title: 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.
authors: Department of Orthopaedic and Trauma Surgery, Pitié-Salpétrière hospital Assistance Publique - Hopitaux de Paris, UPMC, Paris, France. lazennec.jy@wanadoo.fr.|Biomechanics Lab (LBM), Arts et Metiers Paris-Tech, Paris, France. lazennec.jy@wanadoo.fr.|Department of Anatomy, UPMC, Paris, France. lazennec.jy@wanadoo.fr.
authors: Jean Yves
authors: JY
authors: Lazennec
authors: RIM Maussins-Nollet, 114 rue Nollet, 75017, Paris, France.
authors: Dominique
authors: D
authors: Folinais
authors: Rothschild Hospital Assistance Publique - Hopitaux de Paris, Paris, France.
authors: Samy
authors: S
authors: Bendaya
authors: Biomechanics Lab (LBM), Arts et Metiers Paris-Tech, Paris, France.|Avicenne Hospital Assistance Publique - Hopitaux de Paris, Bobigny, France.
authors: Marc Antoine
authors: MA
authors: Rousseau
authors: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
authors: Aidin Eslam
authors: AE
authors: Pour
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D010465:Perception; D004856:Postural Balance / Q000502:physiology; D011187:Posture / Q000502:physiology; D012678:Sensation Disorders / Q000209:etiology* / Q000503:physiopathology; D013130:Spinal Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D051598:Whole Body Imaging / Q000379:methods
keywords: EOS; Global tilt; Hip flexion; Hip-spine syndrome; Knee alignment; Knee flessum; Knee-spine syndrome; Pelvic tilt; Sagittal femoral tilt; Sitting position; Spinal postural balance; Spinal sagittal alignment; Spinal stenosis; Spinopelvic parameters; Standing position; Total hip prosthesis; Total knee prosthesis