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Introduction: Segmental instability of the spine caused by the decreased height of intervertebral discs is one of the major causes of chronic low back pain affecting 70-80% of the adult population. The decrease in height is due to degenerative lesions induced by vertical compression overload of the disc. Objective: A preliminary study was performed to determine if disc degeneration due to overload could be stopped. We hypothesized that disc distraction during fusion surgery from posterior approach could reduce the pressure on the discs, degeneration could be stopped, and perhaps the function could be restored. Methods: To characterize the condition of the discus, we used the determination glycosaminoglycan content, which is responsible for the disc-bound water content and thus for ensuring its elasticity. The use of gadolinium contrast agent in MRI (dGEMRIC) is an accepted method for determining the glycosaminoglycan content of the intervertebral disc, as the concentration of absorbed contrast agent is inversely proportional to the number of glycosaminoglycans in the intervertebral discs. In addition to pre- and postoperative dGEMRIC data, we examined disc height, lumbar lordosis, visual analog pain scale, and the Oswestry Disability Index. Results: All patients underwent monosegmental fusion following posterior distraction of the affected segment due to segmental instability. During the surgeries, lumbar lordosis did not decrease despite posterior distraction. The heights of the discus increased by an average of 3 mm, the pain decreased, and the Oswestry Disability Index improved. In the dGEMRIC studies, an average of 309.18 units/cm2 of gadolinium accumulated in the discs before surgery, which decreased postoperatively to 174.43 units/cm2. All changes were significant at the p = 0.05 significance level. Conclusion: The trend of our preliminary results suggests that increasing the height of the discs can reduce the hydrostatic pressure in the discs, resulting in an, SCOPUS: ar.j, info:eu-repo/semantics/published

La maladie de Kienböck fragilise le lunatum, qui souvent évolue vers la fracture et le collapsus. Divers facteurs ont été évoqués pour en expliquer l’origine, principalement anatomiques, comme l’index radio-ulnaire distal négatif, la structure trabéculaire du lunatum ou la pente de la glène radiale. Le carpe est soumis à des forces de compression qui tendent à le disloquer ou à l’écraser. Cette compression transmise par les métacarpiens se concentre dans le carpe vers l’espace radio-scapho-lunaire.La prise en charge chirurgicale la plus courante de la maladie de Kienböck avant le collapsus arthrosique est la décompression du lunatum par raccourcissement osseux de voisinage. Si l'ostéotomie transversale de raccourcissement du radius est la plus répandue, d’autres ostéotomies ont été proposées: l'ostéotomie de soustraction externe du radius, de soustraction interne du radius, d’accourcissement du capitatum, parfois étendue à l’hamatum. Ces différentes ostéotomies ayant un résultat différent sur l’anatomie, on peut supposer un effet de décompression variable sur le lunatum.Notre point de vue est que pour éviter la fracture du lunatum, il faut le soustraire durablement aux contraintes, en les déviant vers le scaphoïde ou le triquetrum. L’espace radio-scaphoïdien paraît moins à risque de conflit par hyperpression que l’espace ulno-carpien. Notre hypothèse est que pour dévier les contraintes vers le scaphoïde, il ne faut pas que le raccourcissement concerne la colonne externe du carpe, et l’espace radio-scaphoïdien. Nous avons envisagé de planifier une ostéotomie du radius pour ne pas décomprimer le scaphoïde. L’ostéotomie “Camembert” consiste à réséquer un coin osseux délimité entre le bord ulnaire du radius et le centre de la glène radiale.La technique est réalisée par voie dorsale, avec une résection contrôlée sous ampli, et une ostéosynthèse par une agrafe. Les résultats sont rapportés sur une série de 11 poignets opérés à sept ans de recul. Ils sont excellents et bon, Kienböck's disease weakens the lunate, which often evolves to fracture and collapse. Various factors, mainly anatomical, have been suggested to explain its origin, such as the negative distal radioulnar index, the trabecular structure of the lunate or the slope of the radial glenoid. The carpus is subjected to compressive loads that tend to dislocate or collapse it. This load transmitted by the metacarpals is concentrated through the carpus towards the radio-scapho-lunate space.The most common surgical management of Kienböck's disease prior to osteoarthritic collapse is decompression of the lunate by neighbourhood bone shortening. While transverse osteotomy for radius shortening is the most common, other osteotomies have been proposed: lateral radius shortening osteotomy, medial radius shortening osteotomy, capitate shortening, sometimes extended to the hamate. As these different osteotomies have a different result on the anatomy, a variable unloading effect of the lunate can be assumed.Our point of view is that to avoid a lunate fracture, it must be durably relieved from stresses by diverting it towards the scaphoid or the triquetrum. The radio-scaphoid space seems less at risk of hyperpressure than the ulno-carpal space. Our hypothesis is that to deviate the stresses towards the scaphoid, the shortening must involve neither the external column of the carpus, nor the radius facing the scaphoid. The "Camembert" osteotomy consists in resecting a bone wedge delimited between the ulnar edge of the radius and the centre of the radial glenoid.The technique is performed dorsally, with controlled bone resection under fluoroscopy. Osteosynthesis is completed with a staple. The results are reported on a series of 11 wrists with seven years follow-up. They are excellent and good in 8 cases, correct in 2 cases, and bad once.We conducted a biomechanical finite element analysis comparing the decompression of the lunate following different osteotomies. Some osteotomies may result, Doctorat en Sciences médicales (Médecine), info:eu-repo/semantics/nonPublished

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Purpose: The global appearance of scoliosis in the horizontal plane is not really known. Therefore, the aims of this study were to analyze scoliosis in the horizontal plane using vertebral vectors in two patients classified with the same Lenke group, and to highlight the importance of the information obtained from these vertebral vector-based top-view images in clinical practice. Methods: Two identical cases of scoliosis were selected, based on preoperative full-body standing anteroposterior and lateral radiographs obtained by the EOS™ 2D/3D system. Three-dimensional (3D) surface reconstructions of the spinal curves were performed by using sterEOS™ 3D software before and after surgery. In both patients, we also determined the vertebral vectors and horizontal plane coordinates for analyzing the curves mathematically before and after surgery. Results: Despite the identical appearance of spinal curves in the frontal and sagittal planes, the horizontal views seemed to be significantly different. The vertebral vectors in the horizontal plane provided different types of parameters regarding scoliosis and the impact of surgical treatment: reducing lateral deviations, achieving harmony of the curves in the sagittal plane, and reducing rotations in the horizontal plane. Conclusions: Vertebral vectors allow the evolution of scoliosis curve projections in the horizontal plane before and after surgical treatment, along with representation of the entire spine. The top view in the horizontal plane is essential to completely evaluate the scoliosis curves, because, despite the similar representations in the frontal and sagittal planes, the occurrence of scoliosis in the horizontal plane can be completely different. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]., SCOPUS: ar.j, info:eu-repo/semantics/published

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Early anthropological examination of Neandertal skeletal material by Marcellin Boule gave rise to popular images of Neandertals as brutish, ape-like creatures who walked hunched over with bent knees and a shuffling gait. Today, it is generally thought that Neandertals moved in a similar manner to humans with locomotive patterns within human ranges of variation and a bipedal gait likely to be indistinguishable from that of modern humans However, this hypothesis has not been tested by using the Neandertal skeleton as a whole. There is no complete Neandertal skeleton in the fossil record. The aim of this thesis was to reconstruct a complete virtual skeleton of a Neandertal based on the Spy II remains for educational museology purposes and for biomechanical analysis. Comparative analyses of Neandertal and modern human bones (pelvis, femur, rib) using different reference populations from Belgium were also undertaken. These studies were performed with a view to further understanding Neandertal bone morphology in comparison to modern humans, to assist in the reconstruction of the Neandertal Spy II skeleton and to aid in biomechanical analysis. A study on the sex determination of the pelves showed that there was no difference between physical linear measurements and virtual measurements, which was an important validation. The lhpFusionBox musculoskeletal software, which was developed at ULB, was used to scale available Neandertal and modern human bones to reconstruct the skeleton. Previous methods in the literature have only scaled bones of the same nature. A novel and validated scaling method was used to scale the Kebara 2 pelvis to the dimensions of the Spy II femur (as Spy II only has a small piece of sacrum) via the Neandertal 1 femur and pelvis. The reconstruction of a complete Neandertal skeleton based on the Spy II remains enabled the validation of individual reconstructions of bones, reconstructed long bones to be compared together with other limb proportions of Nea, Historiquement, le travaux de Marcellin Boule ont donné lieu à des représentations populaires de Néandertaliens vus comme des créatures simiesques bestiales qui se déplaçaient courbés avec des genoux pliés en traînant les pieds. Aujourd'hui, il est généralement admis que les Néandertaliens se déplaçaient d'une manière similaire à l'homme moderne avec une locomotion bipède. Toutefois, cette hypothèse n'a pas été encore testée sur un squelette néandertalien dans son ensemble. Comme il n’existe aucun squelette de Néandertalien entier, le but de cette thèse était de reconstituer un squelette virtuel complet sur la base des restes de Spy II à des fins éducatives de muséologie et pour l'analyse biomécanique.Des analyses comparatives d’os de Néandertalien et d’humains modernes (bassin, fémur, côtes) en utilisant diverses populations de référence de Belgique ont également été menées. Ces études ont été réalisées en vue de comprendre la morphologie néandertalienne, pour aider à la reconstruction du squelette Spy II et à l'analyse biomécanique. Une étude sur la détermination du sexe à partir des pelvis a montré qu'il n'y avait pas de différence entre les mesures linéaires physiques et les mesures virtuelles, ce qui était une validation importante.Le logiciel musculosquelettique lhpFusionBox, développé à l'ULB, a été utilisé pour reconstruire le squelette. Un nouveau procédé de mise à l'échelle validé a été utilisé pour mettre à l'échelle le bassin de Kebara 2 aux dimensions du fémur de Spy II (comme Spy II ne possède qu’un petit fragment de sacrum) via le fémur et le bassin de Neandertal 1. La reconstruction d'un squelette complet de Néandertalien a apporté de nouvelles connaissances sur cette espèce dans différents domaines. Elle a permis la validation des reconstructions individuelles des os, de comparer les os longs reconstruits avec d'autres proportions des membres de Néandertaliens, de faire une estimation de stature, et de reconsidérer les attributions antérieures d'os, Doctorat en Sciences biomédicales et pharmaceutiques (Médecine), info:eu-repo/semantics/nonPublished

Purpose: A posterior-anterior vertebral vector is proposed to facilitate visualization and understanding of scoliosis. The aim of this study was to highlight the interest of using vertebral vectors, especially in the horizontal plane, in clinical practice. Methods: We used an EOS two-/three-dimensional (2D/3D) system and its sterEOS 3D software for 3D reconstruction of 139 normal and 814 scoliotic spines—of which 95 cases were analyzed pre-operatively and post-operatively, as well. Vertebral vectors were generated for each case. Vertebral vectors have starting points in the middle of the interpedicular segment, while they are parallel to the upper plate, ending in the middle of the segment joining the anterior end plates points, thus defining the posterior-anterior axis of vertebrae. To illustrate what information could be obtained from vertebral vector-based top-view images, representative cases of a normal spine and a thoracic scoliosis are presented. Results: For a normal spine, vector projections in the transverse plane are aligned with the posterior-anterior anatomical axis. For a scoliotic spine, vector projections in the horizontal plane provide information on the lateral decompensation of the spine and the lateral displacement of vertebrae. In the horizontal plane view, vertebral rotation and projections of the sagittal curves can also be analyzed simultaneously. Conclusions: The use of posterior-anterior vertebral vector facilitates the understanding of the 3D nature of scoliosis. The approach used is simple. These results are sufficient for a first visual analysis furnishing significant clinical information in all three anatomical planes. This visualization represents a reasonable compromise between mathematical purity and practical use., SCOPUS: re.j, info:eu-repo/semantics/published

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By the end of the 20th century the vertically organized hospitals formed into a closed hierarchical system, in which the healthcare supply significantly fragmented. The existing hospitals in the current organization are not prepared for the increase in longevity, nor for the high growth in the number of chronic and long-term illnesses and the multimorbidity since they were not designed for extended carry treatments. The fast incorporation of high-tech and very expensive technologies into healthcare generates an economic crisis. Solving the supply and economic crisis at the same time cannot be achieved without changing the structure of hospitals. Future hospitals will be organized in a network, conducting special treatments according to disease profiles. According to present knowledge, this is the only structure that allows for economies in scale, the proper spending of the ever-shrinking resources, and to ensure the effective patient care required after the changing of disorder structures and patient corporate identities., SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction: Of the world-wide used Cotrel-Dubousset instrumentation and surgical technique providing breakthrough for the three-dimensional correction and multi-segmental fixation of spinal deformity surgery in Hungary is linked to the author's name, who carried out 1655 spine deformity surgeries in the last 21 years. Aim: The aim of the author was to discuss his own results in the field of spine surgery and compare his own data to those published in the international literature. Method: At the beginning hooks, followed by hybrid instrumentation with hooks in thoracic area and transpedicular screws in lumbar spine have been used for the segmental fixation. During the correction process, initially the classic derotation maneuver was used, followed by the translation and then the in situ bending techniques and, finally, a combination of the above three techniques have been applied. Results: In addition to the restoration of normal sagittal balance, an average of 40.8° (SD, 25.9), a 65.5% correction was achieved in the frontal plane, which partly exceeds and partly consistent with the published international results. The incidence of inflammation (3.9%), and mechanical complications (1.7%) was similar to the international average, while the incidence of neurological complications (0.48%) was slightly lower than the average of international data. Conclusions: The author believes that the better correction results as compared to the international average could be due to the always consistent application of the Cotrel-Dubousset instrumentation correction philosophy based on the meticulous segmental analysis of spine deformities., SCOPUS: ar.j, info:eu-repo/semantics/published

Low back pain (LBP) has become one of the greatest public health problems. The differentiation between specific and non-specific low back pain is mandatory. In the specific low back pain are classified all diseases whose etiology is well defined, quick and accurate diagnosis is required for specific treatment. Other types of low back pain can be considered non-specific. The management of acute low back pain is mainly based on analgesic treatment and early mobilization. Maintaining activity can prevent chronicity of LBP. Chronicity factors are multiple, mainly psycho-social and professional. The chronic low back pain treatment goals are the reduction of pain and better activity/participation to achieve the prevention of disability and maintaining work ability. Multidisciplinary treatment programs including personalized and guided physical therapy, cognitive behavioral therapy and short-term training programs will help to improve, restore and maintain the function in chronic low back pain., SCOPUS: ar.j, info:eu-repo/semantics/published

The low back pain has become one of the greatest public health problems worldwide. The author based on the current international standards summarizes the knowledge necessary for every day treatment of low back pain. In acute low back pain the author underlines the necessity of the rapid, accurate diagnosis and separation for specific and nonspecific low back pain. In specific acute low back pain the treatment should focus on to eliminate the root causes. In non-specific cases pain killing treatment and early active mobilization is the choice for the therapeutic process. Beside analgesia, the primary goal of the treatment is to prevent becoming chronic the symptomatology. Objectives of the management of chronic low back pain are effective pain reduction, continuous maintainance of physical activity, prevention of permanent disability, and restoration of working ability. Analgesics, non steroid anti-inflammatory drugs, and muscle relaxants reduce pain, while multidisciplinary management programs, personalized and guided physiotherapy, cognitive behavioral therapy, as well as short training programs will help to restore function. Surgical treatment is only indicated in degenerative cases and only after the failure of conservative therapy., SCOPUS: re.j, info:eu-repo/semantics/published

Study Design Reproducibility study of SterEOS 3-dimensional (3D) software in large, idiopathic scoliosis (IS) spinal curves. Objective To determine the accuracy and reproducibility of various 3D, software-generated radiographic measurements acquired from a 2-dimensional (2D) imaging system. Summary of Background Data SterEOS software allows a user to reconstruct a 3D spinal model from an upright, biplanar, low-dose, X-ray system. The validity and internal consistency of this system have not been tested in large IS curves. Methods EOS images from 30 IS patients with curves greater than 50 were collected for analysis. Three observers blinded to the study protocol conducted repeated, randomized, manual 2D measurements, and 3D software generated measurements from biplanar images acquired from an EOS Imaging system. Three-dimensional measurements were repeated using both the Full 3D and Fast 3D guided processes. A total of 180 (120 3D and 60 2D) sets of measurements were obtained of coronal (Cobb angle) and sagittal (T1-T12 and T4-T12 kyphosis; L1-S1 and L1-L5; and pelvic tilt, pelvic incidence, and sacral slope) parameters. Intra-class correlation coefficients were compared, as were the calculated differences in values generated by SterEOS 3D software and manual 2D measurements. The 95% confidence intervals of the mean differences in measures were calculated as an estimate of reproducibility. Results Average intra-class correlation coefficients were excellent: 0.97, 0.97, and 0.93 for Full 3D, Fast 3D, and 2D measures, respectively (p =.11). Measurement errors for some sagittal measures were significantly lower with the 3D techniques. Both the Full 3D and Fast 3D techniques provided consistent measurements of axial plane vertebral rotation. Conclusions SterEOS 3D reconstruction spine software creates reproducible measurements in all 3 planes of deformity in curves greater than 50. Advancements in 3D scoliosis imaging are expected to improve our understanding and treatme, SCOPUS: ar.j, info:eu-repo/semantics/published

Les buts de cette thèse sont les suivants :préciser les critères de datation d’une lésion ligamentaire scapho-lunaire instable ;analyser l’apport de l’imagerie par résonance magnétique (IRM) dans le diagnostic lésionnel des ligaments extrinsèques du carpe ;étudier l’apport de l’arthroscopie en particulier dans la classification de l’instabilité prédynamique scapho-lunaire et dans le testing des ligaments extrinsèques ;isoler une éventuelle nouvelle structure anatomique stabilisatrice du carpe ;et enfin évaluer à court terme les résultats de la capsulodèse à l’intercarpien dorsal selon Viegas. Trois critères arthroscopiques sont décrits et analysés statistiquement sur 100 arthroscopies, pour dater le traumatisme responsable d’une lésion ligamentaire instable du carpe. La turbidité du liquide synovial (T0 à T4), l’infiltration synoviale hémorragique (S0 à S2) et l’état du cartilage (C0 à C4) sont corrélés au délai post-traumatique. La turbidité et l’infiltration synoviale hémorragique sont les plus significatives (p < 0.001). La corrélation entre le grade de chondropathie et le délai post-traumatique est également significative (p < 0.01). L’infiltration synoviale est le caractère prédictif le plus puissant. La combinaison des trois critères renforce la prédictibilité. Il est dès lors possible de confirmer l’anamnèse, de préciser s’il s’agit d’une lésion instable aiguë ou subaiguë (moins de six semaines), ou chronique récente (six semaines à trois mois) ou chronique ancienne (plus de trois mois), ou encore de documenter un état antérieur inconnu du patient. Les ligaments extrinsèques du poignet peuvent être examinés de façon précise par IRM. Deux études, l’une sur poignets indemnes, l’autre rétrospective sur poignets pathologiques, ont permis de préciser le système d’imagerie et le mode d’utilisation les plus efficaces dans l’examen de ces ligaments. L’analyse de ces structures anatomiques fines aux directions obliques et courbes est optimalisée par l’utilisation d’un, Doctorat en Sciences médicales, info:eu-repo/semantics/nonPublished

Purpose: A new concept of vertebra vectors based on spinal three-dimensional (3D) reconstructions of images from the EOS system, a new low-dose X-ray imaging device, was recently proposed to facilitate interpretation of EOS 3D data, especially with regard to horizontal plane images. This retrospective study was aimed at the evaluation of the spinal layout visualized by EOS 3D and vertebra vectors before and after surgical correction, the comparison of scoliotic spine measurement values based on 3D vertebra vectors with measurements using conventional two-dimensional (2D) methods, and an evaluation of horizontal plane vector parameters for their relationship with the magnitude of scoliotic deformity. Methods: 95 patients with adolescent idiopathic scoliosis operated according to the Cotrel-Dubousset principle were subjected to EOS X-ray examinations pre- and postoperatively, followed by 3D reconstructions and generation of vertebra vectors in a calibrated coordinate system to calculate vector coordinates and parameters, as published earlier. Differences in values of conventional 2D Cobb methods and methods based on vertebra vectors were evaluated by means comparison T test and relationship of corresponding parameters was analysed by bivariate correlation. Relationship of horizontal plane vector parameters with the magnitude of scoliotic deformities and results of surgical correction were analysed by Pearson correlation and linear regression. Results: In comparison to manual 2D methods, a very close relationship was detectable in vertebra vector-based curvature data for coronal curves (preop r 0.950, postop r 0.935) and thoracic kyphosis (preop r 0.893, postop r 0.896), while the found small difference in L1-L5 lordosis values (preop r 0.763, postop r 0.809) was shown to be strongly related to the magnitude of corresponding L5 wedge. The correlation analysis results revealed strong correlation between the magnitude of scoliosis and the lateral translation of apical ve, SCOPUS: ar.j, info:eu-repo/semantics/published

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