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  1. Article: Toe Acrometastasis as an Initial Sign of Metastasis in a Patient With a Large Cell Lung Carcinoma.

    Malhame, Zakhia Michael / El Rachkidi, Rami

    Cureus

    2022  Volume 14, Issue 10, Page(s) e30861

    Abstract: Acrometastases are rare lesions that originate most commonly from the primary lung cancer. They can mislead the diagnosis and the treatment, since they often appear as an osteomyelitis of the affected area. The presence of these metastases is a sign of ... ...

    Abstract Acrometastases are rare lesions that originate most commonly from the primary lung cancer. They can mislead the diagnosis and the treatment, since they often appear as an osteomyelitis of the affected area. The presence of these metastases is a sign of poor prognosis, with a life expectancy of few months. We report a case of a 78-year-old male with an acrometastasis to the distal phalanx of the right fourth toe. It was the first sign that his previously diagnosed large cell lung carcinoma had reached a metastatic stage. Amputation of the toe was considered in this case where the intense pain of his acrometastasis could not be managed even with strong analgesics.
    Language English
    Publishing date 2022-10-30
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.30861
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Early Revision Surgery for Distal Adding-On Correction in Lenke 1 and 2 Adolescent Idiopathic Scoliosis.

    El Rachkidi, Rami / Silvestre, Clément / Roussouly, Pierre

    Cureus

    2022  Volume 14, Issue 11, Page(s) e30960

    Abstract: Objective To evaluate the outcome of an early revision strategy for postoperative distal adding-on (DAO) after Lenke 1 and 2 adolescent idiopathic scoliosis (AIS) surgery. Summary of background data Improper choice of the lowest instrumented vertebra ( ... ...

    Abstract Objective To evaluate the outcome of an early revision strategy for postoperative distal adding-on (DAO) after Lenke 1 and 2 adolescent idiopathic scoliosis (AIS) surgery. Summary of background data Improper choice of the lowest instrumented vertebra (LIV) is a major cause of postoperative imbalance and unsatisfactory results in AIS surgery. The long-term consequences of such imbalance remain unclear. Early corrective surgery has not been described. Methods We retrieved the records of operated AIS patients at the former institution of the senior author. There were 18 cases of early revision by one-level distal extension of instrumentation and fusion. Patients were reoperated based on progressive distal local imbalance and clinical lumbar asymmetry. Several local and global balance parameters were compared on serial long-standing radiographs before and after the index surgery, before and after the revision surgery, and at the last follow-up. The Kruskal-Wallis test was used for the comparison of the results. A value of p<0.05 was considered significant. Results All patients were female with a mean age of 13.9 years. The mean delay between the two surgeries was 8.4 months and the last follow-up was at 32.5 months after the revision surgery. Unsatisfactory results after the index surgery were reflected by a progressive increase in disc angulation below the lowest instrumented vertebra (LIV) and an increased tilt and rotation of the LIV+1. The clinical lumbar shift was also accentuated from 19 mm to 25 mm. Revision surgery significantly reduced local and global balance parameters. There was a decrease in the LIV translation (from 26 mm to 19 mm) and of the wedging below it (from 7.9° to 1.3°) and a better positioning of the LIV+1 with less tilt (from 14.6° to 3.6°), translation (from 22.2 mm to 13.8 mm) and rotation (from 20° to 15°). The clinical lumbar shift was reduced from 25 mm to 3.6 mm. Global coronal and sagittal balance were also ameliorated. All results were maintained at a mean follow-up of 32.5 months from the revision surgery. No complications were noted and there was no need for a blood transfusion. Conclusion The revision surgery proposed in this paper is simple with low morbidity and may be considered as a fine-tuning of the failed index surgery. Further studies are needed to evaluate the long-term consequences of treated and untreated postoperative distal adding-on in AIS surgery.
    Language English
    Publishing date 2022-11-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.30960
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  3. Article: Posterior Ligamentous Complex Injuries of the Thoracolumbar Spine: Importance and Surgical Implications.

    Bizdikian, Aren Joe / El Rachkidi, Rami

    Cureus

    2021  Volume 13, Issue 10, Page(s) e18774

    Abstract: The soft tissues surrounding the spine play a primordial role in its stability, the most important of which are located posteriorly and are deemed the posterior ligamentous complex (PLC). Injuries to the PLC in the setting of thoracolumbar trauma are ... ...

    Abstract The soft tissues surrounding the spine play a primordial role in its stability, the most important of which are located posteriorly and are deemed the posterior ligamentous complex (PLC). Injuries to the PLC in the setting of thoracolumbar trauma are often dreaded and little attention has been given to them in the management protocols of thoracolumbar trauma. This review aims to summarize and contextualize current concepts in PLC injuries of the thoracolumbar spine with the aim to provide a clear guide for clinical management. Injuries to the PLC may be suspected on the clinical exam but are often missed, leading to serious complications, including instability and neurological compromise. The diagnosis is often made indirectly by spinal radiographs and CT-scanning or by direct visualization of soft tissues via magnetic resonance imaging. The latter remains the standard imaging modality and is mandatory for patients with a high suspicion of PLC injury. PLC injuries are associated with vertebral fractures and follow a progressive pattern of severity, depending on the mechanism of injury and extent of trauma. Surgical management is warranted, as PLC damage renders the spine unstable. Although fusion was once the standard of care and remains applicable for certain patients, recent endeavors of temporary spinal fixation without fusion are increasingly gaining traction in patients with PLC injuries. In conclusion, PLC injuries are challenging as they are often missed, poorly understood, and are not easily managed. Proper diagnosis and management are crucial to avoid long-standing complications such as spinal instability. Considering the paucity of available data on such an important topic in thoracolumbar trauma, this review article aims to contextualize current concepts in PLC injuries in order to demystify this sparsely covered subject.
    Language English
    Publishing date 2021-10-14
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.18774
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Role of bilateral staged hip arthroplasty in Hip-spine syndrome: A case report.

    Bizdikian, Aren Joe / Assi, Ayman / Semaan, Karl / Otayek, Joeffroy / Karam, Mohamad / Massaad, Abir / Jaber, Elena / Ghanem, Ismat / El Rachkidi, Rami

    Medicine

    2023  Volume 102, Issue 49, Page(s) e36296

    Abstract: Rationale: Hip-spine syndrome is a frequent finding in patients presenting with symptoms both at the level of the hip and spine.: Patient concerns: Patient previously operated of lumbar laminectomy for supposed spinal stenosis presenting with ... ...

    Abstract Rationale: Hip-spine syndrome is a frequent finding in patients presenting with symptoms both at the level of the hip and spine.
    Patient concerns: Patient previously operated of lumbar laminectomy for supposed spinal stenosis presenting with persistent pain and disability.
    Diagnoses: Clinical examination and imaging showed severe bilateral hip osteoarthritis. Full body standing and sitting biplanar radiographs showed an associated severe sagittal malalignment. 3D motion analysis and health-related quality of life (HRQOL) questionnaires showed a severe functional impact.
    Interventions: He was operated of a staged bilateral total hip arthroplasty using the direct anterior approach.
    Outcomes: Spinopelvic and sagittal alignment parameters, as well as 3D motion analysis and HRQOL scores showed significant improvement after the first, then the second total hip arthroplasty.
    Lessons: Comprehensive functional diagnostic testing, including full body standing and seated radiographs, 3D gait analysis and HRQOL questionnaires may provide important information for future management.
    MeSH term(s) Male ; Humans ; Arthroplasty, Replacement, Hip/methods ; Quality of Life ; Spine/surgery ; Osteoarthritis, Hip/surgery ; Sitting Position
    Language English
    Publishing date 2023-11-25
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 80184-7
    ISSN 1536-5964 ; 0025-7974
    ISSN (online) 1536-5964
    ISSN 0025-7974
    DOI 10.1097/MD.0000000000036296
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Kinematic adaptations from self-selected to fast speed walking in patients with adult spinal deformity.

    Abi Karam, Krystel / El Rachkidi, Rami / Semaan, Karl / Saad, Eddy / Fakhoury, Marc / Saade, Maria / Ayoub, Elma / Rteil, Ali / Jaber, Elena / Mekhael, Elio / Nassim, Nabil / Massaad, Abir / Ghanem, Ismat / Assi, Ayman

    Spine deformity

    2024  Volume 12, Issue 2, Page(s) 423–431

    Abstract: Purpose: To investigate kinematic adaptations from self-selected to fast speed walking in ASD patients.: Methods: 115 primary ASD and 66 controls underwent biplanar radiographic X-rays and 3D gait analysis to calculate trunk, segmental spine and ... ...

    Abstract Purpose: To investigate kinematic adaptations from self-selected to fast speed walking in ASD patients.
    Methods: 115 primary ASD and 66 controls underwent biplanar radiographic X-rays and 3D gait analysis to calculate trunk, segmental spine and lower limb kinematics during self-selected and fast speed walking. Kinematic adaptation was calculated as the difference (Δ) between fast and self-selected speed walking. ASD with 7 or more limited kinematic adaptation parameters were classified as ASD-limited-KA, while those with less than 7 limited kinematic adaptation parameters were classified as ASD-mild-KA.
    Results: 25 patients were classified as ASD-limited-KA and 90 as ASD-mild-KA. ASD-limited-KA patients walked with a lesser increase of pelvic rotation (Δ = 1.7 vs 5.5°), sagittal hip movement (Δ = 3.1 vs 7.4°) and shoulder-pelvis axial rotation (Δ = 3.4 vs 6.4°) compared to controls (all p < 0.05). ASD-limited-KA had an increased SVA (60.6 vs - 5.7 mm), PT (23.7 vs 11.9°), PI-LL (9.7 vs - 11.7°), knee flexion (9.2 vs - 0.4°) and a decreased LL (44.0 vs 61.4°) compared to controls (all p < 0.05). Kinematic and radiographic alterations were less pronounced in ASD-mild-KA. The limited increase of walking speed was correlated to the deteriorated physical component summary score of SF-36 (r = 0.37).
    Discussion: Kinematic limitations during adaptation from self-selected to fast speed walking highlight an alteration of a daily life activity in ASD patients. ASD with limited kinematic adaptations showed more severe sagittal malalignment with an increased SVA, PT, PI-LL, and knee flexion, a decreased LL and the most deteriorated quality of life. This highlights the importance of 3D movement analysis in the evaluation of ASD.
    MeSH term(s) Adult ; Humans ; Biomechanical Phenomena ; Quality of Life ; Spine/diagnostic imaging ; Walking ; Lower Extremity
    Language English
    Publishing date 2024-01-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 2717704-X
    ISSN 2212-1358 ; 2212-134X ; 2212-1358
    ISSN (online) 2212-1358 ; 2212-134X
    ISSN 2212-1358
    DOI 10.1007/s43390-023-00799-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: ASD with high pelvic retroversion develop changes in their acetabular orientation during walking.

    Assi, Ayman / Rebeyrat, Guillaume / El Rachkidi, Rami / Semaan, Karl / Saad, Eddy / Mekhael, Elio / Nassim, Nabil / Massaad, Abir / Lafage, Virginie / Ghanem, Ismat / Pillet, Hélène / Skalli, Wafa

    Brain & spine

    2023  Volume 3, Page(s) 101752

    Abstract: Introduction: It was hypothesized that pelvic retroversion in Adult Spinal Deformity (ASD) can be related to an increased hip loading explaining the occurrence of hip-spine syndrome.: Research question: How pelvic retroversion can modify acetabular ... ...

    Abstract Introduction: It was hypothesized that pelvic retroversion in Adult Spinal Deformity (ASD) can be related to an increased hip loading explaining the occurrence of hip-spine syndrome.
    Research question: How pelvic retroversion can modify acetabular orientation in ASD during walking?
    Methods: 89 primary ASD and 37 controls underwent 3D gait analysis and full-body biplanar X-rays. Classic spinopelvic parameters were calculated from 3D skeletal reconstructions in addition to acetabular anteversion, abduction, tilt, and coverage. Then, 3D bones were registered on each gait frame to compute the dynamic value of the radiographic parameters during walking. ASD patients having a high PT were grouped as ASD-highPT, otherwise as ASD-normPT. Control group was divided in: C-aged and C-young, age matched to ASD-hightPT and ASD-normPT respectively.
    Results: 25/89 patients were classified as ASD-highPT having a radiographic PT of 31° (vs 12° in other groups, p ​< ​0.001). On static radiograph, ASD-highPT showed more severe postural malalignment than the other groups: ODHA ​= ​5°, L1L5 ​= ​17°, SVA ​= ​57.4 ​mm (vs 2°, 48° and 5 ​mm resp. in other groups,all p ​< ​0.001). During gait, ASD-highPT presented a higher dynamic pelvic retroversion of 30° (vs 15° in C-aged), along with a higher acetabular anteversion of 24° (vs 20°), external coverage of 38° (vs 29°) and a lower anterior coverage of 52° (vs 58°,all p ​< ​0.05).
    Conclusion: ASD patients with severe pelvic retroversion showed an increased acetabular anteversion, external coverage and lower anterior coverage during gait. These changes in acetabular orientation, computed during walking, were shown to be related to hip osteoarthritis.
    Language English
    Publishing date 2023-05-02
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2772-5294
    ISSN (online) 2772-5294
    DOI 10.1016/j.bas.2023.101752
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Functional assessment using 3D movement analysis can better predict health-related quality of life outcomes in patients with adult spinal deformity: a machine learning approach.

    Mekhael, Elio / El Rachkidi, Rami / Saliby, Renee Maria / Nassim, Nabil / Semaan, Karl / Massaad, Abir / Karam, Mohamad / Saade, Maria / Ayoub, Elma / Rteil, Ali / Jaber, Elena / Chaaya, Celine / Abi Nahed, Julien / Ghanem, Ismat / Assi, Ayman

    Frontiers in surgery

    2023  Volume 10, Page(s) 1166734

    Abstract: Introduction: Adult spinal deformity (ASD) is classically evaluated by health-related quality of life (HRQoL) questionnaires and static radiographic spino-pelvic and global alignment parameters. Recently, 3D movement analysis (3DMA) was used for ... ...

    Abstract Introduction: Adult spinal deformity (ASD) is classically evaluated by health-related quality of life (HRQoL) questionnaires and static radiographic spino-pelvic and global alignment parameters. Recently, 3D movement analysis (3DMA) was used for functional assessment of ASD to objectively quantify patient's independence during daily life activities. The aim of this study was to determine the role of both static and functional assessments in the prediction of HRQoL outcomes using machine learning methods.
    Methods: ASD patients and controls underwent full-body biplanar low-dose x-rays with 3D reconstruction of skeletal segment as well as 3DMA of gait and filled HRQoL questionnaires: SF-36 physical and mental components (PCS&MCS), Oswestry Disability Index (ODI), Beck's Depression Inventory (BDI), and visual analog scale (VAS) for pain. A random forest machine learning (ML) model was used to predict HRQoL outcomes based on three simulations: (1) radiographic, (2) kinematic, (3) both radiographic and kinematic parameters. Accuracy of prediction and RMSE of the model were evaluated using 10-fold cross validation in each simulation and compared between simulations. The model was also used to investigate the possibility of predicting HRQoL outcomes in ASD after treatment.
    Results: In total, 173 primary ASD and 57 controls were enrolled; 30 ASD were followed-up after surgical or medical treatment. The first ML simulation had a median accuracy of 83.4%. The second simulation had a median accuracy of 84.7%. The third simulation had a median accuracy of 87%. Simulations 2 and 3 had comparable accuracies of prediction for all HRQoL outcomes and higher predictions compared to Simulation 1 (i.e., accuracy for PCS = 85 ± 5 vs. 88.4 ± 4 and 89.7% ± 4%, for MCS = 83.7 ± 8.3 vs. 86.3 ± 5.6 and 87.7% ± 6.8% for simulations 1, 2 and 3 resp.,
    Discussion: This study showed that kinematic parameters can better predict HRQoL outcomes than stand-alone classical radiographic parameters, not only for physical but also for mental scores. Moreover, 3DMA was shown to be a good predictive of HRQoL outcomes for ASD follow-up after medical or surgical treatment. Thus, the assessment of ASD patients should no longer rely on radiographs alone but on movement analysis as well.
    Language English
    Publishing date 2023-05-03
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2773823-1
    ISSN 2296-875X
    ISSN 2296-875X
    DOI 10.3389/fsurg.2023.1166734
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  8. Article: Spinopelvic Adaptations in Standing and Sitting Positions in Patients With Adult Spinal Deformity.

    El Rachkidi, Rami / Massaad, Abir / Saad, Eddy / Kawkabani, Georges / Semaan, Karl / Abi Nahed, Julien / Ghanem, Ismat / Lafage, Virginie / Skalli, Wafa / Assi, Ayman

    Cureus

    2022  Volume 14, Issue 8, Page(s) e28113

    Abstract: Purpose To describe spinopelvic adaptations in the standing and sitting positions in patients with adult spinal deformity (ASD). Methods Ninety-five patients with ASD and 32 controls completed health-related quality of life (HRQOL) questionnaires: short ... ...

    Abstract Purpose To describe spinopelvic adaptations in the standing and sitting positions in patients with adult spinal deformity (ASD). Methods Ninety-five patients with ASD and 32 controls completed health-related quality of life (HRQOL) questionnaires: short form 36 (SF36), Oswestry Disability Index (ODI), and visual analog scale (VAS) for pain. They underwent biplanar radiography in both standing and sitting positions. Patients with ASD were divided into ASD-front (frontal deformity Cobb > 20°, n = 24), ASD-sag (sagittal vertical axis (SVA) > 50 mm, pelvic tilt (PT) > 25°, or pelvic incidence (PI)-lumbar lordosis (LL) > 10°, n = 40), and ASD-hyper thoracic kyphosis (TK >60°, n = 31) groups. Flexibility was defined as the difference (Δ) in radiographic parameters between the standing and sitting positions. The radiographic parameters were compared between the groups. Correlations between HRQOL scores were evaluated. Results All participants increased their SVA from standing to sitting (ΔSVA<0), except for patients with ASD-sag, who tended to decrease their SVA (78-62 mm) and maximize their pelvic retroversion (27-40° vs 10-34° in controls, p<0.001). They also showed reduced thoracic and lumbar flexibility (ΔLL = 3.4 vs 37.1°; ΔTK = -1.7 vs 9.4° in controls, p<0.001). ASD-hyperTK showed a decreased PT while sitting (28.9 vs 34.4° in controls, p<0.001); they tended to decrease their LL and TK but could not reach values for controls (ΔLL = 22.8 vs 37.1° and ΔTK = 5.2 vs 9.4°, p<0.001). The ASD-front had normal standing and sitting postures. ΔSVA and ΔLL were negatively correlated with the physical component scale (PCS of SF36) and ODI (r = -0.39 and r = -0.46, respectively). Conclusion Patients with ASD present with different spinopelvic postures and adaptations from standing to sitting positions, with those having sagittal malalignment most affected. In addition, changes in standing and sitting postures were related to HRQOL outcomes. Therefore, surgeons should consider patient sitting adaptations in surgical planning and spinal fusion. Future studies on ASD should evaluate whether physical therapy or spinal surgery can improve sitting posture and QOL, especially for those with high SVA or PT.
    Language English
    Publishing date 2022-08-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.28113
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  9. Article ; Online: L5 incidence: an important parameter for spinopelvic balance evaluation in high-grade spondylolisthesis.

    Sebaaly, Amer / El Rachkidi, Rami / Grobost, Pierre / Burnier, Marion / Labelle, Hubert / Roussouly, Pierre

    The spine journal : official journal of the North American Spine Society

    2018  Volume 18, Issue 8, Page(s) 1417–1423

    Abstract: Background: In high-grade spondylolisthesis (HGSPL), the pelvic incidence (PI) is not a reliable measurement because of doming of the sacrum. Measurement of L5 incidence (L5I) was described as a tool to measure pelvic morphology in HGSPL and for ... ...

    Abstract Background: In high-grade spondylolisthesis (HGSPL), the pelvic incidence (PI) is not a reliable measurement because of doming of the sacrum. Measurement of L5 incidence (L5I) was described as a tool to measure pelvic morphology in HGSPL and for surgical follow-up.
    Objective: We aimed to evaluate L5I in HGSPL and its relationship to other spinopelvic parameters.
    Study design: A retrospective study of a cohort of 184 patients with HGSPL was carried out.
    Methods: Whole spine radiographs were analyzed for PI, pelvic tilt (PT), sacral slope, lumbar lordosis (LL), L5I, L5 tilt (L5T), L5 slope, lumbosacral kyphosis, and slip percentage. Statistical analysis and correlation were made (Pearson correlation test; p<.05). In accordance to Cohen, statically significant correlation were considered strong if R>0.5, moderate if 0.3<R<0.5, and small if R<0.3.<br />Results: A total of 184 cases were analyzed, with a female-to-male ratio of 2.35 and a mean age of 20.1 years. Sacral doming was present in 73% of the cases. Mean L5I incidence was 65.2° and strongly correlated to other sagittal parameters, especially PT (R=0.7), LL (R=0.7), L5T (R=0.77), and L5 slope (R=0.83). There was less but still strong correlation to Dubousset lumbosacral kyphosis (Dub-LSK) angle (R=-0.63) and percentage of slippage (R=0.56). L5 tilt showed nearly perfect correlation to PT (R=0.95). Forty-four percent of the cases were balanced HGSPL, whereas 56% of the cases were unbalanced HGSPL. L5 incidence was found to be a good predictor of local imbalance with a cutoff of L5I=61.
    Conclusion: This paper describes L5I, which is a positional parameter in HGSPL. L5 incidence is a simple and reliable measure in the preoperative setting in HGSPL. Its correlation with spinal sagittal parameters (especially PT and LL) is strong and was found to be better than Dub-LSK. There is also a good correlation between L5I and HGSPL pelvic parameters (slip percentage and lumbosacral kyphosis). We recommend its use for evaluation of surgical correction and recommend the value of 60° as cutoff value to define spinopelvic balance in HGSPL.
    MeSH term(s) Female ; Humans ; Kyphosis/diagnostic imaging ; Kyphosis/epidemiology ; Lordosis/diagnostic imaging ; Lordosis/epidemiology ; Lumbosacral Region/diagnostic imaging ; Male ; Posture ; Radiography ; Spondylolisthesis/diagnostic imaging ; Spondylolisthesis/epidemiology ; Young Adult
    Language English
    Publishing date 2018-01-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2037072-6
    ISSN 1878-1632 ; 1529-9430
    ISSN (online) 1878-1632
    ISSN 1529-9430
    DOI 10.1016/j.spinee.2018.01.014
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  10. Article: EOS(®) biplanar X-ray imaging: concept, developments, benefits, and limitations.

    Melhem, Elias / Assi, Ayman / El Rachkidi, Rami / Ghanem, Ismat

    Journal of children's orthopaedics

    2016  Volume 10, Issue 1, Page(s) 1–14

    Abstract: Purpose: In 1992, Georges Charpak invented a new type of X-ray detector, which in turn led to the development of the EOS(®) 2D/3D imaging system. This system takes simultaneous anteroposterior and lateral 2D images of the whole body and can be utilized ... ...

    Abstract Purpose: In 1992, Georges Charpak invented a new type of X-ray detector, which in turn led to the development of the EOS(®) 2D/3D imaging system. This system takes simultaneous anteroposterior and lateral 2D images of the whole body and can be utilized to perform 3D reconstruction based on statistical models. The purpose of this review is to present the state of the art for this EOS(®) imaging technique, to report recent developments and advances in the technique, and to stress its benefits while also noting its limitations.
    Methods: The review was based on a thorough literature search on the subject as well as personal experience gained from many years of using the EOS(®) system.
    Results: While EOS(®) imaging could be proposed for many applications, it is most useful in relation to scoliosis and sagittal balance, due to its ability to take simultaneous orthogonal images while the patient is standing, to perform 3D reconstruction, and to determine various relationships among adjacent segments (cervical spine, pelvis, and lower limbs). The technique has also been validated for the study of pelvic and lower-limb deformity and pathology in adult and pediatric populations; in such a study it has the advantage of allowing the measurement of torsional deformity, which classically requires a CT scan.
    Conclusions: The major advantages of EOS(®) are the relatively low dose of radiation (50-80 % less than conventional X-rays) that the patient receives and the possibility of obtaining a 3D reconstruction of the bones. However, this 3D reconstruction is not created automatically; a well-trained operator is required to generate it. The EOS(®) imaging technique has proven itself to be a very useful research and diagnostic tool.
    Language English
    Publishing date 2016-02-16
    Publishing country England
    Document type Journal Article
    ZDB-ID 2279410-4
    ISSN 1863-2548 ; 1863-2521
    ISSN (online) 1863-2548
    ISSN 1863-2521
    DOI 10.1007/s11832-016-0713-0
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