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Study design National cross-sectional study.Objective Thoracic kyphosis (TK) is related to sagittal parameters as pelvic tilt (PT), lumbar lordosis (LL) and pelvic incidence (PI). The equation TK = 2 (PT+LL–PI) was validated for adolescents. The purpose of this study was to investigate if this equation correctly predicts TK regardless of age.Methods Sagittal alignment parameters were assessed on full spine radiographs of 2599 individuals without spine pathology (1488 females, 1111 males). Calculated TK (CTK) = 2 (PT+LL–PI) and measured TK (MTK) were compared by calculating the gap and using a linear regression between both parameters. Subgroup analyses were performed for gender, age, TK groups (≤20°, 21°-40°, 41°-60°, >60°), and PI groups (<45°, 45°-60°, >60°).Results Average values in the total population were: MTK 45.0°, CTK 36.9°. Average TK gap was 8.1°, 5.2° in females (intercept 11.7, slope .61) and 11.9° in males (intercept 7.1, slope .58). The mean gap was 3.6° for 15-34 years, 5.7° under 15 years and it increased progressively after 35 years with a maximum of 19.9° over 80 years. The gap also increased with the amount of MTK: -3.5° for TK<20° up to 17.3° for TK >60°. Differences in gaps were minor between PI groups. The intercept was smallest and slopes >.6 for PI <45° and TK ≤20°.Conclusion The formula TK=2 (PT+LL-PI) yielded moderate accuracy for adolescents and young adults, but did not fit for over 35 years and under 15. The amount and variance in TK increased in elderly subjects, which made the formula less accurate.

Study design Descriptive radiographic analysis of a prospective multi-center database.Objective This study aims to provide normative values of spinopelvic parameters and their correlations according to age and pelvic incidence (PI) of subjects without spinal deformity.Methods After Institutional Review Board (IRB) approval, 1540 full spine radiographs were analyzed. Subjects were divided into 3 groups of PI: low PI < 45°, intermediate PI 45–60°, high PI > 60°, and then stratified by age (20–34, 35–49, 50–64, > 65 Y.O). Pelvic and spinal parameters were measured. Statistical analysis between parameters was performed using Bayesian inference and correlation.Results Mean age was 53.5 years (845 females, 695 males, range 20–93 years). In low PI group, lumbar lordosis (LL) decrease was mainly observed in the 2 younger age groups. In medium and high PI groups, loss of lordosis was linear during aging and occurred mainly on the distal arch of lordosis. Moderate PI group had a stable lordosis apex and thoracolumbar inflection point. High PI group had a stable thoracolumbar inflection point and a more distal lordosis apex in elderly subjects. For all subjects, kyphosis and pelvic tilt (PT) increased with age. There was a constant chain of correlation between PI and age groups. Proximal lumbar lordosis (PLL) was correlated with kyphosis and sagittal vertical axis (SVA C7), while the distal lumbar lordosis (DLL) was correlated with PI and PT.Conclusion This study provides a detailed repository of sagittal spinopelvic parameters normative values with detailed analysis of segmental kyphosis and lordosis distribution according to gender, age, and PI.

With an aging population, degenerative spinal diseases are contributing significantly to the healthcare's burden. Spinal alignment in the context of adult spinal deformities has become an important domain of research.

Les fractures bi-isthmiques de C2 représentent 15 à 20 % des fractures du rachis cervical et la stratégie de prise en charge de ces fractures reste encore sujette à débat, reposant principalement sur la classification d’Effendi modifiée par Levine et Edwards. L’objectif de cette étude prospective, multicentrique et observationnelle était de recenser la prise en charge initiale des fractures bi-isthmiques de C2 en France. Les complications et les taux de consolidation étaient analysés en fonction du type de fracture et du traitement proposé.

Study Design: Inter- and intraobserver reliability study. Object: To assess the reliability of a new radiographic classification of degenerative spondylolisthesis of the lumbar spine (DSLS). Summary of Background Data: DSLS is a common cause of chronic low back and leg pain in adults. To this date, there is no consensus for a comprehensive analysis of DSLS. The reliability of a new DSLS classification system based on sagittal alignment was assessed. Methods: Ninety-nine patients admitted to our spinal surgery department for surgical treatment of DSLS between January 2012 and December 2015 were included. Three observers measured sagittal alignment parameters with validated software: segmental lordosis (SL), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Full body low-dose lateral view radiographs were analyzed and classified according to three main types: Type 1A: preserved LL and SL; Type 1B: preserved LL and reduced SL (=5°); Type 2A: PI-LL =10° without pelvic compensation (PT &lt;25°); Type 2B: PI-LL =10° with pelvic compensation (PT =25°); Type 3: global sagittal malalignment (SVA =40 mm). The three observers classified radiographs twice with a 3-week interval for intraobserver reproducibility. Interobserver reproducibility was calculated using Fleiss ? and intra-class coefficient. Intraobserver reproducibility was calculated using Cohen ?. Results: Mean age was 68.8 ± 9.8 years. Mean sagittal alignment parameters values were the following: PI: 60.1° ± 12.7°; PI-LL was 12.2° ± 13.9°, PT: 24.7° ± 8.5°; SVA: 44.9 mm ± 44.6 mm; SL: 16.6° ± 8.4°. Intraobserver repeatability showed an almost perfect agreement (ICC > 0.92 and Cohen ? > 0.89 for each observer). Fleiss ? value for interobserver reproducibility was 0.82, with percentage agreement among observers between 88% and 89%. Conclusion: This new classification showed an excellent inter- and intraobserver reliability. This simple method could be an additional sagittal balance tool helping surgeons improve their preoperative DSLS analysis.

Inter- and intraobserver reliability study.

Cervical spine deformity represents a broad spectrum of pathologies that are both complex in etiology and debilitating towards quality of life for patients. Despite advances in the understanding of drivers and outcomes of cervical spine deformity, only one classification system and one system of nomenclature for osteotomy techniques currently exist. Moreover, there is a lack of standardization regarding the indications for each technique. This article reviews the adult cervical deformity (ACD) and current classification and nomenclature for osteotomy techniques, highlighting the need for further work to develop a unified approach for each case and improve communication amongst the spine community with respect to ACD. Deformitäten der Halswirbelsäule (HWS) umfassen ein breites Spektrum an Pathologien, die sowohl komplex in ihrer Ätiologie sind als auch die Lebensqualität der Patienten belasten. Trotz der verbesserten Kenntnisse von Einflussfaktoren und Ergebnissen der HWS-Deformitäten existieren bisher nur ein einziges Klassifikationssystem und eine Nomenklatur für Osteotomieverfahren. Zudem fehlt eine Standardisierung bezüglich der Indikationsstellung zu den einzelnen Verfahren. Dieser Beitrag gibt eine Übersicht über die Deformitäten der Halswirbelsäule bei Erwachsenen („adult cervical deformity“, ACD) sowie die aktuellen Klassifikationen und Nomenklaturen für Osteotomieverfahren. Hierbei soll betont werden, dass es weiterer Arbeiten zur Entwicklung eines einheitlichen Verfahrens für einzelne Fälle sowie einer Verbesserung der Kommunikation in der Spine Community in Bezug auf ACD bedarf.

Retrospective single-center.

The authors regret that one of the co-author’s name was misspelt as “Brice Illharreborde, MD, PhD’” in the proof. However, the name should be spelled as “Brice Ilharreborde, MD, PhD’”.

Le spondylolisthésis dégénératif lombaire (SDL) est une cause fréquente de lombo-radiculalgie chronique. Une nouvelle classification basée sur l’analyse de l’équilibre sagittal est proposée et pourrait aider le chirurgien dans sa décision thérapeutique.

Introduction Much debate about postoperative outcomes regarding surgical approaches for cervical spondylotic myelopathy (CSM) exists in the literature with no clear evidence of superiority. We propose a novel method for assessing health-related quality of life (HRQOL) outcomes by taking into account each patient's baseline at postoperative time points and analyzing the “area under the curve” (AUC), a proxy for suffering time.Patients and Methods Post hoc analysis of a prospective, multicenter database of patients with CSM. A total of 165 patients met the following inclusion criteria: symptomatic CSM, age older than 18 years, and 2-year follow-up with modified Japanese Orthopaedic Association (mJOA) and neck disability index (NDI). The anterior approach group (AAG) (n= 110) and posterior approach group (PAG) (n= 55) were compared at baseline, 1 year, and 2 years for each HRQOL. This comparison was repeated with normalization, using the patient's baseline as the anchor, followed by an integration and comparison of AUC. Results and Conclusion:For the first time, AUC analysis was applied to evaluating patients with CSM. Nonnormalized HRQOLs demonstrated the AAG started higher and met better standards at all times points compared with the PAG. Normalized mJOA demonstrated the PAG actually did better at 2 years, whereas NDI suggested that the AAG did better, although this was not significant. AUC analysis further supported the superiority of the PAG, with statistical significance at 1 and 2 years' time points, suggesting that patients who undergo the posterior approach may suffer less in the first 2 years of their postoperative course.

Introduction Cervical sagittal alignment (C2–C7 SVA) has been correlated to myelopathy severity but kyphosis as a regional parameter has not been demonstrated to correlate with health-related quality of life (HRQOL) measures. We hypothesized that regional and focal sagittal cervical alignment may also correlate with HRQOLs in patients with cervical spondylotic myelopathy (CSM).Patients and Methods Post hoc analysis of a prospective, multicenter database of patients with CSM. A total of 151 patients met inclusion criteria (47%): symptomatic CSM, age > 18 years, baseline lateral radiographs, modified Japanese Orthopaedic Association (mJOA) and neck disability index (NDI). Average age was 56.3 ± 11.7 years with females making up 43.9% (n= 69) of the study population. Regional alignment and HRQOLs were analyzed with patients stratified into a high-cSVA group (hiSVA, n= 45, 0.5 SD ≥ mean) or a low cSVA group (loSVA, n= 43, 0.5 SD ≤ mean). Focal alignment (kyphosis and olisthesis between adjacent vertebrae) analysis was also conducted.Results The hiSVA (mean cSVA 39.4 ± 7.4 mm) cohort had a significantly worse mJOA than the loSVA (mean cSVA 11.31 ± 5.3 mm) cohort (mean mJOA 12.5 vs. 13.7, p= 0.037). No significant correlations between C2–C7 lordosis and HRQOLs existed. There were significant correlations with focal alignment and worse clinical assessments: max sagittal slip with mJOA (R= −0.24, p= 0.002) and Nurick (R= 0.18, p= 0.024). Level of slip was also significant, with olisthesis at higher levels correlating with worse health status. Number of kyphotic segments also positively correlated with NDI (R= 0.19, p< 0.001).Conclusion Similar to previous studies, high baseline cSVA correlated with significantly worse mJOA. Interestingly, the mean cSVA of the hiSVA cohort was 39.4 ± 7.4 mm, suggesting that 40 mm may be a potential threshold below which cervical sagittal malalignment should be corrected. Regarding focal alignment, increased olisthesis is correlated with worse mJOA and Nurick grade, especially at higher cervical levels. Even focal abnormalities all along the cervical spine are correlated with worse NDI, demonstrating that while level of olisthesis may matter, the number of vertebrae with a kyphotic relationship may also cause pain and disability.

Introduction The effect of surgical approach on outcomes for cervical spondylotic myelopathy (CSM) is controversial. Fehlings et al showed that patients treated with anterior techniques tend to be younger, less impaired, and had more focal pathology. In this study, we compared outcomes of an anterior approach group (AAG) versus a posterior approach group (PAG) with a focus on the effect of sagittal alignment.Patients and Methods Post hoc analysis of a prospective, multicenter database of patients with CSM. A total of 117 patients met inclusion criteria, were nonrandomized to an AAG (n= 51) or PAG (n= 62), with postoperative static lateral radiographs, Nurick assessment, and health-related quality of life outcomes at 6 months and/or 1 year. The AAG underwent anterior decompression and fusion, PAG either laminoplasty or laminectomy with fusion. Sagittal regional and focal parameters were compared by multivariate regression.Results At baseline, the groups showed significant age difference (AAG 51 years, PAG 62 years, p< 0.001), rheumatological comorbidity (AAG 3%, PAG 19%, p= 0.011), and modified Japanese orthopaedic association (mJOA). The PAG had significantly more regional malalignment at baseline, but there were no focal alignment differences between the two. Surgical features were significantly different for greater than three levels treated (AAG 27%, PAG 97%, p< 0.001) and blood loss (AAG 152 mL, PAG 380 mL, p< 0.001). After surgery, both AAG and PAG improved significantly in mJOA and Nurick grade, however, there was no statistically significant difference in mJOA postoperatively. AAG had a significant decrease in SVA whereas the PAG had a significant increase in SVA. There were no relevant postoperative focal alignment differences.Conclusion The PAG had older patients with more disability. Even when age, baseline mJOA, and regional parameters were controlled, the PAG cohort still correlated with worse CGH_C7 SVA and TS–CL. It is interesting to note that the PAG had a lower mJOA than the AAG at baseline, they both improved and were not significantly different postoperatively. This suggests that both techniques relieve symptomatic disease, but patients in the posterior group may continue to progress in sagittal misalignment.

Introduction Outcomes for cervical spondylotic myelopathy (CSM) have been measured by numerous health-related quality of life (HRQOL) scales such as the disease-specific modified Japanese Orthopaedic Association (mJOA) and the regional-specific neck disability index (NDI). However, there is no literature analyzing the correlation of myelopathy improvement to regional neck disability changes after surgery.Materials and Methods Post hoc analysis of a prospective, multicenter database of patients with CSM. A total of 217 patients (78%) met the following inclusion criteria: symptomatic CSM, age over 18 years, and 6 months follow-up with mJOA and NDI. The patient population had a mean age of 57 years and 42% were females (n= 92). NDI and mJOA were analyzed at baseline and 6 months post-op for the entire group. Correlations were also analyzed by the following subgroups: anterior approach group (AAG, n= 141) and posterior approach group (PAG, n= 76).Results From baseline to 6 months, there was a statistically significant improvement in both mJOA (BL 12.87–6 M 15.25, p< 0.0001) and NDI (BL 42.25–6M 31.61, p< 0.0001) in the overall group. There was a significant small negative correlation between NDI and mJOA at baseline (R=  − 0.34, p< 0.0001) and at 6-month follow-up (R=  − 0.44, p< 0.0001). Within the AAG, there was also a significant negative correlation between NDI and mJOA at baseline (R=  − 0.31, p< 0.0001) and 6 months (R=  − 0.53, p< 0.0001). Within the PAG, there was also a significant negative correlation between NDI and mJOA at baseline (R=  − 0.43, p< 0.0001) and 6 months (R=  − 0.34, p= 0.003).Conclusion Overall, NDI has a significant negative correlation with mJOA at baseline and postoperatively in patients with CSM. This correlation increases postoperatively in the overall group. The PAG showed a decrease in the correlation coefficient after surgery, whereas the AAG showed an increase. This could be because the posterior approach tended to be a more extensive surgery for multilevel disease in older patients, compared with the anterior approach, resulting in more soft tissue disruption and a delay in neck active motion. Regardless of the approach, mJOA still remains significantly correlated with NDI.

Introduction Cervical stenosis is a defining feature of CSM. Matsunaga et al proposed that elements of stenosis are both static and dynamic, where the dynamic elements magnify the canal deformation of the static state. We hypothesize that dynamic motion may be associated with myelopathy severity and neck disability and present novel methods of dynamic motion analysis in CSM.Patients and Methods Post hoc analysis of a prospective, multicenter database of patients with CSM. A total of 110 patients (34%) met inclusion criteria symptomatic CSM, age over 18 years, baseline flexion/extension radiographs, and HRQOLs (mJOA, NDI, SF-36, and Nurick grade). The mean age was 57 ± 12 years with 41% female (n= 46). Correlations with HRQOLs were analyzed for regional and focal parameters in flexion and extension. Baseline dynamic parameters (F/E cone relative to a fixed C7, center of rotation, range of motion arc relative to the COR) were also analyzed for correlations to HRQOLs.Results At baseline, the mean HRQOLs demonstrated disability and the mean radiographic parameters demonstrated sagittal malalignment. Among regional parameters, there was a significant correlation between increased C2–C7 angle in flexion and Nurick grade (R= 0.189, p= 0.048) with no significant correlations in extension. Focal parameters including C7 slip were significantly correlated with disability (Flex R= −0.377, p= 0.003; Ext R= −0.261, p= 0.027). Reduced flexion/extension motion cones, a more posterior center of rotation, and smaller range of motion correlated with worse HRQOLs.Conclusion Dynamic motion analysis may play an important role in understanding CSM. Focal parameters demonstrated a significant correlation with worse HRQOLs especially C7 slip in flexion and extension. Novel methods of motion analysis demonstrated reduced motion cones correlated with worse myelopathy grades. More posterior center of rotation and smaller range of motion were both correlated with worse general health scores (PCS and Nurick).

L’augmentation de la population âgée coïncide avec une demande fonctionnelle en constante évolution. Les déformations rachidiennes dégénératives (DRD) requièrent des techniques chirurgicales de correction telles que les ostéotomies transpédiculaires (OTP), associées à des risques de complications et de reprise chirurgicale. Néanmoins, les OTP ont démontré un bénéfice clinique potentiel tout âge confondu, même si leur ratio bénéfice risque sur le patient âgé n’est pas clairement identifié. L’objectif de cette étude est d’évaluer l’alignement sagittal et son évolution après OTP dans une population âgée de plus de 70ans.

La sténose cervicale est une caractéristique de la myélopathie cervico-arthrosique (MCA). Matsunaga a défini les éléments de sténose comme étant statiques et dynamiques. L’hypothèse principale de cette étude est l’association de la MCA et de l’instabilité dynamique. Une nouvelle méthode d’analyse dynamique de la MCA est également proposée.

Le maintien du regard horizontal est un élément essentiel de la posture érigée. Dans la littérature, il est fréquemment mesuré par le Chin Brow Vertical Angle (CBVA) mais sa mesure est souvent difficile dans les radiographies sagittales du rachis. Les objectifs de cette étude sont d’évaluer la corrélation ente le CBVA et deux angles plus accessibles – la pente de la ligne de Francfort (slope of the line of sight, SLS) et la pente de la ligne de McGregor (McGS), ainsi que leurs corrélations avec l’Index d’Oswestry (ODI).