Spino-pelvic alignment influences disc hydration properties after AIS surgery: a prospective MRI-based study

Autor: Jérôme Sales de Gauzy, Erik Estivalèzes, Pascal Swider, Kariman Abelin-Genevois, Annick Sevely, Jérôme Briot
Přispěvatelé: Centre National de la Recherche Scientifique - CNRS (FRANCE), Institut National Polytechnique de Toulouse - Toulouse INP (FRANCE), Université Toulouse III - Paul Sabatier - UT3 (FRANCE), Croix-Rouge française (FRANCE), Centre Hospitalier Universitaire de Toulouse - CHU Toulouse (FRANCE), Institut de Mécanique des Fluides de Toulouse - IMFT (Toulouse, France), Croix rouge française, Institut de mécanique des fluides de Toulouse (IMFT), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées, CHU Toulouse [Toulouse], Institut National Polytechnique de Toulouse - INPT (FRANCE)
Rok vydání: 2015
Předmět:
Male
Pelvic incidence
medicine.medical_specialty
Adolescent
medicine.medical_treatment
[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery
Adolescent idiopathic scoliosis
Body Water
medicine
Humans
Orthopedics and Sports Medicine
Prospective Studies
skin and connective tissue diseases
Prospective cohort study
medicine.diagnostic_test
business.industry
Follow up studies
Magnetic resonance imaging
Intervertebral disc
Middle Aged
Magnetic Resonance Imaging
Sagittal plane
Scoliosis surgery
Disc hydration
medicine.anatomical_structure
Scoliosis
[SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system
Spinal fusion
Lordosis
Female
Surgery
sense organs
Neurosurgery
Radiology
Rhumatologie et système ostéo-articulaire
business
Follow-Up Studies
MRI
Zdroj: European Spine Journal
European Spine Journal, Springer Verlag, 2015, 24 (6), pp.1183-1190. ⟨10.1007/s00586-015-3875-4⟩
ISSN: 1432-0932
0940-6719
DOI: 10.1007/s00586-015-3875-4
Popis: International audience; Purpos: To analyze the disc hydration and volumetric changes of the intervertebral disc after scoliosis surgery depending on the sagittal spino-pelvic organization.Methods We conducted a prospective MRI study in 45patients with surgically treated adolescent idiopathic scoliosis (AIS) with a minimum 2-year follow-up. Fusion ended at L1 (n = 13), L2 (n = 14), L3 (n = 11) or L4 (n = 7). Total disc (Vd) and nucleus volumes (Vn) were extrapolated from 3D reconstruction using a custom-made image processing software (Biomechlab, Toulouse, France). Nucleus and external disc contours were semi-automatically detected on turbo spin echo T2-weighted sequence joined 3-mm sagittal cuts. Disc hydration was extrapolated from the nucleus–disc volume ratio (Vn/Vd). Radiographic sagittal parameters were measured pre- and post-operatively on full spine standing views (pelvic incidence, sacral slope, L1S1 lumbar lordosis). Lumbo-pelvic congruity was calculated by the ratio LL/SS according to Stagnara.Results: Mean PI of the cohort was 55° (34°–85°). After surgical correction, lumbar lordosis was slightly increased by 3° (p = 0.02) decreasing lumbo-pelvic congruity from1.37 to 1.27 (p\0.01). When pelvic incidence was less than 55° (mean PI 46°), nucleus volumes have increased on average by 30 % compared to the preoperative status in the unfused lumbar discs, while the total disc volumes has remained stable. Five-year follow-up (n = 13) confirmed the constant improvement of the disc hydration ratio. When PI was high (mean PI 64°), volumetric changes were verymild and significant changes in nucleus volumes and disc hydration ratio concerned only the intermediate lumbar levels (L2L3, L3L4 and L4L5).Conclusions:This prospective MRI study showed a significant and sustainable improvement in T2 hypersignal of the disc, indirectly indicating improvement of disc hydration content after AIS surgery. Analysis of disc volumetric changes according to the pelvic incidence suggests that these changes are under the influence of the sagittal spino-pelvic alignment. PI seems to play a key role in the homeostasis of the discs under fusion and should be taken into account for preoperative planning. The restoration of the lumbo-pelvic congruence may help to limit early degenerative changes in the free-motion segment discs after AIS surgery. Hydration content was less sensitive to surgery when PI was high, suggesting higher shear stress in the lower discs. Longer follow-up is required to confirm this hypothesis.
Databáze: OpenAIRE
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