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Meynard A, Broussolle T, Barrey C. Giant intradural calcification of the thoracic spine. Joint Bone Spine 2024; 91:105724. [PMID: 38582361 DOI: 10.1016/j.jbspin.2024.105724] [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] [Received: 02/03/2024] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024]
Affiliation(s)
| | | | - Cédric Barrey
- Spine Surgery Unit, Hospices Civils de Lyon, Lyon, France
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Messerer R, Aldugman M, Morgado A, Barrey C. Spinal extradural arachnoid cysts: a rare entity and review of the literature. Eur Spine J 2024; 33:872-880. [PMID: 38063861 DOI: 10.1007/s00586-023-08057-w] [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: 03/15/2023] [Revised: 09/30/2023] [Accepted: 11/18/2023] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Spinal extradural arachnoid cysts (SEDC) are rare primary spinal lesions, accounting for less than 1% of all spinal epidural lesions. The literature contains only case reports of this pathology, and treatment remains controversial due to its rarity. Major reported SEDC cases are caused by leaking out of cerebrospinal fluid through a dural defect in the thecal sac forming an extradural cyst. Other reports describe non-communicating SEDC cases where the dural defect was not identified. We report a literature review on SEDC and the case of a 53 year‑old female who presented with type IA extradural cyst with subarachnoid space communication. METHODS Literature review, preoperative imaging and surgical technique. RESULTS The extradural cyst was excised completely and the dural defect was repaired. After surgical decompression, neurological symptoms gradually recovered. CONCLUSIONS The extradural arachnoid cyst is an uncommon entity. Preoperative imaging is one of the determining elements in orienting the therapeutic management of the SEDCs. The choice of the surgical technique must be the least invasive in order to avoid postoperative complications. Subtotal or complete excision of the cyst, followed by obliteration of the communication stalk and repair of the dural defect is the gold standard treatment.
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Affiliation(s)
- Rostom Messerer
- Department of Neurosurgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
- Department of Neurosurgery, Annecy Genevois Hospital, Epagny Metz-Tessy, France.
| | - Mohammed Aldugman
- Department of Neurosurgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Alexis Morgado
- Department of Neurosurgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Cédric Barrey
- Department of Neurosurgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
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Meynard A, Fréchède B, Pommier B, Mitton D, Barrey C. Biomechanical Comparison of Facet Versus Laminar C2 Screws. Neurosurgery 2023; 93:910-917. [PMID: 37057918 DOI: 10.1227/neu.0000000000002492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/14/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Transpedicular or transisthmic screws for C2 instrumentation represent the gold standard; however, the anatomy is not always compatible (hypoplastic pedicles, procidentia of the vertebral artery). Laminar screws (LS) have been proposed as a rescue technique and recently, bicortical facet screws (FS). To date, the biomechanical property of FS remains unknown. OBJECTIVE To compare the pull-out resistance of bicortical facet (FS) vs laminar (LS) C2 screws. METHODS Thirty-two human cadaveric C2 vertebrae were screened by CT scan imaging and dual x-ray absorptiometry before receiving both techniques and were randomized according to side and sequence (FS or LS first). Screw positioning was validated using 2-dimensional x-rays. Sixty-four mechanical tests were performed using pure tensile loading along the axis of the screws until pull-out. Mean pull-out strengths were compared using paired tests, multivariate and survival analysis (Kaplan-Meier curves). RESULTS The morphometric data were consistent with previous studies. Over 64 tests, the mean pull-out strength of LS (707 ± 467 N) was significantly higher than that of FS (390 ± 230 N) ( P = .0004). Bone mineral density was weakly correlated with pull-out strength (r = 0.42 for FS and r = 0.3 for LS). Both techniques were mechanically equivalent for vertebrae in which intralaminar cortical grip was not achievable for LS. The mean pull-out strength for LS with laminar cortical grip (1071 ± 395 N) was significantly higher than that of LS without (423 ± 291 N) ( P < .0001). CONCLUSION Our results suggest that bicortical FS of C2 offer less mechanical resistance than LS.
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Affiliation(s)
- Alexandre Meynard
- Spine Surgery Unit, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, and University Claude Bernard of Lyon 1, Bron , France
- LBMC UMR T 9406, Univ Lyon, Univ Claude Bernard Lyon 1, Univ Gustave Eiffel, Lyon , France
| | - Bertrand Fréchède
- LBMC UMR T 9406, Univ Lyon, Univ Claude Bernard Lyon 1, Univ Gustave Eiffel, Lyon , France
| | - Benjamin Pommier
- Spine Surgery Unit, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, and University Claude Bernard of Lyon 1, Bron , France
| | - David Mitton
- LBMC UMR T 9406, Univ Lyon, Univ Claude Bernard Lyon 1, Univ Gustave Eiffel, Lyon , France
| | - Cédric Barrey
- Spine Surgery Unit, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, and University Claude Bernard of Lyon 1, Bron , France
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris , France
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Broussolle T, Roux JP, Chapurlat R, Barrey C. Murine models of posterolateral spinal fusion: A systematic review. Neurochirurgie 2023; 69:101428. [PMID: 36871885 DOI: 10.1016/j.neuchi.2023.101428] [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] [Received: 12/22/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Rodent models are commonly used experimentally to assess treatment effectiveness in spinal fusion. Certain factors are associated with better fusion rates. The objectives of the present study were to report the protocols most frequently used, to evaluate factors known to positively influence fusion rate, and to identify new factors. METHOD A systematic literature search of PubMed and Web of Science found 139 experimental studies of posterolateral lumbar spinal fusion in rodent models. Data for level and location of fusion, animal strain, sex, weight and age, graft, decortication, fusion assessment and fusion and mortality rates were collected and analyzed. RESULTS The standard murine model for spinal fusion was male Sprague Dawley rats of 295g weight and 13 weeks' age, using decortication, with L4-L5 as fusion level. The last two criteria were associated with significantly better fusion rates. On manual palpation, the overall mean fusion rate in rats was 58% and the autograft mean fusion rate was 61%. Most studies evaluated fusion as a binary on manual palpation, and only a few used CT and histology. Average mortality was 3.03% in rats and 1.56% in mice. CONCLUSIONS These results suggest using a rat model, younger than 10 weeks and weighing more than 300 grams on the day of surgery, to optimize fusion rates, with decortication before grafting and fusing the L4-L5 level.
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Affiliation(s)
- T Broussolle
- Department of Spine Surgery, P. Wertheimer University Hospital, GHE, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France; Inserm UMR 1033, université Claude-Bernard Lyon 1, Lyon, France.
| | - Jean-Paul Roux
- Inserm UMR 1033, université Claude-Bernard Lyon 1, Lyon, France
| | - R Chapurlat
- Inserm UMR 1033, université Claude-Bernard Lyon 1, Lyon, France
| | - C Barrey
- Department of Spine Surgery, P. Wertheimer University Hospital, GHE, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France; Arts et métiers ParisTech, ENSAM, 151, boulevard de l'Hôpital, 75013 Paris, France
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Blondel B, Prost S, Chaussemy D, Mohsinaly Y, Ghailane S, Pascal-Moussellard H, Assaker R, Barrey C, Gille O, Charles YP, Fuentes S. How was spinal surgery activity maintained during the COVID-19 pandemic? Results of a French multicenter observational study. Orthop Traumatol Surg Res 2023; 109:103221. [PMID: 35093563 PMCID: PMC8801597 DOI: 10.1016/j.otsr.2022.103221] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/01/2021] [Accepted: 09/20/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The French Society of Spinal Surgery (SFCR) offered guidelines during the COVID pandemic. The objective of this work was to report the organization and activity in spinal surgery during the first month of confinement across 6 centers in France. The secondary objective was to monitor the adequacy of our practices within the SFCR guidelines. MATERIAL AND METHODS This prospective multicenter observational study reported spinal surgery activity in each institution from March 16 to April 16, 2020, as well as the organizational changes applied. Surgical activity was compared to that of the same period in 2019 in each center and evaluated according to the SFCR guidelines, in order to control the adequacy of our practices during a pandemic period. RESULTS During the peak of the epidemic, 246 patients including 6 COVID-positive patients were treated surgically. The most significant drops in activity were found in Strasbourg (-81.5%) and Paris (-65%), regions in which the health situation was the most critical, but also in Bordeaux (-75%) despite less viral circulation. Operating rooms functioned at 20 to 50% of their normal capacity. There was a significant reduction in procedures for degenerative spine conditions or deformities, in line with the SFCR guidelines. CONCLUSION Maintaining spinal surgery is possible and desirable, even in times of health crisis. The indications must be considered according to the emergency criteria developed by learned societies and adapted to health developments and to the technical possibilities of treatment, by center. LEVEL OF PROOF IV.
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Affiliation(s)
- Benjamin Blondel
- Unité de chirurgie rachidienne, APHM, CNRS, ISM, CHU de Timone, Aix-Marseille Université, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Solène Prost
- Unité de chirurgie rachidienne, APHM, CNRS, ISM, CHU de Timone, Aix-Marseille Université, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Dominique Chaussemy
- Service de neurochirurgie, université de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg, France
| | - Yann Mohsinaly
- Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, 47–83, boulevard de l’hôpital, 75013 Paris, France
| | - Soufiane Ghailane
- Unité de pathologie rachidienne, université de Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - Hughes Pascal-Moussellard
- Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, 47–83, boulevard de l’hôpital, 75013 Paris, France
| | - Richard Assaker
- Service de neurochirurgie, université de Lille, avenue du Professeur Emile-Laine, 59037 Lille, France
| | - Cédric Barrey
- Service de chirurgie du Rachis, université Claude-Bernard de Lyon 1, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - Olivier Gille
- Unité de pathologie rachidienne, université de Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - Yann-Philippe Charles
- Service de chirurgie du rachis, université de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg, France
| | - Stéphane Fuentes
- Unité de chirurgie rachidienne, APHM, CNRS, ISM, CHU de Timone, Aix-Marseille Université, 264, rue Saint-Pierre, 13005 Marseille, France,Corresponding author
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Ferry T, Kolenda C, Laurent F, Leboucher G, Merabischvilli M, Djebara S, Gustave CA, Perpoint T, Barrey C, Pirnay JP, Resch G. Personalized bacteriophage therapy to treat pandrug-resistant spinal Pseudomonas aeruginosa infection. Nat Commun 2022; 13:4239. [PMID: 35869081 PMCID: PMC9306240 DOI: 10.1038/s41467-022-31837-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/04/2022] [Indexed: 12/17/2022] Open
Abstract
Bone and joint infections (BJI) are one of the most difficult-to-treat bacterial infection, especially in the era of antimicrobial resistance. Lytic bacteriophages (phages for short) are natural viruses that can selectively target and kill bacteria. They are considered to have a high therapeutic potential for the treatment of severe bacterial infections and especially BJI, as they also target biofilms. Here we report on the management of a patient with a pandrug-resistant Pseudomonas aeruginosa spinal abscess who was treated with surgery and a personalized combination of phage therapy that was added to antibiotics. As the infecting P. aeruginosa strain was resistant to the phages developed by private companies that were contacted, we set up a unique European academic collaboration to find, produce and administer a personalized phage cocktail to the patient in due time. After two surgeries, despite bacterial persistence with expression of small colony variants, the patient healed with local and intravenous injections of purified phages as adjuvant therapy. Here, the authors describe a patient with a pandrug-resistant Pseudomonas aeruginosa spinal abscess successfully treated with a personalized combination of phage therapy and antibiotics.
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Zumbihl L, Berthezene Y, Hermier M, Barrey C, Bani-Sadr A. Isolated atlas-duplication as a manifestation of persistent proatlas: a case report. Surg Radiol Anat 2022; 44:595-598. [DOI: 10.1007/s00276-022-02918-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
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Miailhes P, Conrad A, Sobas C, Laurent F, Lustig S, Ferry T, Ferry T, Valour F, Perpoint T, Ader F, Roux S, Becker A, Triffault-Fillit C, Conrad A, Pouderoux C, Chauvelot P, Chabert P, Lippman J, Braun E, Lustig S, Servien E, Batailler C, Gunst S, Schmidt A, Sappey-Marinier E, Ode Q, Fessy MH, Viste A, Besse JL, Chaudier P, Louboutin L, Van Haecke A, Mercier M, Belgaid V, Gazarian A, Walch A, Bertani A, Rongieras F, Martres S, Trouillet F, Barrey C, Mojallal A, Brosset S, Hanriat C, Person H, Céruse P, Fuchsmann C, Gleizal A, Aubrun F, Dziadzko M, Macabéo C, Patrascu D, Laurent F, Beraud L, Roussel-Gaillard T, Dupieux C, Kolenda C, Josse J, Craighero F, Boussel L, Pialat JB, Morelec I, Tod M, Gagnieu MC, Goutelle S, Mabrut E. Coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin-rifampin treatment and complex reconstruction were needed for the cure. Arthroplasty 2021; 3:43. [PMID: 35610714 PMCID: PMC8796341 DOI: 10.1186/s42836-021-00097-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/16/2021] [Indexed: 12/04/2022] Open
Abstract
Background Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii, a strictly intracellular pathogen that can cause acute and chronic infection. Chronic Q fever can occur in immunocompetent as well as in immuno-compromised hosts, as a persistent localized infection. The main localizations are endocardial, vascular and, less frequently, osteoarticular. The most frequent osteoarticular form is spondyliscitis. Recommended treatment is combined doxycycline and hydroxychloroquine for 18 months, with cotrimoxazole as another option. Coxiella burnetti infection has been implicated in rare cases of prosthetic joint infection (PJI), and the medical and surgical management and outcome in such cases have been little reported. Case presentation We report an unusual case of chronic Q fever involving a hip arthroplasty in an immunocompromised woman treated with tumor necrosis factor (TNF)-α blockers for rheumatoid arthritis. Numerous surgical procedures (explantation, “second look”, femoral resection and revision by megaprosthesis), modification of the immunosuppressant therapy and switch from doxycycline-hydroxychloroquine to prolonged ofloxacin-rifampin combination therapy were needed to achieve reconstruction and treat the PJI, with a follow-up of 7 years. Conclusions Coxiella burnetti PJI is a complex infection that requires dedicated management in an experienced reference center. Combined use of ofloxacin-rifampin can be effective.
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Dridi M, Krebs-Drouot L, Meyronet D, Dumollard JM, Vassal F, Jouanneau E, Jacquesson T, Barrey C, Grange S, Boutonnat J, Péoc’h M, Karpathiou G. The Immune Microenvironment of Chordomas: An Immunohistochemical Analysis. Cancers (Basel) 2021; 13:cancers13133335. [PMID: 34283048 PMCID: PMC8268246 DOI: 10.3390/cancers13133335] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Chordoma patients may be amenable to immunotherapy; however, the immune microenvironment of chordomas needs further investigation. We performed the immunohistochemical analysis of a chordoma series, showing that these tumors have a unique microenvironment characterized by the absence of PD-L1 tumor cell expression, but feature PD-L1+ immune cells playing a negative prognostic role. Abstract Chordomas are rare sarcomas that are usually treated by surgery and/or radiotherapy since these are chemo-resistant tumors, but immunotherapy could be a possible option for chordoma patients. However, few reports investigating the composition of the chordoma immune microenvironment exist. We immunohistochemically studied 81 chordomas regarding their immune microenvironment factors and compared them with clinicopathological data. Macrophages and CD4 cells were the most prominent inflammatory cell populations, followed by CD8 T cells, while CD20 B cells and high endothelial venules (MECA-79+) were less frequently found. PD-L1 (22C3) expression by inflammatory cells was found in 21 (26%) tumors and was associated with a larger tumor size. None of the cases showed the expression of PD-L1 by tumor cells. Survival analysis showed that younger patients had a better overall survival. Considering the immunohistochemical factors studied, higher CD8, the presence of PD-L1+ immune cells, and higher vascular density were adverse prognostic factors, but in multivariate analysis, only PD-L1+ immune cells retained prognostic significance. To conclude, chordoma tumor cells do not express PD-L1, but PD-L1+ immune cells seem to play a negative prognostic role, supporting the need for further studies in this field and the possible beneficial role of immunotherapy in these patients.
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Affiliation(s)
- Maroa Dridi
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
| | - Lila Krebs-Drouot
- Pathology Department, University Hospital of Grenoble, 38700 Grenoble, France; (L.K.-D.); (J.B.)
| | - David Meyronet
- East Pathology Institute, Hospices Civils de Lyon, 69677 Lyon, France;
- Cancer Cell Plasticity Department, Cancer Research Center of Lyon, 69373 Lyon, France
- Claude Bernard University, Lyon 1, 69100 Lyon, France; (E.J.); (C.B.)
| | - Jean Marc Dumollard
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
| | - François Vassal
- Neurosurgery Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Emmanuel Jouanneau
- Claude Bernard University, Lyon 1, 69100 Lyon, France; (E.J.); (C.B.)
- Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, 69500 Lyon, France;
- Inserm U1052, CNRS UMR5286, «Signaling, Metabolism and Tumor Progression» The Cancer Research Center of Lyon, 69373 Lyon, France
| | - Timothée Jacquesson
- Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, 69500 Lyon, France;
- Department of Anatomy, Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, 69100 Lyon, France
| | - Cédric Barrey
- Claude Bernard University, Lyon 1, 69100 Lyon, France; (E.J.); (C.B.)
- Department of Spine and Spinal Cord Surgery, Neurological Hospital Pierre Wertheimer, 69500 Lyon, France
| | - Sylvain Grange
- Radiology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Jean Boutonnat
- Pathology Department, University Hospital of Grenoble, 38700 Grenoble, France; (L.K.-D.); (J.B.)
| | - Michel Péoc’h
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
| | - Georgia Karpathiou
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
- Correspondence:
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Pommier B, Ferry T, Broussolle T, Barrey C. The fused spine remains at risk of fracture after hardware removal: How should the implants be managed in case of late-onset infections? Neurochirurgie 2021; 68:355-357. [PMID: 34186031 DOI: 10.1016/j.neuchi.2021.06.008] [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] [Received: 11/03/2020] [Revised: 05/27/2021] [Accepted: 06/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- B Pommier
- Hôpital privé de la Loire, Ramsay Santé, 39, boulevard de la Palle, 42100 Saint-Étienne, France.
| | - T Ferry
- University Claude-Bernard, Lyon 1, France; Regional reference center for complex bone and joint infections (CRIOAc Lyon), hospices civils de Lyon, Lyon, France
| | - T Broussolle
- Hôpital privé de la Loire, Ramsay Santé, 39, boulevard de la Palle, 42100 Saint-Étienne, France
| | - C Barrey
- Hôpital privé de la Loire, Ramsay Santé, 39, boulevard de la Palle, 42100 Saint-Étienne, France; University Claude-Bernard, Lyon 1, France; Regional reference center for complex bone and joint infections (CRIOAc Lyon), hospices civils de Lyon, Lyon, France
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Karpathiou G, Dridi M, Krebs-Drouot L, Vassal F, Jouanneau E, Jacquesson T, Barrey C, Prades JM, Dumollard JM, Meyronet D, Boutonnat J, Péoc’h M. Autophagic Markers in Chordomas: Immunohistochemical Analysis and Comparison with the Immune Microenvironment of Chordoma Tissues. Cancers (Basel) 2021; 13:cancers13092169. [PMID: 33946484 PMCID: PMC8124629 DOI: 10.3390/cancers13092169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary In contrast to normal notochords, autophagic factors are often present in chordomas. Furthermore, PD-L1+ immune cells also express LC3B, suggesting the need for further investigations between autophagy and the immune microenvironment. Abstract Chordomas are notably resistant to chemotherapy. One of the cytoprotective mechanisms implicated in chemoresistance is autophagy. There are indirect data that autophagy could be implicated in chordomas, but its presence has not been studied in chordoma tissues. Sixty-one (61) chordomas were immunohistochemically studied for autophagic markers and their expression was compared with the expression in notochords, clinicopathological data, as well as the tumor immune microenvironment. All chordomas strongly and diffusely expressed cytoplasmic p62 (sequestosome 1, SQSTM1/p62), whereas 16 (26.2%) tumors also showed nuclear p62 expression. LC3B (Microtubule-associated protein 1A/1B-light chain 3B) tumor cell expression was found in 44 (72.1%) tumors. Autophagy-related 16‑like 1 (ATG16L1) was also expressed by most tumors. All tumors expressed mannose-6-phosphate/insulin-like growth factor 2 receptor (M6PR/IGF2R). LC3B tumor cell expression was negatively associated with tumor size, while no other parameters, such as age, sex, localization, or survival, were associated with the immunohistochemical factors studied. LC3B immune cell expression showed a significant positive association with programmed death-ligand 1 (PD-L1)+ immune cells and with a higher vascular density. ATG16L1 expression was also positively associated with higher vascular density. Notochords (n = 5) showed different immunostaining with a very weak LC3B and M6PR expression, and no p62 expression. In contrast to normal notochords, autophagic factors such as LC3B and ATG16L1 are often present in chordomas, associated with a strong and diffuse expression of p62, suggesting a blocked autophagic flow. Furthermore, PD-L1+ immune cells also express LC3B, suggesting the need for further investigations between autophagy and the immune microenvironment.
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Affiliation(s)
- Georgia Karpathiou
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
- Correspondence:
| | - Maroa Dridi
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
| | - Lila Krebs-Drouot
- Pathology Department, University Hospital of Grenoble, 38700 Grenoble, France; (L.K.-D.); (J.B.)
| | - François Vassal
- Neurosurgery Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Emmanuel Jouanneau
- Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, 69500 Lyon, France; (E.J.); (T.J.)
- Inserm U1052, CNRS UMR5286, «Signaling, Metabolism and Tumor Progression» The Cancer Research Center of Lyon, 69373 Lyon, France
- Claude Bernard University, Lyon 1, 69100 Lyon, France; (C.B.); (D.M.)
| | - Timothée Jacquesson
- Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, 69500 Lyon, France; (E.J.); (T.J.)
- Department of Anatomy, Faculté de Médecine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, 69100 Lyon, France
| | - Cédric Barrey
- Claude Bernard University, Lyon 1, 69100 Lyon, France; (C.B.); (D.M.)
- Department of Spine and Spinal Cord Surgery, Neurological Hospital Pierre Wertheimer, 69500 Lyon, France
| | - Jean Michel Prades
- Head and Neck Surgery Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France;
| | - Jean Marc Dumollard
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
| | - David Meyronet
- Claude Bernard University, Lyon 1, 69100 Lyon, France; (C.B.); (D.M.)
- East Pathology Institute, Hospices Civils de Lyon, 69677 Lyon, France
- Cancer Research Center of Lyon, Cancer Cell Plasticity Department, 69373 Lyon, France
| | - Jean Boutonnat
- Pathology Department, University Hospital of Grenoble, 38700 Grenoble, France; (L.K.-D.); (J.B.)
| | - Michel Péoc’h
- Pathology Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; (M.D.); (J.M.D.); (M.P.)
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Pommier B, Vasiljevic A, Barrey C. Purely Intraforaminal Meningioma in the Cervical Spine. World Neurosurg 2020; 145:432-433. [PMID: 33049380 DOI: 10.1016/j.wneu.2020.10.006] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 11/28/2022]
Abstract
Meningiomas are mostly benign intradural tumors. Concerning the spine, some of them can extend outside the canal or even develop extradurally but their primary attach is often located in the vertebral canal. Here we present the case of an exceptional purely intraforaminal meningioma mimicking a neurogenic tumor, involving the vertebral artery and presenting with cervicobrachial neuralgia and slight motor deficit.
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Affiliation(s)
- Benjamin Pommier
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
| | - Alexandre Vasiljevic
- Department of Pathology and Neuropathology, GHE, Hospices Civils de Lyon, Lyon, France
| | - Cédric Barrey
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France; University Claude Bernard, Lyon, France; Laboratory of Biomechanics, ENSAM, Arts et Metiers ParisTech, Paris, France
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13
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Di Bartolomeo A, Fenouil T, Giugliano M, Messerer R, Freitas E, Barrey C. Long term recurrence of solitary fibrous tumor involving vertebral body in thoracic spine. A case report. Interdisciplinary Neurosurgery 2020. [DOI: 10.1016/j.inat.2020.100737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Grelat M, Pommier B, Portet S, Amelot A, Barrey C, Leroy HA, Madkouri R. Patients with Coronavirus 2019 (COVID-19) and Surgery: Guidelines and Checklist Proposal. World Neurosurg 2020; 139:e769-e773. [PMID: 32344143 PMCID: PMC7194971 DOI: 10.1016/j.wneu.2020.04.155] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 01/08/2023]
Abstract
The management of patients with novel coronavirus 2019 (COVID-19) represents a new challenge for medical and surgical teams. Each operating room in the world should be prepared thoughtfully, and the development of a protocol and patient route seems mandatory. An adequate degree of protection must be used. We propose recommendations to help different professionals in the establishment of protocols for the management of patients with COVID-19. We also offer a checklist that could be used in the operating room.
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Affiliation(s)
- Michael Grelat
- Department of Neurosurgery, Dijon University Hospital, Dijon, France.
| | - Benjamin Pommier
- Department of Neurosurgery, Saint-Etienne University Hospital, Saint Etienne, France
| | - Sylvain Portet
- Department of Neurosurgery, Lyon University Hospital, Lyon, France
| | - Aymeric Amelot
- Department of Neurosurgery, Tours University Hospital, Tours, France
| | - Cédric Barrey
- Department of Neurosurgery, Lyon University Hospital, Lyon, France
| | | | - Rachid Madkouri
- Department of Neurosurgery, Dijon University Hospital, Dijon, France
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15
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Le Huec JC, Thompson W, Mohsinaly Y, Barrey C, Faundez A. Sagittal balance of the spine. Eur Spine J 2019; 28:1889-1905. [DOI: 10.1007/s00586-019-06083-1] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 11/24/2022]
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16
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Barrey C, Broussolle T. Clinical and radiographic evaluation of bioactive glass in posterior cervical and lumbar spinal fusion. Eur J Orthop Surg Traumatol 2019; 29:1623-1629. [PMID: 31236682 DOI: 10.1007/s00590-019-02477-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 03/21/2019] [Accepted: 06/17/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Spinal surgery of degenerative painful segments is a valuable treatment option in the management of chronic cervical and low back pain. The surgery consists in stabilizing and fusing painful vertebral segment(s). The objective of the study was to report our experience with 45S5 bioactive glass (BAG) to obtain inter-vertebral fusion in the context of posterior spine surgery. MATERIAL AND METHOD In this retrospective study, 30 patients with a wide range of degenerative and traumatic conditions of the cervical or lumbar spine underwent spinal fusion utilizing a synthetic bone graft substitute of BAG (GlassBone™, Noraker, Lyon-Villeurbanne, France). The pain was evaluated by VAS score, and graft consolidation was assessed on according radiographic images at 1-year post-op. RESULTS All patients underwent posterior spinal fusion either in the cervical or the thoraco-lumbar spine. Multi-level fusions represented the majority of the cohort (43% of patients with more than seven levels treated). Radiographic imaging demonstrated excellent fusion rates (93%) at final follow-up, equivalent to the outcomes reported in the literature for autogenous bone, with excellent bone bridging and no spinal implant loosening. Only two cases of non-union were encountered. Additionally, 90% of the patients demonstrated recovery at 1 year after surgery with a pain reduction of 60%. CONCLUSION The results of this retrospective study suggest that the 45S5 BAG may be an interesting alternative option to autologous graft, in terms of safety and bone fusion efficiency. LEVEL OF EVIDENCE IV Retrospective study.
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Affiliation(s)
- Cédric Barrey
- Department of Spine Surgery, P. Wertheimer University Hospital, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, Lyon, France.
| | - Théo Broussolle
- Department of Spine Surgery, P. Wertheimer University Hospital, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, Lyon, France
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17
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Facione J, Villa C, Bonnet X, Barrey C, Thomas-Pohl M, Lapeyre E, Lavaste F, Pillet H, Skalli W. Spinopelvic sagittal alignment of patients with transfemoral amputation. Eur Spine J 2019; 28:1920-1928. [PMID: 31165926 DOI: 10.1007/s00586-019-06017-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 03/22/2019] [Accepted: 05/18/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aims to describe the spinopelvic sagittal alignment in transfemoral amputees (TFAs) from a radiologic study of the spine with a postural approach to better understand the high prevalence of low back pain (LBP) in this population. METHODS TFAs underwent X-rays with 3-D reconstructions of the full spine and pelvis. Sagittal parameters were analyzed and compared to the literature. Differences between TFAs with and without LBP were also observed. RESULTS Twelve subjects have been prospectively included (TFA-LBP group (n = 5) and TFA-NoP group (n = 7)). Four of the five subjects of the TFA-LBP group and two of the seven in TFAs-NoP group had an imbalanced sagittal posture, especially regarding the T9-tilt, significantly higher in the TFA-LBP group than in the TFA-NoP (p = 0.046). Eight subjects (6 TFA-NoP and 2 TFA-LBP) had abnormal low value of thoracic kyphosis (TK). Moreover, the mean angle of TK in the TFA-NoP group was lower than in the TFA-LBP group (p = 0.0511). CONCLUSION In the considered sample, TFAs often present a sagittal imbalance. A low TK angle seems to be associated with the absence of LBP. It can be hypothesized that this compensatory mechanism of the sagittal imbalance is the most accessible in this population. This study emphasizes the importance of considering the sagittal balance of the pelvis and the spine in patients with a TFA to better understand the high prevalence of LBP in this population. It should be completed by the analysis of the spinopelvic balance and the lower limbs in 3D. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Julia Facione
- Physical Medicine and Rehabilitation Unit, Hôpital d'Instruction des Armées Percy, 101 avenue Henri, Barbusse, 92140, Clamart, France. .,Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013, Paris, France.
| | - Coralie Villa
- Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013, Paris, France.,INI, Centre d'Etude et de Recherche sur l'Appareillage des Handicapés, BP 50719, 57147, Woippy Cédex, France
| | - Xavier Bonnet
- Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013, Paris, France
| | - Cédric Barrey
- Department of Neurosurgery and Spine Surgery, P. Wertheimer Hospital, Hospices civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Marie Thomas-Pohl
- Physical Medicine and Rehabilitation Unit, Hôpital d'Instruction des Armées Percy, 101 avenue Henri, Barbusse, 92140, Clamart, France.,Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013, Paris, France
| | - Eric Lapeyre
- Physical Medicine and Rehabilitation Unit, Hôpital d'Instruction des Armées Percy, 101 avenue Henri, Barbusse, 92140, Clamart, France
| | - François Lavaste
- Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013, Paris, France.,INI, Centre d'Etude et de Recherche sur l'Appareillage des Handicapés, BP 50719, 57147, Woippy Cédex, France
| | - Hélène Pillet
- Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013, Paris, France
| | - Wafa Skalli
- Arts et Metiers ParisTech, Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013, Paris, France
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18
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Prost S, Barrey C, Blondel B, Fuentes S, Barresi L, Nicot B, Challier V, Lleu M, Godard J, Kouyoumdjian P, Lonjon N, Marinho P, Freitas E, Schuller S, Allia J, Berthiller J, Charles YP. Hangman's fracture: Management strategy and healing rate in a prospective multi-centre observational study of 34 patients. Orthop Traumatol Surg Res 2019; 105:703-707. [PMID: 31005699 DOI: 10.1016/j.otsr.2019.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 09/20/2018] [Revised: 02/27/2019] [Accepted: 03/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hangman's fractures account for 15% to 20% of all cervical spine fractures. The grading system developed by Effendi and modified by Levine and Edwards is generally used as the basis for management decisions. Nonetheless, the optimal management remains controversial. The objective of this study was to describe the treatments used in France in patients with hangman's fractures. The complications and healing rates were analysed according to the fracture type and treatment used. HYPOTHESIS Among patients with hangman's fracture, those with disc damage must be treated surgically. MATERIAL AND METHODS A prospective, multi-centre, observational study was conducted under the aegis of the French Society for Spine Surgery (SociétéFrançaisedeChirurgieRachidienne, SFCR). Patients were included if they had computed tomography (CT) evidence of hangman's fracture. Follow-up data were collected prospectively. Fracture healing was assessed on CT scans obtained 3 and 12 months after the injury. The type of treatment and complications were recorded routinely. RESULTS We included 34 patients. The fracture type according to Effendi modified by Levine and Edwards was I in 68% of patients, II in 29% of patients, and III in a single patient (3%). The treatment was non-operative in 21 (62%) patients and surgical in 11 (32%). All 28 patients re-evaluated after 1 year had evidence of fracture healing. The remaining 6 patients were lost to follow-up. CONCLUSION Hangman's fracture is associated with low rates of mortality and neurological complications. Non-operative treatment is appropriate in Type I hangman's fracture, with a 100% healing rate in our study. Types II and III are characterised by damage to the ligaments and discs requiring either anterior C2-C3 fusion or posterior C1-C3 screw fixation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Solène Prost
- ISM, CNRS, unité de chirurgie rachidienne, Aix-Marseille université, CHU de Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Cédric Barrey
- Service de neurochirurgie C et chirurgie du rachis, université Claude-Bernard Lyon 1, hôpital P. Wertheimer, 59, boulevard Pinel, 69003 Lyon, France
| | - Benjamin Blondel
- ISM, CNRS, unité de chirurgie rachidienne, Aix-Marseille université, CHU de Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - Stéphane Fuentes
- ISM, CNRS, unité de chirurgie rachidienne, Aix-Marseille université, CHU de Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Laurent Barresi
- Unité de chirurgie rachidienne, CHU de Nice, Institut universitaire de l'appareil Locomoteur et du sport, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Benjamin Nicot
- Département de neurochirurgie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Vincent Challier
- Unité d'orthopédie-traumatologie rachis I, CHU de Bordeaux, hôpital Tripode, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - Maxime Lleu
- Service de neurochirurgie, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon cedex, France
| | - Joël Godard
- Service de neurochirurgie, hôpital Jean-Minjoz, 3, boulevard A. Fleming, 25030 Besançon cedex, France
| | - Pascal Kouyoumdjian
- Service d'orthopédie-traumatologie, CHU de Nîmes, avenue du Pr. Debré, 30000 Nîmes, France
| | - Nicolas Lonjon
- Service de neurochirurgie, hôpital Gui de Chauliac, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - Paulo Marinho
- Service de neurochirurgie, CHRU de Lille, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
| | - Eurico Freitas
- Service de neurochirurgie C et chirurgie du rachis, université Claude-Bernard Lyon 1, hôpital P. Wertheimer, 59, boulevard Pinel, 69003 Lyon, France
| | - Sébastien Schuller
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - Jérémy Allia
- Unité de chirurgie rachidienne, CHU de Nice, Institut universitaire de l'appareil Locomoteur et du sport, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Julien Berthiller
- Pôle IMER, hospices civils de Lyon, 162, avenue Lacassagne, 69424 Lyon cedex 03, France
| | - Yann Philippe Charles
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | -
- Société Française de Chirurgie Rachidienne, 56, rue Boisonnade, 75014 Paris, France
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Picart T, Barritault M, Simon E, Robinson P, Barrey C, Meyronet D, Mertens P. Anatomical and Histological Analysis of a Complex Structure Too Long Considered a Simple Ligament: The Filum Terminale. World Neurosurg 2019; 129:e464-e471. [PMID: 31150849 DOI: 10.1016/j.wneu.2019.05.184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The intradural filum terminale (iFT) connects the conus medullaris (CM) with the dural sac (DS), and the extradural filum terminale (eFT) connects the DS to the coccyx. The aim of the present study was to update the description of the FT and integrate these data in a physiological and pathological context. METHODS Anatomical measurements and histological investigations were performed on 10 human cadavers. RESULTS The mean length of the iFT and eFT was 167.13 and 87.59 mm, respectively. The mean cranial diameter of the iFT was 1.84 mm. It was >2 mm in 2 specimens. The mean half and caudal diameter of the iFT was 0.71 and 0.74 mm, respectively. The cranial diameter of the eFT correlated with the caudal diameter of the eFT (ρ = 0.94; P = 0.02). The level of the CM-iFT junction correlated significantly with the iFT length (ρ = -0.67; P = 0.03). The mobilization of the iFT was not transmitted to the extradural elements and vice versa. The iFT contained axons and ependymal cells, which were dense in the first third and then randomly arranged caudally in islets. This could explain why ependymomas can occur all along the iFT. Ganglion cells were abundant around the junction with the DS. The eFT contained smooth muscle cells, adipocytes, and axons. A mechanoreceptor was identified in 1 specimen. CONCLUSIONS Consistently with their common embryological origin, a real anatomical and histological continuum is present between the CM and FT. The FT should, therefore, no longer be considered a simple ligament but, rather, a complex fibrocellular structure.
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Affiliation(s)
- Thiébaud Picart
- Department of Neurosurgery, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France.
| | - Marc Barritault
- Department of Molecular Biology, Hospices Civils de Lyon, Groupe Hospitalier Est, Bron, France; Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, Lyon, France
| | - Emile Simon
- Department of Neurosurgery, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France; Laboratory of Anatomy, Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, Lyon, France
| | - Philip Robinson
- Hospices Civils de Lyon, Direction de la Recherche Clinique et de l'Innovation, Lyon, France
| | - Cédric Barrey
- Department of Neurosurgery, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - David Meyronet
- Department of Neuropathology, Hospices Civils de Lyon, Groupe Hospitalier Est, Bron, France; Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, Lyon, France
| | - Patrick Mertens
- Department of Neurosurgery, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France; Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, Lyon, France; Laboratory of Anatomy, Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, Lyon, France
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20
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Manet R, Ferry T, Castelain JE, Pardey Bracho G, Freitas-Olim E, Grando J, Barrey C. Relevance of Modified Debridement-Irrigation, Antibiotic Therapy and Implant Retention Protocol for the Management of Surgical Site Infections: A Series of 1694 Instrumented Spinal Surgery. J Bone Jt Infect 2018; 3:266-272. [PMID: 30662819 PMCID: PMC6328300 DOI: 10.7150/jbji.28765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/29/2018] [Indexed: 11/07/2022] Open
Abstract
Introduction: Management of surgical site infections (SSI) after
instrumented spinal surgery remains controversial. The debridement-irrigation, antibiotic
therapy and implant retention protocol (DAIR protocol) is safe and effective to treat deep
SSI occurring within the 3 months after instrumented spinal surgery. Methods: This retrospective study describes the outcomes of patients treated
over a period of 42 months for deep SSI after instrumented spinal surgery according to a
modified DAIR protocol. Results: Among 1694 instrumented surgical procedures, deep SSI occurred in
46 patients (2.7%): 41 patients (89%) experienced early SSI (< 1 month), 3 (7%)
delayed SSI (from 1 to 3 months), and 2 (4%) late SSI (> 3months). A total of 37
patients had a minimum 1 year of follow-up; among these the modified DAIR protocol was
effective in 28 patients (76%) and failed (need for new surgery for persistent signs of
SSI beyond 7 days) in 9 patients (24%). Early second-look surgery (≤ 7days) for
iterative debridement was performed in 3 patients, who were included in the cured group.
Among the 9 patients in whom the modified DAIR protocol failed, none had early second-look
surgery; 3 (33%) recovered and were cured at 1 year follow-up, and 6 (66%) relapsed.
Overall, among patients with SSI and a minimum 1 year follow-up, the modified DAIR
protocol led to healing in 31/37 (84%) patients. Conclusions: The present study supports the effectiveness of a modified DAIR
protocol in deep SSI occurring within the 3 months after instrumented spinal surgery. An
early second-look surgery for iterative debridement could increase the success rate of
this treatment.
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Affiliation(s)
- Romain Manet
- Department of Neurosurgery B, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,Department of Neurosurgery, Clinique Mutualiste Chirurgicale, Saint-Etienne, France
| | - Tristan Ferry
- Department of Infectious Diseases, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France.,Regional reference center for complex bone and joint infections (CRIOAc Lyon), Hospices Civils de Lyon, France.,International research center in infectiology, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Jean-Etienne Castelain
- Department of Spine Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Gilda Pardey Bracho
- Department of Anesthesiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Eurico Freitas-Olim
- Department of Spine Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Jacqueline Grando
- Department of Infectious Diseases Prevention, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Cédric Barrey
- University Claude Bernard Lyon 1, Lyon, France.,Regional reference center for complex bone and joint infections (CRIOAc Lyon), Hospices Civils de Lyon, France.,Department of Spine Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,Laboratory of Biomechanics, Arts et Metiers Paristech, Paris, France
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21
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Lleu M, Charles YP, Blondel B, Barresi L, Nicot B, Challier V, Godard J, Kouyoumdjian P, Lonjon N, Marinho P, Freitas E, Schuller S, Fuentes S, Allia J, Berthiller J, Barrey C. C1 fracture: Analysis of consolidation and complications rates in a prospective multicenter series. Orthop Traumatol Surg Res 2018; 104:1049-1054. [PMID: 30193984 DOI: 10.1016/j.otsr.2018.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 02/06/2017] [Revised: 05/14/2018] [Accepted: 06/04/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Three types of C1 fracture have been described, according to location: type 1 (anterior or posterior arc), type 2 (Jefferson: anterior and posterior arc), and type 3 (lateral mass). Stability depends on transverse ligament integrity. The main aim of the present study was to analyze complications and consolidation rates according to fracture type, age and treatment. MATERIAL AND METHODS The French Society of Spinal Surgery (SFCR) performed a multicenter prospective study on C1-C2 trauma. All patients with recent fracture diagnosed on CT were included. Consolidation on CT was studied at 3 months and 1 year. Medical, neurologic, infectious and mechanical complications were inventoried using the KEOPS data-base. RESULTS Sixty-three of the 417 patients (15.1%) had C1 fracture: type 1 (33.3%), type 2 (38.1%), or type 3 (28.6%). The transverse ligament was intact in 53.9% of cases. Treatment was non-operative in 63.5% of cases, surgical in 27.0%, and surgical after failure of non-operative treatment in 9.5%. There were 8 medical complications, more frequently in patients aged >70 years, following surgery (p<0.0001). The consolidation rate was 84.2% with non-operative treatment, 100% for primary surgery, and 33.3% for secondary surgery (p=0.002). There were 10 cases of non-union, in 4.8% of type 1, 13.6% of type 2 and 33.3% of type 3 fractures (p=0.001). CONCLUSION Medical complications showed association with age and with type of treatment. Non-operative treatment was suited to types 1, 2 and 3 with minimal displacement and intact transverse ligament. C1-C2 fusion was suited to displaced unstable type 2 fracture. Displaced type 3 fracture incurred risk of non-union. Early surgery may be recommended. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Maxime Lleu
- Service de neurochirurgie, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon cedex, France.
| | - Yann Philippe Charles
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, BP 426, 67091 Strasbourg cedex, France
| | - Benjamin Blondel
- Unité de chirurgie du Rachis, université Aix-Marseille, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Laurent Barresi
- Unité de chirurgie rachidienne, CHU de Nice, institut universitaire de l'appareil locomoteur et du sport, hôpital pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Benjamin Nicot
- Département de neurochirurgie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Vincent Challier
- Unité d'orthopédie-traumatologie Rachis I, CHU de Bordeaux, hôpital Tripode, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - Joël Godard
- Service de neurochirurgie, hôpital Jean-Minjoz, 3, boulevard A. Fleming, 25030 Besançon cedex, France
| | - Pascal Kouyoumdjian
- Service d'orthopédie-traumatologie, CHU de Nîmes, avenue du Pr. Debré, 30000 Nîmes, France
| | - Nicolas Lonjon
- Service de neurochirurgie, hôpital Gui de Chauliac, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - Paulo Marinho
- Service de neurochirurgie, CHRU de Lille, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
| | - Eurico Freitas
- Service de neurochirurgie C et chirurgie du Rachis, université Claude-Bernard Lyon 1, hôpital P. Wertheimer, 59, boulevard Pinel, 69003 Lyon, France
| | - Sébastien Schuller
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, BP 426, 67091 Strasbourg cedex, France
| | - Stéphane Fuentes
- Unité de chirurgie du Rachis, université Aix-Marseille, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Jérémy Allia
- Unité de chirurgie rachidienne, CHU de Nice, institut universitaire de l'appareil locomoteur et du sport, hôpital pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Julien Berthiller
- Hospices civils de Lyon, pôle IMER, 162, avenue Lacassagne, 69424 Lyon cedex 03, France
| | - Cédric Barrey
- Service de neurochirurgie C et chirurgie du Rachis, université Claude-Bernard Lyon 1, hôpital P. Wertheimer, 59, boulevard Pinel, 69003 Lyon, France
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Ferry T, Boucher F, Fevre C, Perpoint T, Chateau J, Petitjean C, Josse J, Chidiac C, L’hostis G, Leboucher G, Laurent F, Ferry T, Valour F, Perpoint T, Boibieux A, Biron F, Miailhes P, Ader F, Becker A, Roux S, Triffault-Fillit C, Conrad A, Bosch A, Daoud F, Lippman J, Braun E, Chidiac C, Lustig S, Servien E, Gaillard R, Schneider A, Gunst S, Batailler C, Fessy MH, Herry Y, Viste A, Chaudier P, Courtin C, Louboutin L, Martres S, Trouillet F, Barrey C, Jouanneau E, Jacquesson T, Mojallal A, Braye F, Boucher F, Shipkov H, Chateau J, Gleizal A, Aubrun F, Dziadzko M, Macabéo C, Laurent F, Rasigade JP, Dupieux C, Craighero F, Boussel L, Pialat JB, Morelec I, Janier M, Giammarile F, Tod M, Gagnieu MC, Goutelle S, Mabrut E. Innovations for the treatment of a complex bone and joint infection due to XDR Pseudomonas aeruginosa including local application of a selected cocktail of bacteriophages. J Antimicrob Chemother 2018; 73:2901-2903. [DOI: 10.1093/jac/dky263] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Tristan Ferry
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Fabien Boucher
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Service de Chirurgie Plastique et reconstructrice, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | - Thomas Perpoint
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Joseph Chateau
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Service de Chirurgie Plastique et reconstructrice, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | - Jérôme Josse
- Université Claude Bernard Lyon 1, Lyon, France
- Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Laboratoire de Bactériologie, Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Christian Chidiac
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | | | - Gilles Leboucher
- Pharmacie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- Université Claude Bernard Lyon 1, Lyon, France
- Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Laboratoire de Bactériologie, Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
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N’da H, Dauleac C, Toquart A, Afathi M, Meyronet D, Barrey C. Thoracic spine intra- and extradural dumbbell-shaped meningioma: Case report and extensive review of the literature with 21 cases. Neurochirurgie 2018; 64:206-210. [DOI: 10.1016/j.neuchi.2018.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 02/06/2018] [Accepted: 03/03/2018] [Indexed: 02/03/2023]
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Confavreux CB, Pialat JB, Bellière A, Brevet M, Decroisette C, Tescaru A, Wegrzyn J, Barrey C, Mornex F, Souquet PJ, Girard N. Bone metastases from lung cancer: A paradigm for multidisciplinary onco-rheumatology management. Joint Bone Spine 2018; 86:185-194. [PMID: 29631067 DOI: 10.1016/j.jbspin.2018.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/14/2018] [Indexed: 12/15/2022]
Abstract
Bone is the third metastatic site after liver and lungs. Bone metastases occur in one out of three lung cancers and are usually of osteolytic aspect. Osteolytic bone metastases are responsible of long bone and vertebral fractures leading to restricted mobility, surgery and medullar compression that severely alter quality of life and that have a huge medico-economic impact. In the recent years, Bone Metastatic Multidisciplinary Tumour Board (BM2TB) have been developed to optimize bone metastases management for each patient in harmony with oncology program. In this review, we will go through all the different aspects of bone metastases management including diagnosis and evaluation (CT scan, Tc 99m-MDP bone scan, 18FDG-PET scan and biopsy for molecular diagnosis), systemic bone treatments (zoledronic acid and denosumab) and local treatments (interventional radiology and radiotherapy). Surgical strategies will be discussed elsewhere. Based on the last 2017-Lung Cancer South East French Guidelines, we present a practical decision tree to help the physicians for decision making in order to reach a personalized locomotor strategy for every patient.
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Affiliation(s)
- Cyrille B Confavreux
- Centre expert des métastases et oncologie osseuse secondaire-CEMOS, service de rhumatologie Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France; Université de Lyon, INSERM UMR 1033-Lyos, 69008 Lyon, France.
| | - Jean-Baptiste Pialat
- Université de Lyon, INSERM UMR 1033-Lyos, 69008 Lyon, France; Service de radiologie, centre hospitalier Lyon-Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Aurélie Bellière
- Centre régional de lutte contre le cancer Jean-Perrin, 63000 Clermont-Ferrand, France
| | - Marie Brevet
- Département d'anatomopathologie, groupement hospitalier Est, Hospices Civils de Lyon, 69500 Bron, France
| | - Chantal Decroisette
- Centre Hospitalier Annecy-Genevois, 1, boulevard de l'hôpital, 74370 Metz-Tessy, France
| | - Agnès Tescaru
- Service de médecine nucléaire, centre hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Julien Wegrzyn
- Centre expert des métastases et oncologie osseuse secondaire-CEMOS, service de rhumatologie Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France; Université de Lyon, INSERM UMR 1033-Lyos, 69008 Lyon, France; Département de chirurgie orthopédique - Pavillon T, hôpital Edouard-Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Cédric Barrey
- Département de neurochirurgie et chirurgie du Rachis, université Claude-Bernard Lyon I, hôpital Pierre-Wertheimer, Hospices Civils de Lyon, 69500 Bron, France; Laboratoire de biomécanique, ENSAM, Arts et Métiers Paris Tech, 75003 Paris, France
| | - Françoise Mornex
- Département de radiothérapie oncologie, centre hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France; Université Claude-Bernard Lyon 1-EMR 3738, 69921 Oullins, France
| | - Pierre-Jean Souquet
- Service de pneumologie, centre hospitalier Lyon-Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Nicolas Girard
- Université de Lyon, université Claude-Bernard Lyon 1, Lyon, France; Institut du Thorax Curie Montsouris, Institut Curie, 75005 Paris, France
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25
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Brandão RACS, Martins WCDS, Arantes AA, Gusmão SNS, Perrin G, Barrey C. Titanium versus polyetheretherketone implants for vertebral body replacement in the treatment of 77 thoracolumbar spinal fractures. Surg Neurol Int 2017; 8:191. [PMID: 28868203 PMCID: PMC5569390 DOI: 10.4103/sni.sni_113_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/06/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Titanium and polyetheretherketone (PEEK) implants have been used in spinal surgery with low rejection rates. Compared to titanium, PEEK has many advantages, including a density more similar to that of bone, radiolucency, and a lack of artifacts in computed tomography (CT) and magnetic resonance imaging (MRI). In this study, we evaluated the effectiveness of PEEK cages as an alternative to titanium for bone fusion after fractures of the thoracolumbar spine. We also propose a classification to the impaction index. Methods: We evaluated 77 patients with fractures of the thoracic or lumbar spine who were treated by anterior fixation with titanium cages (TeCorp®) in 46 (59.7%) patients or PEEK (Verte-stak®) in 31 (40.3%) patients from 2006 to 2012 (Neurological Hospital of Lyon). Results: The titanium group achieved 100% fusion, and the PEEK group achieved 96.3% fusion. The titanium systems correlated with higher impact stress directed toward the lower and upper plateaus of the fused vertebrae; there were no nonunions for those treated with titanium group. Nevertheless, there was only one in the PEEK group. There was no significant difference in the pain scale outcomes for patients with ±10 degrees of the sagittal angle. Statistically, it is not possible to associate the variation of sagittal alignment or the impaction with symptoms of pain. The complication rate related to the implantation of cages was low. Conclusions: Titanium and PEEK are thus equally effective options for the reconstruction of the anterior column. PEEK is advantageous because its radiolucency facilitates the visualization of bone bridges.
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Affiliation(s)
- Rafael Augusto Castro Santiago Brandão
- Department of Surgery, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Neurological and Neurosurgical Clinic, Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | | | - Aluízio Augusto Arantes
- Department of Surgery, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Rusconi A, Freitas-Olim E, Coloma P, Messerer R, Barrey C. Bicortical facet screws as a new option for posterior C2 fixation: anatomical study and clinical experience. Eur Spine J 2017; 26:1082-1089. [PMID: 28204927 DOI: 10.1007/s00586-017-4997-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/31/2017] [Accepted: 02/06/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE C2 fixation is a demanding procedure, particularly in patients with variants of C1-C2 anatomy. The inferior articular process (IAP) of the axis can be an alternative for screw placement. We report the results of a CT study of C2 IAP anatomy and we present the clinical experience of 28 patients operated with this technique. METHODS Anatomical study: 50 CT angiographies of the vertebral arteries (VA) were used for this study and, therefore, 100 IAPs were considered. We measured on the axial and sagittal planes the length, height and width of the facet, the distance between the anterior cortex and the VA and the distance between the screw entry point and the VA. We also measured the angle between the sagittal plane and the external tangent line of the VA. CLINICAL REPORT 28 patients were treated with C2 IAP screws at the Spine Surgery Department of the University Hospital in Lyon, France, from January 2014 to January 2016. RESULTS Anatomical study: the mean length of C2 IAP was 12 ± 2 mm, the mean distance between the anterior cortical layer and the VA was 5.2 ± 1.4 mm, and the mean angle we found was 0.2° ± 5.3°. CLINICAL REPORT 16 of the 28 patients presented post-traumatic C1-C2 instability, 8 patients presented degenerative disease, 1 patient was treated for pseudoarthrosis, 1 for tumour, 1 for OPLL and 1 for rheumatoid arthritis. All the screws were correctly positioned and there was no VA injury. CONCLUSION IAP screws can represent a safe alternative option for C2 fixation.
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Affiliation(s)
- Angelo Rusconi
- Spine Surgery Department, Lyon University Hospital, 52 Boulevard Pinel, 69500, Bron, France.
| | - E Freitas-Olim
- Spine Surgery Department, Lyon University Hospital, 52 Boulevard Pinel, 69500, Bron, France
| | - P Coloma
- Spine Surgery Department, Lyon University Hospital, 52 Boulevard Pinel, 69500, Bron, France
| | - R Messerer
- Spine Surgery Department, Lyon University Hospital, 52 Boulevard Pinel, 69500, Bron, France
| | - C Barrey
- Spine Surgery Department, Lyon University Hospital, 52 Boulevard Pinel, 69500, Bron, France
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27
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Bachour E, Coloma P, Freitas E, Messerer R, Michel F, Barrey C. [Surgical correction of post-vertebroplasty kyphosis by pedicle substraction osteotomy. Regarding three cases]. Neurochirurgie 2017; 62:321-326. [PMID: 28120770 DOI: 10.1016/j.neuchi.2016.07.006] [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] [Received: 08/29/2015] [Revised: 05/24/2016] [Accepted: 07/09/2016] [Indexed: 10/20/2022]
Abstract
We report a case of three patients treated with pedicle subtraction osteotomy for post-vertebroplasty kyphosis. These patients were initially treated with a vertebroplasty for vertebral fracture (two cases) and spinal lymphoma (1 case). All of these patients worsened progressively on a clinical and radiographic level with progression of the spinal deformity in the form of kyphosis. The surgery consisted of transpedicular osteotomy instrumented at the level of the vertebra cemented with maximum removal of intra-corporeal cement. One of the three patients required a supplementary anterior approach to achieve good quality bone fusion. In all three cases the post-vertebroplasty kyphosis was able to be reduced by at least 50 % emphasizing the feasibility and relevance of the pedicle subtraction osteotomy in a context of cemented vertebra.
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Affiliation(s)
- E Bachour
- Service de neurochirurgie C et chirurgie du rachis, hôpital neurologique et neurochirurgical P.-Wertheimer, hospices civils de Lyon, université Claude-Bernard-Lyon I, 69003 Lyon, France.
| | - P Coloma
- Service de neurochirurgie C et chirurgie du rachis, hôpital neurologique et neurochirurgical P.-Wertheimer, hospices civils de Lyon, université Claude-Bernard-Lyon I, 69003 Lyon, France.
| | - E Freitas
- Service de neurochirurgie C et chirurgie du rachis, hôpital neurologique et neurochirurgical P.-Wertheimer, hospices civils de Lyon, université Claude-Bernard-Lyon I, 69003 Lyon, France.
| | - R Messerer
- Service de neurochirurgie C et chirurgie du rachis, hôpital neurologique et neurochirurgical P.-Wertheimer, hospices civils de Lyon, université Claude-Bernard-Lyon I, 69003 Lyon, France.
| | - F Michel
- Service de neurochirurgie C et chirurgie du rachis, hôpital neurologique et neurochirurgical P.-Wertheimer, hospices civils de Lyon, université Claude-Bernard-Lyon I, 69003 Lyon, France.
| | - C Barrey
- Service de neurochirurgie C et chirurgie du rachis, hôpital neurologique et neurochirurgical P.-Wertheimer, hospices civils de Lyon, université Claude-Bernard-Lyon I, 69003 Lyon, France.
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Lucas F, Mitton D, Frechede B, Barrey C. Short isthmic versus long trans-isthmic C2 screw: anatomical and biomechanical evaluation. Eur J Orthop Surg Traumatol 2016; 26:785-91. [PMID: 27170334 DOI: 10.1007/s00590-016-1770-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/29/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Harms technique is now considered as the gold standard to stabilize C1-C2 cervical spine. It has been reported to decrease the risk of vertebral artery injury. However, the risk of vascular injury does not totally disappear, particularly due to the proximity of the trans-isthmic C2 screw with the foramen transversarium of C2. In order to decrease this risk of vertebral artery injury, it has been proposed to use a shorter screw which stops before the foramen transversarium. OBJECT The main objective was to compare the pull-out strength of long trans-isthmic screw (LS) versus short isthmic screw (SS) C2 screw. An additional morphological study was also performed. METHOD Thirteen fresh-frozen human cadaveric cervical spines were included in the study. Orientation, width and height of the isthmus of C2 were measured on CT scan. Then, 3.5-mm titanium screws were inserted in C2 isthmus according to the Harms technique. Each specimen received a LS and a SS. The side and the order of placement were determined with a randomization table. Pull-out strengths and stiffness were evaluated with a testing machine, and paired samples were compared using Wilcoxon signed-rank test and also the Kaplan-Meier method. RESULTS The mean isthmus transversal orientation was 20° ± 6°. The mean width of C2 isthmus was less than 3.5 mm in 35 % of the cases. The mean pull-out strength for LS was 340 ± 85 versus 213 ± 104 N for SS (p = 0.004). The mean stiffness for the LS was 144 ± 40 and 97 ± 54 N/mm for the SS (p = 0.02). DISCUSSION The pull-out strength of trans-isthmic C2 screws was significantly higher (60 % additional pull-out resistance) than SSs. Although associated with an inferior resistance, SSs may be used in case of narrow isthmus which contraindicates 3.5-mm screw insertion but does not represent the first option for C2 instrumentation. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- François Lucas
- Neurosurgery Department, University de CAEN, University Hospital of CAEN, Caen, France. .,Service de Neurochirurgie, CHU, Avenue de la Côte de Nacre, 14032, Caen Cedex, France.
| | - David Mitton
- Université de Lyon, 69622, Lyon, France.,LBMC, UMR_T9406, IFSTTAR, 69675, Bron, France.,Université Lyon 1, Villeurbanne, France
| | - Bertrand Frechede
- Université de Lyon, 69622, Lyon, France.,LBMC, UMR_T9406, IFSTTAR, 69675, Bron, France.,Université Lyon 1, Villeurbanne, France
| | - Cédric Barrey
- Department of Spine Surgery, Hôpital P Wertheimer, University Claude Bernard Lyon 1, 59 Boulevard Pinel, 69394, Lyon, France.,Laboratory of Biomechanics, ENSAM, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75640, Paris, France
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29
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Amabile C, Pillet H, Lafage V, Barrey C, Vital JM, Skalli W. A new quasi-invariant parameter characterizing the postural alignment of young asymptomatic adults. Eur Spine J 2016; 25:3666-3674. [PMID: 27055441 DOI: 10.1007/s00586-016-4552-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Our study aims to describe the postural alignment of young asymptomatic subjects from head to feet from bi-planar standing full-body X-rays, providing database to compare to aging adults. Novelty resides in the inclusion of the head and lower limbs in the erected posture's analysis. METHODS For 69 young asymptomatic subjects (18-40 years old) 3D reconstructions of the head, spine, pelvis and lower limbs segments were performed from bi-planar full-body X-rays. Usual studied spinal, pelvic and lower limbs' parameters were computed in 3D, sagittal and frontal planes of the patient. Relationships between these parameters were investigated. Inclinations of different lines were studied to characterize the erected posture. RESULTS Values found for spinal curvatures, pelvic parameters and lower limbs geometrical parameters agreed with the literature: thoracic kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt and sagittal vertical axis were respectively in average of 26.9° (SD 7.2°), 30.5° (SD 7.5°), 51.0° (SD 9.4°), 11.1° (SD 5.6°) and -8.9 mm (SD 21.6 mm). The angle between the vertical and the line joining the most superior point of dentiform apophyse of C2 (OD) and the center of the bi-coxofemoral axis (HA) was the less variable one (SD 1.6°). CONCLUSIONS This study on 3D postural alignment reports the geometry of the spine, pelvis and lower limbs, of the young asymptomatic adult. The less variable angle is the one of the line OD-HA with the vertical, highlighting the vertical alignment of the head above the pelvis. This study provides a basis for future comparisons when investigating aging populations.
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Affiliation(s)
- Celia Amabile
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France. .,Spine Service, Hospital for Special Surgery, 535 East 70th Street, Belaire 4-E, New York, NY, 10021, USA.
| | - Hélène Pillet
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, 535 East 70th Street, Belaire 4-E, New York, NY, 10021, USA
| | - Cédric Barrey
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France.,Department of Neurosurgery and Spine Surgery, P Wertheimer Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, 59 Boulevard Pinel, 69003, Lyon, France
| | - Jean-Marc Vital
- Department of Orthopaedics and Spine Surgery, University Hospital of Bordeaux, Bordeaux, France
| | - Wafa Skalli
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France
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Virot E, Barrey C, Chidiac C, Ferry T. Chronic enterococcal spinal implant infection 6 years after instrumentation of a severe scoliosis in a 22-year-old woman. BMJ Case Rep 2015; 2015:bcr-2015-209782. [PMID: 26040830 DOI: 10.1136/bcr-2015-209782] [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: 11/04/2022] Open
Affiliation(s)
| | - Cédric Barrey
- Hospices Civils de Lyon, Lyon, France Université Claude Bernard Lyon 1, Lyon, France
| | - Christian Chidiac
- Hospices Civils de Lyon, Lyon, France Université Claude Bernard Lyon 1, Lyon, France Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Tristan Ferry
- Hospices Civils de Lyon, Lyon, France Université Claude Bernard Lyon 1, Lyon, France Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
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31
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Obeid I, Bourghli A, Boissière L, Vital JM, Barrey C. Complex osteotomies vertebral column resection and decancellation. Eur J Orthop Surg Traumatol 2014; 24 Suppl 1:S49-57. [PMID: 24831304 DOI: 10.1007/s00590-014-1472-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/26/2014] [Indexed: 11/25/2022]
Abstract
Pedicle subtraction osteotomy (PSO) is nowadays widely used to treat sagittal imbalance. Some complex malalignment cases cannot be treated by a PSO, whereas the imbalance is coronal or mixed or the sagittal imbalance is major and cannot be treated by a single PSO. The aim of this article was to review these complex situations--coronal imbalance, mixed imbalance, two-level PSO, vertebral column resection, and vertebral column decancellation, and to focus on their specificities. It wills also to evoke the utility of navigation in these complex cases.
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Affiliation(s)
- Ibrahim Obeid
- Department of Orthopaedics and Spine Surgery, University Hospital of Bordeaux, Bordeaux, France,
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Bourdillon P, Perrin G, Lucas F, Debarge R, Barrey C. C1-C2 stabilization by Harms arthrodesis: indications, technique, complications and outcomes in a prospective 26-case series. Orthop Traumatol Surg Res 2014; 100:221-7. [PMID: 24629457 DOI: 10.1016/j.otsr.2013.09.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 12/04/2012] [Revised: 07/23/2013] [Accepted: 09/27/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION C1-C2 arthrodesis is a surgical challenge due to the proximity of neurovascular structures (vertebral arteries and spinal cord) and the wide range of motion of the joint, hampering bone fusion. A variety of techniques have been successively recommended to reduce anatomic risk and improve results in terms of biomechanical stability and fusion rates. Recently, Harms described a new technique using polyaxial screws in the C1 lateral masses and C2 pedicles. MATERIAL AND METHOD The present study reports our experience in a consecutive series of 26 patients operated on by C1-C2 arthrodesis using the Goel and Harms technique, and details technical aspects step by step. Routine systematic immediate postoperative CT and 6-month CT controlled screw positioning and assessed fusion. Follow-up was at least 1 year, except in 2 cases (10 months). RESULTS Twenty-six patients with a mean age of 57 years were included. Indications comprised: C2 non-union (n=11), C1-C2 fracture and/or dislocation (n=11), inflammatory pathology (n=2) and tumoral pathology (n=2). The results showed the technique to be reliable (no neurovascular complications and 85% of screws with perfect positioning) and an excellent rate of fusion (100% at 6 months). CONCLUSION Anatomic and biomechanical considerations, combined with the present clinical and radiological outcomes, indicate that Goel and Harms fusion is to be considered the first-line attitude of choice for posterior C1-C2 arthrodesis. LEVEL OF EVIDENCE Level IV prospective study.
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Affiliation(s)
- P Bourdillon
- Service de Neurochirurgie C et Chirurgie du Rachis, Hôpital Pierre-Wertheimer, GHE, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - G Perrin
- Service de Neurochirurgie C et Chirurgie du Rachis, Hôpital Pierre-Wertheimer, GHE, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, 59, boulevard Pinel, 69500 Bron, France.
| | - F Lucas
- Service de Neurochirurgie C et Chirurgie du Rachis, Hôpital Pierre-Wertheimer, GHE, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - R Debarge
- Service de Neurochirurgie C et Chirurgie du Rachis, Hôpital Pierre-Wertheimer, GHE, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - C Barrey
- Service de Neurochirurgie C et Chirurgie du Rachis, Hôpital Pierre-Wertheimer, GHE, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, 59, boulevard Pinel, 69500 Bron, France; Laboratoire de Biomécanique, Art et Métiers Paristech, ESNAM, 151, boulevard de l'Hôpital, 75013 Paris, France
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Dudoit T, Lucas F, Halewa E, Emery E, Barrey C. IRM et prise en charge des fractures non neurologiques du rachis thoraco-lombaire. Neurochirurgie 2013. [DOI: 10.1016/j.neuchi.2013.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Barrey C, Roussouly P, Le Huec JC, D'Acunzi G, Perrin G. Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J 2013; 22 Suppl 6:S834-41. [PMID: 24052406 DOI: 10.1007/s00586-013-3030-z] [Citation(s) in RCA: 285] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/08/2013] [Accepted: 09/08/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Aging spine is characterized by facet joints arthritis, degenerative disc disease, bone remodeling and atrophy of extensor muscles resulting in a progressive kyphosis of the lumbar spine. OBJECTIVE The aim of this paper is to describe the different compensatory mechanisms for patients with severe degenerative lumbar spine. MATERIAL AND METHODS According to the severity of the imbalance, three stages are observed: balanced, balanced with compensatory mechanisms and imbalanced. For the two last stages, the compensatory mechanisms permit to limit the consequences of loss of lumbar lordosis on global sagittal alignment and therefore contribute to keep the sagittal balance of the spine. RESULTS The basic concept is to extend adjacent segments of the kyphotic spine allowing for compensation of the sagittal unbalance but potentially inducing adverse effects. CONCLUSION Finally, we propose a three-step algorithm to analyze the global balance status and take into consideration the presence of the compensatory mechanisms in the spinal, pelvic and lower limb areas.
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Affiliation(s)
- Cédric Barrey
- Department of Neurosurgery C and Spine Surgery, Neurological Hospital, 59 boulevard Pinel, 69394, Lyon, France,
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Barrey C, Launay O, Freitas E, Michel F, Laurent F, Chidiac C, Perrin G, Ferry T. The follow-up of patients with postoperative infection of the spine. Eur J Orthop Surg Traumatol 2013; 23 Suppl 1:S29-34. [DOI: 10.1007/s00590-013-1243-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/15/2013] [Indexed: 11/25/2022]
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Barrey C, Ene B, Louis-Tisserand G, Montagna P, Perrin G, Simon E. Vascular Anatomy in the Lumbar Spine Investigated by Three-Dimensional Computed Tomography Angiography: The Concept of Vascular Window. World Neurosurg 2013; 79:784-91. [DOI: 10.1016/j.wneu.2012.03.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 01/27/2012] [Accepted: 03/29/2012] [Indexed: 01/26/2023]
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Lucas F, Mitton D, Frechede B, Emery E, Perrin G, Skalli W, Barrey C. Vissage isthmique versus trans-isthmique de C2 : étude anatomique biomécanique. Neurochirurgie 2012. [DOI: 10.1016/j.neuchi.2012.10.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Barrey C, Freitas E, Michel F, Perrin G. Ostéotomie trans-pédiculaire : indications, technique, résultats, morbidité. Neurochirurgie 2012. [DOI: 10.1016/j.neuchi.2012.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barrey C, Champain S, Campana S, Ramadan A, Perrin G, Skalli W. Sagittal alignment and kinematics at instrumented and adjacent levels after total disc replacement in the cervical spine. Eur Spine J 2012; 21:1648-59. [PMID: 22331142 DOI: 10.1007/s00586-012-2180-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 10/02/2011] [Accepted: 01/28/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of the study was to report radiological outcomes after total disc replacement (TDR) in the cervical spine through a 24 months follow-up (FU) prospective study with a special focus on sagittal alignment and kinematics at instrumented and adjacent levels. MATERIALS AND METHODS Thirty-two patients, who sustained one-level TDR with a ball-and-socket arthroplasty (Discocerv(™) implant, Scient'x/Alphatec Spine, USA) were consecutively included in the study. Clinical (visual analogical scale and neck disability index) and radiological parameters were measured preoperatively and postoperatively at 3/6 months, 1-year and 2-year FU. Sagittal alignment, ranges of motion (ROM) and center of rotations (CORs) were analyzed using specific motion analysis software (Spineview(™), Paris, France). Patients CORs were compared with those of a control group of 39 normal and asymptomatic subjects. RESULTS Both local and C3-C7 lordosis significantly increased postoperatively (+8° and +13° at 2 years, respectively). At instrumented level ROM in flexion-extension (FE) was measured to 10.2° preoperatively versus 7.5° at 1 year and 6.1° at 2 years. There were no differences in ROM at adjacent levels between pre and postoperative assessments. When compared with control group and preoperative measurements, we noted postoperative cranial shift of the COR at instrumented level for patients group. In contrast, there was no difference in CORs location at adjacent levels. CONCLUSION Through this prospective study, we observed that cervical lordosis consistently increased after TDR. In addition, although ball-and-socket arthroplasty did not fully restore native segmental kinematics with significant reduction of motion in FE and consistent cranial shift of the COR, no significant changes in terms of ROM and CORs were observed at adjacent levels.
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Affiliation(s)
- Cédric Barrey
- Department of Spine Surgery, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, Lyon, France.
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Khan A, Barrey C, Massourides H, Perrin G. Lumbar hemivertebra in an adult treated by transpedicular osteotomy. World Neurosurg 2011; 77:592.e5-9. [PMID: 22120388 DOI: 10.1016/j.wneu.2011.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 04/11/2011] [Accepted: 04/26/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemivertebra frequently occurs in pediatric patients and is treated with vertebral excision to stop the progression of the deformity. A case of L3 hemivertebra associated with lumbar kyphoscoliosis in an adult is reported. CASE DESCRIPTION A 46-year-old woman presented with severe chronic back pain of 6 years' duration. Radiologic examinations showed that the L3 vertebra had a trapezoidal shape revealing a partially segmented hemivertebra. RESULTS The patient underwent a two-stage corrective surgery. The first stage consisted of a transpedicular osteotomy (TPO) with posterior instrumentation from L1 to L5 and a bone graft; 1 month later, anterior interbody fusions were performed at L2-3 and L3-4 using interbody cages and bone morphogenetic protein. No postoperative complication was reported after 2 years of follow-up. CONCLUSIONS TPO improved clinical symptoms, corrected the spinal deformity, and reduced the lumbar kyphosis.
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Affiliation(s)
- Ahmad Khan
- University of Lyon 1, and Department of Neurosurgery and Spine Surgery, Pierre Wertheimer Hospital, Hospices Civil de Lyon, Lyon, France
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Le Huec JC, Charosky S, Barrey C, Rigal J, Aunoble S. Sagittal imbalance cascade for simple degenerative spine and consequences: algorithm of decision for appropriate treatment. Eur Spine J 2011; 20 Suppl 5:699-703. [PMID: 21811823 DOI: 10.1007/s00586-011-1938-8] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 07/11/2011] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The main objective of all the sagittal compensating mechanisms is to allow a subject to stand and keep an erect position. MATERIALS AND METHODS The cascade of compensating mechanisms appears progressively with the increasing amount of imbalance of the spine until compensation is no longer possible. The loss of lumbar lordosis can be considered as the initiating event of sagittal imbalance. This loss of the normal lordosis pushes the C7 plumb line forward. RESULTS The assessment of sagittal balance has to include to be complete: a parameter measuring the global balance of the trunk, either C7 plumb line and sacral plateau, the position of the pelvis rotation by the pelvic tilt, and a description of the position of the lower limbs. Those three parameters have been taken into account by the newly described method called full balance integrated (FBI). This evaluation is easily done on a sagittal full spine standing X-ray from C2 to the pelvis, including the first 10 cm of the femur. CONCLUSION Three questions to answer: What is the value of the pelvis incidence? Is the patient balanced? Are there compensatory mechanisms?
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Affiliation(s)
- J C Le Huec
- Spine Unit 2, Surgical Research Lab, Bordeaux University Hospital, 33076, Bordeaux, France.
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Barrey C, Roussouly P, Perrin G, Le Huec JC. Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J 2011; 20 Suppl 5:626-33. [PMID: 21796393 DOI: 10.1007/s00586-011-1930-3] [Citation(s) in RCA: 283] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Aging of the spine is characterized by facet joints arthritis, degenerative disc disease and atrophy of extensor muscles resulting in a progressive kyphosis. Recent studies confirmed that patients with lumbar degenerative disease were characterized by an anterior sagittal imbalance, a loss of lumbar lordosis and an increase of pelvis tilt. The aim of this paper was thus to describe the different compensatory mechanisms which are observed in the spine, pelvis and/or lower limbs areas for patients with severe degenerative spine. METHODS We reviewed all the compensatory mechanisms of sagittal unbalance described in the literature. RESULTS According to the severity of the imbalance, we could identify three different stages: balanced, balanced with compensatory mechanisms and imbalanced. For the two last stages, the compensatory mechanisms permitted to limit consequences of lumbar kyphosis on the global sagittal alignment. Reduction of thoracic kyphosis, intervertebral hyperextension, retrolisthesis, pelvis backtilt, knee flessum and ankle extension were the main mechanisms described in the literature. The basic concept of these compensatory mechanisms was to extend adjacent segments of the kyphotic spine allowing for compensation of anterior translation of the axis of gravity. CONCLUSIONS To avoid underestimate the severity of the degenerative spine disorder, it thus seems important to recognize the different compensatory mechanisms from the upper part of the trunk to the lower limbs. We propose a three steps algorithm to analyse the balance status and determine the presence or not of these compensatory mechanisms: measurement of pelvis incidence, assessment of global sagittal alignment and analysis of compensatory mechanisms successively in the spine, pelvis and lower limbs areas.
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Affiliation(s)
- Cédric Barrey
- Department of Neurosurgery C and Spine Surgery, Neurological Hospital, 59 boulevard Pinel, 69394, Lyon, France.
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Barrey C, Massourides H, Cotton F, Perrin G, Rode G. Charcot spine: Two new case reports and a systematic review of 109 clinical cases from the literature. Ann Phys Rehabil Med 2010; 53:200-20. [DOI: 10.1016/j.rehab.2009.11.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 11/04/2009] [Indexed: 11/25/2022]
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Barrey C, Mosnier T, Jund J, Perrin G, Skalli W. In vitro evaluation of a ball-and-socket cervical disc prosthesis with cranial geometric center. J Neurosurg Spine 2009; 11:538-46. [PMID: 19929355 DOI: 10.3171/2009.6.spine0949] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Few biomechanical in vitro studies have reported the effects of disc replacement on motion and kinematics of the cervical spine. The purpose of this study was to analyze motion through 3D load-displacement curves before and after implantation of a ball-and-socket cervical disc prosthesis with cranial geometric center; special focus was placed on coupled motion, which is a well-known aspect of normal cervical spine kinematics. METHODS Six human cervical spines were studied. There were 3 male and 3 female cadaveric specimens (mean age at death 68.5 +/- 5 years [range 54-74 years]). The specimens were evaluated sequentially in 2 different conditions: first they were tested intact; then the spinal specimens were tested after implantation of a ball-and-socket cervical disc prosthesis, the Discocerv, at the C5-6 level. Pure moment loading was applied in flexion/extension, left and right axial rotation, and left and right lateral bending. All tests were performed under load control with a 3D measurement system. RESULTS No differences were found to be statistically significant after comparison of range of motion between intact and instrumented spines for all loading conditions. The mean range of motion for intact spines was 10.3 degrees in flexion/extension, 5.6 degrees in lateral bending, and 5.4 degrees in axial rotation; that for instrumented spines was 10.4, 5.2, and 4.8 degrees , respectively. No statistical difference was observed for the neutral zone nor stiffness between intact and instrumented spines. Finally, the coupled motions were also preserved during axial rotation and lateral bending, with no significant difference before and after implantation. CONCLUSIONS This study demonstrated that, under specific testing conditions, a ball-and-socket joint with cranial geometrical center can restore motion in the 3 planes after discectomy in the cervical spine while maintaining physiological coupled motions during axial rotation and lateral bending.
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Affiliation(s)
- Cédric Barrey
- Department of Neurosurgery, Hôpital Neurologique P Wertheimer, Lyon, France.
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Barrey C, Ramadan A, Campana S, Perrin G, Skalli W. La cinématique du rachis cervical après arthroplastie : évaluation en flexion–extension et inclinaison latérale. Neurochirurgie 2009. [DOI: 10.1016/j.neuchi.2009.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
OBJECTIVE The main objectives of this study were to analyze and compare spinopelvic parameters, including the pelvis shape, in a population of 40 patients with degenerative spondylolisthesis (DSPL) and to compare these patients with a control group of asymptomatic volunteers. METHODS Forty patients with DSPL were included in this study. Spinopelvic parameters were analyzed on preoperative full spine x-rays in a standardized standing position. The following spinopelvic parameters were measured: pelvic incidence (PI), sacral slope, pelvic tilt, lumbar lordosis, thoracic kyphosis, and positioning of the C7 plumb line. The population of patients was compared with a control population of 154 normal and asymptomatic adults who were studied in a recently published study. In order to understand variations of spinopelvic parameters, a control group was matched according to the PI, which is a morphological parameter. RESULTS The PI was significantly greater for patients with DSPL (60.1 +/- 10.6 degrees) compared with the control group (52 +/- 10.7 degrees) (P < 0.0005). After matching according to the pelvic incidence, the DSPL population was characterized by an anterior translation of the C7 plumb line (P < 0.05), a loss of lumbar lordosis (P < 0.0005), and a decrease of the sacral slope (P < 0.0005). Retrolisthesis and/or segmental intervertebral hyperextension were observed in the upper lumbar spine in 30% of the cases. CONCLUSION Matching according to the PI between the patients in the study and the control group enabled us to understand variations of the spinopelvic parameters in a population of patients with DSPL. DSPL patients were characterized by a greater PI than the asymptomatic population; therefore, we suggest that a high PI may be a predisposing factor in developing DSPL. Finally, we observed significant variations in spinopelvic alignment, such as loss of lordosis and sagittal unbalance, which were partially compensated by pelvis back tilt and hyperextension in the upper lumbar spine.
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Affiliation(s)
- Cédric Barrey
- Department of Neurosurgery, Hôpital Neurochirurgical P.Wertheimer, Lyon, France.
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Barrey C, Piassi E, Belliard H, Perrin G. Résultats des arthrodèses cervicales sur trois niveaux par cage-plaque. Neurochirurgie 2007. [DOI: 10.1016/j.neuchi.2007.09.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barrey C, Montagna P, Mosbah K, Belliard H, Cristini A, Perrin G. Intérêt de l’arthrodèse inter-somatique par voie antérieure dans la prise en charge des lombo-radiculalgies: à propos d’une série consécutive de 31 patients. Neurochirurgie 2007. [DOI: 10.1016/j.neuchi.2007.09.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Barrey C, Jund J, Noseda O, Roussouly P. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 2007; 16:1459-67. [PMID: 17211522 PMCID: PMC2200735 DOI: 10.1007/s00586-006-0294-6] [Citation(s) in RCA: 458] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Revised: 11/19/2006] [Accepted: 12/13/2006] [Indexed: 02/06/2023]
Abstract
Retrospective analysis of the spino-pelvic alignment in a population of 85 patients with a lumbar degenerative disease. Several previous publications reported the analysis of spino-pelvic alignment in the normal and low back pain population. Data suggested that patients with lumbar diseases have variations of sagittal alignment such as less distal lordosis, more proximal lumbar lordosis and a more vertical sacrum. Nevertheless most of these variations have been reported without reference to the pelvis shape which is well-known to strongly influence spino-pelvic alignment. The objective of this study was to analyse spino-pelvic parameters, including pelvis shape, in a population of 85 patients with a lumbar degenerative disease and compare these patients with a control group of normal volunteers. We analysed three different lumbar degenerative diseases: disc herniation (DH), n = 25; degenerative disc disease (DDD), n = 32; degenerative spondylolisthesis (DSPL), n = 28. Spino-pelvic alignment was analysed pre-operatively on full spine radiographs. Spino-pelvic parameters were measured as following: pelvic incidence, sacral slope, pelvic tilt, lumbar lordosis, thoracic kyphosis, spino-sacral angle and positioning of C7 plumb line. For each group of patients the sagittal profile was compared with a control population of 154 asymptomatic adults that was the subject of a previous study. In order to understand variations of spino-pelvic parameters in the patients' population a stratification (matching) according to the pelvic incidence was done between the control group and each group of patients. Concerning first the pelvis shape, patients with DH and those with DDD demonstrated to have a mean pelvic incidence equal to 49.8 degrees and 51.6 degrees, respectively, versus 52 degrees for the control group (no significant difference). Only young patients, less than 45 years old, with a disc disease (DH or DDD) demonstrated to have a pelvic incidence significantly lower (48.3 degrees) than the control group, P < 0.05. On the contrary, in the DSPL group the pelvic incidence was significantly greater (60 degrees) than the control group (52 degrees), P < 0.0005. Secondly the three groups of patients were characterized by significant variations in spino-pelvic alignment: anterior translation of the C7 plumb line (P < 0.005 for DH, P < 0.05 for DDD and P < 0.05 for DSPL); loss of lumbar lordosis after matching according to pelvic incidence (P < 0.0005 for DH, DDD and DSPL); decrease of sacral slope after matching according to pelvic incidence (P = 0.001 for DH, P < 0.0005 for DDD and P < 0.0005 for DSPL). Measurement of the pelvic incidence and matching according to this parameter between each group of patients and the control group permitted to understand variations of spino-pelvic parameters in a population of patients.
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Affiliation(s)
- Cédric Barrey
- Department of Neurosurgery, Hôpital Neurochirurgical P. Wertheimer, 59 boulevard Pinel, 69394 Lyon, France.
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