Jean-Paul Steib - ArgoSpine

PREOPERATIVE ASSESMENT OFIMBALANCETREATMENT, INDICATION,SURGICAL PLANNINGJ-P STEIBSTRASBOURGLes HôpitauxUniversitairesde STRASBOURGARGOSPINE 09No funds were received in support of this study

HUMAN EVOLUTION• Erect posture and bipedal gait– Iliofemoral angle opening– Lumbar lordosis

AGING SPINE• Loss of– Lumbar lordosis– Hip extension• Causes :– Wearing effect of time– Seating position• Consultation :– Intolerable– PainfulHovorka

EXAMINATION• Lying, sitting, climbing• No problem• Walking, standing• Problem• Hip extension• Knees flexionFalse balance !hip extension testbe careful of X-ray

RADIOLOGY• CT scan, MRI :– Lying, no stress• X-ray :– No indication for lying X-ray– Utility of full spine, standing

RADIOLOGY• Duval-Beaupère :– Sacral tilt (version) : 12°– Sacral slope: 42°– Incidence : 54°• I = ST + SS– Β = α + γ• T9 tilt : 11°

RADIOLOGY

DYNAMIC VIEWS• Functionnal MRI• Myelogram– Weigth barring– Flexion-extension

DYNAMIC VIEWS• Myelogram– Weigth barring– Flexion-extension

DYNAMIC VIEWS

PREOPERATIVE ASSESSMENT• Imaging analysis :– Surgical method to be used• Opening the canal :– Sustained compression• Reduction : synthesis + fusion– Dynamic compression Prevention of flat back

LAST EXAMPLE

LAST EXAMPLE

• In situ bending– To prevent• TPSO– To correctSURGICAL PLANNINGJ-M Vital

NEVER TOO MUCH LORDOSIS• Generally not• But, less in seating position– To refrain in neurological patients• It’s impossible today to do spine surgerywithout knowing a minimum in spine balance• It must be important !Take care !