1
|
Gaume M, Loiselet K, Chekir H, Langlais T, Boddaert N, Stricker S, Pannier S, Skalli W, Miladi L, Vergari C. Evidence of spinal stiffening following fusionless bipolar fixation for neuromuscular scoliosis: a shear wave elastography assessment of lumbar annulus fibrosus. Eur Spine J 2024; 33:1617-1623. [PMID: 37924389 DOI: 10.1007/s00586-023-08013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/12/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023]
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.
Collapse
Affiliation(s)
- Mathilde Gaume
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France.
- Arts Et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France.
- Necker Hospital, 149 Rue de Sevres, 75015, Paris, France.
| | - Klervie Loiselet
- Pediatric Radiology Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Hedi Chekir
- Pediatric Radiology Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Tristan Langlais
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
- Arts Et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Sarah Stricker
- Neurosurgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Stéphanie Pannier
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Wafa Skalli
- Arts Et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - Lotfi Miladi
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - Claudio Vergari
- Arts Et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| |
Collapse
|
2
|
Gaume M, Langlais T, Loiselet K, Pannier S, Skalli W, Vergari C, Miladi L. Spontaneous induced bone fusion in minimally invasive fusionless bipolar fixation in neuromuscular scoliosis: a computed tomography analysis. Eur Spine J 2023; 32:2550-2557. [PMID: 37133763 DOI: 10.1007/s00586-023-07745-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/11/2023] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE Posterior spinal fusion (PSF) at skeletal maturity is still the gold standard in children with neuromuscular scoliosis (NMS) who underwent fusionless surgery. The aim of this computed tomography (CT) study was to quantify the spontaneous bone fusion at the end of a lengthening program by minimally invasive fusionless bipolar fixation (MIFBF), that could avoid PSF. METHODS NMS operated on with MIFBF from T1 to the pelvis and at final lengthening program were included. CT was performed at least five years postoperatively. The autofusion was classified as completely or not fused at the facets joint (on both coronal and sagittal plane, right and left side, from T1 to L5), and around the rods (axial plane, right and left side, from T5 to L5). Vertebral body heights were assessed. RESULTS Ten patients were included (10.7y ± 2 at initial surgery). Mean Cobb angle was 82 ± 20 preoperatively and 37 ± 13 at last follow-up. CT were performed on average 6.7y ± 1.7 after initial surgery. Mean preoperative and last follow-up thoracic vertebrae height were respectively 13.5 mm ± 1.7 and 17.4 mm ± 1.7 (p < 0.001). 93% facets joints were fused (out of 320 analyzed joints), corresponding to 15/16 vertebral levels. Ossification around the rods was observed in 6.5±2.4 levels out of 13 in the convex side, and 4.2 ± 2.2 in the concave side (p = 0.04). CONCLUSIONS This first computed quantitative study showed MIFBF in NMS preserved spinal growth, while it induced 93% of facet joints fusion. This could be is an additional argument when questionning the real need for PSF at skeletal maturity.
Collapse
Affiliation(s)
- M Gaume
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, 149 rue de Sevres, 75015, Paris, France.
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France.
| | - T Langlais
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, 149 rue de Sevres, 75015, Paris, France
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - K Loiselet
- Pediatric Radiology Department, Necker University Hospital, APHP, University of Paris-Cité, Paris, France
| | - S Pannier
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, 149 rue de Sevres, 75015, Paris, France
| | - W Skalli
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - C Vergari
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - L Miladi
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, University of Paris-Cité, 149 rue de Sevres, 75015, Paris, France
| |
Collapse
|
3
|
Gaume M, Gerard P, Khouri N, Glorion C, Dubousset J, Miladi L. Long-term outcomes of ilio-sacral screws in minimally invasive bipolar fusionless technique for neuromuscular scoliosis: a retrospective study in 167 patients. Arch Orthop Trauma Surg 2023; 143:1761-1767. [PMID: 35041079 DOI: 10.1007/s00402-021-04332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/21/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Pelvic fixation in patients with neuromuscular scoliosis is difficult, due to their fragile general condition and poor bone quality. Many techniques have been described, associated with high rates of mechanical complications. The objective of this work was to evaluate the mechanical complications and long-term radiological results of ilio-sacral screw pelvic fixation. MATERIALS AND METHODS 167 consecutive patients with neuromuscular scoliosis who underwent minimally invasive bipolar fixation with ilio-sacral screw pelvic fixation were retrospectively reviewed. The instrumentation consisted in a bilateral sliding rods construct extended from T1 to the sacrum, anchored proximally by double-hook claws and distally by ilio-sacral screws through a minimally invasive approach. Mechanical complications and radiographic measurements (angle of the major coronal curve, pelvic obliquity, lumbar lordosis) were evaluated preoperatively, postoperatively, and at the last follow-up. RESULTS Mean operative age was 12 ± 3 years, and follow-up 6.4 years (3.0-10.4 years). Pelvic obliquity decreased from 20° preoperatively to 5° (77% correction) at last follow-up, Angle of the major coronal curve from 75° to 36° (52% correction), and lumbar lordosis from 28° to 38°. 16 mechanical complications in nine patients occurred: screw prominence (n = 1), connector failure (n = 4), screw malposition (n = 11). Unplanned surgery was required in seven cases, two were managed during rod lengthening, seven did not require treatment. CONCLUSION In this series of neuromuscular patients operated by ilio-sacral screws as pelvic fixation, the results were stable with a mean follow-up of more than 6 years and the complication rate was reduced comparatively to the literature. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Mathilde Gaume
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France
| | - Pierre Gerard
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France
| | - Nejib Khouri
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France
| | - Christophe Glorion
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France
| | | | - Lotfi Miladi
- Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France.
| |
Collapse
|
4
|
Gaume M, Njiki J, Vaugier I, Orliaguet G, Verollet D, Glorion C, Essid A, Mbieleu B, Zini J, Fayssoile A, Quijano-Roy S, Desguerre I, Miladi L, Bergounioux J. Perioperative complications after posterior spinal fusion versus minimally invasive fusionless surgery in neuromuscular scoliosis: a comparative study. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04727-4. [PMID: 36534211 DOI: 10.1007/s00402-022-04727-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Early-onset scoliosis is a common deformity in neuromuscular disease. When conservative treatment becomes ineffective, several surgical options can be proposed. The most common technique is posterior spinal fusion (PSF) consisting of performing a multiple segmental instrumentation with pedicular screws on the full spine associated with decortication and bone graft. Minimally invasive fusionless surgery (MIFS) is an alternative to correct and fix definitively the spine without graft. The objective of this study was to compare early surgical inpatient period between PSF and MIFS in neuromuscular scoliosis. MATERIAL AND METHODS 140 NMS operated by PSF or MIFS between 2012 and 2017 was retrospectively reviewed. The following data were compared between groups: general characteristics (age, sex, etiology), preoperative preparation (halo traction, noninvasive ventilation or tracheostomy), Cobb angle and pelvic obliquity correction, use of drugs (vasopressor and/or inotropes, expansion fluids, transfusion and volumes), postoperative complications, and need of noninvasive ventilation. RESULTS 75 patients were managed by PSF with a mean age of 14.3 ± 2.3y and 65 by MIFS with a mean age of 11.8 ± 3y. Average pelvic obliquity and major curve correction were similar postoperatively. Intraoperative blood transfusion was significantly more common in PSF group (OR, 14; 95% CI [6.3-33.0]). Vasopressors were used non-significantly more often in the PSF group and expansion fluids similar in the two groups. PSF group had more overall complications (OR, 4.6; 95% CI [2.3-9.8]), more infections (OR, 3.6; 95% CI [1.5-9.3]) and more hemodynamic complications (OR, 4.1; 95% CI [1.4-15.1]). Average intubation duration was 5 days in the PSF and 4 days in MIFS (p = 0.05). CONCLUSION In this series of neuromuscular patients, the complication rate was reduced in MIFS comparatively to PSF, with lower blood transfusion and less infections.
Collapse
Affiliation(s)
- Mathilde Gaume
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, 149 Rue de Sevres, 75015, Paris, France. .,University of Paris, Paris, France.
| | - Josiane Njiki
- Pediatric Intensive Care, Raymond Poincaré University Hospital, APHP, Garches, France
| | - Isabelle Vaugier
- INSERM CIC1429, Raymond Poincaré University Hospital, APHP, Garches, France
| | - Gilles Orliaguet
- University of Paris, Paris, France.,Pediatric Anesthesiology Department, Necker University Hospital, APHP, Paris, France
| | - Delphine Verollet
- Pediatric Neurology, Physical Medicine, and Rehabilitation Department, Raymond Poincaré University Hospital, APHP, Garches, France
| | - Christophe Glorion
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, 149 Rue de Sevres, 75015, Paris, France.,University of Paris, Paris, France
| | - Aben Essid
- Pediatric Intensive Care, Raymond Poincaré University Hospital, APHP, Garches, France
| | - Blaise Mbieleu
- Pediatric Intensive Care, Raymond Poincaré University Hospital, APHP, Garches, France
| | - Justine Zini
- Pediatric Intensive Care, Raymond Poincaré University Hospital, APHP, Garches, France
| | - Abdallah Fayssoile
- Pediatric Neurology and ICU, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, 92380, Garches, France.,Versailles Saint Quentin en Yvelines University, Versailles, France
| | - Susana Quijano-Roy
- Pediatric Neurology, Physical Medicine, and Rehabilitation Department, Raymond Poincaré University Hospital, APHP, Garches, France.,Versailles Saint Quentin en Yvelines University, Versailles, France
| | - Isabelle Desguerre
- Pediatric Intensive Care, Raymond Poincaré University Hospital, APHP, Garches, France.,Pediatric Neurology Departments, Necker University Hospital, APHP, Paris, France
| | - Lotfi Miladi
- Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, 149 Rue de Sevres, 75015, Paris, France.,University of Paris, Paris, France
| | - Jean Bergounioux
- Pediatric Intensive Care, Raymond Poincaré University Hospital, APHP, Garches, France.,Versailles Saint Quentin en Yvelines University, Versailles, France
| |
Collapse
|
5
|
Gaume M, Hajj R, Khouri N, Johnson MB, Miladi L. One-Way Self-Expanding Rod in Neuromuscular Scoliosis: Preliminary Results of a Prospective Series of 21 Patients. JB JS Open Access 2021; 6:JBJSOA-D-21-00089. [PMID: 34934886 PMCID: PMC8683234 DOI: 10.2106/jbjs.oa.21.00089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Fusionless techniques for the treatment of neuromuscular early-onset scoliosis (EOS) are increasingly used to preserve spinal and thoracic growth and to postpone posterior spinal fusion (PSF). These techniques have greatly improved thanks to magnetically controlled growing rods, which allow the avoidance of repeated surgery. However, the surgery-related complication rate remains high. The objective of the current study was to report the preliminary outcomes of 21 patients with neuromuscular EOS who were treated with a 1-way self-expanding rod (OWSER). This device was designed to avoid repeated surgery and preserve spinal and thoracic growth thanks to its free rod sliding.
Collapse
Affiliation(s)
- M Gaume
- Department of Orthopaedic Surgery, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France
| | - R Hajj
- Department of Orthopaedic Surgery, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France
| | - N Khouri
- Department of Orthopaedic Surgery, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France
| | - M B Johnson
- Department of Orthopaedics, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - L Miladi
- Department of Orthopaedic Surgery, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France
| |
Collapse
|
6
|
Gaume M, Vergari C, Khouri N, Skalli W, Glorion C, Miladi L. Minimally Invasive Surgery for Neuromuscular Scoliosis: Results and Complications at a Minimal Follow-up of 5 Years. Spine (Phila Pa 1976) 2021; 46:1696-1704. [PMID: 33907082 DOI: 10.1097/brs.0000000000004082] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study. OBJECTIVE The aim of this study was to report the results of an alternative technique to growing rods (GR) for neuromuscular scoliosis using a minimally invasive fusionless surgery with a minimum of 5 years' follow-up. SUMMARY OF BACKGROUND DATA Conservative treatment is not effective in progressive neuromuscular scoliosis. Early surgery using GR is increasingly advocated to control the deformity while preserving spinal and thoracic growth before arthrodesis. These techniques still provide a high rate of complications. METHODS The technique relies on a bilateral double rod sliding instrumentation anchored proximally by four hooks claws and distally to the pelvis by iliosacral screws through a minimally invasive approach. The clinical and radiological outcomes of 100 consecutive patients with neuromuscular scoliosis who underwent this fusionless surgery with a minimum follow-up of 5 years were reviewed. RESULTS 6.5 ± 0.7 years after initial surgery, six patients were lost of follow-up and 11 died of unrelated raison. Of the 83 remaining patients at latest follow-up, mean Cobb angle was stable to 35.0° which correspond to 61% correction of the initial deformation. Mean pelvic obliquity was 29.6° (0.3°-80.0°) preoperatively and 7.2 (0.2°-23.5°) at latest follow-up. Correction of the hyper kyphosis remained stable. Skeletal maturitywas reached in 42 of 83 patients (50.6%). None of these patients has required spinal fusion. The global complication rate was 31.3%. CONCLUSION The outcomes of this minimally invasive fusionless technique at 5 years follow-up showed a stable correction of spinal deformities and pelvic obliquity over time, with a reduced rate of complication. The arthrodesis was not required for all patients at skeletal maturity. This technique could be a good alternative to arthrodesis for neuromuscular scoliosis.Level of Evidence: 3.
Collapse
Affiliation(s)
- Mathilde Gaume
- Pediatrics Orthopedics Department, Necker Hospital, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
- Arts et Métiers ParisTech, LBM/lnstitut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Claudio Vergari
- Arts et Métiers ParisTech, LBM/lnstitut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Nejib Khouri
- Pediatrics Orthopedics Department, Necker Hospital, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Wafa Skalli
- Arts et Métiers ParisTech, LBM/lnstitut de Biomécanique Humaine Georges Charpak, Paris, France
| | - Christophe Glorion
- Pediatrics Orthopedics Department, Necker Hospital, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lotfi Miladi
- Pediatrics Orthopedics Department, Necker Hospital, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| |
Collapse
|
7
|
Gaume M, Saudeau E, Gomez-Garcia de la Banda M, Azzi-Salameh V, Mbieleu B, Verollet D, Benezit A, Bergounioux J, Essid A, Doehring I, Dabaj I, Desguerre I, Barnerias C, Topouchian V, Glorion C, Quijano-Roy S, Miladi L. Minimally Invasive Fusionless Surgery for Scoliosis in Spinal Muscular Atrophy: Long-term Follow-up Results in a Series of 59 Patients. J Pediatr Orthop 2021; 41:549-558. [PMID: 34411042 DOI: 10.1097/bpo.0000000000001897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment of spinal muscular atrophy (SMA) scoliosis has evolved in the last decade, with the emergence of fusionless surgical techniques that allow correction of the deformity before the end of growth spurt. These techniques are expected to delay definitive spine fusion and preserve trunk growth. PURPOSE The aim was to evaluate long-term clinical, radiologic, and respiratory outcomes of a minimally invasive fusionless surgery (MIFLS) in SMA scoliosis. METHODS All children affected with SMA scoliosis who underwent MIFLS in our department from 2011 to 2019 were included. The instrumentation consisted in a bilateral sliding rod construct from T1 to the sacrum, anchored proximally by double-hook claws and distally by iliosacral screws. Clinical, genetic, respiratory and radiographic data were retrospectively reviewed. A patient's satisfaction survey was performed. RESULTS A total of 59 children with genetic confirmation of SMA (9SMA1c, 47SMA2, and 3SMA3) underwent MIFLS at a mean age of 11±1.9 years. All of them were nonwalker at the time of surgery. Twenty-six were treated with intrathecal Nusinersen. Mean follow-up was 5.2 years (2 to 9.6 y). Mean major coronal curve improved from 79±15 to 41±16 degrees and pelvic obliquity decreased from 24±11 to 5.9±4 degrees. Mean space available for lung improved from 77% to 93%. Mechanical or infectious complications occurred in 9 patients, with removal of the implant in 1. 6 children required unplanned surgeries. Postoperative bracing was needed in 13 children. Mean gain weight 3 years after the first surgery was 6 kg. 91.5% of patients had a positive satisfaction of the surgery. There was no significant impact in respiratory function postoperatively. Only 30 children required rod lengthening procedures, with a mean interval between procedures of 1.9 years (0.5 to 3.7 y). No arthrodesis was required at last follow-up in any patient. CONCLUSION Bipolar MIFLS in SMA preserves spinal and thoracic growth without interference with respiratory function. It provides a significant correction of spinal deformity and pelvic obliquity, having a reduced rate of complications. The correction of spinal deformity was maintained at long term, not requiring definitive fusion at the end of growth. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
| | | | - Marta Gomez-Garcia de la Banda
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
- Nord-Est-Ile de France Neuromuscular Center at the French Network (FILNEMUS), Euro-NMD ERN (European Neuromuscular Centers Network)
| | - Viviane Azzi-Salameh
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
- Nord-Est-Ile de France Neuromuscular Center at the French Network (FILNEMUS), Euro-NMD ERN (European Neuromuscular Centers Network)
| | - Blaise Mbieleu
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
| | | | - Audrey Benezit
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
- Nord-Est-Ile de France Neuromuscular Center at the French Network (FILNEMUS), Euro-NMD ERN (European Neuromuscular Centers Network)
| | - Jean Bergounioux
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
- UMR U1179 (INSERM/UVSQ) Physiopathologie, Biothérapie et Pharmacologie appliquées (END-ICAP), Montigny Le Bretonneaux, France
| | - Aben Essid
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
| | - Isabelle Doehring
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
| | - Ivana Dabaj
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
| | - Isabelle Desguerre
- Paediatric Neurology, Necker Enfants Malades Hospital, Paris Descartes University
- Nord-Est-Ile de France Neuromuscular Center at the French Network (FILNEMUS), Euro-NMD ERN (European Neuromuscular Centers Network)
| | - Christine Barnerias
- Paediatric Neurology, Necker Enfants Malades Hospital, Paris Descartes University
| | | | | | - Susana Quijano-Roy
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
- Nord-Est-Ile de France Neuromuscular Center at the French Network (FILNEMUS), Euro-NMD ERN (European Neuromuscular Centers Network)
- UMR U1179 (INSERM/UVSQ) Physiopathologie, Biothérapie et Pharmacologie appliquées (END-ICAP), Montigny Le Bretonneaux, France
| | | |
Collapse
|
8
|
Vergari C, Gaume M, Persohn S, Miladi L, Skalli W. From in vitro evaluation of a finite element model of the spine to in silico comparison of spine instrumentations. J Mech Behav Biomed Mater 2021; 123:104797. [PMID: 34492614 DOI: 10.1016/j.jmbbm.2021.104797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/24/2022]
Abstract
Growth-preserving spinal surgery suffer from high complications rate. A recent bipolar instrumentation using two anchoring points (thoracic and pelvic) showed lower rates, but its biomechanical behaviour has not been characterised yet. The aim of this work was to combine in vitro and in vivo data to improve and validate a finite element model (FEM) of the spine, and to apply it to compare bipolar and classical all-screws implants. Spinal segments were tested in vitro to measure range of motion (ROM). Thoracic segments were also tested with bipolar instrumentation to measure ROM and rod strain using a strain gage. A subject-specific FEM of the spine, pelvis and ribcage of an in vivo asymptomatic subject was built. Spinal segments were extracted from it to reproduce the in-vitro mechanical tests. Experimental and simulated ROM and rod strain were compared. Then, the full trunk FEM was used to compare bipolar and all-screws instrumentations. The FEM fell within 1° of the experimental corridors, and both in silico and in vitro instrumentation rods showed 0.01% maximal axial strain. Bipolar and all-screws constructs had similar maximal Von Mises stresses. This work represents a first step towards subject-specific simulation to evaluate spinal constructs for neuromuscular scoliosis in children.
Collapse
|
9
|
Gennari A, Langlais T, Litrico S, Persohn S, Allain J, Skalli W. Biomechanical specimen assessment by low dose biplanar X-ray study of fusion constructions using a posterior lumbar cage with integrated anchors and posterior adjunctive fixators. Comput Methods Biomech Biomed Engin 2021; 25:536-542. [PMID: 34392764 DOI: 10.1080/10255842.2021.1966625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective was to compare L4/5 range of motions of fusion constructs using anchored cages. Twelve human cadaveric spine were tested in intact condition, and divided into TLIF and PLIF groups. Testing consisted in applying pure moments in flexion-extension, lateral bending and axial rotation. The computation of intersegmental motion was assessed using 3 D biplanar radiographs. In TLIF group, the addition of contralateral transfacet decreased flexion-extension motion (39%; p = 0.036) but without difference with the ipsilateral pedicle screw construction (53%; p = 0.2). In PLIF group, the addition of interspinous anchor reduced flexion-extension motion (12%; p = 0.036) but without difference with the bilateral pedicle screw construction (17%; p = 0.8).
Collapse
Affiliation(s)
- A Gennari
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France.,Neurosurgery, Spine Unit, CHU, Nice, France
| | - T Langlais
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France.,Département Othopédie Pédiatrique, Hôpital des Enfants, Purpan, Toulouse Université, France
| | - S Litrico
- Neurosurgery, Spine Unit, CHU, Nice, France
| | - S Persohn
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - J Allain
- Orthopedic Surgery, Spine Unit, Clinique Geoffroy Saint-Hilaire, Paris, France
| | - W Skalli
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France
| |
Collapse
|
10
|
Abstract
ABSTRACT Scoliosis is a three-dimensional deformity of the spine that occurs during growth. Surgery is indicated when the curve progresses despite conservative treatment. The traditional surgical treatment involves correction of the deformity using segmental spinal fixation to obtain solid bone fusion by decortication and bone grafting. Vertebral osteotomies or even vertebrectomies may be required for huge deformities. These techniques provide good results, but they are invasive, involving lengthy surgery, increased blood loss, and longer recovery times. Therefore, we developed another technique: The Minimally Invasive Bipolar Technique, based on gradual internal correction of the deformity secondary to viscoelastic relaxation of the trunk. This method is aimed at reducing surgical risks while providing satisfactory results and improving quality of life for the patients and their families. Additionally, this technique is cost effective for public health. T ype of the study: Update article.
Collapse
|
11
|
Poulet Y, Eyssartier C, Marsan T, Valdes-Tamayo L, Robert M, Billard P, Rouch P, Thoreux P, Sauret C. Lumbar lordosis obtained with and without intervertebral thoracic spine motions during rhythmic gymnastics movements: a preliminary study. Comput Methods Biomech Biomed Engin 2020. [DOI: 10.1080/10255842.2020.1815320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Y. Poulet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
- Centre d’Etudes et de Recherche sur l’Appareillage des Handicapés, Institution Nationale des Invalides, Créteil, France
| | - C. Eyssartier
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - T. Marsan
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - L. Valdes-Tamayo
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - M. Robert
- Fédération Française de Gymnastique, Paris, France
| | - P. Billard
- Fédération Française de Gymnastique, Paris, France
| | - P. Rouch
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - P. Thoreux
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
- Hôpital Avicenne, Université Sorbonne Paris Nord, Sorbonne Paris-Cité, AP-HP, Bobigny, France
| | - C. Sauret
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
- Centre d’Etudes et de Recherche sur l’Appareillage des Handicapés, Institution Nationale des Invalides, Créteil, France
| |
Collapse
|