.
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Envejecimiento/fisiología , Sacro/diagnóstico por imagen , Espondilolistesis/diagnóstico por imagen , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Radiografía , Sacro/anatomía & histologíaAsunto(s)
Pelvis/diagnóstico por imagen , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Enfermedades de la Columna Vertebral/patología , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/patología , Animales , Humanos , Incidencia , Pan troglodytes , Radiografía , Enfermedades de la Columna Vertebral/epidemiologíaRESUMEN
Forty-five consecutive patients operated between 1986 and 1995 were evaluated to assess the long term results of patellofemoral arthroplasty. Revision had to be performed in 8 cases for the following reasons: loosening (3), lateral impingement (3), malposition (1) and persistent patella instability (1). Two groups of patients were identified based upon the preoperative assessment: 21 had primary osteoarthritis without anatomic malalignment (group C) and 24 had a history of patellofemoral instability and trochlear dysplasia demonstrated by clinical and radiological evaluation (group D). Only 43% of good results were found in group C whereas in group D, the percentage of good results was close to 83%. The most common cause of poor results in group C was the degenerative involvement of the femorotibial compartments (5 patients had to undergo total knee arthroplasty subsequently). For group D patients, femorotibial osteoarthritis was not a determinant factor as regards the outcome of patellofemoral arthroplasty. To the authors, it appears that the best indication for patellofemoral arthroplasty is femoropatellar osteoarthritis with malalignment in patients having a normal femorotibial axis even in the presence of femorotibial osteoarthritis as long as the latter does not exceed grade II.
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Artroplastia de Reemplazo/métodos , Fémur/cirugía , Rótula/cirugía , Adulto , Anciano , Artroplastia de Reemplazo/efectos adversos , Artroplastia de Reemplazo de Rodilla , Femenino , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/cirugía , Prótesis Articulares/efectos adversos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Osteoartritis/complicaciones , Osteoartritis/cirugía , Osteocondrodisplasias/complicaciones , Osteocondrodisplasias/cirugía , Falla de Prótesis , Reoperación , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Osteonecrosis/diagnóstico , Enfermedades de la Columna Vertebral/diagnóstico , Biopsia , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Osteonecrosis/etiología , Factores de Riesgo , Sensibilidad y Especificidad , Enfermedades de la Columna Vertebral/etiología , Tomografía Computarizada por Rayos XRESUMEN
Lipoma arborescens is a villous lipomatous proliferation of the synovial membrane characterized by chronic and painless synovial effusion. The aetiology is unknown. It has to be included in the differential diagnosis of chronic monoarticular disease in childhood. Magnetic resonance imaging provides a highly efficient tool for the diagnosis of this very rare condition. This is indeed the fourth paediatric case reported. Rather than resorting to the often inconvenient surgical synovectomy commonly recommended, we chose to treat the knee of this 13-yr-old boy with intra-articular osmic acid.
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Articulación de la Rodilla/patología , Lipoma/diagnóstico , Sinovitis/diagnóstico , Adolescente , Diagnóstico Diferencial , Humanos , Artropatías/tratamiento farmacológico , Artropatías/patología , Articulación de la Rodilla/diagnóstico por imagen , Lipoma/tratamiento farmacológico , Imagen por Resonancia Magnética , Masculino , Tetróxido de Osmio/uso terapéutico , Dolor/etiología , Radiografía , Membrana Sinovial/patología , Sinovitis/tratamiento farmacológicoRESUMEN
Scoliotic curvatures can only be assessed through three-dimensional (3D) procedures. Measurement of the axial vertebral rotation appears to be of primary importance for such techniques. Nevertheless, traditional methods are based only on 2D data, obtained through antero-posterior radiographic projections of the spine. A 3D method is described in this study, taking into account the sagittal tilt of the vertebrae. Only such a measurement provides a real 3D method for a true appraisal of the scoliotic spine. The practical implications are developed.
Asunto(s)
Procesamiento de Imagen Asistido por Computador , Escoliosis/diagnóstico por imagen , Artefactos , Humanos , Radiografía , Rotación , Columna Vertebral/diagnóstico por imagenRESUMEN
This paper proposes an anatomical parameter, the pelvic incidence, as the key factor for managing the spinal balance. Pelvic and spinal sagittal parameters were investigated for normal and scoliotic adult subjects. The relation between pelvic orientation, and spinal sagittal balance was examined by statistical analysis. A close relationship was observed, for both normal and scoliotic subjects, between the anatomical parameter of pelvic incidence and the sacral slope, which strongly determines lumbar lordosis. Taking into account the Cobb angle and the apical vertebral rotation confers a three-dimensional aspect to this chain of relations between pelvis and spine. A predictive equation of lordosis is postulated. The pelvic incidence appears to be the main axis of the sagittal balance of the spine. It controls spinal curves in accordance with the adaptability of the other parameters.
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Pelvis/anatomía & histología , Postura , Columna Vertebral/anatomía & histología , Adulto , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Valores de Referencia , Escoliosis/patología , Escoliosis/fisiopatología , Columna Vertebral/patología , Columna Vertebral/fisiopatologíaRESUMEN
Femoral vein compression by a synovial cyst of the hip is described, and the differential diagnosis is discussed. Such a lesion may be associated with rheumatoid arthritis, idiopathic necrosis of the femoral head or acute arthritis. The various clinical patterns are reviewed.
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Vena Femoral , Articulación de la Cadera/cirugía , Quiste Sinovial/complicaciones , Constricción Patológica , Edema/etiología , Femenino , Humanos , Persona de Mediana Edad , Quiste Sinovial/cirugíaRESUMEN
Two cases of "camptocormia" or progressive and reducible kyphosis acquired in the elderly are reported. This sagittal imbalance of the spine is induced by fatty involution of the paravertebral muscles. One case was symmetrical, the other one unilateral. This rare pathology should be considered during the spinal examination. Bony fusion is problematic owing to the muscular insufficiency. The primary treatment is medical, by strengthening and corticotherapy.
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Envejecimiento/metabolismo , Cifosis/metabolismo , Metabolismo de los Lípidos , Enfermedades Musculares/metabolismo , Anciano , Femenino , Humanos , Cifosis/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Músculos/metabolismo , Enfermedades Musculares/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
The authors report the case of a 62-year-old patient whose desire to recover mobility of the knee, arthrodesed 22 years ago, led them to perform a total arthroplasty. The result was satisfactory. The contraindications and implications of such procedures are discussed with reference to 13 other cases reported in the literature.
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Artrodesis , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla , Femenino , Humanos , Persona de Mediana Edad , ReoperaciónRESUMEN
The authors report their clinical experience with Graf's supple intervertebral stabilization system. The results are discussed with respect to the biomechanical and clinical definitions of vertebral instability and the natural evolution of degenerative disease of the lumbar spine. The result are favorable for the cases with clinical instability, but are not as good for the degenerative cases or after discectomy. In spite of the short-term clinical benefits for the cases with pathological articular hypermobility, the authors are cautious regarding the use of this technique. They emphasize the unknown long-term clinical and biomechanical evolution and the difficulties encountered for secondary arthrodesis caused by the volume of the pedicular screws.
Asunto(s)
Tornillos Óseos , Ligamentos/cirugía , Enfermedades de la Columna Vertebral/cirugía , Adulto , Anciano , Fenómenos Biomecánicos , Femenino , Humanos , Inestabilidad de la Articulación/cirugía , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Radiografía , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Enfermedades de la Columna Vertebral/fisiopatologíaRESUMEN
A case of vertebral necrosis of L4 is reported in a young woman without previous steroid therapy. Only the intraoperative histological examination was able to confirm the diagnosis as a benign vertebral collapse, because the CT scan and MR imaging were suggestive of a malignant involvement. The authors report the various criteria proposed to distinguish benign and malignant vertebral collapse with magnetic resonance imaging. These equivocal criteria should be viewed within the context of tissue replacement within the necrotic area during the evolution. Transpedicular biopsy is emphasized. Only the histological examination is specific and allows right planning of the surgical procedure.