title: Clinical and stereoradiographic analysis of adult spinal deformity with and without rotatory subluxation.
abstract: BACKGROUND
  In degenerative adult spinal deformity (ASD), sagittal malalignment and rotatory subluxation (RS) correlate with clinical symptomatology. RS is defined as axial rotation with lateral listhesis. Stereoradiography, recently developed for medical applications, provides full-body standing radiographs and 3D reconstruction of the spine, with low radiation dose.
  
  
  OBJECTIVE
  3D stereoradiography improves analysis of RS and of its relations with transverse plane and spinopelvic parameters and clinical impact.
  
  
  METHODS
  One hundred and thirty adults with lumbar ASD and full-spine EOS® radiographs (EOS Imaging, Paris, France) were included. Spinopelvic sagittal parameters and lateral listhesis in the coronal plane were measured. The transverse plane study parameters were: apical axial vertebral rotation (apex AVR), axial intervertebral rotation (AIR) and torsion index (TI). Two groups were compared: with RS (lateral listhesis>5mm) and without RS (without lateral listhesis exceeding 5mm: non-RS). Correlations between radiologic and clinical data were assessed.
  
  
  RESULTS
  RS patients were significantly older, with larger Cobb angle (37.4° vs. 26.6°, P=0.0001), more severe sagittal deformity, and greater apex AVR and TI (respectively: 22.9° vs. 11.3°, P<0.001; and 41.0° vs. 19.9°, P<0.001). Ten percent of patients had AIR>10° without visible RS on 2D radiographs. RS patients reported significantly more frequent low back pain and radiculalgia.
  
  
  CONCLUSIONS
  In this EOS® study, ASD patients with RS had greater coronal curvature and sagittal and transverse deformity, as well as greater pain. Further transverse plane analysis could allow earlier diagnosis and prognosis to guide management.
  
  
  METHODS
  4, retrospective study.
authors.affiliation: Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA; Service de chirurgie orthopédique, hôpital européen Georges-Pompidou, université Paris V, AP-HP, 20, rue Leblanc, 75015 Paris, France; Laboratoire de biomécanique, Arts et Métiers Paris Tech, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: emmanuelle.ferrero@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Ferrero
authors.affiliation: Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA.
authors.forename: R
authors.initials: R
authors.lastname: Lafage
authors.affiliation: Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA.
authors.forename: V
authors.initials: V
authors.lastname: Challier
authors.affiliation: Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA.
authors.forename: B
authors.initials: B
authors.lastname: Diebo
authors.affiliation: Service de chirurgie orthopédique, hôpital européen Georges-Pompidou, université Paris V, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Guigui
authors.affiliation: Service de chirurgie, hôpital universitaire Robert-Debré, boulevard Sérurier, 75019 Paris, France.
authors.forename: K
authors.initials: K
authors.lastname: Mazda
authors.affiliation: Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA.
authors.forename: F
authors.initials: F
authors.lastname: Schwab
authors.affiliation: Laboratoire de biomécanique, Arts et Métiers Paris Tech, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: W
authors.initials: W
authors.lastname: Skalli
authors.affiliation: Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA.
authors.forename: V
authors.initials: V
authors.lastname: Lafage
mesh_terms: D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D017116:Low Back Pain / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013121:Spinal Curvatures / Q000000981:diagnostic imaging*; D013131:Spine / Q000000981:diagnostic imaging*; D064232:Visual Analog Scale
keywords: 3D analysis; Adult spinal deformity; Rotatory subluxation; Sagittal alignment; Transverse plane analysis