Papers by Virginie Lafage
Journal of neurosurgery. Spine, Jan 13, 2015
OBJECT Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pel... more OBJECT Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pelvic parameters have demonstrated the compensatory mechanisms of pelvis translation in addition to rotation. However, the mechanisms recruited for this pelvic rotation were not assessed. This study aims to analyze the relationship between spinopelvic and lower-extremity parameters and clarify the role of pelvic translation. METHODS This is a retrospective study of patients with spinal deformity and full-body EOS images. Patients with only stenosis or low-back pain were excluded. Patients were grouped according to T-1 spinopelvic inclination (T1SPi): sagittal forward (forward, > 0.5°), neutral (-6.3° to 0.5°), or backward (< -6.3°). Pelvic translation was quantified by pelvic shift (sagittal offset between the posterosuperior corner of the sacrum and anterior cortex of the distal tibia), hip extension was measured using the sacrofemoral angle (SFA; the angle formed by the middle of t...
Journal of neurosurgery. Spine, 2013
Spine, 2010
Objective. To describe the spinal and rib cage modifications using computed tomography (CT).
Spine Journal, 2010
Coronal decompensation occurred in 3.7% of adult scoliosis patients after multilevel spinal fusio... more Coronal decompensation occurred in 3.7% of adult scoliosis patients after multilevel spinal fusion in our series. Predisposing factors included the presence of pelvic obliquity and a double major curve pattern in which the more exible lumbar curve was corrected more than the thoracic. Postoperative CI persisted from initial to nal follow up, with lower SRS self image and function scores compared to CB patients. Introduction: The fate of adult scoliosis patients who develop signi cant coronal imbalance (CI) following spinal fusion has not been critically evaluated. We report the prevalence and outcomes of coronal decompensation in a consecutive series of multilevel spinal fusions for adult scoliosis. Methods: A consecutive series of 148 patients with adult idiopathic/degenerative scoliosis who underwent a multilevel primary posterior spinal fusion (>5 levels fused) at a single institution from 2002-2007 were reviewed. A minimum two year followup was required. There were 133 females/15 males; mean age at surgery 48.2 years (range 18-81). Posterior fusion alone was performed in 66 patients (44.6%), while 82 patients (55.4%) had a combined posterior/anterior fusion. Results: Five patients (3.7%) had CI of >4cm from the C7 plumb to the center sacral vertical line at two months postop. All CI patients had double major curve patterns, (avg thor Cobb: 56°, avg lumbar Cobb: 58.6°), increased lumbar exibility on bending, and no preop CI. Compared to the coronally balanced (CB) patients, CI patients had statistically longer posterior fusions (14.0 vs. 10.0 levels, p=0.014), presence of preop pelvic obliquity (5.0° vs. 0.0°, p=0.027), and similar preop coronal balance (1. ). All CI patients were fused to L4 or below compared to 25.9% of CB patients (p=0.33). CI patients had a larger coronal imbalance at initial followup (5.7cm vs. 2.1cm, p<0.001), which persisted at nal followup (6.2cm vs. 1.7cm, p<0.001). Final pelvic obliquity was greater in CI patients (p=0.02). SRS scores at nal followup for CI vs. CB were lower for self image (2.8 vs. 4.2, p=0.047) and function (3.0 vs. 3.8, p=0.06). CI and CB groups were similar in terms of age, gender, and preop coronal/sagittal Cobb angles. Conclusion: CI developed in 3.7% of patients in our series. Risk factors for CI identi ed in this study include a double major curve with a more exible lumbar curve and preexisting pelvic obliquity. In patients who developed CI, both the thoracic and lumbar curves were fused to L4 or below, and lumbar curve correction exceeded thoracic correction. CI did not improve from initial to nal follow up. SRS self image and function scores were lower for CI vs. CB patients.
Spine Journal, 2010
Study Design. Consecutive, multicenter retrospective review. Objective. To evaluate if change in ... more Study Design. Consecutive, multicenter retrospective review. Objective. To evaluate if change in thoracic kyphosis (TK) has a positive or negative impact on spinopelvic alignment after lumbar pedicle subtraction osteotomy (PSO) with short fusions. Summary of Background Data. In the setting of sagittal malalignment, the effect of large vertebral resections can now be anticipated in long fusions, but their impact on unfused segments (reciprocal changes [RC]) remains poorly understood. Methods. A total of 34 adult patients (mean age = 54 years; SD = 12) who underwent lumbar PSO with upper instrumented vertebra below T10 were included. Radiographic analysis included pre-and postassessment of TK, lumbar lordosis (LL), sagittal vertical axis (SVA), T1 spinopelvic inclination (T1SPI), pelvic tilt (PT), and pelvic incidence (PI). Final SVA and PT were analyzed to determine successful realignment. RC in the thoracic spine was designated favorable or unfavorable on the basis of impact on fi nal SVA and PT. Results. Mean PSO resection was 26 ° . LL increased from 20 ° to 49 ° ( P < 0.001). SVA improved from 14 to 4 cm ( P < 0.001), and PT improved from 33 ° to 25 ° ( P < 0.001). Mean increase in TK was 13 ° ( P = 0.002) but was unchanged in 11 patients. Five patients had a favorable RC, and 18 patients had an unfavorable RC. Unfavorable RC was attributed to junctional failure in 6 of 18 patients. Signifi cant differences in the unfavorable RC group included age and greater preoperative PT, PI, SVA, and T1SPI. Conclusion. Signifi cant postoperative alignment changes can occur through unfused thoracic spinal segments after lumbar PSO. Unfavorable RC may limit optimal correction and lead to clinical failures. Risk factors for unfavorable thoracic RC include older patients, larger preoperative PI and PT, and worse preoperative T1SPI and are not simply due to junctional failure. Care should be taken with selective lumbar fusion and PSO in older patients and in those with severe preoperative spinopelvic parameters.
Spine Journal, 2010
appropriate bracing treatment. The two have not been combined in a study until now. PURPOSE: To v... more appropriate bracing treatment. The two have not been combined in a study until now. PURPOSE: To verify the efficacy of a complete, conservative treatment of Adolescent Idiopathic Scoliosis (AIS) according to the best methodological and management criteria defined in the literature. STUDY DESIGN/SETTING: Retrospective study in a prospective database. PATIENT SAMPLE: We included all AIS patients respecting the SRS inclusion criteria (age 10 years or older; Risser test 0-2; Cobb degrees 25-40 ; no prior treatment; less than one year post-menarchal) who had reached the end of treatment since our institute database start in 2003. Thus we had 44 females and four males, with an age of 12.861.6 at the commencement of the study. OUTCOME MEASURES: SRS criteria fro Bracing studies (unchanged; worsened 6 or more; over 45 at the end of treatment; surgically treated; two years' follow-up); clinical criteria (ATR, Aesthetic Index, plumbline distances); radiographic criteria (Cobb degrees); and ISICO criteria (optimal; minimal). METHODS: According to individual needs, two patients have been treated with Risser casts followed by Lyon brace, 40 with Lyon or sport braces (14 for 23 hours per day, 23 for 21 h/d, and seven for 18 h/d at start), and two with exercises only (1 male, 1 female): these were excluded from further analysis. Statistics. Paired ANOVA and t-test, Tukey-Kramer and chi-square test. RESULTS: Median reported compliance during the 4.261.4 treatment years was 90% (range 5-106%). No patient progressed beyond 45 , nor was any patient fused, and this remained true at the two-year follow-up for the 85% that reached it. Only two patients (4%) worsened, both with single thoracic curve, 25-30 Cobb and Risser 0 at the start. We found statistically significant reductions of the scoliosis curvatures (-7.1 ): thoracic (-7.3 ), thoracolumbar (-8.4 ) and lumbar (-7.8 ), but not double major. Statistically significant improvements have also been found for aesthetics and ATR. CONCLUSIONS: Respecting also SOSORT management criteria and thus increasing compliance, the results of conservative treatment were much better than what had previously been reported in the literature using SRS criteria only.
Spine Journal, 2009
Methods: This is a multicenter consecutive retrospective review of 105 patients (mean age 54yo, 2... more Methods: This is a multicenter consecutive retrospective review of 105 patients (mean age 54yo, 22M, 83F) who underwent lumbar PSO procedures for correction of major sagittal mal‐alignment (mean pre SVA= 14.3 cm). Pre‐and post‐op free standing full length sagittal ...
Spine Journal, 2009
difference in: 1) total complications PSO vs no PSO, 2) total pseudarthroses PSF vs APSF, and 3) ... more difference in: 1) total complications PSO vs no PSO, 2) total pseudarthroses PSF vs APSF, and 3) postop HRQL outcomes between pts with or without complications. CONCLUSIONS: Posterior approach with osteotomy achieved equivalent sagittal spinal alignment and postoperative HRQL scores without an increase in pseudoarthrosis rates compared to APSF in pts undergoing revision surgery with extension of fusion to the sacro-pelvis. PSO achieved a statistically significant improvement in SVA correction without increasing complications. Postoperative HRQL outcomes were equivalent to the published literature of primary surgery to the pelvis.
Spine Journal, 2010
RC group compared to the other patients included; age and greater pre-operative PT, PI, SVA and T... more RC group compared to the other patients included; age and greater pre-operative PT, PI, SVA and T1SPI . There was no difference in preoperative LL or PSO degree of resection between RC groups. CONCLUSIONS: Sagittal alignment can be anticipated in PSO with long fusions to the upper thoracic spine. Significant postoperative alignment changes can occur through unfused spinal segments following lumbar PSO with a UIV below T10. Unfavorable RC may limit optimal correction (SVA, PT) and can lead to clinical failures. Risk factors for unfavorable thoracic RC include: older patients, larger pre-op PI and PT and worse pre-op T1 spino-pelvic inclination. Most cases of unfavorable RC are not simply due to junctional failure. Care should be taken with selective lumbar fusion and PSO in older patients and those with unfavorable preop spino-pelvic parameters.
Spine Journal, 2011
Conclusion: Symptomatic RF occurred in 5.4% of ASD cases and in 14.9% of PSO cases. The majority ... more Conclusion: Symptomatic RF occurred in 5.4% of ASD cases and in 14.9% of PSO cases. The majority of RFs occurred within one year and occurred with all rod compositions and diameters. Early failure was most common following PSO and occurred at the PSO site, suggesting that RF may be due to stress at the PSO site or excessive rod contouring. Postoperative sagittal malalignment may increase the risk for RF. The top podium presentations accepted in each category are invited to submit their manuscripts for consideration. Winners are selected on the basis of their manuscripts and presentations.
Spine Journal, 2008
Object. Pedicle subtraction osteotomy (PSO) is a spinal realignment technique that may be used to... more Object. Pedicle subtraction osteotomy (PSO) is a spinal realignment technique that may be used to correct sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal plane correction in the setting of deformity. However, the quantitative effect of PSO level and focal angular change on postoperative spinopelvic parameters has not been well described. The purpose of this study is to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spinopelvic parameters.
Spine Journal, 2010
97% of the implants were rated ''clinically accepted position''. In 3% the trajectory was misplac... more 97% of the implants were rated ''clinically accepted position''. In 3% the trajectory was misplaced, and intra-operative manual correction was performed. The main reasons for misplacement were planning errors, unstable platform and skiving of the working channel. The total rate of failures decreased from 33% in 2006 to 4% in 2009, with no procedures being aborted in 2008-9. No neurologic complications occurred in this cohort. CONCLUSIONS: Robotic guidance has several clear advantages. The first is the need to pre-planed implants. Subtle anatomical variances of pedicles or trajectories are made clear and simplify the surgical plan. The system is accurate, with 97% clinically acceptable placements. The chances of neurological injury are low (0% in this cohort, 0.7% transient nerve deficit in a multicenter series of 600 cases, 49% percent execute through minimal invasive approaches). The system allows percutaneous and minimal invasive surgery with high levels of safety. The added value of robotic guidance is clear in revision cases, in deformed spine, in multiple level vertebral body augmentation, in percutaneous fracture fixation and in localization of small lesions as Osteoid Osteoma. Further studies will determine cost effectiveness, to assess if better accuracy will lead to better spinal mechanics and to decrease adjacent level degeneration. Robotic guidance, minimized surgical access and time may lead to shorten infection rates and shorter recovery from surgery. FDA DEVICE/DRUG STATUS: Mazor robotic system, Legacy Spinal fixation device, Kyphoplasty: Approved for this indication.
Spine Journal, 2010
We evaluated thirty-four consecutive patients with metastatic spine tumors who were treated surgi... more We evaluated thirty-four consecutive patients with metastatic spine tumors who were treated surgically. Posterior spinal fusion with instrumentation was performed in 9 cases, anterior and posterior fusion with instrumentation and artificial bodies in 14 cases, laminectomy in 8 cases, and TES in 3 cases. The prognosis of all patients was evaluated by Tokuhashi's score (15 points) and the spread of the lesions was evaluated by Tomita's surgical staging classification preoperatively. The clinical results of all patients were evaluated by the pain scale (grade 0-3), Frankel's classification, and the ADL scale . RESULTS: Applying the Tokuhashi Score for the estimation of life expectancy with vertebral metastases was found to provide very reliable results that were statistically significant (p!0.05). The analysis according to Tomita's surgical staging classification was useful in selecting the procedure. The cases treated with artificial vertebral bodies and instrumentation showed good clinical results in pain, paralysis, and ADL, especially for those patients with thyroid, breast or prostate cancer. Posterior fusion with instrumentation was useful for pain. Laminectomy was not useful for patients with pain and paralysis, except for those with thyroid, breast or prostate cancer (p!0.05). CONCLUSIONS: Tokuhashi's prognostic scoring and Tomita's surgical staging classification are useful in the treatment of metastatic spine tumors.
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Papers by Virginie Lafage