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The global alignment in patients with lumbar spinal stenosis: our experience using the EOS full-body images

  • Original Article • SPINE - LUMBAR
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Abstract

Lumbar stenosis is frequently observed and treated by spine surgeons. The extent of neurological decompression and the potential spinal fixation are the basic concerns when surgery is planned. But this segmented approach to the problem is sometimes insufficient due to the complex functional situations induced by a sagittal imbalance of the patient and the combination of pathologies known as hip-spine or knee-spine syndromes. A total of 373 consecutive patients included from our EOS and clinical data base. Patients were divided in two groups. Group A included patients presenting exclusive spinal issues (172 cases) out of whom 117 (68 %) had sagittal imbalance. Among 201 patients with associated lower limbs issues (group B), 122 (61 %) had sagittal imbalance. The perception of imbalance was noticed in 54 % (93 cases) in group A and 57 % (115 cases) in group B. In the global series of 239 imbalanced cases, the key point was a spine issue for 165 patients (the 117 patients with only spine problems and 48/122 cases with combined spine and lower limbs problems). But in the patients with combined spine and lower limbs problems, we individualized hip-spine syndromes (24/122 patients) and knee-spine syndromes (13/122 patients). In some cases, (37/122 patients) the anatomical and functional situations were more complex to characterize a spine-hip or a hip-spine problem. The EOS full-body images provide new information regarding the global spinal and lower limbs alignment to improve the understanding of the patient functional posture. This study highlights the importance of the lower limb evaluation not only as compensatory mechanism of the spinal problems but also as an individualized parameter with its own influence on the global balance analysis.

Level of evidence IV diagnostic case series.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Pitié-Salpétrière hospital Assistance Publique – Hopitaux de Paris, UPMC, Paris, France

    Jean Yves Lazennec

  2. Biomechanics Lab (LBM), Arts et Metiers Paris-Tech, Paris, France

    Jean Yves Lazennec & Marc Antoine Rousseau

  3. Department of Anatomy, UPMC, Paris, France

    Jean Yves Lazennec

  4. RIM Maussins-Nollet, 114 rue Nollet, 75017, Paris, France

    Dominique Folinais

  5. Rothschild Hospital Assistance Publique – Hopitaux de Paris, Paris, France

    Samy Bendaya

  6. Avicenne Hospital Assistance Publique – Hopitaux de Paris, Bobigny, France

    Marc Antoine Rousseau

  7. Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA

    Aidin Eslam Pour

Authors
  1. Jean Yves Lazennec
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  2. Dominique Folinais
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  3. Samy Bendaya
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  4. Marc Antoine Rousseau
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  5. Aidin Eslam Pour
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Correspondence to Jean Yves Lazennec.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Lazennec, J.Y., Folinais, D., Bendaya, S. et al. The global alignment in patients with lumbar spinal stenosis: our experience using the EOS full-body images. Eur J Orthop Surg Traumatol 26, 713–724 (2016). https://doi.org/10.1007/s00590-016-1833-4

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  • DOI: https://doi.org/10.1007/s00590-016-1833-4

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