Olivier Gille

University of Bordeaux, Burdeos, Aquitaine, France

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Publications (69)53.33 Total impact

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    ABSTRACT: Management of C1-C2 instability is very challenging, especially when tumoral lesions are involved.
    08/2014;
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    ABSTRACT: Lumbo-pelvic indexes appeared recently in the literature taking advantage from the relationship between pelvic incidence (PI) and lumbar lordosis (LL). Schwab proposed to subtract LL from PI (PI-LL) as Boissière proposed the lumbar lordosis index (LLI), which is the ratio between LL and PI (LL/PI). Both indexes have been described to weight LL by a constant parameter not affected by degenerative processes, the PI. The aim of this study is to evaluate these parameters in adult spinal deformity (ASD) by analyzing their relationship with spinal malalignment and vertebral osteotomies.
    06/2014;
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    ABSTRACT: Complete intraspinal canal rod migration with posterior bone reconstitution has never been described in the adolescent idiopathic scoliosis (AIS) population. We present an unusual but significant delayed neurological complication after spinal instrumentation surgery.
    06/2014;
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    ABSTRACT: Degenerative spondylolisthesis is common in adults. No consensus is available about the analysis or surgical treatment of degenerative spondylolisthesis. In 2013, the French Society for Spine Surgery (Societe francaise de chirurgie du rachis) held a round table discussion to develop a classification system and assess the outcomes of the main surgical treatments. A multicentre study was conducted in nine centres located throughout France and Luxembourg. We established a database on a prospective cohort of 260 patients included between July 2011 and July 2012 and a retrospective cohort of 410 patients included in personal databases between 2009 and 2013. For patients in the prospective cohort clinical assessments were performed before and after surgery using the self-administered functional impact questionnaire AQS, SF12, and Oswestry Disability Index (ODI). Type of treatment and complications were recorded. Antero-posterior and lateral full-length radiographs were used to measure lumbar lordosis (LL), segmental lordosis (SL), pelvic incidence (PI), pelvic tilt (PT), sagittal vertical axis (SVA), and percentage of vertebral slippage. Mean follow-up was 10 months. We started a randomised clinical trial comparing posterior fusion of degenerative spondylolisthesis with versus without an inter-body cage. 60 patients were included, 30 underwent 180° fusion and 30 underwent 360° fusion using an inter-body cage implanted via a transforaminal approach. We evaluated the quality of neural decompression achieved by minimally invasive fusion technique. In a subgroup of 24 patients computed tomography (CT) was performed before and after the procedure and then compared. Mean age was 67 years and 73% of degenerative spondylolisthesis were located at L4-L5 level. The many surgical procedures performed in the prospective cohort were posterior fusion (39%), posterior fusion combined with inter-body fusion (36%), dynamic stabilization (15%), anterior lumbar fusion (8%), and postero-lateral fusion without exogenous material (2%). Peri-operative complications of any severity occurred in 17% of patients. The AQS, ODI and SF12 scores were improved significantly at follow-up. We found no differences in clinical improvements across surgical procedure types. Circumferential fusion (360°) was associated with greater relief of nerve root pain and better lordosis recovery after 1 year compared to postero-lateral fusion (180°). Post-operative CT images showed effective decompression of nervous structures after minimally invasive fusion. Longer follow-up of our patients is needed to assess the stability of the results of the various surgical procedures. Based on a radiological analysis, the authors propose a new classification with five types of degenerative spondylolisthesis: type 1, SL > 5° and LL > PI-10°; type 2, SL < 5° and LL > PI-10°; type 3, LL < PI-10°; type 4, LL < PI-10° and compensated sagittal balance with PT > 25°; and type 5, sagittal imbalance with SVA > 4 cm. Proof level IV Observational cohort study. Retrospective review of prospectively collected outcome data.
    Orthopaedics & Traumatology Surgery & Research 01/2014; · 1.06 Impact Factor
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    ABSTRACT: Le spondylolisthésis dégénératif ou arthrosique est une pathologie fréquente de l’adulte. Il n’y a pas actuellement de consensus autour de l’analyse et du traitement chirurgical de cette pathologie. La Société française de chirurgie du rachis a tenu une table ronde en 2013, dont les buts étaient de proposer une classification de cette pathologie et d’étudier le résultat des différentes options chirurgicales proposées. Une étude multicentrique a été menée, regroupant 9 centres repartis sur le territoire national français et le Luxembourg. La base de données réunit une cohorte prospective de 260 patients inclus entre juillet 2011 et juillet 2012 et une cohorte rétrospective de 410 patients inclus dans des bases de données personnelles entre 2009 et 2013. Pour la cohorte prospective, l’évaluation clinique a été réalisée avec le questionnaire de sténose lombaire AQS, le SF12 et le score d’Oswestry. Le type de traitement et les complications chirurgicales étaient notés. Le recul moyen était de 10 mois. Pour les 670 patients, les radiographies du rachis en entier de face et de profil ont été analysées avec mesure de la lordose lombaire (LL), de la lordose segmentaire (LS), de l’incidence pelvienne (IP), de la version pelvienne (VP), de l’axe vertical rapporte au sacrum (SVA) et du pourcentage de glissement. Nous avons démarré une étude clinique prospective randomisée comparant l’ostéosynthèse postérieure du spondylolisthésis dégénératif avec ou sans cage intersomatique. Soixante patients ont été inclus, 30 ont eu une arthrodèse 180° et 30 une arthrodèse 360° avec une cage implantée par une voie transforaminale. Nous avons évalué la qualité de la décompression neurologique par technique d’arthrodèse mini-invasive. Des scanners pré- et postopératoires ont été réalisés pour un sous-groupe de 24 patients et ont été comparés. L’âge moyen était de 67 ans, 73 % des spondylolisthésis étaient à l’étage L4-L5. Dans 39 % des cas de la cohorte prospective, une arthrodèse instrumentée postérieure a été réalisée, dans 36 % des cas, une arthrodèse circonférentielle, dans 15 %, une stabilisation dynamique, dans 8 % des cas, une arthrodèse antérieure, et dans 2 %, une arthrodèse postérieure sans matériel. Il y a eu 17 % de complications graves ou mineures dans la periode peri-operatoire. L’AQS, le SF12 et le score d’Oswestry ont été améliorés significativement par l’opération quelle que soit la technique. À 10 mois postopératoire, il n’est pas noté de différence statistique entre les différents traitements chirurgicaux. La comparaison de la technique d’arthrodèse circonférentielle (360°) et de l’arthrodèse posterolatérale (180°) a montré à 1 an une meilleure amélioration de la douleur radiculaire et un plus grand gain de lordose dans le groupe 360°. Une bonne décompression neurologique était obtenue dans les arthrodèses mini-invasives sur les contrôles tomodensitométriques. Cette étude nécessite un suivi à plus long terme pour évaluer la pérennité des résultats des différents traitements chirurgicaux. Basée sur l’analyse radiologique, les auteurs proposent une nouvelle classification du spondylolisthésis dégénératif en 5 stades : stade 1, LS > 5° et LL > IP-10° ; stade 2, LS < 5° et LL > IP-10° ; stade 3, LL < IP-10° ; stade 4, LL < IP-10° et équilibre sagittal compensé avec VP > 25° ; et stade 5, déséquilibre sagittal avec SVA > 4 cm.
    Revue de Chirurgie Orthopédique et Traumatologique 01/2014; 100(6):S157–S161.
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    ABSTRACT: To evaluate the long-term tolerance of bisphosphonates proposed as an alternative therapeutic option for symptomatic unresectable benign bone tumors and to evaluate the long-term efficacy of this treatment. From March 2007 to March 2011, patients with unresectable symptomatic benign bone tumors were consecutively included in this institutional review board-approved study and treated with bisphosphonates. Prospectively long-term follow-up is reported. The study endpoints were to describe the long-term tolerance, the clinical evolution of pain for each patient and the radiological success defined as a complete disappearance of inflammation and ossification of the bone lesion. All complications and side effects were recorded. Eight patients (mean age 16 years; range 7-42) with various tumor subtypes were included: aneurysmal bone cysts (N=5), Langerhans cell histiocytosis (N=1), osteoblastoma (N=1), and a giant cell tumor (N=1). Tumors were located in cervical (N=4) or thoracic (N=1) vertebrae, femoral shaft (N=1), acetabulum (N=1) and sacrum (N=1). Mean number of bisphosphonate cycles was 3 (range: 1-6) over a median period of 10 months. The median clinical and imaging follow-up period was 21 months (6 to 63 months). No severe complications due to treatment or lesion recurrence were reported. Pain disappeared within 6 weeks of the first cycle for all but one patient. Ossification of the bone lesion was observed for all patients but one, complete for two and partial for the five others. Bisphosphonates appear to be an effective option without adverse effects for the non-operative management of symptomatic benign bone tumors.
    Bone 10/2013; · 4.46 Impact Factor
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    ABSTRACT: El acceso de la columna cervical puede realizarse por vías anteriores o posteriores, cuya elección depende de la enfermedad que se va a tratar, de la extensión de las lesiones y de las costumbres de los equipos quirúrgicos. La vía posterior es sencilla y directa. Permite acceder a los arcos posteriores. Sin embargo, plantea problemas, como la colocación del paciente y la infección de la herida quirúrgica. Las vías anteriores son las más usadas en la actualidad, pero plantean problemas diversos, dependiendo de los niveles vertebrales expuestos. La vía transoral permite un acceso directo del cuerpo del axis, pero sus indicaciones son escasas. La vía preesternocleidomastoidea es la más usada para exponer la columna cervical inferior. Además, permite acceder a la porción suprahioidea de la columna cervical superior. No obstante, plantea el problema del riesgo de lesión del nervio laríngeo inferior, sobre todo a nivel C7-T1. Las vías retroesternocleidomastoidea, preesternocleidomastoidea anterolateral y preesternocleidomastoidea retrovascular permiten acceder a la cara anterolateral de la columna cervical y a la arteria vertebral homolateral.
    EMC - Técnicas Quirúrgicas - Ortopedia y Traumatología. 03/2013; 5(1):1–13.
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    ABSTRACT: PURPOSE: Sagittal malalignment is frequently observed in adult scoliosis. C7 plumb line, lumbar lordosis and pelvic tilt are the main factors to evaluate sagittal balance and the need of a vertebral osteotomy to correct it. We described a ratio: the lumbar lordosis index (ratio lumbar lordosis/pelvic incidence) (LLI) and analyzed its relationships with spinal malalignment and vertebral osteotomies. METHODS: 53 consecutive patients with a surgical adult scoliosis had preoperative and postoperative full spine EOS radiographies to measure spino-pelvic parameters and LLI. The lack of lordosis was calculated after prediction of theoretical lumbar lordosis. Correlation analysis between the different parameters was performed. RESULTS: All parameters were correlated with spinal malalignment but LLI is the most correlated parameter (r = -0.978). It is also the best parameter in this study to predict the need of a spinal osteotomy (r = 1 if LLI <0.5). CONCLUSION: LLI is a statistically validated parameter for sagittal malalignment analysis. It can be used as a mathematical tool to detect spinal malalignment in adult scoliosis and guides the surgeon decision of realizing a vertebral osteotomy for adult scoliosis sagittal correction. It can be used as well for the interpretation of clinical series in adult scoliosis.
    European Spine Journal 02/2013; · 2.47 Impact Factor
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    ArgoSpine News & Journal 12/2012; 24(3-4).
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    ABSTRACT: Introduction Le traitement des fractures du rachis cervical survenant dans le cadre de spondylarthrite ankylosante (SAA) est controversé. Hypothèse Le traitement chirurgical par voie antérieure est une technique fiable pour traiter ces fractures et éventuellement corriger la cyphose cervicothoracique induite par la SAA. Patients et méthodes Cette série rétrospective continue, entre 1990 et 2010, incluait 19 patients de 33 à 84 ans présentant une fracture du rachis cervical bas dans le contexte d’une SAA. Le recul moyen était de 45 mois. Seize patients ont été traités chirurgicalement par voie antérieure. Une ostéosynthèse antérieure a été réalisée pour tous ces patients, accompagnée pour cinq patients sans déficit neurologique d’une correction de la cyphose cervicothoracique dans le même temps chirurgical. La cyphose régionale a été mesurée en préopératoire, en postopératoire immédiat et au plus long recul. Résultats Il y a cinq décès, tous survenus chez des patients tétraplégiques post-traumatiques complets. La majorité des troubles neurologiques incomplets se sont améliorés (66 %). Il n’y a pas eu d’aggravation neurologique. Parmi les 16 patients opérés par voie antérieure, deux cas ont motivé un temps postérieur complémentaire pour persistance d’un déficit neurologique. Tous les patients opérés qui ont survécus soit 14 patients, ont consolidé avec un délai de consolidation moyen de quatre mois (trois à sept mois), sans aggravation de la cyphose au recul. Pour les cinq cas de correction associée de la cyphose, la correction moyenne a été de 26° (18–36°), sans complication neurologique. Discussion Les résultats présentés nous encouragent à proposer une ostéosynthèse par voie antérieure pour la prise en charge de ces fractures cervicales sur SAA, accompagnée d’une correction de la cyphose cervicothoracique chez les patients non neurologiques. Type d’étude Étude rétrospective : niveau IV.
    Revue de Chirurgie Orthopédique et Traumatologique 09/2012; 98(5):472–480.
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    ABSTRACT: Controversy exists surrounding optimal treatment of cervical spine fractures secondary to ankylosing spondylitis (AS). The anterior approach is an effective surgical technique for these fractures and can be used to correct the AS-induced cervical-thoracic kyphosis. This continuous, retrospective series between 1990 and 2010 included 19 patients aged 33 to 84 years who presented with a lower cervical spine fracture in the context of AS. The average follow-up was 45 months. Sixteen of these patients were surgically treated using an anterior approach and anterior fixation. In five patients without any neurological deficit, their cervical-thoracic kyphosis was corrected during the same surgery. Regional kyphosis was measured before the surgery, immediately after the surgery and at the last follow-up. Five deaths occurred; these were all patients with post-traumatic complete quadriplegia. Most the incomplete neurological problems improved (66%). In no cases did the neurological condition worsen. Among the 16 patients operated with the anterior approach, two patients also required an additional procedure with a posterior approach because of a persistent neurological deficit. The fractures in the operated patients who survived (14 patients) had healed within an average 4-month delay (range 3-7 months), without worsening of the kyphosis at final follow-up. In the five cases where the kyphosis was corrected, the correction averaged 26° (range 18-36°); there were no neurological complications. Based on these results, we suggest using the anterior approach to perform internal fixation as a treatment for cervical fractures secondary to AS and to correct the cervical-thoracic kyphosis in patients without neurological deficits. Level IV - retrospective study.
    Orthopaedics & Traumatology Surgery & Research 08/2012; 98(5):543-51. · 1.06 Impact Factor
  • ArgoSpine News & Journal 06/2012; 24(1-2).
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    ABSTRACT: Description of the surgical management of major spinal deformities in patients with Parkinson disease (PD). To evaluate the effectiveness of the construct, the incidence and types of complications, and patient satisfaction. The association of degenerative, neuromuscular, and osteoporotic diseases in PD can lead to major complications after spine surgery. We treated PD patients with major spinal deformities by a posterior-only approach for spinal fusion from T2 to the sacrum. : This retrospective study reviews 12 consecutive patients with PD undergoing this surgery in a 2-year span at a single institution. Radiographs were taken with the EOS low-dose system (EOS Imaging, Paris, France) before and 3 months after surgery and at the last follow-up visit and were evaluated by a spine surgeon not involved in the surgery. Complications were analyzed. The functional outcome was assessed with the SRS-30 questionnaire. The patients' mean age was 68±6.2 years, the mean duration of PD 10±4.9 years, and the mean follow-up 32.8±6.9 months. Six patients had first surgeries, and 6 revisions. Statistically significant improvement was observed in all patients in the frontal and the sagittal planes after surgery. The sagittal vertical axis improved from 15.2±9.3 cm preoperatively to 0.5±3.2 cm at the last follow-up. Six patients had revision, 3 times for instrumentation failure, twice for proximal junctional kyphosis at T1-T2, and once for an epidural hematoma. The SRS-30 questionnaire indicated strong patient satisfaction, with 11 patients who would have the same procedure again if they had the same condition. This is the first reported series of PD patients undergoing posterior spinal fusion from T2 to the sacrum for major deformities. This study indicates that good correction of sagittal and frontal balance enables good clinical and radiologic results that remain stable over time even when complications occur.
    Journal of spinal disorders & techniques 03/2012; 25(3):E53-60. · 1.21 Impact Factor
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    ABSTRACT: The minimally invasive transpsoas approach can be employed to treat various spinal disorders, such as disc degeneration, deformity, and lateral disc herniation. With this technique, visualization is limited in comparison with the open procedure and the proximity of the lumbar plexus to the surgical pathway is one limitation of this technique. Precise knowledge of the regional anatomy of the lumbar plexus is required for safe passage through the psoas muscle. The primary objective of this study was to determine the anatomic position of the lumbar plexus branches and sympathetic chain in relation to the intervertebral disc and to define a safe working zone. The second objective was to compare our observations with previous anatomical studies concerning the transpsoas approach. A total of 60 lumbar plexus in 8 fresh cadavers from the Department of Anatomy were analyzed in this study. Coronal and lateral X-Ray images were obtained before dissection in order to eliminate spine deformity or fracture. All cadavers were placed in a lateral decubitus position with a lateral bolster. Dissection of the lumbar plexus was performed. All nerve branches and sympathetic chain were identified. Intervertebral disc space from L1L2 to L4L5 was divided into four zones. Zone 1 being the anterior quarter of the disc, zone 2 being the middle anterior quarter, zone 3 the posterior middle quarter and zone 4 the posterior quarter. Crossing of each nervous branch with the disc was reported and a safe working zone was determined for L1L2 to L4L5 disc levels. A safe working zone was defined by the absence of crossing of a lumbar plexus branch. No anatomical variation was found during blunt dissection. As described previously, the lumbar plexus is composed of the ventral divisions of the first four lumbar nerves and from contributions of the sub costal nerve from T12. The safe working zone includes zones 2 and 3 at level L1L2, zone 3 at level L2L3, zone 3 at level L3L4, and zone 2 at level L4L5. No difference was observed between right and left sides as regards the relationships between the lumbar plexus and the intervertebral disc. We observed some differences concerning the safe working zone in comparison with other cadaveric studies. The small number of cadaveric specimens used in anatomical studies probably explains theses differences. The minimally invasive transpsoas lateral approach was initially developed to reduce the complications associated with the traditional procedure. The anatomical relationships between the lumbar plexus and the intervertebral disc make this technique particularly risky a L4L5. Alternative techniques, such as transforaminal interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF) or anterior interbody fusion (ALIF) should be used at this level.
    Anatomia Clinica 03/2012; 34(2):151-7. · 0.93 Impact Factor
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    ABSTRACT: Limited data is available regarding heterotopic ossification (HO) after cervical disc replacement (CDR). The goal of this study was to determine the incidence of HO after CDR with the Mobi-C artificial disc to identify the risk factors for HO, and to investigate whether HO affects clinical outcome and range of motion (ROM). Seventy one patients were included in this study. The mean follow-up was 21 months. Radiological evaluation included grading of HO and assessment of ROM for each level treated. HO was detectable in 23 treated segments (27.7%). The mean ROM was 8.1 degrees preoperatively and increased to 10.2 degrees at the last follow-up visit. Nevertheless, HO did not appear to affect clinical outcomes. HO appears to be a common complication after CDR. No specific risk factors have been clearly identified in our study. Long-term follow-up will be needed to assess the clinical significance of HO.
    Acta orthopaedica Belgica 02/2012; 78(1):80-6. · 0.63 Impact Factor
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    ABSTRACT: Prospective study. To analyze the sagittal balance after single-level cervical disc replacement (CDR) and range of motion (ROM). To define clinical and radiologic parameters those have a significant correlation with segmental and overall cervical curvature after CDR. Clinical outcomes and ROM after CDR with Mobi-C (LDR, Troyes, France) prosthesis have been documented in few studies. No earlier report of this prosthesis has studied correlations between static and dynamic parameters or those between static parameters and clinical outcomes. Forty patients were evaluated. Clinical outcome was assessed using the Short Form-36 questionnaire, Neck Disability Index, and a Visual Analog Scale. Spineview software (Surgiview, Paris, France) was used to investigate sagittal balance parameters and ROM. The mean follow-up was 24.3 months (range: 12 to 36 mo). Clinical outcomes were satisfactory. There was a significant improvement of Short Form-36, Neck Disability Index, and Visual Analog Scale scores. Mean ROM was 8.3 degrees preoperatively and 11.0 degrees postoperatively (P=0.013). Mean preoperative C2C7 curvature was 12.8 and 16.0 degrees at last follow-up (P=0.001). Mean preoperative functional spinal unit (FSU) angle was 2.3 and 5.3 degrees postoperatively (P<0.0001). Mean postoperative shell angle was 5.5 degrees. There was a significant correlation between postoperative C2C7 alignment and preoperative C2C7 alignment, change of C2C7 alignment, preoperative and postoperative FSU angle, and prosthesis shell angle. There was also a significant correlation between postoperative FSU angle and preoperative C2C7 alignment, preoperative FSU angle, change of FSU angle, and prosthesis shell angle. Regression analysis showed that prosthesis shell angle and preoperative FSU angle contributed significantly to postoperative FSU angle. Moreover, preoperative C2C7 alignment, preoperative FSU angle, postoperative FSU angle, and prosthesis shell angle contributed significantly to postoperative C2C7 alignment. No significant correlation was observed between ROM and sagittal parameters. Few correlations were found between sagittal alignment and clinical results. CDR with this prosthesis provided favorable clinical outcomes and maintains ROM of the FSU, overall and segmental cervical alignment. Long-term follow-up will be needed to assess the effectiveness and advantages of this procedure.
    Journal of spinal disorders & techniques 11/2011; 25(1):10-6. · 1.21 Impact Factor
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    ABSTRACT: A case report. To describe a case of regression of a giant cell tumor (GCT) of the cervical spine, which was treated with zoledronic acid as single therapy. Bisphosphonates are antiresorptive drugs used in patients with myeloma and bone metastases to treat pain and skeletal events. Despite the emerging evidence of antitumoral effects in adjuvant therapy for GCT of bone, the use of bisphosphonates as a single agent has not been described. Case study with follow-up examination and radiological control 36 months after the beginning of therapy. A review of the literature is also provided. The imaging data at admission evidenced an extensive osteolytic lesion on C5 and C6 vertebral bodies. An open biopsy confirmed the diagnosis of GCT. It was decided to immobilize the cervical spine with rigid collar and to start monthly intravenous zoledronic acid. The subsequent clinical and radiological follow-up during 3 years revealed a marked regression of the lesion. The use of a bisphosphonate agent for GCT of the cervical spine showed potential therapeutic benefits as previously described for other osteolytic disorders. This finding could lead to further investigation on the role and true value of these drugs as possible adjuvants in the management of GCT of bone.
    Spine 11/2011; 37(6):E396-9. · 2.16 Impact Factor
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    Anatomia Clinica 07/2011; · 0.93 Impact Factor
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    ABSTRACT: Magnetic resonance imaging (MRI) is increasingly used to study skeletal muscles patients with muscular disorders. We report an MRI technique for evaluating the trunk muscles. This technique takes both the component surface area (CSA) and the density of the muscles on MRI axial slices into account . Using a computer-based image analysis system, we combined MRI data measuring the muscle CSA, which was separated into the contractile component (CCSA) and the non-contractile component (NCCSA). The purpose of this study was to analyze the reliability of this method of measuring the CSA, CCSA and NCCSA in trunk muscles on MRI axial slices through L4 and T12. Thirty volunteer subjects were enrolled in this study. Two acquisitions were performed. For the reliability analyses, each of the two slices (T12 and L4) from 30 subjects was measured by three raters trained in this technique, on two occasions 2 weeks apart. Each muscle was surrounded and its CSA, NCCSA and CCSA were recorded. For each muscle, the agreement between the two sets of 30 measurements performed by three observers was evaluated by calculating an intra-class correlation coefficient (ICC). Regarding the slice through L4 and T12, the reliabilities of the measurement of CSA, CCSA were very good for all the muscles except the parietal muscles. MRI measurements of the trunk muscle cross-sectional areas and of the CCSA and NCCSA are reliable.
    Anatomia Clinica 05/2011; 33(8):735-41. · 0.93 Impact Factor
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    ABSTRACT: The minimally invasive lateral retroperitoneal transpsoas approach is a recent technique developed for lumbar interbody fusion and discectomy. The proximity of the retroperitoneal vessels and ventral nerve roots to the surgical pathway increases the risk of injury to these anatomical structures. A precise knowledge of the regional anatomy of the lumbar plexus is required for safe passage through the psoas muscle. Preoperative examination of the axial MRI images will allow the surgeon to observe the neural structures at the operative levels and confirm that abdominal vessels do not obstruct the lateral disc space. The objective of this study was to determine the anatomic position of the ventral nerve roots and the retroperitoneal vessels in relation to the vertebral body in the degenerative spine and to delineate a safe working zone using magnetic resonance imaging (MRI). We retrospectively evaluated lumbar spine MRI in 78 patients (from L1-L2 to L4-L5). The total number of lumbar vertebrae measured was 304 levels. Sagittal MRI sections were used to measure disc height (anterior, middle, posterior). Axial MRI sections were used to measure the sagittal and transversal vertebral endplate diameters, the overlap between ventral nerve roots and the posterior border of the lower endplate of the vertebral body, and the overlap between the retroperitoneal vessels and the anterior border of the lower endplate of the vertebral body. The safe zone was subsequently calculated. It was defined as the relative lower endplate vertebral body sagittal diameter that is anterior to the nerve root and is posterior to the retroperitoneal vessels. The safe working zone was 75.3% of the lower endplate of the vertebral body sagittal diameter at L1-L2, 59.5% at L2-L3, 51.9% at L3-L4 and 37.8% at L4-L5 levels. This area significantly decreases from L1-L2 to L4-L5 (p < 0.05). Compared with L1-L2, L2-L3 levels, the more anterior position of the nerve root and the more posterior position of the retroperitoneal vessels at the L4-L5 level causes a significant reduction of this area. Compared with the L3-L4 level, we observed that the safe zone decrease was simply secondary to the more anterior position of the nerve roots at the L4-L5 level. Preoperative planning and safe zone delineation are a simple method to assess the relative position of neural and vascular anatomic structures in relation to the surgical area. This method can help spine surgeons to prevent perioperative complications.
    Anatomia Clinica 03/2011; 33(8):665-71. · 0.93 Impact Factor

Publication Stats

268 Citations
53.33 Total Impact Points

Institutions

  • 2004–2013
    • University of Bordeaux
      Burdeos, Aquitaine, France
  • 2012
    • Université Bordeaux 1
      Talence, Aquitaine, France
  • 2009–2012
    • Université Victor Segalen Bordeaux 2
      Burdeos, Aquitaine, France
    • Université de Nîmes
      Nismes, Languedoc-Roussillon, France
  • 2006–2011
    • Centre Hospitalier Universitaire de Bordeaux
      Burdeos, Aquitaine, France