Adultes avec déformation rachidienne : traitement chirurgical et évaluation musculaire

Abstract : Adult spinal deformity(ASD) refers to abnormal curvatures of the spine in patients who have completed their growth. Due to its prevalence, clinical impact, and the relatively high rate of surgical failures, they represent a therapeutic challenge. Research has been able to demonstrate that the preservation or the restoration of the sagittal alignment, are key objectives of surgical treatment. The objective of this thesis is to analyze the treatment of ASD patients, with particular interest in restoration of sagittal alignment and to develop tools to assess the spino-pelvic musculature of ASD patients. Based on an analysis of a multicenter database, the first two articles present an evaluation of the surgical treatment in term of clinical effectiveness and radiographic realignment. In addition, the discrepancies between surgical preoperative planning and operative execution have been studied with a prospective data collection, and have highlighted the necessity to understand better the role of the muscles in the maintaining of the posture. Therefore two methods for the characterization of the muscles involved in the sagittal alignment have been validated. Both methods are based on manual segmentation of specific MRI acquisition (Dixon methods) in order to obtain precise fat infiltration quantification in addition to muscular volume. One method permits to obtain 3D reconstruction able to generate patient–specific musculoskeletal model. The other one open the path to a clinical purpose, because necessitate only segmentation of four slices to obtain an relevant evaluation of the muscular system. Finally, thanks to the first protocol the muscular system of ASD patients have been described.
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Bertrand Moal. Adultes avec déformation rachidienne : traitement chirurgical et évaluation musculaire. Biomécanique [physics.med-ph]. Ecole nationale supérieure d'arts et métiers - ENSAM, 2014. Français. ⟨NNT : 2014ENAM0034⟩. ⟨tel-01134206⟩

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