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Evidence of spinal stiffening following fusionless bipolar fixation for neuromuscular scoliosis: a shear wave elastography assessment of lumbar annulus fibrosus

Article dans une revue avec comité de lecture
Author
GAUME, Mathilde
524328 Service de chirurgie orthopédique et traumatologie pédiatrique [CHU Necker ]
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]
ccLOISELET, Klervie
41309 Service de radiologie pédiatrique [CHU Necker]
CHEKIR, Hedi
41309 Service de radiologie pédiatrique [CHU Necker]
ccLANGLAIS, Tristan
524328 Service de chirurgie orthopédique et traumatologie pédiatrique [CHU Necker ]
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]
ccBODDAERT, Nathalie
41309 Service de radiologie pédiatrique [CHU Necker]
STRICKER, Sarah
85426 Service de neurochirurgie pédiatrique [CHU Necker]
PANNIER, Stéphanie
524328 Service de chirurgie orthopédique et traumatologie pédiatrique [CHU Necker ]
ccSKALLI, Wafa
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]
MILADI, Lotfi
524328 Service de chirurgie orthopédique et traumatologie pédiatrique [CHU Necker ]
ccVERGARI, Claudio
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]

URI
http://hdl.handle.net/10985/24818
DOI
10.1007/s00586-023-08013-8
Date
2023-11
Journal
European Spine Journal

Abstract

Objectives There are no established criteria for stiffness after fusionless surgery for neuromuscular scoliosis (NMS). As a result, there is no consensus regarding the surgical strategy to propose at long-term follow-up. This study reports the first use of shear wave elastography for assessing the mechanical response of lumbar intervertebral discs (IVDs) after fusionless bipolar fixation (FBF) for NMS and compares them with healthy controls. The aim was to acquire evidence from the stiffness of the spine following FBF. Patients and methods Nineteen NMS operated on with FBF (18 ± 2y at last follow-up, 6 ± 1 y after surgery) were included prospectively. Preoperative Cobb was 89 ± 20° and 35 ± 1° at latest follow-up. All patients had reached skeletal maturity. Eighteen healthy patients (20 ± 4 y) were also included. Shear wave speed (SWS) was measured in the annulus fibrosus of L3L4, L4L5 and L5S1 IVDs and compared between the two groups. A measurement reliability was performed. Results In healthy subjects, average SWS (all disc levels pooled) was 7.5 ± 2.6 m/s. In NMS patients, SWS was significantly higher at 9.9 ± 1.4 m/s (p < 0.05). Differences were significant between L3L4 (9.3 ± 1.8 m/s vs. 7.0 ± 2.5 m/s, p = 0.004) and L4L5 (10.3 ± 2.3 m/s vs. 7.1 ± 1.1 m/s, p = 0.0006). No difference was observed for L5S1 (p = 0.2). No correlation was found with age at surgery, Cobb angle correction and age at the SWE measurement. Conclusions This study shows a significant increase in disc stiffness at the end of growth for NMS patients treated by FBF. These findings are a useful adjunct to CT-scan in assessing stiffness of the spine allowing the avoidance of surgical final fusion at skeletal maturity.

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Evidence of spinal stiffening ...
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