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Purpose: Spinal osteotomies performed to treat fixed spinal deformities are technically demanding and associated with a high complications rate. The main purpose of this study was to analyze complications and their risk factors in spinal osteotomies performed for fixed sagittal imbalance from multiple etiologies. Methods: The study consisted of a blinded retrospective analysis of prospectively collected data from a large multicentre cohort of patients who underwent 3-columns (3C) spinal osteotomy, between january 2010 and january 2017. Clinical and radiological datas were compared pre and post operatively. Complications and their risks factors were analyzed.Results: Two hundred eighty-six 3C osteotomies were performed in 273 patients. At 1year follow-up, both clinical (VAS pain, ODI and SRS-22 scores) and radiological (SVA, SSA, loss of lordosis and pelvic version) parameters were significantly improved (p were assessed as risk factors for overall complication (p (p=0.02).Conclusion: Spinal 3C osteotomies were efficient to improve both clinical and radiological parameters despite high rates of complication. Efforts should be made to reduce operative time which appears to be the strongest predictive risk factor for complication.

Las reintervenciones tardias de pacientes operados de la columna no son excepcionales. Cada vez es mayor el numero de pacientes que presentan dolor y deformaciones de la columna, que se toleran mal en nuestras sociedades modernas. Las instrumentaciones y tecnicas se han perfeccionado en los ultimos 30 anos, con el objetivo principal de mejorar los resultados quirurgicos y con la posibilidad de realizar intervenciones cada vez mas complejas. Sin embargo, los resultados de estos tratamientos quirurgicos no siempre son tan buenos como seria de esperar y el numero de pacientes que deben someterse a una reintervencion tardia no deja de aumentar. La confianza de los cirujanos de la columna en las nuevas tecnicas ha dado lugar a un aumento de las indicaciones quirurgicas (sobre todo en adultos), a pesar de una mejor comprension de la biomecanica de la columna. Esta situacion paradojica tiende a explicar el hecho de que los progresos suelen producirse despues de una sucesion de pruebas y errores. La experiencia de los autores de este articulo se basa en 318 reintervenciones tardias en los ultimos 25 anos. Tanto las tecnicas de revisiones como sus complicaciones varian segun las afecciones iniciales y los grupos de edad, pero todas requieren intervenciones prolongadas, agresivas y peligrosas, con un riesgo quirurgico muy elevado. El numero de complicaciones observadas es importante, aunque si se respetan varios requisitos, los resultados obtenidos en los casos mas complejos suelen ser satisfactorios en ultima instancia. Entre las diversas lecciones que se han extraido de esta experiencia, es esencial conceder la prioridad a la restauracion del equilibrio global de la columna. Esto es aplicable tanto a la cirugia inicial como a las reintervenciones. Al considerar los requisitos de esta cirugia, es indispensable confiarla a equipos experimentados que dominen todas estas tecnicas quirurgicas complejas y que dispongan de un entorno adecuado para el tratamiento de estos pacientes.

Introduction Deformity associating coronal and sagittal malalignment can severely impair quality of life in Parkinson's disease (PD). Realignment using patient-specific rods (PSRs) is useful for achieving alignment goals. Methods This was a retrospective single-center analysis of a prospectively maintained database of all PD patients who underwent surgery between January 2013 and January 2017. Clinical evaluation, preoperatively and at 1 year's follow-up, used the Oswestry Disability Index (ODI). Radiological evaluation used systematic preoperative and 1-year postoperative full-spine radiographs. Results Twelve patients were included: 6 female, 6 male; mean age, 68.4 years. Mean follow-up was 40.8 months [range 12–70]. On average, 14 levels were fused [range 10–18]. Unplanned revision surgery was necessary for 8 patients at a mean 15.625 months after index surgery. Mean preoperative ODI score was 64% preoperatively [range 56–70] versus 52% [range 28–64] at 1 year's follow-up (P = 0.004). Lumbar lordosis improved significantly, from −16.7° preoperatively to −41.4° at 1 year (P = 0.006). Pelvic tilt was the least effectively corrected parameter, with a mean preoperative value of 31.6° vs. 27.8° at 1 year (P = 0.19). Mean preoperative sagittal vertical axis was 149.7 mm versus 73.6 mm at 1 year (P = 0.013). Mean preoperative coronal tilt was 68.2 mm versus 22.9 mm at 1 year (P = 0.007). Conclusion Parkinson's disease is a degenerative disease frequently associated with major spine malalignment. The severity of the postural disorders in these patients needs special precautions to avoid complications.

Resume Introduction Les desequilibres rachidiens peuvent fortement impacter la qualite de vie des patients. Differents parametres sagittaux sont utilisees comme objectifs de realignement, cependant environ 50 % des patients sont insuffisamment corriges en postoperatoire. Afin d’ameliorer la correction, il existe des tiges pre-cintrees dont les rayons de courbures sont definis en fonction de l’equilibre sagittal « ideal » du patient. Mais il n’existe pas d’etude portant sur la modification du rayon de courbure en fonction du type de connexions entre les vis pediculaires et les tiges. L’objectif de cette etude experimentale etait de quantifier l’effet d’aplatissement de tiges pre-cintrees en fonction du mode de connexion vis-tige : vis a chargement superieur vs. vis a dome avec connecteur lateral. Materiel et methode Les tests etaient realises dans une machine de compression axiale sur 3 montages utilisant 2 tiges fixee a l’aide de vis a chargement superieur, puis sur 3 montages utilisant 2 tiges fixees a l’aide de vis a dome avec connecteur lateral. Les mesures d’angulation maximales etaient realisees apres mise en charge et apres suppression de la charge. Le critere de jugement principal etait la comparaison de la moyenne d’angulation de chaque type de montage a chaque etape. Resultats L’angulation moyenne des montages avec des vis a chargement superieur en charge a 500 N significativement reduit par rapport aux montages utilisant des vis a dome avec connecteur lateral (En moyenne 18,6° vs 24,5° respectivement, p Conclusion In vitro, les vis a chargement superieur ont un effet d’aplatissement significativement superieur a celui des vis a dome avec connecteur lateral. Ces resultats devront etre confirmes in-vivo, cependant la connaissance du comportement des tiges en fonction du type de connexion avec les vis peut etre un element important afin de limiter le risque de sous-correction dans le plan sagittal. Niveau de preuve III.

Resume La prise en charge des lesions posterieures de l’anneau pelvien sans complication neurologique ne fait pas encore l’objet d’un consensus. Differentes fixations ont ete decrites et, plus recemment, des montages pouvant associer fixation lombo-iliaque et fixation iliosacree. Ces fixations sont particulierement indiquees en cas de dissociation spinopelvienne avec un deplacement fracturaire important dans le plan sagittal. Cependant, ces techniques exposent a des complications, notamment infectieuses et cutanees importantes en postoperatoire. Aussi, nous proposons une technique de fixation lombo-iliaque et iliosacree mini-invasive des lesions posterieures de l’anneau pelvien. L’intervention est menee en decubitus ventral et comporte un vissage pediculaire L4 ou L5 et une vis iliaque sous controle fluoroscopique, une distraction peroperatoire est possible en fonction de l’importance du deplacement. Une vis iliosacree est ensuite mise en place en percutane afin de permettre une reduction dans le plan transversal et assurant ainsi un montage en triangulation. En moyenne, sur 5 patients operes selon cette technique, le deplacement vertical moyen etait de 11,9 ± 6,9 mm (SD) en preoperatoire (min = 1,3, max = 19,7) versus 3,7 ± 3,2 mm en postoperatoire (min = 0,3, max = 6,7) et le deplacement frontal de 7,46 ± 3,7 mm en preoperatoire (min = 4,2, max = 12,4) versus 2,56 ± 2 mm en postoperatoire (min = 0,3, max = 4,3). La fixation lombo-iliaque et iliosacree mini-invasive constitue une alternative dans la prise en charge des lesions de l’anneau pelvien posterieur sans troubles neurologiques et notamment les dissociations spinopelviennes.

Study design National cross-sectional study. Background 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. Objective: 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 (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 TK60°. Differences in gaps were minor between PI groups. The intercept was smallest and slopes >.6 for PI 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.

International audience; BackgroundAccurate screw placement remains challenging, especially in the cervical spine. We present our first experience of minimally invasive posterior cervical and upper thoracic pedicle screw fixation in the lower cervical spine.MethodsThis study reports a case series of patients, undergoing posterior percutaneous pedicle fixation using Cirq robotic assistance coupled to the Airo intraoperative computed tomography scan and Brainlab navigation system. Routine computed tomography was performed on postoperative day 2 to evaluate pedicle screw placement. The effective dose was calculated.ResultsBetween February 2020 and December 2020, 7 patients (4 men and 3 women) were treated. The mean age was 58.8 years (range, 29–75 years). Fixation was performed with a cannulated PASS OCT Reconstruction System (Medicrea). Overall, 28 screws were placed within cervical and upper thoracic pedicles. According to the Neo and Heary classification, 85.7% were rated as acceptable and 14.3% as poor. The radiation dose received by the patient was 9.1 mSv (range, 7.7–10.6 mSv). The radiation dose received by the surgical staff was 0 mSv. The postoperative course was excellent.ConclusionsPosterior miniopen fixation using Cirq robotic assistance coupled with an intraoperative computed tomography navigation system is a major innovation that can improve the accuracy of pedicle screw positioning, with acceptable patient radiation and reduced surgical team exposure.

International audience; Introduction: In adolescent idiopathic scoliosis (AIS) patients, mechanical consequences of posterior spinal fusion within the spine remain unclear. Through dynamic assessment, gait analysis could help elucidating this particular point. The aim of this study was to describe early changes within the spine following fusion with hybrid instrumentation in adolescents with idiopathic scoliosis, using gait analysis. Materials and methods: We conducted a single-centre prospective study including AIS patients scheduled for posterior spinal fusion (PSF) using hybrid instrumentation with sublaminar bands. Patients underwent radiographic and gait analyses preoperatively and during early postoperative period. Among gait parameters, motion of cervicothoracic, thoracolumbar and lumbosacral junctions was measured in the three planes. Results: We included 55 patients (mean age 15 years, 84% girls). Fusion was performed on 12 levels and mean follow-up was 8 months. There was a moderately strong correlation between thoracolumbar sagittal motion and lumbosacral junction pre- and postoperatively (R = - 0.6413 and R = - 0.7040, respectively, all p < 0.001), meaning that the more thoracolumbar junction was in extension, the more lumbosacral extension movements decreased. There was a trend to significance between postoperative SVA change and thoracolumbar sagittal motion change (R = - 0.2550, p = 0.059). Discussion: This is the first series reporting dynamic changes within the spine following PSF using hybrid instrumentation in AIS patients. PSF led to symmetrization of gait pattern. In the sagittal plane, we found that thoracolumbar extension within the fused area led to decreased extension at cervicothoracic and lumbosacral junctions. Even though consequences of such phenomenon are unclear, attention must be paid not to give a too posterior alignment when performing PSF for AIS patients.

Introduction Complex spinal surgery is known to be at risk of complications. Surgical site infection is a serious complication in spine surgery and its frequency is significantly increased in adult spinal deformity correction. The aim of this study is to identify patients’ characteristics and risk factors of surgical site infection (SSI) following an osteotomy. Methods This is a single-center retrospective study of patients who underwent an osteotomy between January 2015 and December 2017. Surgical site infection diagnosis was based upon patient's clinical evidence of infection, biologic parameters, microbiological criteria and/or image findings. Results In total, 102 patients were eligible and 70 were women (68.6%). Mean age was 65 years old (27–83 years) and mean body mass index (BMI) was 26.14 kg.m−2 (18.4–44.1). Eleven patients were in the SSI group and 91 in the No-SSI group. The mean Schwab grade was 1.5 (1–4) in the SSI group vs. 1.4 (1–5) in the No-SSI group (P = 0.435). The mean operative time was on 201.9 minutes (67–377). Mean length of stay was 20.6 days (10–73) in the SSI group vs. 15 days (5–44) in the No-SSI group (P = 0.041). Favorable outcome was found in 10 patients (90.9%) in the SSI group. Conclusion Correction surgery for adult spinal deformity with osteotomies carries a high risk of complications specially SSI. Identification of risk factors, prevention and medical management of SSI should be well assessed.

Resume Introduction La scoliose idiopathique de l’adolescent est une pathologie frequente en orthopedie pediatrique et pour laquelle l’analyse est habituellement faite grâce a la radiographie standard. Cependant, les conditions de realisation de la radiographie sont totalement differentes de la position qu’adopte le patient dans ses activites quotidienne. Notre hypothese etait que la position statique du tronc etait differente de sa posture dynamique. Notre objectif etait d’etudier les differences entre les analyses statiques et dynamiques en analyse quantifiee du mouvement (AQM) dans une population d’adolescents porteurs d’une scoliose idiopathique. Patients et methodes Dans une etude prospective monocentrique, nous avons inclus des adolescents porteurs d’une scoliose idiopathique programmes pour une correction chirurgicale. La veille de l’intervention chirurgicale, des radiographies et une AQM etaient realisees (acquisitions statique et dynamique). Differents parametres etaient mesures a la radiographie et en AQM, dont le coronal vertical axis (CVA), le sagittal vertical axis (SVA) et l’inclinaison des epaules de face. Resultats Nous avons inclus 62 patients âges en moyenne de 15,5 ans. Il existait une correlation significative pour la majorite des parametres entre mesure radiographique et AQM statique. En revanche, la mesure dynamique du CVA, du SVA et de l’inclinaison des epaules n’etait pas correlee a leur mesure statique (respectivement R = 0,229 ; 0,198 et −0,109, tous p > 0,05). Il y avait une inversion de l’inclinaison des epaules entre la position statique et l’analyse a la marche (−0,9 vs 0,5°, p = 0,031). Discussion Cette etude est la premiere a comparer la position du tronc en statique et a la marche dans une population d’adolescents porteurs d’une scoliose idiopathique. Nos resultats suggerent que l’analyse radiographique ne permet qu’une analyse partielle de l’alignement rachidien et ne permet pas de tirer des conclusions fiables quant a l’equilibre dynamique du tronc. L’AQM permet d’apporter des informations nouvelles sur la posture dynamique du tronc.

Resume Introduction Les fractures-eclatement de L5 representent un faible pourcentage de l’ensemble des fractures de la colonne vertebrale dont la strategie de traitement n’est pas encore standardisee. Les caracteristiques anatomiques et biomecaniques lombo-sacrees creent des types de fractures qui different de celles de la jonction thoraco-lombaire. L’objectif de cette etude etait d’evaluer les resultats du traitement chirurgical des fractures-eclatement de L5 apres stabilisation posterieure et reconstruction de la colonne anterieure. Patients et methodes Six patients avec une fracture instable de L5 isolee ont ete inclus. Les dossiers medicaux, les radiographies et des scores cliniques etaient analyses. Les resultats portaient sur la restauration de la hauteur du corps vertebral, de la lordose/cyphose vertebrale, la stenose canalaire et les parametres de l’equilibre sagittal a differentes phases de la prise en charge. Resultats Aucun patient n’a presente d’aggravation neurologique. La hauteur vertebrale anterieure mediane preoperatoire etait de 41 mm vs 48 mm en postoperatoire. La cyphose traumatique moyenne preoperatoire, mesuree par l’angle de Cobb (local et regional), etait de 21,5 degres et 33 degres avec une amelioration respective de 7,5 et 5,5 degres apres instrumentation. La stenose canalaire moyenne, liee a la retropulsion du fragment osseux dans le canal, etait mesuree a 67 % en preoperatoire et a 35 % en postoperatoire. Au dernier recul, une fusion anterieure etait obtenue dans tous les cas et il etait note une restauration de l’equilibre sagittal. Cliniquement, tous les patients avaient une incapacite minimale a moderee en utilisant l’indice d’Oswestry. La capacite de retour au travail montrait des resultats a long terme consideres comme bon a excellent. Discussion Les resultats du traitement des fractures instables de L5 avec stabilisation posterieure et reconstruction de la colonne anterieure montrent un benefice sur le resultat fonctionnel a long terme, la stabilisation de la colonne vertebrale et les parametres radiologiques. Niveau de preuve IV, etude retrospective.

Resume Introduction La survenue d’une metastase vertebrale constitue un tournant evolutif d’une maladie tumorale et, malgre leur incidence croissante, la prise en charge n’est pas standardisee. Differents scores pronostiques ont ete proposes, mais la progression des therapeutiques anti-tumorales, ainsi que les progres chirurgicaux, ont rendu ces differents scores moins precis et parfois discordants pour un meme patient. Il apparait donc utile de trouver de nouveaux outils de determination pronostique. L’objectif de cette etude etait de determiner les facteurs de risque biologique de survenue de complications et de deces postoperatoires chez des patients operes d’une metastase vertebrale. Materiel et methodes Il s’agit d’une etude multicentrique, prospective. Tous les patients operes d’une metastase vertebrale, entre novembre 2015 et mai 2017, ont ete inclus. Les donnees epidemiologiques principales et les parametres biologiques etaient recueillis en preoperatoire : CRP, albuminemie et calcemie preoperatoires. La strategie chirurgicale, la survenue d’un deces et/ou d’une complication postoperatoire etaient colligees de maniere prospective. Resultats Sur les 264 patients initialement inclus, 5 sont decedes en postoperatoire immediat, 107 sont decedes dans les 6 premiers mois. Au total, 57 patients etaient vivants a 1 an postoperatoire, 26 patients (10 %) etaient perdus de vue. L’albuminemie inferieure a 35 g/L (29 % des patients en preoperatoire), la calcemie superieure a 2,6 nmol/L (8 % des patients) et la CRP superieure a 10 mg/L (47,5 % des patients) etaient associees a un risque de survenu de deces significativement superieur. Seule l’elevation de CRP etait correlee a une augmentation des complications postoperatoires. Conclusion Cette etude confirme la valeur pronostique des trois parametres biologiques (taux de CRP, albuminemie, calcemie) concernant la survie de patients operes d’une metastase vertebrale. La creation d’un score hybride, prenant en compte non seulement des parametres cliniques mais egalement des parametres biologiques, devrait etre envisagee afin de preciser l’estimation de la survie de ces patients.

Resume La presence d’une symptomatologie radiculaire est un motif de consultation frequent en pathologie rachidienne. La realisation d’infiltrations epidurales, bien que largement utilisees, reste encore sujette a discussion. Il est ainsi possible d’approcher l’espace epidural par une voie transforaminale, interlamaire ou en passant par le hiatus sacro-coccygien. L’objectif de ce travail est donc de decrire la technique d’infiltration epidurale par le hiatus sacro-coccygien et d’en rapporter notre experience. Au-dela de l’effet therapeutique, l’infiltration du hiatus sacro-coccygien peut avoir un interet en tant que test diagnostique ou en solution d’attente. Un guidage pour un positionnement optimal de l’aiguille sous S3 est recommande. L’infiltration par le hiatus sacro-coccygien constitue donc une alternative interessante dans la prise en charge de la radiculopathie lombaire chez l’adulte.

Introduction L5 burst fractures represent a small percentage of all spine fractures. Treatment strategy has not yet been standardized. Anatomical features and their biomechanical characteristics create fracture patterns which differ from those at the thoracolumbar junction. The objective of this study was to evaluate L5 burst fracture surgical treatment outcomes after posterior stabilization and reconstruction of the anterior column. Patients and methods Six patients with fifth lumbar isolated unstable burst fractures were analyzed. Medical records, radiographs, and clinical scores were obtained. The results were evaluated based on restoration of vertebral body height, spinal lordosis/kyphosis, canal compromise and sagittal alignment at several phases of treatment. Results No patient showed neurologic deterioration, regardless of treatment. The median preoperative anterior vertebral height was 41 mm and postoperative was 48 mm. The median preoperative kyphotic angle as measured by Cobb angle (local and regional) was 21.5 degrees and 33 degrees which improved respectively by 7.5 and 5.5 degrees following instrumentation. The median amount of backward protrusion of bony fragment into the canal was measured at 67% preoperatively and at 35% postoperatively. There were no pseudarthrosis and anterior arthrodesis solid fusion was visible in all cases. There were a sagittal alignment restoration. At one year of follow up, fusion was obtained in all the cases, all patients had minimal to moderate disability using Oswestry Disability Index. The ability to return to work revealed a good-to-excellent long-term result. Discussion The results of treatment of 5th lumbar unstable burst fractures with posterior stabilization and reconstruction of the anterior column show benefit on durable functional outcome, spine stabilization and radiologic parameters. Level of evidence IV, retrospective study.

Background Odontoid fractures are the most common lesions of the upper cervical spine in patients >70 years old. These fractures are associated with frequent comorbidities, and minimally invasive techniques might have the potential to reduce postoperative complications while ensuring better precision. The aim of this study was to report an innovative technique and preliminary results of minimally invasive atlantoaxial fixation using a three-dimensional intraoperative navigation system and percutaneous approach. Methods This retrospective study included 5 consecutive patients with an acute traumatic odontoid type II fracture managed using a percutaneous Harms fixation under three-dimensional intraoperative navigation guidance. Results C1 lateral mass screws and C2 isthmus screws were successfully placed in all patients. In all cases (100%), adequate screw positioning with no medial breach and no transverse foramen obstruction was observed. No intraoperative complications, such as injury of the vertebral artery, spinal nerve root, or spinal cord, occurred. None of the 5 patients received blood transfusion during or after the procedure. During the follow-up period (mean, 11.2 months; range, 5-16 months), 4 patients (80%) demonstrated a favorable clinical recovery, and only 1 patient required occasional medication for moderate pain. Mean radiation exposure was 4.83 mSV for each patient and 0 mSv for surgical staff. Conclusions Minimally invasive atlantoaxial fixation using an intraoperative three-dimensional navigation system is a safe and effective alternative to the conventional approach that reduces postoperative morbidity.

Since the outbreak of coronavirus disease 2019 (COVID-19) in December 2019 in China, various measures have been adopted in order to attenuate the impact of the virus on the population. With regard to spine surgery, French physicians are devoted to take place in the national plan against COVID-19, the French Spine Surgery Society therefore decided to elaborate specific guidelines for management of spinal disorders during COVID-19 pandemic in order to prioritize management of patients. A three levels stratification was elaborated with Level I: Urgent surgical indications, Level II: Surgical indications associated to a potential loss of chance for the patient and Level III: Non-urgent surgical indications. We also report French experience in a COVID-19 cluster region illustrated by two clinical cases. We hope that the guidelines formulated by the French Spine Surgery Society and the experience of spine surgeons from a cluster region will be helpful in order optimizing the management of patients with urgent spinal conditions during the pandemic.

Traumatic fractures of the thoracolumbar spine are common. Their management considers the fracture type according to the various classifications in existence, as well as the patient's background and age. In some cases, the occurrence of a fracture on a spine with an unoperated scoliotic deformity can be observed. This entity, not described in the literature, can pose a therapeutic challenge and is not present in any existing treatment algorithm. The main objective of this work was to describe the characteristics and management of vertebral fractures in patients with unoperated idiopathic scoliosis.We carried out a monocentric retrospective study in all patients operated on for a spinal fracture between May 2011 and August 2020, with a history of unoperated adolescent idiopathic scoliosis. We collected epidemiological data including the surgical course of each patient and the final result. The patients were categorized according to the surgical strategy (extensive fusion and correction of the deformity, short osteosynthesis without considering the scoliosis, vertebroplasty, orthopedic treatment) and the final clinical and radiological result evaluated at the last follow-up.Ten patients were included in this study with a total number of 16 fractured vertebrae. The population was 80% female, with an average age of 36.3 years. The majority of fractures were type A, at the thoracolumbar junction. The curves were classified as Lenke 1A in 5 cases, 1B in 2 cases, 1C in 1 case and 5C for 2 patients. Ultimately, 3 patients underwent extended fusion with correction of scoliosis, 6 localized osteosynthesis and 1 percutaneous vertebroplasty. In 50% of cases, a change of surgical strategy had to be made, due to worsening of the deformity or hyperalgesia. The last follow-up was at 19.7 months on average. Five patients had a good final clinical result, 5 patients had persistence of significant pain (lower back pain or cruralgia).This is the first study investigating the association of vertebral fractures and the presence of unoperated idiopathic scoliosis. The results of our study highlight the management challenges and difficulties in therapeutic decision making. The presence of a pre-existing curve is thus an important parameter to consider, and should lead to the discussion of performing an extended fusion secondarily in view of the risk of poor results from localized surgery.IV.

Retrospective cross-sectional study.The aim was to describe spinopelvic alignment types by pelvic incidence (PI) and age to compare the Roussouly classification between pediatric and adult populations.The Roussouly classification was validated for adults. Alignment types may vary during growth.Radiographs of 1706 non pathologic individuals (5-49 yr) were analyzed. Individuals ≤19 years were stratified by chronological age and skeletal maturity (triradiate cartilage, Risser), and compared with adults. Global and spinopelvic alignment parameters were assessed. Roussouly Types 1, 2, 3, 3A (anteverted pelvis), and 4 were determined. The distribution of parameters was analyzed by Bayesian inference. The relationship between PI and age by Roussouly type was modeled by linear regression.The Sagittal Vertical Axis C7 decreased during growth and was significantly smaller in adults (20-34 yr) (Pr0.99). Thoracic kyphosis and lumbar lordosis increased during growth and were larger in adults (Pr0.025). Lordosis increased mainly in the cranial arch (Pr0.025). PI and pelvic tilt increased during growth and were larger in adults (Pr0.025). In children and adolescents, PI45° represented the largest proportion, significantly larger compared with adults (Pr0.99). Proportions of Roussouly Types 1 and 2 were similar throughout ages. Types 3 and 4 were rarer during the prepubertal period (Pr0.025). The proportion of Type 3A was significantly higher in children and adolescents (Pr0.99). Linear regression showed that Type 4 had the largest PI increase with age, with significantly higher curve slope compared with other types (Pr0.9999). Types 3, 3A and 2 had similar slopes and lowest PI increase with age.Global and spinopelvic alignment changed during childhood and adolescence, leading to different kyphosis and lordosis distribution compared with adults. Growth-related PI increase influenced Roussouly types with typical predominance of Type 3A in the pediatric population and larger PI increase in Type 4.Level III.

Cervical MRI is the gold standard for surgical planning of degenerative cervical myelopathy; however, the symptomatic postoperative recurrence rate is high in the medium and long term (9.1% to 10.7%) and may bring into question the quality of the preoperative surgical plan. The objective of this study was to evaluate cervical spinal stenosis and intramedullary hyperintensity with dynamic cervical MRI to determine the recurrence rate and clinical improvement in a cohort of patients who had dynamic cervical MRI incorporated into their surgical plan.This was a prospective, single-center study. Upon enrolment and at each follow-up visit, patients completed the mJOA score, NDI, cervical pain on visual analog scale (VAS) and radicular pain on VAS. Every enrolled patient underwent dynamic cervical MRI (in neutral, flexion and extension positions). Five levels were measured in the three positions, resulting in 915 levels for analysis.Sixty-one patients were included. Eighty-four levels had an intramedullary hyperintensity in neutral position, 93 in extension and 112 in flexion. The mean sagittal diameter varied the most at C4-C5, going from 7.13 mm (SD 2.32) on average in neutral to 6.30 mm (SD 2.22) in extension and 8.29 mm (SD 2.10) in flexion, a variation of -12% and +16%, respectively. A Mühle grade ≥ 2 was found in 134 levels in neutral position versus 189 in extension and 110 in flexion. None of the patients had worse neurological symptoms following the dynamic cervical MRI. The mean postoperative follow-up was 4.4 years (SD 0.88). Two patients (3.1%) required surgical revision because the implants had shifted. One patient developed symptomatic adjacent segment disease.Preoperative surgical planning that incorporates dynamic cervical MRI before the surgical treatment of degenerative cervical myelopathy appears to be a safe and reliable method and one that helps reduce symptoms in the long term.IV.

Low-grade isthmic spondylolisthesis (ISPL) is generally treated by circumferential fusion with interbody graft, although there is no consensus on technique.The various interbody fusion strategies provide satisfactory fusion rates and clinical results.A multicenter retrospective study analyzed lumbar interbody fusion for low-grade ISPL performed between March 2016 and March 2019. Techniques comprised: circumferential fusion on a posterior or a transforaminal approach (PLIF, TLIF: n=57), combined anterior (ALIF) + posterolateral fusion (ALIF+PLF: n=60), and ALIF + percutaneous posterior fixation (ALIF+PPF: n=55). Function was assessed on a lumbar and a radicular visual analog scale (AVS-L, VAS-R, Oswestry Disability Index (ODI) and Short Form 12 (SF12).85.3% of the 129 patients showed fusion (Lenke 1 or 2), with no significant differences between the ALIF-PLF or ALIF-PPF groups and the PLIF or TLIF groups (p=0.3). Likewise, there was no difference in fusion rates between the ALIF-PPF and ALIF-PLF subgroups (p=0.28). VAS-L (p0.001) and VAS-R (p0.0001), ODI (p0.001) and SF12 physical (PCS) (p0.01) and mental component sores (MCS) (p0.001) all showed significant improvement at 12 months. Combined approaches provided greater clinical efficacy than TLIF or PLIF for lumbar (p0.0001) and radicular pain (p0.05), ODI (p0.0001) and SF12 PCS (p0.01). At 12 months, there was no clinical difference between the ALIF-PPF and ALIF-PLF subgroups. However, patents with interbody non-union (Lenke 3 or 4) had lower SF12 PCS scores (p0.004) and VAS-L ratings (p0.001) than Lenke 1-2 patients.Low-grade ISPL treated by circumferential arthrodesis and interbody graft showed 85.3% consolidation at 2 years, with equivalent outcomes between anterior and posterior techniques. Successful fusion was associated with better clinical results.IV.

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Retrospective cross-sectional study.The aim was to describe existing global sagittal alignment parameters across ages and to analyze differences according to gender and pelvic incidence (PI).Variability with age has been reported. It remains unclear how gender and spinopelvic morphology could additionally influence global alignment parameters.Radiographs of 2599 individuals (5-93 y) were analyzed. Translation parameters were: Sagittal Vertical Axis (SVA)-C7, SVA-C2, SVA-Center Acoustic Meatus (CAM), C7/Sacrofemoral Distance (SFD) ratio. Inclination parameters were: C7-Vertical Tilt (VT), T1-VT and T9-VT, Odontoid-Hip Axis (OD-HA), OD-CAM. Pelvic compensation parameters were: T1-Pelvic Angle (TPA), Global Tilt (GT), Spino-Sacral Angle (SSA). Global sagittal alignment (GSA) was considered among formulae. The distribution of parameters was analyzed using a Bayesian inference. Correlations with spinopelvic parameters were investigated.SVA-C7, SVA-C2, SVA-CAM were larger in males and high PI, and increased significantly after 50 years (Pr0.9999). C7/SFD decreased during growth and was larger in low PI (Pr=0.951). There was no correlation with spinopelvic parameters. Age-related variations of inclination parameters were nonsignificant. T1-VT and T9-VT increased with PI and were significantly larger in high PI (Pr0.95). C7-VT was significantly larger in low PI (Pr0.9999). OD-HA and OD-CAM were constant and increased after 80 years. TPA and GT increased with PI (Pr0.9999) and age after 35 years (Pr0.9999). SSA decreased nonsignificantly after 50 years. TPA correlated with PI (ρ=0.6130) and pelvic tilt (PT) (ρ=0.8375). GT correlated with PI (ρ=0.5961) and PT (ρ=0.8996). SSA correlated with sacral slope (ρ=0.9026). GSA was larger in high PI (Pr0.9999) and increased after 35 years (Pr0.9999). GSA correlated with PT (ρ=0.7732).Translation parameters increase with age, more prominently in males and high PI. Variations of inclination parameters are smaller. Pelvic compensation parameters and GSA increase with age and are closely related to PT and spinopelvic morphology.Level III.

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

Owing to recent advances in cancer therapy, updated data are required for clinicians counselling patients on treatment of spinal metastases. To analyse the outcomes of surgical treatments of spinal metastases. Prospective and multicentric study that included consecutively patients operated on for spinal metastases between January 2016 and January 2017. Overall survival was calculated with the Kaplan-Meier method. Cox proportional hazard model was used to calculate hazard ratio (HR) analysing mortality risk according to preoperative Karnofsky performance status (KPS), mobility level and neurological status. A total of 252 patients were included (145 males, 107 females) aged a mean 63.3 years. Median survival was 450 days. Primary cancer sites were lung (21%) and breast (19%). Multiple spinal metastases involved 122 patients (48%). Concomitant skeletal and visceral metastases were noted in 90 patients (36%). Main procedure was laminectomy and posterior fixation (57%). Overall, pain and mobility level were improved postoperatively. Most patients had normal preoperative motor function (50%) and remained so postoperatively. Patients “bedbound” on admission were the less likely to recover. In-hospital death rate was 2.4% (three disease progression, one septic shock, one pneumonia, one pulmonary embolism). Complication rate was 33%, deep wound infection was the most frequent aetiology. Higher mortality was observed in patients with poorest preoperative KPS (KPS 0–40%, HR = 3.1, p

Resume Introduction Les fractures bi-isthmiques de C2 representent 15 a 20 % des fractures du rachis cervical et la strategie de prise en charge de ces fractures reste encore sujette a debat, reposant principalement sur la classification d’Effendi modifiee par Levine et Edwards. L’objectif de cette etude prospective, multicentrique et observationnelle etait de recenser la prise en charge initiale des fractures bi-isthmiques de C2 en France. Les complications et les taux de consolidation etaient analyses en fonction du type de fracture et du traitement propose. Materiel et methode Il s’agit d’une etude multicentrique prospective conduite sous l’egide de la Societe francaise de chirurgie rachidienne. Pour inclure un patient dans l’etude, le diagnostic de fracture bi-pediculaire de C2 devait etre pose sur un examen tomodensitometrique du rachis cervical. Le suivi etait realise de facon prospective, la consolidation etait confirmee sur un scanner 3 mois apres le traumatisme puis 1 an de suivi. Le type de traitement et les complications etaient systematiquement notes. Resultats Trente-quatre patients ont ete inclus, selon la classification d’Effendi modifiee Levine, 68 % presentaient des lesions de type 1, 29 % presentaient des lesions de type 2, un seul patient presentait une lesion de type 3 (3 %). Vingt et un patients de notre cohorte (62 %) ont beneficie d’un traitement orthopedique, 11 patients ont beneficie d’un traitement chirurgical (32 %). A 1 an post-prise en charge une consolidation etait consideree comme acquise pour 28 patients, 6 patients etait perdus de vue. Conclusion Les taux de mortalite et de complications neurologiques sont faibles apres une fracture bi-pediculaire de C2. Les fracture de type 1 peuvent beneficier d’un traitement orthopedique qui presente des taux de consolidation de 100 % dans cette serie, Les types 2 ou 3 correspondant a des fractures avec lesions disco-ligamentaires constituent une indication chirurgicales par voie anterieure de type arthrodese C2–C3 ou par voie posterieure par vissage C1–C3. Niveau de preuve III.

Resume Introduction L’analyse radiographique est l’outil principal pour l’evaluation de la deformation rachidienne dans la scoliose idiopathique de l’adolescent. En raison de l’impact incertain de l’exposition repetee aux radiations ionisantes, de nouvelles methodes doivent etre developpees. Parmi elles, les acquisitions statiques lors de l’analyse de la marche (AQM) se sont developpees depuis plusieurs annees, sans qu’aucune etude de correlation avec les parametres radiographiques usuels n’ait ete menee. Notre hypothese etait qu’il etait possible d’evaluer la deformation rachidienne chez des adolescents porteurs de scoliose idiopathique a partir des donnees d’une acquisition statique d’AQM. Notre objectif etait donc de mener une etude de correlation entre les parametres obtenus a partir d’une acquisition statique au laboratoire d’analyse quantifiee du mouvement et les parametres radiographiques usuels chez des adolescents porteurs d’une scoliose idiopathique. Patients et methode Des adolescents porteurs de scoliose idiopathique et programmes pour correction chirurgicale etaient inclus dans l’etude. Une analyse de la marche etait realisee la veille de l’intervention ainsi qu’une evaluation radiographique de face et de profil. Le protocole d’acquisition AQM comportait l’analyse de la position de 32 marqueurs reflechissants, dont 6 etaient utilises pour la description du rachis. Le coronal vertical axis (CVA), l’angle de Cobb thoracique, l’angle de Cobb lombaire, le sagittal vertical axis (SVA), la cyphose thoracique, la lordose lombaire et la version pelvienne etaient collectes et compares a leurs equivalents radiographiques. Resultats La serie comportait 57 patients (âge : 15,2 ans, 84 % de filles). Il y avait 45 patients Lenke 1, 12 Lenke 5. L’angle de Cobb principal moyen etait de 51,9°. Dans le plan frontal, le CVA (R = 0,524, p Conclusions Les resultats de cette etude montrent que les parametres tires de l’analyse de la marche refletent de facon precise la deformation rachidienne observee a la radiographie. La deformation lombaire etait plus difficile a caracteriser, probablement parce que celle-ci etait de faible amplitude dans notre serie. La recherche doit se concentrer sur l’amelioration des performances de l’AQM, notamment dans sa capacite a detecter une aggravation des courbures. Ainsi, l’AQM pourrait permettre une diminution de l’exposition aux radiations ionisantes chez ces patients. Niveau de preuve III.

Radiography is the main tool used to assess spinal deformities in patients with adolescent idiopathic scoliosis (AIS) but requires repeated exposure to ionising radiation, potentially raising safety concerns. Consequently, new methods are needed. Among them, the acquisition of static parameters during quantitative gait analysis (QGA) has received attention in recent years. However, no data on correlations linking static QGA parameters to standard radiographic parameters are available. The objective of this study was to assess correlations between static QGA parameters and standard radiographic parameters in patients with AIS.Spinal deformities in patients with AIS can be evaluated based on static QGA parameters.We studied patients scheduled for surgery to treat AIS. On the day before surgery, QGA was performed and antero-posterior and lateral radiographs obtained. QGA involved analysing the positions of 32 reflective markers, including 6 used to assess the spine. The coronal vertical axis (CVA), thoracic and lumbar Cobb angles, sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, and pelvic tilt were recorded and compared to the corresponding radiographic parameters.The study included 57 patients, including 48 (84%) females, with a mean age of 15.2 years. Among them, 45 had Lenke 1 and 12 Lenke 5 scoliosis. The mean main Cobb angle was 51.9°. In the coronal plane, significant correlations with the corresponding radiographic parameters were found for the CVA (R=0.524, p0.01) and thoracic Cobb angle (R=0.599, p0.01). All the sagittal parameters correlated significantly with the corresponding radiographic parameters: SVA, R=0.313; pelvic tilt, R=0.342; thoracic kyphosis, R=0.575; and lumbar lordosis, R=0.360 (p0.05 for all four parameters).In this study, static QGA parameters accurately reflected the spinal deformities visualised radiographically. The lumbar deformity was more difficult to characterise, probably because it was mild in our population. Research efforts should focus on improving the performance of QGA, notably for detecting curve progression. Thus, QGA may allow a decrease in radiation exposure of patients with AIS.III.

Resume Introduction Les fractures en flexion-distraction du rachis representent environ 15 % des fractures thoraco-lombaire avec 25 % de troubles neurologiques. Leur prise en charge chirurgicale ne fait toujours pas consensus. En l’absence de troubles neurologiques, la fixation percutanee presente un interet en permettant une stabilisation rapide avec une reduction satisfaisante, completee si necessaire par un temps anterieur mini-invasif. Cette etude presente les resultats de 28 cas de fractures du rachis thoraco-lombaire en flexion-distraction sans complication neurologique pris en charge par technique mini invasive. Materiel et methodes Il s’agit d’une etude monocentrique retrospective conduite entre 2008 et 2015, les patients inclus etaient âges de plus de 16 ans, sans troubles neurologiques. L’analyse des fractures s’effectuait par tomodensitometrie en preoperatoire avec mesure de la cyphose regionale post traumatique. La technique operatoire comprenait une fixation posterieure percutanee eventuellement associee a un geste mini-invasif anterieur en cas de lesions discale a l’IRM ou en cas de forte comminution corporeale. Le temps operatoire, les pertes sanguines et les complications postoperatoire etaient colligees. La cyphose regionale et la fusion osseuse etaient evaluees par une nouvelle tomodensitometrie a 1 an postoperatoire. Resultats Dix-sept hommes et 11 femmes ont ete inclus (âge moyen 29,2 ans). Un temps anterieur complementaire etait realise dans 11 cas (39 %) : pour 5 cas dans des fractures de type B1 en raison d’une importante comminution corporeale (corporectomie et arthrodese par cage expansible remplie d’os et de BMP-2) et pour 6 cas dans des fractures de type B2 en raison d’une atteinte discale a l’IRM (discectomie et arthrodese intervertebrale par greffon iliaque). La cyphose regionale etait significativement reduite (17,3° vs 5,7°, p Conclusion Chez les patients sans troubles neurologiques initial, une prise en charge par chirurgie mini invasive soit par fixation posterieure isolee soit associe a un geste anterieur mini invasif permet une excellente consolidation au prix d’un traumatisme operatoire et d’un saignement faible. Niveau de preuve IV.

Although the reduction of traumatic fractures of the thoracolumbar spine is of good quality during conventional so-called open procedures, the alternative minimally invasive approach also appears to confer good results. The aim of this study was to measure the radiological parameters before and after minimally invasive surgery, in order to assess the quality of the reduction of thoracolumbar compression fractures.This retrospective, monocentric study included 112 patients with a mean age of 48.9 years, presenting with 135 type A thoracolumbar compression fractures treated by a posterior minimally invasive surgical approach comprising vertebral augmentation or posterior osteosynthesis or a mixed procedure.The parameters analyzed were significantly lower whatever the procedure in the immediate postoperative period. Mean regional and local kyphosis, posterior wall displacement, and mean vertebral height were significantly lower (p0.01). Fracture reduction was better when osteosynthesis was associated with vertebral augmentation. In the osteosynthesis subgroup with osteosynthesis hardware removal but without vertebral augmentation, we found a significant worsening of the regional kyphosis (p0.05).The management of thoracolumbar compression fractures by a posterior minimally invasive approach allows excellent fracture reduction with a restoration of the spinal canal, vertebral height and kyphosis.IV.

Purpose. The aim of this study is to analyze results according to postoperative pelvic incidence-lumbar lordosis (PI-LL) mismatch in the management of adult spine deformity (ASD) patients. Recently, it has been reported that in addition to lumbar lordosis amount, lordosis repartition between its proximal and distal parts was crucial. Methods. We enrolled 77 consecutive ASD patients who underwent posterior spinal fusion and deformity correction between 2015 and 2018. On preoperative and 1-year follow-up radiographs, we analyzed different parameters such as L1-S1 lumbar lordosis, L1-L4 proximal lordosis (PLL), L4-S1 distal lordosis (DLL), pelvic tilt (PT), sagittal vertical axis (SVA), and PI-LL mismatch. Comparisons were performed according to postoperative PI-LL mismatch (defined as “aligned” when PI-LL was p < 0.001 , respectively). On the other hand, PT remained unchanged (30° vs. 28°, p > 0.05 ). 35 patients were classified as “aligned” and 42 as “not aligned.” Patients from the “aligned” group had a significantly lower PI than patients from the “not aligned” group (52° vs. 61°, p = 0.009 ). Postoperative PLL was not different between groups (18° vs. 16° p > 0.05 ), whereas DLL was significantly higher in the “aligned” group (31° vs. 22°, p = 0.003 ). PI-LL was significantly correlated to DLL (rho = 0.407, p < 0.001 ) but not with PLL (rho = 0.110, p = 0.342 ). Conclusions. Our results revealed that in ASD patients, postoperative malalignment was associated with a lack of DLL restoration. “Not aligned” patients had also a significantly higher pelvic incidence. Specific attention must be paid to restore optimal distal lumbar lordosis in order to set the amount and the distribution of optimal postoperative lumbar lordosis.