As part of our partnership with ArgoSpine, we're republishing select content from the ArgoSpine News and Journal for our audience. The article below, written by Jean Dubousset of the Academie Nationale de Medecine in Paris, France, was first published in 2009.
When I started my residency, scoliosis imaging was almost limited to the AP view! With a maximum format of 36cm x 43cm. From time to time, two different shots had to be done to check the entire spine with of course two different centerings! Even more rarely, a lateral view was required mainly to visualize a precise region, such as the lumbosacral junction. When necessary of course a laminogram was performed to explore a tumoral lesion or congenital anomaly. When an intracanalar lesion was suspected, myelography or myeloencephalography was used to assess, for example, the craniovertebral junction.
It was in 1979 that we attracted the attention of surgeons by proposing the main topic of the GES held in Montreal: “Idiopathic scoliosis as seen from the lateral view”. This was also the time where 30- 90cm long films were systematically used by every practitioner for scoliosis. Together with Henry Graf and Jérome Hecqet, by combining these two shots, we developed the 3D schematic reconstruction of the spine presenting the prognosis of infantile scoliosis based upon this 3D reconstruction and especially the view from the top.
The development of CT scan with its 3D reconstruction was also a revolution but not as big as the explosion of MRI allowing to study the soft tissues and especially the spinal cord beautifully from the brain to the sacral canal. Numerous pathologies were described, numerous new techniques, -neurosurgical as well as orthopaedic were developed for the best of the patient using the T1 and T2 sequences. Reconstruction from CT scan cuts allows to determine the volume of the thorax and lungs, as well as the spinal penetration ndex. During this time, thanks to this work and permanent collaboration with the biomechanical engineers from Ensam, a much more precise 3D reconstruction was obtained from stereoradiographic Xray studies.
Finally, the study of the scoliosis was not completed until Xrays of the whole body from head to feet were obtained in AP and sagittal view, especially for the assessment of balance and its evolution pre- or post-operatively, as well as spontaneous developments resulting from the “ageing spine”, for example. These are the reasons why the EOS system with its numerous possibilities and very low dose radiation exposure was designed. We have to mention another imaging study: 3D kinematics of the spine -with or without scoliosis- thanks to external markers and checking of the 3D dynamic motion of the spine with its subsequent dynamic balance.
During my career, I have witnessed, like everywhere in medicine, an explosive improvement of imaging techniques allowing to better analyse the deformities, to think up new treatments and finally to enhance patients’ care at a level never achieved before.
