Solène Prost

To determine clinical and radiographic factors associated with early progression of hip osteoarthritis following long lumbosacral fusion, and to identify independent predictors of rapid joint space narrowing. This retrospective single-centre study included 119 patients (mean age 67.4 ± 8.6 years) who underwent long posterior fusion (≥ five levels across L5-S1). The most affected hip-defined by the smallest preoperative joint space width (JSW)-was analysed on standing EOS radiographs. Rapid progression was defined as JSW loss > 0.5 mm/year. Clinical, surgical, and spinopelvic parameters were compared between progression and non-progression groups. Variables with p < 0.10 in univariate analysis were entered into a multivariate logistic regression model. Rapid progression occurred in 37.8% of patients. The progression group showed higher BMI (27.9 ± 5.8 vs 25.1 ± 4.4, p = 0.018), greater pelvic incidence (PI) (58.1 ± 9.8 vs 51.4 ± 10.6°, p = 0.014), and higher postoperative sagittal vertical axis (SVA) (61.2 ± 46.9 vs 42.8 ± 33.7 mm, p = 0.012). In multivariate analysis, a one-standard deviation increase in postoperative sagittal vertical axis (SVA) was independently associated with rapid hip joint space narrowing (OR = 2.20; 95% CI 1.22-3.96; p = 0.009). Residual postoperative sagittal imbalance after long lumbosacral fusion is independently associated with early radiographic hip joint degeneration. Optimizing sagittal alignment may help reduce mechanical overload on the hip joints. IV - Retrospective analytical study.

Introduction In asymptomatic subjects, variations of cervical sagittal alignment parameters according to age and spinopelvic organization have been reported. A large range of compensation phenomena has been observed in degenerative spinal deformity in order to maintain horizontal gaze, but it remains unclear how age and spinopelvic morphology could additionally influence cervical alignment. The aim of this observational retrospective study was to describe the distribution of cervical sagittal alignment parameters according to age and pelvic incidence in subjects with and without degenerative spinal deformity in order to precisely evaluate cervical compensation phenomena in adult spinal deformity (ASD). Material and methods Radiographs of 478 subjects (327 females and 151 males) were distributed into 235 asymptomatic and 243 deformed subjects. Occipito-cervical parameters were McGregor-C1, McGregor-C2, C1–C2 and occipito-C2 angles. The cervicothoracic inflection point (CTIP) was determined. Caudal cervical sagittal alignment parameters were: C2–C7 lordosis, C2-apex (superior arch), apex-CTIP (inferior arch), occipito-C3 and occipito-C4 angles, C7-slope and T1-slope. The distribution of parameters was analyzed using a Bayesian inference (significant when Pr > 0.975 or Pr < 0.025). Comparisons between asymptomatic and deformed subjects were done after matching on age (40–60 years; > 60 years) and on PI (< 45°; 45–60°; > 60°). Results Among occipito-cervical parameters, there was no significant change in McGregor-C1 angle. However, McGregor-C2 angle was significantly higher in the ASD group (Pr = 0.0029), with influence of age (Pr = 0.023), but PI influence. C1–C2 lordosis was significantly higher in the ASD group compared to the asymptomatic group (Pr < 0.0007), without influence of age or PI noticed. C2–C7 lordosis was also higher in the ASD group (Pr < 0.025) with a role of age and PI (Pr < 0.025). Cervical lordosis in the superior arch was significantly higher in the ASD group (Pr > 0.999), without influence of age or PI. In the inferior arch, the lordosis angle was not modified according to the group, but there was an influence of age (Pr < 0.0007). C7-slope and T1-slope were higher according the age group (Pr < 0.0012), without influence of the group or PI. Conclusion This observational study highlights cervical sagittal alignment adaptations in degenerative spinal deformity, matched on age and pelvic incidence. The inferior cervical spine seemed to be modified with a higher lordosis, increasing with age responding to the age-related thoracic kyphosis increase. In addition to that, the superior cervical spine hyperextends more in adult degenerative deformity to maintain horizontal gaze. Level of evidence III.

Article: Erector spinal plane block use for rehabilitation in spine surgery: is pain a good endpoint? - Minerva Anestesiologica 2023 Feb 08 - Minerva Medica - Journals

Background: In the past decades, it has been recognized that sagittal alignment of the spine is crucial. Although the evolution of spinal alignment with growth has previously been described, there are no data for key parameters such as the exact shapes (extent and magnitude) of spinal curvatures. The goals of this study were therefore to determine normative values of spinopelvic sagittal parameters and to explore their variation during growth, based on the analysis of a large national cohort of healthy children. Methods: The radiographic data of 1,059 healthy children were analyzed in a retrospective, multicenter study. Full spine radiographs were used to measure several sagittal parameters, such as pelvic parameters, T1-T12 thoracic kyphosis (TK), and L1-S1 lumbar lordosis (LL). TK was divided into proximal, middle, and distal parts, and LL was divided into proximal and distal parts. Patients were stratified into 5 groups according to skeletal maturity (based on age, Risser stage, and triradiate cartilage status). Results: During growth, pelvic incidence increased from 40° to 46° and pelvic tilt increased from 4° to 9° (p < 0.05), whereas sacral slope remained constant. The peak of change in pelvic parameters occurred at the beginning of pubertal growth in Group 2 (the first part of the pubertal growth spurt). TK slightly increased among groups from 39° to 41° (p = 0.005), with the peak of change occurring in Group 4 (pubertal growth deceleration). LL increased from 51° to 56° (p < 0.001), with the peak of change occurring in Group 3 (the second part of the pubertal growth spurt). Segmental analysis revealed that most of the TK and LL changes occurred in the distal TK and proximal LL, with the other parts remaining constant. Conclusions: This is one of the largest studies showing changes in sagittal alignment with growth in normal children and adolescents. We found that changes in spinal shape were cascading phenomena. At the beginning of the growth peak, pelvic incidence increased. This change in pelvic morphology led to an increase in LL, involving its proximal part. Finally, TK increased, in its distal part, at the end of pubertal growth. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Purpose The aim was to describe radiographic cervical sagittal alignment variations according to age, gender and pelvic incidence (PI) and to investigate relationships with thoracic alignment. Methods A total of 2599 individuals (5–93 years) without spinal deformity were studied. Cranial cervical parameters were: McGregor slope, occipita-C2 angle, McGregor-C2 lordosis and C1–C2 lordosis. Caudal cervical parameters were: C2–C7, cranial arch and caudal arch lordosis and C7- and T1-slope. A Bayesian inference compared parameter distributions. Correlations with spinopelvic and global alignment parameters were investigated. Results Among cranial cervical parameters, variations of McGregor slope were non-significant. McGregor-C2 lordosis and C1–C2 lordosis were smaller in males and increased significantly during growth, whereas the occipito-C2 angle decreased (Pr > 0.95). The occipito-C2 angle was larger and McGregor-C2 lordosis was smaller in low PI (Pr > 0.95). Among caudal cervical parameters, C2–C7 lordosis and C7- and T1-slope were larger in males and increased after 50 years (Pr > 0.95). Lordosis changes were non-significant in the cranial arch, whereas values increased in the caudal arch after 35 years (Pr > 0.95). Caudal parameter differences were non-significant between PI groups. Strong correlations existed between C2–C7, caudal arch lordosis, C7-slope, T1-slope and thoracic kyphosis. The sagittal vertical axis C2 correlated with caudal arch lordosis and T1-slope (ρ > 0.5; Pr > 0.95). Conclusion Cervical alignment parameters vary according to age, gender and PI. In the cranial cervical spine, changes occur mainly during growth. In the caudal cervical spine, lordosis increases in the caudal arch, which is related to thoracic kyphosis increase with age. The caudal cervical arch acts as a compensatory segment by progressive extension, allowing horizontal gaze.