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

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.

Sagittal Spinopelvic Translation Is Combined With Pelvic Tilt During the Standing to Sitting Position: Pelvic Incidence Is a Key Factor in Patients Who Underwent THA

“…All patients underwent preoperative and postoperative standing and sitting full-body biplanar EOS acquisitions (EOS imaging, SA) according to our standard of care. EOS images of the spine, pelvis, and lower extremities in natural standing and sitting positions were obtained using a previously defined protocol [ 21 , 22 ]. Standing images were obtained while the patients put similar weight on both lower extremities in their comfortable position with horizontal gaze.…”

Relationships between Paraspinal Muscle and Spinopelvic Sagittal Balance in Patients with Lumbar Spinal Stenosis

“…Sagittal balance is a situation where the individual is able to maintain a stable standing position with minimal muscle effort. Spinopelvic sagittal alignment is important in lumbar degenerative diseases [6][7][8][9][10][11] and many studies investigated the spinopelvic sagittal parameters in standing position [12][13][14][15] . A previous comparative study found that the prevalence of sagittal imbalance was higher in patients with lumbar spine stenosis (LSS) compared with healthy people 16 .…”

How do global sagittal alignment and posture change after total hip arthroplasty?

“…The EOS imaging system provides new opportunities regarding the global spinal and lower extremities alignment and evolution. It also provides valuable information regarding the lower limb function and pelvic motions in different functional positions [12,13].…”