Olivier Gille

Université Bordeaux 1, Talence, Aquitaine, France

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Publications (84)79.61 Total impact

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    ABSTRACT: Study design: A retrospective clinical review OBJECTIVE.: To evaluate the sagittal correction efficacy of a thoracic Pedicle Subtraction Osteotomy (PSO), to determine and predict changes at both the cervical and lumbar mobile unfused segments following whether an upper or lower level thoracic PSO. Summary of background data: Thoracic PSO is a technically challenging but increasingly valid procedure in the treatment of fixed thoracic deformities.Anatomical characteristics differentiate upper and lower segment thoracic PSO's and define its corrective ability. There is yet paucity in the literature concerning the causality between the osteotomy level and the reciprocal changes observed postoperatively at the adjacent unfused curves. Methods.: Data collection from a single institutional database was carried out retrospectively by reviewing medical records and imaging of fixed thoracic kyphotic deformity patients submitted to a single level thoracic PSO. Results: 17 patients (11 M:6F), with a mean age of 44 years (range, 17-76). 59% had a previous spine surgery. The mean follow-up was of 55 months (range, 27-122). In 6 patients PSO was performed in the upper thoracic segment (T1-T6) and in 11 patients between T7-T12 (lower thoracic segment), allowing a mean local kyphosis correction of 31° and 41° respectively. The mean cervical and lumbar lordosis globally improved. The upper thoracic PSO group had a significant improvement of the cervical lordosis with a mean C7 slope correction of 28° (p = 0.004) while in the lower thoracic PSO group a more pronounced correction of the maximal lumbar lordosis was observed (22°, p = 0.033). Conclusions: Following a fixed sagittal thoracic deformity, the predominant lordotic compensation seems to occur at the nearest mobile curve from the deformity apex. The PSO induced restoration of the thoracic kyphosis relieved the compensatory cervical and/or lumbar excessive lordosis, which were present preoperatively and are now no longer needed to achieve balance and maintain horizontal gaze. Level of evidence: 4.
    No preview · Article · Dec 2015 · Spine
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    ABSTRACT: Les anomalies d’orientation de l’acétabulum peuvent favoriser le développement d’arthrose de hanche, de conflit fémoro-acétabulaire (CFA), voire de malposition de cupule acétabulaire. L’ostéotomie trans-pédiculaire (OTP), utilisée pour corriger des déséquilibres sagittaux du rachis, pourrait, en modifiant les paramètres pelviens, modifier l’orientation acétabulaire.
    No preview · Article · Oct 2015 · Revue de Chirurgie Orthopédique et Traumatologique
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    ABSTRACT: Background: Abnormalities in acetabular orientation can promote the development of hip osteoarthritis, femoro-acetabular impingement, or even acetabular cup malposition. The objective of the present study was to determine whether pedicle substraction osteotomy (PSO) to correct sagittal spinal imbalance affected acetabular orientation. Hypothesis: PSO performed to correct sagittal spinal imbalance affects acetabular orientation by changing the pelvic parameters. Materials and methods: This was a descriptive study in which two observers measured the acetabular parameters on both sides in 19 patients (38 acetabula) before and after PSO for post-operative flat-back syndrome. Mean time from PSO to post-operative measurements was 19months. Measurements were taken twice at a 2-week interval, on standing images obtained using the EOS(®) imaging system and sterEOS(®) software to obtain 3D reconstructions of synchronised 2D images. Acetabular anteversion and inclination were measured relative to the vertical plane. Mean pre-PSO and post-PSO values were compared using the paired t-test, and P values lower than 0.05 were considered significant. To assess inter-observer and intra-observer reproducibility, we computed the intra-class correlation coefficients (ICCs). Results: The measurements showed significant acetabular retroversion after PSO, of 7.6° on the right and 6.5° on the left (P<0.001). Acetabular inclination diminished significantly, by 4.5° on the right and 2.5° on the left (P<0.01). Inclination of the anterior pelvic plane decreased by 8.4° (P<0.01). Pelvic incidence was unchanged, whereas sacral slope increased by 10.5° (P<0.001) and pelvic tilt decreased by 10.9° (P<0.001). The ICC was 0.98 for both inter-observer and intra-observer reproducibility. Conclusion: Changing the sagittal spinal alignment modifies both the pelvic and the acetabular parameters. PSO significantly increases sacral slope, thus inducing anterior pelvic tilt with significant acetabular retroversion. The measurements obtained using sterEOS(®) showed good inter-observer and intra-observer reproducibility. To our knowledge, this is the first study of changes in acetabular version after PSO.
    No preview · Article · Sep 2015 · Orthopaedics & Traumatology Surgery & Research

  • No preview · Article · Sep 2015
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    ABSTRACT: Spine surgery in patients with ankylosing spondylitis includes osteosynthesis (arthrodesis) in order to stabilise fractures and osteotomy to correct severe anterior imbalance. Fractures with neurological symptoms can be life-threatening. Fractures without neurological deficits are difficult to diagnose because they can result from minor trauma and often involve spinal junctions, notably the cervicothoracic junction. In all cases of fractures, osteosynthesis should be extended to stabilise the powerful leverage created by the stiffened intervertebral segments. Pseudarthrosis occurs frequently, typically because of diagnostic delays, or improper management, especially orthopaedic treatment. Regarding severe anterior imbalance, total hip replacement should be considered first in cases of concurrent disabling coxitis. Osteotomies, which consist in opening an anterior wedge in the spine to rotate the cephalad portion posteriorly, are most often performed in the lumbar spine, and only rarely in the cervical or pelvic regions. Regardless of where they are performed, osteotomies are characterised by many demanding aspects (installation, intubation, osteopenia) and a high incidence of complications. Nevertheless, surgery ensures consolidation and recovery of baseline status in cases of fracture, and a marked improvement in functional status when osteotomies are performed.
    No preview · Article · Mar 2015 · Revue du Rhumatisme Monographies
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    ABSTRACT: Cervical spine alignment interests appeared recently and relationships between the pelvis and the cervical spine have been reported but remain unclear. In this study, postoperative changes for cranial, cervical, lumbar and sagittal balance parameters have been measured in adult scoliosis surgery without major sagittal malalignment to appreciate the adaptation of the cervical spine. Twenty-nine consecutive patients with a surgical adult degenerative scoliosis treated with a T8-T11 to iliac fusion without PSO or multiple Ponte's osteotomies had preoperative and postoperative full spine EOS radiographies to measure spino-pelvic parameters. Correlation analysis between the different parameters was performed. Lower cervical, lordosis, lumbar lordosis and thoracic kyphosis were increased in postoperative as no changes were observed for upper cervical lordosis. C1-C7 CL highly correlated (0.85 in preoperative and 0.87 in postoperative) with C7 slope, which highly correlated itself with global balance parameters (0.74 in preoperative and 0.71 in postoperative for CAM-PL) underlining the relationship between cervical spine alignment and global malalignment. Modifications of lower CL are observed, as upper CL remains constant. If no correlation was found for LL, TK and CL changes, CL appears to be highly correlated with C7 slope, which highly correlated itself with sagittal global balance parameters. C7 slope appears as a base for CL influenced by the spine global alignment.
    No preview · Article · Mar 2015 · European Spine Journal
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    ABSTRACT: Degenerative spondylolisthesis (DS) is common degenerative spinal disease. Recent studies highlighted relationship between DS and high pelvic incidence (PI). Moreover, impact of spinopelvic alignment on clinical outcomes has been emphasized. We aimed at describing epidemiologic and sagittal spinopelvic parameters in patients with DS, comparing them with asymptomatic volunteers, and determining a classification of DS patients. In this retrospective multicenter study of prospectively collected data, any adult patients treated for lumbar DS were included. Demographic data as well as radiographic parameters such as PI, pelvic tilt (PT), maximal lumbar lordosis (LLmax), lumbosacral lordosis, thoracic kyphosis, and C7tilt were recorded. DS patients were compared to 709 asymptomatic, age-matched volunteers. Cluster analyses were used to classify patients in homogenous groups. 654 patients were included (72 % female, 67 years). DS patients had greater PI (58.8° vs. 53.2°, p < 0.001) and C7tilt (p < 0.001). LLmax and lumbosacral lordosis were significantly smaller in the DS group. Cluster analysis allowed for the identification of 2 groups of patients according to C7tilt-159 patients with anterior C7tilt and 495 with normal C7tilt. In each group, 3 subgroups were found with different PI and sagittal spinopelvic parameters. Predominance of high PI and female gender was emphasized in DS population. Moreover, these findings highlighted the importance of sagittal alignment analysis in DS with 24 % of patients with anterior malalignment and in the remaining 76 % (normal C7Tilt), more than 50 % had pelvic retroversion. Consequently, DS sagittal malalignment should lead to specific surgical correction adapted to each subgroup of patients.
    No preview · Article · Feb 2015 · European Spine Journal
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    ABSTRACT: Purpose The alignment of the cervical spine is of primary importance to maintain horizontal gaze and contributes to the functional outcome of patients. Cervical spine alignment after correction of major sagittal imbalance has rarely been reported in the literature. Methods Retrospective review of 31 consecutive patients with sagittal plane deformities operated by lumbar pedicle subtraction osteotomy. Pre-operative and 3 months post-operative full-length radiographies were analyzed for spinopelvic and cervical-specific parameters. Results There was a significant increase in lumbar lordosis (LL), thoracic kyphosis, and sacral slope. There was also a significant decrease in pelvic tilt, pelvic incidence minus LL, knee flexion and sagittal vertical axis. The cervical analysis revealed that there was no significant difference between pre- and post-operative global cervical lordosis (CL) angle and external auditory meatus (EAM) tilt. There was a significant decrease of C7 slope and distal CL, while a significant increase in occipito-C2 (OC2) angle was observed. Conclusion LL restoration decreased the need of compensation at the pelvis and thoracic spine. The distal CL and C7 slope decreased because there was no need for compensation at this level after the surgery, but the proximal cervical spine takes a slightly flexed position to maintain horizontal sight. EAM tilt measures the head position toward C7, and is close to 0° even in severe cases. Changes of this parameter after surgery are insignificant, probably due to the balance between upper and lower cervical segments; when one of these segments shifts backward the other shifts forward and the result is a balanced head over C7.
    Full-text · Article · Jan 2015 · European Spine Journal
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    ABSTRACT: Authors examined a case series of patients younger than 18 years old who had sustained a traumatic thoracolumbar spine fracture to evaluate radiological and clinical findings of coronal spinal balance, after conservative treatment. From 1996 to 2014, a tricentric cohort of 48 patients with an average age of 12 years was radiographically reviewed at 50 months. Cobb angle of fractured vertebra and regional Cobb angle were measured both at baseline and follow-up. Analyses were done according to initial Risser grade, number of fractures and level of injury. There was a total of 11 scoliosis. In group with Risser grade 3 or above, with a single vertebral fracture and lumbar fracture, final regional Cobb angle was statistically higher than initial regional Cobb angle. The prevalence of scoliosis in our population is higher than those of idiopathic scoliosis; Risser grade 3 or above, lumbar fracture and a single fracture seem to account for more severe coronal deformation.
    No preview · Article · Jan 2015 · European Spine Journal

  • No preview · Article · Nov 2014 · Revue de Chirurgie Orthopédique et Traumatologique
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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.
    No preview · Article · Oct 2014 · Revue de Chirurgie Orthopédique et Traumatologique
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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.
    Full-text · Article · Oct 2014 · Orthopaedics & Traumatology Surgery & Research
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    ABSTRACT: Introduction Management of C1–C2 instability is very challenging, especially when tumoral lesions are involved. Case report We present the case of a 65-year-old male, with a recently discovered small cell lung carcinoma, presenting progressive tetraparesis due to a secondary lesion involving the body of C2 with complete collapse of its anterior part and major C1–C2 instability in all planes. The patient underwent a reconstructive surgery of the upper cervical spine during two sessions. First, an emergency surgery was done by a high anterior cervical approach, where reconstruction of the body of C2 was done by an original technique using a C3 body to odontoid long screw with bone cement filling around the screw at the level of C2, and an anterior buttress plate put from C2 to C4. A posterior surgery was performed after 48 h to stabilize the spine posteriorly with C1 to C5 instrumentation. The patient recovered from his neurological symptoms, and underwent complementary adjuvant radiotherapy with chemotherapy later on. Conclusion Literature is sparse on the treatment of major C1–C2 instability, especially when a secondary lesion is involved, the current case shows a successful treatment strategy with an original technique that was never described before in the literature. The patient was pain free at 1 year follow-up with a stable construct.
    Full-text · Article · Aug 2014 · European Spine Journal
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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.
    Full-text · Article · Jun 2014 · European Spine Journal
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    ABSTRACT: Introduction 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. Case report A 24-year-old woman presented with lower limb weakness (ASIA D) 8 years after posterior instrumentation from T2 to L4 for AIS. CT scan and MRI demonstrated intra-canal rod migration with complete laminar reconstitution. The C-reactive protein was slightly elevated (fluctuated between 10 and 20 mg/l). Radiographs showed the convex rod had entered the spinal canal. The patient was taken into the operating room for thoracic spinal decompression and removal of the convex rod. This Cotrel-Dubousset rod, which had been placed on the convexity of the thoracic curve had completely entered the canal from T5 to T10 and was totally covered by bone with the eroded laminae entirely healed and closed. There was no pseudarthrosis. Intra-operatively, the fusion mass was opened along the whole length of this rod and the rod carefully removed and the spinal cord decompressed. The bacteriological cultures returned positive for Propionibacterium acnes. The patient recovered fully within 2 months post-operatively. Conclusion We opine that the progressive laminar erosion with intra-canal rod migration resulted from mechanical and infectious-related factors. The very low virulence of the strain of Propionibacterium acnes is probably involved in this particular presentation where the rod was trapped in the canal, owing to the quite extensive laminar reconstitution.
    Full-text · Article · Jun 2014 · European Spine Journal

  • No preview · Article · Nov 2013 · Revue de Chirurgie Orthopédique et Traumatologique

  • No preview · Article · Nov 2013 · Revue de Chirurgie Orthopédique et Traumatologique
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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.
    Full-text · Article · Oct 2013 · Bone
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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.
    No preview · Article · Mar 2013
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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.
    Full-text · Article · Feb 2013 · European Spine Journal