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Daher M, Aoun M, Kreichati G, Kharrat K, Sebaaly A. Hybrid vs all pedicle screws constructs in adolescent idiopathic scoliosis: a metaanalysis of clinical and radiological outcomes. Spine Deform 2024:10.1007/s43390-024-00886-z. [PMID: 38684642 DOI: 10.1007/s43390-024-00886-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/13/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) affects around 1 to 3% of young individuals, leading to spinal deformities typically exceeding a Cobb angle of 10 degrees without congenital or neuromuscular causes. Advances in treatment now include various surgical techniques such as posterior fusion utilizing all-pedicle screw constructs or hybrid constructs. METHODS PubMed, Cochrane, and Google Scholar (pages 1-20) were searched up until February 2024. Comparative studies in which the cohort was separated into two groups (HC and PSC) were included. Data consisting of, surgery-related outcomes, sagittal radiographic outcomes, coronal radiographic outcomes, and patient-reported outcomes, was extracted and compared. RESULTS Twenty-eight studies including 3435 patients were included. Higher rates of complications (Odds-Ratio = 1.99, p < 0.00001) and reoperations (Odds-Ratio = 2.82, p < 0.00001) were seen in the hybrid group. Better radiographic coronal correction was seen in the PSC group in both the major curve (Mean Difference = 5.97, p < 0.00001) and the secondary curve (Mean Difference = - 10.73, p < 0.0001). However, restoration of sagittal alignment was better in the HC group when assessing thoracic kyphosis (Mean Difference = 2.97, p = 0.02) and lumbar lordosis (Mean Difference = 3.17, p = 0.005). CONCLUSION While all-pedicle screw constructs demonstrated greater stability in AIS compared to hybrid constructs, resulting in reduced rates of reoperations and complications, as well as improved correction of major and secondary curves, they were unable to fully restore optimal sagittal alignment.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopedic Surgery, Brown University, Providence, RI, 02906, USA
- Faculty of Medicine, School of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Marven Aoun
- Faculty of Medicine, School of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Gaby Kreichati
- Faculty of Medicine, School of Medicine, Saint Joseph University, Beirut, Lebanon
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Khalil Kharrat
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Amer Sebaaly
- Faculty of Medicine, School of Medicine, Saint Joseph University, Beirut, Lebanon.
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
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Aoun M, Daher M, Bizdikian AJ, Kreichati G, Kharrat K, Sebaaly A. Implant density in adolescent idiopathic scoliosis: a meta-analysis of clinical and radiological outcomes. Spine Deform 2024:10.1007/s43390-024-00860-9. [PMID: 38573487 DOI: 10.1007/s43390-024-00860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) affects 1-3% of adolescents, and treatment approaches, including the density of constructs in surgical fusion, vary among orthopedic surgeons. Studies have sought to establish whether high-density or low-density constructs offer superior clinical and radiological outcomes, yet conclusive results are lacking. This meta-analysis aims to provide a definitive answer to the controversial and ambiguous question surrounding the efficacy of different pedicle screw densities in treating AIS. METHODS PubMed, Cochrane, and Google Scholar (page 1-20) were searched till December 2023. The studied outcomes were Major Cobb angle, major curve correction, lumbar curve, kyphosis (T5-T12), lumbar lordosis, coronal balance, LIV Tilt angle, TAV translation, LAV translation, apical trunk rotation, trunk shift, SRS-22, operative time, blood loss, complications and cost. RESULTS Twenty-four studies (total of 1985 patients, 1045 in LD group and 940 in HD group) were included in this meta-analysis. A statistically significant better improvement in ATR (p = 0.02) and LIV tilt angle (p = 0.02) was seen in the high-density group. On the other hand, longer operative time (p = 0.002), blood loss (p = 0.0004) and costs (p = 0.02) were seen in the high-density group. No difference was seen in the remaining radiographic and clinical outcomes between both surgeries. CONCLUSION Both low-density (LD) and high-density (HD) screw constructs show comparable and satisfactory radiographic and QOL for AIS patients. Furthermore, HD constructs had increased costs, operative time, and blood loss associated. However, a definitive conclusion cannot be made and more studies taking into account multiple additional variables are necessary to do so.
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Affiliation(s)
- Marven Aoun
- School of Medicine, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Mohammad Daher
- School of Medicine, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
- Department of Orthopedic Surgery, Brown University, Providence, RI, 02906, USA
| | - Aren-Joe Bizdikian
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Gaby Kreichati
- School of Medicine, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Khalil Kharrat
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Amer Sebaaly
- School of Medicine, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon.
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
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Assi A, Daher M, Zalaquett Z, Aoun M, Youssef B, Kreichati G, Kharrat K, Sebaaly A. Intensive Care Unit Admission After Spine Surgery: A Narrative Review. Int J Spine Surg 2024:8593. [PMID: 38569930 DOI: 10.14444/8593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Intensive care unit (ICU) admissions constitute a substantial financial challenge for health care systems and patients and are linked to various potentially life-altering complications. A wide range of patient-related, surgical, and medical factors are associated with an increased risk of ICU admission following spine surgery. DISCUSSION The most notable examples include lung, heart, and kidney disease, as well as estimated blood loss and length of surgery. Various scores that include the most significant patient- and procedure-related factors have been described to assess the risk associated with surgery for individual patients. To date, the fusion risk score and the American Society of Anesthesiologists score have been the most useful in predicting postoperative complications and admission to the ICU. However, other risk factors have also been implicated in ICU admission and length of stay. The current scores must further adapt by using the available evidence to fulfill their intended purpose. Moreover, a handful of measures have shown efficacy in decreasing ICU admission and length of stay, with their benefits still to be demonstrated by future research. CONCLUSION This review underscores the risk factors predictive of ICU admission following spine surgery and will help surgeons and clinicians in patient stratification. However, future studies are needed to validate the role of protective measures in preventing ICU admissions and the significance of certain risk factors.
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Affiliation(s)
- Ahmad Assi
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Mohammad Daher
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
- Department of Orthopedic Surgery, Brown University, Providence, RI, USA
| | - Ziad Zalaquett
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Marven Aoun
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Bryan Youssef
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Gaby Kreichati
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Khalil Kharrat
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Amer Sebaaly
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
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Daher M, Aoun M, El-Sett P, Kreichati G, Kharrat K, Sebaaly A. Unilateral Versus Bilateral Cages in Lumbar Interbody Fusions: A Meta-Analysis of Clinical and Radiographic Outcomes. World Neurosurg 2024; 186:158-164. [PMID: 38561031 DOI: 10.1016/j.wneu.2024.03.142] [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: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Bilateral cages are often used for interbody fusion. However, this procedure may not be possible in some cases making unilateral cages a reasonable alternative. The literature remains divided on the clinical and radiological distinctions when comparing unilateral to bilateral cages in lumbar interbody fusion. Thus, this meta-analysis will analyze the clinical and radiographic outcomes between these 2 groups. METHODS PubMed, Cochrane, and Google Scholar (page 1-20) were searched till January 2024. The clinical outcomes evaluated were the incidence of adverse events, surgery-related parameters, and patient reported outcomes. RESULTS Lower rates of pseudoarthrosis, subsidence, were reported in the bilateral cages group (P = 0.01, P = 0.001, respectively) whereas shorter operative time (OR time), and lower estimated blood loss were seen in unilateral cage group (P < 0.001, and P = 0.003). There was no statistically significant difference in the remaining analyzed outcomes. CONCLUSIONS Unilateral cages were shown to be superior due to their reduced OR time and estimated blood loss. As for the higher rate of pseudoarthrosis, this outcome may not be related to the cage numbers and it did not affect clinical outcomes. Nevertheless, one must consider other factors such as radiographic sagittal parameters before making a surgical decision.
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Affiliation(s)
- Mohammad Daher
- Faculty of medicine, Saint Joseph University, Beirut, Lebanon; Department of Orthopedic Surgery, Brown University, Providence, Rhode Island, USA
| | - Marven Aoun
- Faculty of medicine, Saint Joseph University, Beirut, Lebanon
| | - Pierre El-Sett
- Faculty of medicine, Saint Joseph University, Beirut, Lebanon
| | - Gaby Kreichati
- Faculty of medicine, Saint Joseph University, Beirut, Lebanon; Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Khalil Kharrat
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Amer Sebaaly
- Faculty of medicine, Saint Joseph University, Beirut, Lebanon; Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon.
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Chalhoub R, Mouawad A, Aoun M, Daher M, El-Sett P, Kreichati G, Kharrat K, Sebaaly A. Will ChatGPT be Able to Replace a Spine Surgeon in the Clinical Setting? World Neurosurg 2024:S1878-8750(24)00314-0. [PMID: 38417624 DOI: 10.1016/j.wneu.2024.02.101] [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: 11/14/2023] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE This study evaluates ChatGPT's performance in diagnosing and managing spinal pathologies. METHODS Patients underwent evaluation by two spine surgeons (and the case was discussed and a consensus was reached) and ChatGPT. Patient data, including demographics, symptoms, and available imaging reports, were collected using a standardized form. This information was then processed by ChatGPT for diagnosis and management recommendations. The study assessed ChatGPT's diagnostic and management accuracy through descriptive statistics, comparing its performance to that of experienced spine specialists. RESULTS A total of 97 patients with various spinal pathologies participated in the study, with a gender distribution of 40 males and 57 females. ChatGPT achieved a 70% diagnostic accuracy rate and provided suitable management recommendations for 95% of patients. However, it struggled with certain pathologies, misdiagnosing 100% of vertebral trauma and facet joint syndrome, 40% of spondylolisthesis, stenosis, and scoliosis, and 22% of disc-related pathologies. Furthermore, ChatGPT's management recommendations were poor in 53% of cases, often failing to suggest the most appropriate treatment options and occasionally providing incomplete advice. CONCLUSIONS While helpful in the medical field, ChatGPT falls short in providing reliable management recommendations, with a 30% misdiagnosis rate and 53% mismanagement rate in our study. Its limitations, including reliance on outdated data and the inability to interactively gather patient information, must be acknowledged. Surgeons should use ChatGPT cautiously as a supplementary tool rather than a substitute for their clinical expertise, as the complexities of healthcare demand human judgment and interaction.
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Affiliation(s)
- Ralph Chalhoub
- Saint Joseph University, Faculty of medicine, Beirut, Lebanon
| | - Antoine Mouawad
- Saint Joseph University, Faculty of medicine, Beirut, Lebanon
| | - Marven Aoun
- Saint Joseph University, Faculty of medicine, Beirut, Lebanon
| | - Mohammad Daher
- Saint Joseph University, Faculty of medicine, Beirut, Lebanon; Department of Orthopedic Surgery, Brown University, Providence, Rhode Island, USA
| | - Pierre El-Sett
- Saint Joseph University, Faculty of medicine, Beirut, Lebanon; Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Gaby Kreichati
- Saint Joseph University, Faculty of medicine, Beirut, Lebanon; Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Khalil Kharrat
- Saint Joseph University, Faculty of medicine, Beirut, Lebanon; Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Amer Sebaaly
- Saint Joseph University, Faculty of medicine, Beirut, Lebanon; Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon.
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Daher M, Kreichati G, Aoun M, Riouallon G, Kharrat K, Sebaaly A. Approaches in Anterior Column Support in Adult Spinal Deformity Surgery: A Meta-Analysis of Clinical and Radiologic Outcomes. World Neurosurg 2024; 182:91-98. [PMID: 38008165 DOI: 10.1016/j.wneu.2023.11.094] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE This meta-analysis was conducted to compare anterior lumbar interbody fusion (ALIF) with transforaminal lumbar interbody fusion (TLIF) in terms of postoperative complications, improvement in radiographic parameters, and patient-reported outcomes. METHODS PubMed, Cochrane, and Google Scholar (pages 1-20) databases were searched up to June 2023. The studied outcomes were the rate of rod failures, rod failures requiring revision surgery, all complications, all revision surgeries, the change in pelvic tilt, sacral slope, Cobb angle, lumbar lordosis (LL), sagittal vertical axis, the postoperative pelvic incidence-LL, and LL, and the improvement in back pain and Oswestry Disability Index (ODI). RESULTS Six studies were included in this meta-analysis. ALIF showed higher postoperative lordosis (P = 0.003) and better improvement in ODI (P = 0.0001). No difference was seen in the remaining outcomes between ALIF and TLIF. CONCLUSIONS Although ALIF had better improvement in ODI, the mean difference was 6.5 points, which is below the minimal clinically important difference, stripping this result of any clinical value. Furthermore, even though ALIF had better postoperative lordosis, the change in LL postoperatively was not different between ALIF and TLIF. With no difference in complications, sagittal and coronal alignment, and patient-reported outcomes, TLIF was shown in this study to be favored instead of ALIF in adult spinal deformity surgery to avoid all the double approach-related comorbidity.
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Affiliation(s)
- Mohammad Daher
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Gaby Kreichati
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon; Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Marven Aoun
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Guillaume Riouallon
- Department of Orthopedic Surgery, Centre Hospitalier Paris Saint Joseph, Paris, France
| | - Khalil Kharrat
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Amer Sebaaly
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon; Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon.
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Ziade N, Maroof A, Elzorkany B, Abdullateef N, Adnan A, Abogamal A, Saad S, El Kibbi L, Alemadi S, Ansari A, Abi Najm A, Younan T, Kharrat K, Sebaaly A, Rachkidi R, Witte T, Baraliakos X. What is the best referral strategy for axial spondyloarthritis? A prospective multicenter study in patients with suspicious chronic low back pain. Joint Bone Spine 2023; 90:105579. [PMID: 37080284 DOI: 10.1016/j.jbspin.2023.105579] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/24/2023] [Accepted: 04/01/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE To assess the value of referral strategies for axial spondyloarthritis (axSpA) in patients with suspicious chronic inflammatory low back pain (LBP), to estimate the value of inflammatory back pain (IBP) for referral, and to identify the predictive factors of the final diagnosis of axSpA in Middle Eastern Arab countries. METHODS The study was multicentric, prospective, and conducted in LBP first-line clinics (rheumatology, internal, family medicine, orthopedic surgery, neurosurgery, and neurology). Consecutive adult patients aged under 45years were included in case of LBP suspicious of inflammatory nature according to the first-line physician. The rheumatologist's final diagnosis was the gold standard. The diagnostic properties of ten referral strategies (Brandt I, II, III, Hermann, RADAR, RADAR 2/3, MASTER, Braun, CAFASPA, and ASAS) and of IBP were calculated. A multivariable logistic regression identified the clinical predictive factors of axSpA. RESULTS In 515 referred patients, axSpA was confirmed in 48%, refuted in 43%, and diagnosis remained inconclusive in 9%. The optimal referral strategy was the MASTER (PLR 3.3), which comprises IBP, good response to NSAIDs, positive HLA-B27, and SpA family history. Considering strategies without HLA-B27, the RADAR 2/3 had a PLR of 2.9 (IBP, good response to NSAIDs, any extra-musculoskeletal manifestation). The predictive factors for axSpA were MRI sacroiliitis, positive HLA-B27, high CRP, psoriasis, IBP, and longer symptom duration. Of all patients, 35% were self-referred, 16% were referred by primary care physicians, and 15% by neuro/orthopedic surgeons. CONCLUSION Optimizing physicians' awareness of these clinical features may enhance referral in axSpA.
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Affiliation(s)
- Nelly Ziade
- Saint-Joseph University, Beirut, Lebanon; Hotel-Dieu de France Hospital, Beirut, Lebanon.
| | | | | | | | | | | | - Sahar Saad
- King Hamad University Hospital Bahrain, Bahrain
| | | | | | | | - Antonella Abi Najm
- Saint-Joseph University, Beirut, Lebanon; Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Tonine Younan
- Saint-Joseph University, Beirut, Lebanon; Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Khalil Kharrat
- Saint-Joseph University, Beirut, Lebanon; Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Amer Sebaaly
- Saint-Joseph University, Beirut, Lebanon; Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Rami Rachkidi
- Saint-Joseph University, Beirut, Lebanon; Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Torsten Witte
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
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Sebaaly A, Kreichati G, Tarchichi J, Kharrat K, Daher M. Transforaminal lumbar interbody fusion using banana-shaped and straight cages: meta-analysis of clinical and radiological outcomes. Eur Spine J 2023; 32:3158-3166. [PMID: 37326836 DOI: 10.1007/s00586-023-07797-z] [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: 10/08/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Transforaminal lumbar interbody fusion (TLIF) surgery rate increased over the last decade. There is no consensus about the better shape of cage to use in TLIF. This meta-analysis was conducted to compare the shape focusing on bony union, lordosis restoration as well as perioperative complications. METHODS PubMed, Cochrane, and Google Scholar (page 1-20) were searched till September 2022. The clinical outcomes consisted of the bony union, segmental and lumbar lordosis restoration, quality of life, and operation-related outcomes. RESULTS Only 5 studies were included in this meta-analysis. Straight-shaped cages tended to have a lower subsidence rate compared to banana-shaped cages (p = 0.10), had a better restoration of segmental lordosis (p < 0.0001), better disc height restoration (p = 0.01), as well as a higher Oswestry Disability Index decrease (p = 0.0002). CONCLUSION Straight-shaped cages had a better restoration of lumbar lordosis, disc height, and a lower subsidence rate when compared to banana-shaped cages. This may be explained by the absence of the optimal placement of the curved cages, which is at the most anterior part of the disc space. Better conducted randomized controlled trial could strengthen these findings.
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Affiliation(s)
- Amer Sebaaly
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - Gaby Kreichati
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jean Tarchichi
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Khalil Kharrat
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Mohammad Daher
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Daher M, Sebaaly A, Aad SJA, Kharrat K, Kreichati G. Exceptional Spinal Mobility Caused by Charcot Disease: Case Description with Several Years of Follow-Up. Indian J Orthop 2023; 57:1338-1343. [PMID: 37525730 PMCID: PMC10386985 DOI: 10.1007/s43465-023-00937-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/17/2023] [Indexed: 08/02/2023]
Abstract
A spinal cord injury is now the most common cause of Charcot Spinal Arthropathy (CSA). Paraplegia, loss of pain sensation, laminectomies, and spinal fusions involving more than 5 levels are all risk factors for developing this condition. Low back pain and spinal abnormalities are common symptoms. Circumferential arthrodesis is the chosen treatment. Implant failure and new-onset CSA, which necessitates re-instrumentation, are some of the risks associated with this treatment. This is the case of a patient with a post-traumatic spinal cord injury presenting with spinal Charcot disease with a very long follow-up. We report a unique complication with the replacement of the discal space and portions of the vertebral bodies by fibrotic tissue with an extraordinary spinal movement in the coronal and sagittal planes. Recurrent Charcot disease at the same level or at a caudal level is a devastating complication in spinal surgery. Since this disease naturally exposes the patient to iterative surgeries, it would be wise to limit the extent of the arthrodesis to an optimal number of levels sufficient to ensure perfect stability of the construct and not to be very extensive from the first surge. The risk would increase the fused levels which limit the availability of mobile buffer levels and increase the stress on the remaining levels. Regular follow-ups to the patient should be done to detect recurrence at the same site or distal to the instrumentation.
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Affiliation(s)
- Mohammad Daher
- School of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Amer Sebaaly
- School of Medicine, Saint Joseph University, Beirut, Lebanon
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | | | - Khalil Kharrat
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
| | - Gaby Kreichati
- School of Medicine, Saint Joseph University, Beirut, Lebanon
- Department of Orthopedic Surgery Spine Unit, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon
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Daher M, Kreichati G, Kharrat K, Sebaaly A. In Reply to the Letter to the Editor Regarding "Vertebroplasty versus Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: A Meta-Analysis". World Neurosurg 2023; 173:298. [PMID: 37189318 DOI: 10.1016/j.wneu.2023.02.050] [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: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Mohammad Daher
- School of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Gaby Kreichati
- School of Medicine, Saint Joseph University, Beirut, Lebanon; Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Khalil Kharrat
- School of Medicine, Saint Joseph University, Beirut, Lebanon; Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Amer Sebaaly
- School of Medicine, Saint Joseph University, Beirut, Lebanon; Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon.
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Daher M, Kreichati G, Kharrat K, Sebaaly A. Vertebroplasty versus Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: A Meta-Analysis. World Neurosurg 2023; 171:65-71. [PMID: 36455843 DOI: 10.1016/j.wneu.2022.11.123] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 10/10/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND One of the most frequent consequences of osteoporosis is osteoporotic vertebral compression fractures, which makes it one of the most prevalent health care crises in the world. Two things are needed to manage them: 1) pain management, and 2) fracture stabilization. To take care of both, 2 methods are commonly used: 1) vertebroplasty and 2) kyphoplasty (KP) without a clear consensus on which is the better one. A meta-analysis was done comparing both techniques in the management of osteoporotic vertebral compression fractures. METHODS PubMed, Cochrane, and Google Scholar (page 1-20) were searched updated to October 2022. Two reviewers determined the eligibility of the studies independently. Only 8 studies were included in the meta-analysis. The clinical outcomes consisted of the complications (cement leakage, adjacent level fractures), the visual analog scale scores, Oswestry disability index, kyphotic wedge angle, and vertebral body height restoration. RESULTS KP was shown to be superior to vertebroplasty in terms of reducing cement leakage, and increasing postoperative vertebral body height. The comparison of the rest of the outcomes was statistically insignificant between both techniques. CONCLUSIONS Although KP could significantly increase postoperative vertebral body height and decrease the risk of cement leakage, the fact that it is more costly and has a longer operative time raises the question about the cost effectiveness of the procedure.
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Affiliation(s)
- Mohammad Daher
- School of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Gaby Kreichati
- School of Medicine, Saint Joseph University, Beirut, Lebanon; Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Khalil Kharrat
- School of Medicine, Saint Joseph University, Beirut, Lebanon; Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Amer Sebaaly
- School of Medicine, Saint Joseph University, Beirut, Lebanon; Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon.
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12
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Abstract
Scheuermann's Kyphosis (SK) is a rigid spinal kyphosis. Several theories have been proposed concerning its pathogenesis, but it is, to this day, still unknown. It has a prevalence of 0.4-8.3% in the population with a higher incidence in females. Clinical examination with x-rays is needed to differentiate and confirm this diagnosis. Non-surgical management is reserved for smaller deformities and in skeletally immature patients, whereas surgery is recommended for higher deformities. Combined anterior and posterior approach was considered the gold standard for the surgical treatment of this disease, but there is an increasing trend toward posterior-only approaches especially with use of segmental fixation. This study reviews the pathophysiology of SK while proposing a treatment algorithm for its management.
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Affiliation(s)
- Amer Sebaaly
- School of Medicine, Saint Joseph University, Beirut, Lebanon,Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon,Correspondence should be addressed to A Sebaaly;
| | - Sarah Farjallah
- Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Khalil Kharrat
- Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Gaby Kreichati
- School of Medicine, Saint Joseph University, Beirut, Lebanon,Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Mohammad Daher
- School of Medicine, Saint Joseph University, Beirut, Lebanon
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13
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Karam M, Ghanem I, Vergari C, Khalil N, Saadé M, Chaaya C, Rteil A, Ayoub E, Saad E, Kharrat K, Skalli W, Assi A. Global malalignment in adolescent idiopathic scoliosis: the axial deformity is the main driver. Eur Spine J 2022; 31:2326-2338. [PMID: 34985548 DOI: 10.1007/s00586-021-07101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/16/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the global alignment of non-operated subjects with adolescent idiopathic scoliosis. METHOD A total of 254 subjects with AIS and 64 controls underwent low dose biplanar X-rays and had their spine, pelvis, and rib cage reconstructed in 3D. Global alignment was measured in the sagittal and frontal planes by calculating the OD-HA angle (between C2 dens to hip axis with the vertical). Subjects with AIS were classified as malaligned if the OD-HA was > 95th percentile relative to controls. RESULTS The sagittal OD-HA in AIS remained within the normal ranges. In the frontal plane, 182 AIS were normally aligned (Group 1, OD-HA = 0.9°) but 72 were malaligned (Group 2, OD-HA = 2.9°). Group 2 had a more severe spinal deformity in the frontal and horizontal planes compared to Group 1 (Cobb: 42 ± 16° vs. 30 ± 18°; apical vertebral rotation AVR: 19 ± 10° vs. 12 ± 7°, all p < 0.05). Group 2 subjects were mainly classified as Lenke 5 or 6. 19/72 malaligned subjects had a mild deformity (Cobb < 30°) but a progressive scoliosis (severity index ≥ 0.6). The frontal OD-HA angle was found to be mainly determined (adjusted-R2 = 0.22) by the apical vertebral rotation and secondarily by the Lenke type. CONCLUSIONS This study showed that frontal malalignment is more common in distal major structural scoliosis and its main driver is the apical vertebral rotation. This highlights the importance of monitoring the axial plane deformity in order to avoid worsening of the frontal global alignment.
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Affiliation(s)
- Mohamad Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Nour Khalil
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Maria Saadé
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Céline Chaaya
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Ali Rteil
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Elma Ayoub
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Eddy Saad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Khalil Kharrat
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon. .,Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France.
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14
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Assi A, Karam M, Skalli W, Vergari C, Vialle R, Pietton R, Bizdikian AJ, Kharrat K, Dubousset J, Ghanem I. A Novel Classification of 3D Rib Cage Deformity in Subjects With Adolescent Idiopathic Scoliosis. Clin Spine Surg 2021; 34:331-341. [PMID: 33591022 DOI: 10.1097/bsd.0000000000001139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a multicentric cross-sectional descriptive study. OBJECTIVE To analyze patterns of 3D rib cage deformity in subjects with adolescent idiopathic scoliosis (AIS) and their relationship with the spinal deformity. SUMMARY OF BACKGROUND DATA Subjects with AIS present with rib cage deformity that can affect respiratory functions. The 3D rib cage deformities in AIS and their relationship to the spinal deformity are still unelucidated. METHODS A total of 200 AIS and 71 controls underwent low-dose biplanar x-rays and had their spine and rib cage reconstructed in 3-dimensional (D). Classic spinopelvic parameters were calculated in 3D and: rib cage gibbosity, thickness, width, volume and volumetric spinal penetration index (VSPI). Subjects with AIS were classified as: group I with mild rib cage deformity (n=88), group II with severe rib cage deformity (n=112) subgrouped into IIa (high gibbosity, n=48), IIb (high VSPI, n=48), and IIc (both high gibbosity and VSPI, n=16). RESULTS Groups IIa and IIb had a higher Cobb angle (33 vs. 54 degrees and 46 degrees, respectively) and torsion index (11 vs. 14 degrees and 13 degrees, respectively) than group I. Group IIb showed more severe hypokyphosis (IIb=21 degrees; IIa=33 degrees; I=36 degrees; control=42 degrees) with a reduced rib cage volume (IIb=4731 cm3; IIa=4985 cm3; I=5257 cm3; control=5254 cm3) and thickness (IIb=135 mm; IIa=148 mm; I=144 mm; control=144 mm). Group IIa showed an increasingly large local gibbosity descending from proximal to distal levels and did not follow the axial rotation of the spine. Group IIc showed characteristics of both groups IIa and IIb. CONCLUSIONS This new classification of 3D rib cage deformity in AIS shows that the management of cases with high VSPI (groups IIb and IIc) should focus on restoring as much kyphosis as possible to avoid respiratory repercussions. Treatment indications in groups I and IIa would follow the consensual basic principles reported in the literature regarding bracing and surgery.
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Affiliation(s)
- Ayman Assi
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech
| | - Mohamad Karam
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech
| | - Claudio Vergari
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech
| | - Raphael Vialle
- Department of Pediatric Orthopedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Raphael Pietton
- Department of Pediatric Orthopedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Aren J Bizdikian
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Khalil Kharrat
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Jean Dubousset
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech
| | - Ismat Ghanem
- Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
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15
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Kawkabani G, Saliby RM, Mekhael M, Rachkidi R, Massaad A, Ghanem I, Kharrat K, Kreichati G, Saad E, Lafage V, Lafage R, Skalli W, Assi A. Gait kinematic alterations in subjects with adult spinal deformity and their radiological determinants. Gait Posture 2021; 88:203-209. [PMID: 34118744 DOI: 10.1016/j.gaitpost.2021.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 09/28/2020] [Revised: 04/30/2021] [Accepted: 06/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adults with spinal deformity (ASD) are known to have postural malalignment affecting their quality of life. Classical evaluation and follow-up are usually based on full-body static radiographs and health related quality of life questionnaires. Despite being an essential daily life activity, formal gait assessment lacks in clinical practice. RESEARCH QUESTION What are the main alterations in gait kinematics of ASD and their radiological determinants? METHODS 52 ASD and 63 control subjects underwent full-body 3D gait analysis with calculation of joint kinematics and full-body biplanar X-rays with calculation of 3D postural parameters. Kinematics and postural parameters were compared between groups. Determinants of gait alterations among postural radiographic parameters were explored. RESULTS ASD had increased sagittal vertical axis (SVA:34 ± 59 vs -5 ± 20 mm), pelvic tilt (PT:19 ± 13 vs 11 ± 6°) and frontal Cobb (25 ± 21 vs 4 ± 6°) compared to controls (all p < 0.001). ASD displayed decrease walking speed (0.9 ± 0.3 vs 1.2 ± 0.2 m/s), step length (0.58 ± 0.11 vs 0.64 ± 0.07 m) and increased single support (0.45 ± 0.05 vs 0.42 ± 0.04 s). ASD walked with decreased hip extension in stance (-3 ± 10 vs -7 ± 8°), increased knee flexion at initial contact and in stance (10 ± 11 vs 5 ± 10° and 19 ± 7 vs 16 ± 8° respectively), and decreased knee flexion/extension ROM (55 ± 9 vs 59 ± 7°). ASD had increased trunk flexion (12 ± 12 vs 6 ± 11°) and reduced dynamic lumbar lordosis (-11 ± 12 vs -15 ± 7°, all p < 0.001). Sagittal knee ROM, walking speed and step length were negatively determined by SVA; lack of lumbar lordosis during gait was negatively determined by radiological lumbar lordosis. SIGNIFICANCE Static compensations in ASD persist during gait, where they exhibit a flexed attitude at the trunk, hips and knees, reduced hip and knee mobility and loss of dynamic lordosis. ASD walked at a slower pace with increased single and double support times that might contribute to their gait stability. These dynamic discrepancies were strongly related to static sagittal malalignment.
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Affiliation(s)
| | | | - Mario Mekhael
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Rami Rachkidi
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Abir Massaad
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Ismat Ghanem
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Khalil Kharrat
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Gaby Kreichati
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Eddy Saad
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | | | - Renaud Lafage
- Spine Service, Hospital for Special Surgery, New York, USA
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Ayman Assi
- Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
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16
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Mekhael M, Kawkabani G, Saliby RM, Skalli W, Saad E, Jaber E, Rachkidi R, Kharrat K, Kreichati G, Ghanem I, Lafage V, Assi A. Toward understanding the underlying mechanisms of pelvic tilt reserve in adult spinal deformity: the role of the 3D hip orientation. Eur Spine J 2021; 30:2495-2503. [PMID: 33638719 DOI: 10.1007/s00586-021-06778-4] [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] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/05/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore 3D hip orientation in standing position in subjects with adult spinal deformity (ASD) presenting with different levels of compensatory mechanisms. METHODS Subjects with ASD (n = 159) and controls (n = 68) underwent full-body biplanar X-rays with the calculation of 3D spinopelvic, postural and hip parameters. ASD subjects were grouped as ASD with knee flexion (ASD-KF) if they compensated by flexing their knees (knee flexion ≥ 5°), and ASD with knee extension (ASD-KE) otherwise (knee flexion < 5°). Spinopelvic, postural and hip parameters were compared between the three groups. Univariate and multivariate analyses were then computed between spinopelvic and hip parameters. RESULTS ASD-KF had higher SVA (67 ± 66 mm vs. 2 ± 33 mm and 11 ± 21 mm), PT (27 ± 14° vs. 18 ± 9° and 11 ± 7°) and PI-LL mismatch (20 ± 26° vs - 1 ± 18° and - 13 ± 10°) when compared to ASD-KE and controls (all p < 0.05). ASD-KF also had a more tilted (34 ± 11° vs. 28 ± 9° and 26 ± 7°), anteverted (24 ± 6° vs. 20 ± 5° and 18 ± 4°) and abducted (59 ± 6° vs. 57 ± 4° and 56 ± 4°) acetabulum, with a higher posterior coverage (100 ± 6° vs. 97 ± 7° for ASD-KE) when compared to ASD-KE and controls (all p < 0.05). The main determinants of acetabular tilt, acetabular abduction and anterior acetabular coverage were PT, SVA and LL (adjusted R2 [0.12; 0.5]). CONCLUSIONS ASD subjects compensating with knee flexion have altered hip orientation, characterized by increased posterior coverage (acetabular anteversion, tilt and posterior coverage) and decreased anterior coverage which can together lead to posterior femoro-acetabular impingement, thus limiting pelvic retroversion. This underlying mechanism could be potentially involved in the hip-spine syndrome.
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Affiliation(s)
- Mario Mekhael
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Georges Kawkabani
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Renée Maria Saliby
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Eddy Saad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Elena Jaber
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Rami Rachkidi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Khalil Kharrat
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Gaby Kreichati
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Virginie Lafage
- Department of Orthopedic surgery, Hospital for Special Surgery, New York, USA
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon. .,Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
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17
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Karam M, Bizdikian AJ, Khalil N, Bakouny Z, Obeid I, Ghanimeh J, Labaki C, Mjaess G, Karam A, Skalli W, Kharrat K, Ghanem I, Assi A. Alterations of 3D acetabular and lower limb parameters in adolescent idiopathic scoliosis. Eur Spine J 2020; 29:2010-2017. [PMID: 32246232 DOI: 10.1007/s00586-020-06397-5] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/11/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the 3D deformity of the acetabula and lower limbs in subjects with adolescent idiopathic scoliosis (AIS) and their relationship with spino-pelvic alignment. METHODS Two hundred and seventy-four subjects with AIS (frontal Cobb: 33.5° ± 18° [10°-110°]) and 84 controls were enrolled. All subjects underwent full-body biplanar X-rays with subsequent 3D reconstructions. Classic spino-pelvic and lower limb parameters were collected as well as acetabular parameters: acetabular orientation in the 3 planes (tilt, anteversion and abduction), center-edge angle (CEA) and anterior and posterior sector angles. Subjects with AIS were represented by both lower limb sides and classified by elevated (ES) or lowered (LS), depending on the frontal pelvic obliquity. Parameters were then compared between groups. Determinants of acetabular and lower limb alterations were investigated among spino-pelvic parameters. RESULTS Acetabular abduction was higher on the ES in AIS (59.2° ± 6°) when compared to both LS (55.6° ± 6°) and controls (57.5° ± 3.9°, p < 0.001). CEA and acetabular anteversion were higher on the LS in AIS (32° ± 6.1°, 20.5° ± 5.7°) when compared to both ES (28.7° ± 5.1°, 19.8° ± 5.1°) and controls (29.8° ± 4.8°, 19.1° ± 4°, respectively, p < 0.001). Anterior sector angle was lower on both ES and LS in AIS when compared to controls. CEA, acetabular abduction and acetabular anteversion were found to be mostly determined (adjusted R2: 0.08-0.32) by pelvic tilt and less by frontal pelvic obliquity, frontal Cobb and T1T12. CONCLUSIONS Subjects with AIS had a more abducted acetabulum at the lowered side, more anteverted acetabulum and a lack of anterior coverage of both acetabula. These alterations were strongly related to pelvic tilt.
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Affiliation(s)
- Mohammad Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Aren Joe Bizdikian
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Nour Khalil
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Ziad Bakouny
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | | | - Joe Ghanimeh
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Chris Labaki
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Georges Mjaess
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Aya Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Khalil Kharrat
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Beirut, Lebanon.
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
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18
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Rizkallah M, Sebaaly A, Kharrat K, Kreichati G. Is There Still a Place for Convex Hemiepiphysiodesis in Congenital Scoliosis in Young Children? A Long-Term Follow-up. Global Spine J 2020; 10:406-411. [PMID: 32435559 PMCID: PMC7222690 DOI: 10.1177/2192568219858305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 11/21/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES To evaluate the long-term effect of convex growth arrest (CGA) on coronal deformity correction in congenital scoliosis. METHODS Twenty-two patients with congenital scoliosis operated by 1-staged double approach hemiephysiodesis by bone grafting of the convex side without instrumentation are included. Eighteen curves had an isolated hemivertebra while 4 curves had congenital bar. Subgroup analysis was performed according to age at surgery (3 years cutoff), type of malformation (hemivertebra vs congenital bar), and severity of curve (35° cutoff). RESULTS Patients' mean age at surgery was 3 years (range 0.5-8 years), with a mean frontal Cobb angle of 40.59°. Mean follow-up is 10.7 years (range 5.5-25 years). Overall results showed mean frontal Cobb angle reduction of 35.47% (40.59° to 27.41°). Detailed analysis showed that 15 curves had a mean correction of 51.8%, 5 stabilized and 2 had a mean aggravation of 25.11%. Subgroup analysis revealed that patients operated ≤3 years of age had mean cobb angle correction of 43.1% versus 21.49% in patients operated >3 years (P = .140). Mean correction of 44.5% was gained in curves with isolated hemivertebra compared with 1.3% in curves with congenital bar (P = .004). A 58.17% mean correction was reached in curves ≤35° versus 23.68% in curves >35° (P = .032). CONCLUSIONS A limited convex hemiepiphysiodesis still has a place in congenital scoliosis care when it is performed in patients ≤3 years old, with curves ≤35°, and with isolated hemivertebra. It spares patients the risks of vertebral resection and instrumentation, while fusing the same number of levels.
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Affiliation(s)
- Maroun Rizkallah
- Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon,Maroun Rizkallah, Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University, Alfred Naccache Street, Achrafieh, Beirut 00961, Lebanon.
| | - Amer Sebaaly
- Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Khalil Kharrat
- Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Gaby Kreichati
- Hôtel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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19
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Bakouny Z, Khalil N, Otayek J, Bizdikian AJ, Yared F, Salameh M, Bou Zeid N, Ghanem I, Kharrat K, Kreichati G, Lafage R, Lafage V, Assi A. Are the sagittal cervical radiographic modifiers of the Ames-ISSG classification specific to adult cervical deformity? J Neurosurg Spine 2019; 29:483-490. [PMID: 30052148 DOI: 10.3171/2018.2.spine171285] [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] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/21/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe Ames-International Spine Study Group (ISSG) classification has recently been proposed as a tool for adult cervical deformity evaluation. This classification includes three radiographic cervical sagittal modifiers that have not been evaluated in asymptomatic adults. The aim of this study was to determine whether the sagittal radiographic modifiers described in the Ames-ISSG cervical classification are encountered in asymptomatic adults without alteration of health-related quality of life (HRQOL).METHODSThe authors conducted a cross-sectional study of subjects with an age ≥ 18 years and no cervical or back-related complaints or history of orthopedic surgery. All subjects underwent full-body biplanar radiographs with the measurement of cervical, segmental, and global alignment and completed the SF-36 HRQOL questionnaire. Subjects were classified according to the sagittal radiographic modifiers (chin-brow vertical angle [CBVA], mismatch between T1 slope and cervical lordosis [TS-CL], and C2-7 sagittal vertical axis [cSVA]) of the Ames-ISSG classification for cervical deformity, which also includes a qualitative descriptor of cervical deformity, the modified Japanese Orthopaedic Association (mJOA) myelopathy score, and the Scoliosis Research Society (SRS)-Schwab classification for spinal deformity assessment. Characteristics of the subjects classified by the different modifier grades were compared.RESULTSOne hundred forty-one asymptomatic subjects (ages 18-59 years, 71 females) were enrolled in the study. Twenty-seven (19.1%) and 61 (43.3%) subjects were classified as grade 1 in terms of the TS-CL and CBVA modifiers, respectively. Ninety-eight (69.5%) and 4 (2.8%) were grade 2 for these same respective modifiers. One hundred thirty-six (96.5%) subjects had at least one modifier at grade 1 or 2. There was a significant relationship between patient age and grades of TS-CL (p < 0.001, Cramer's V [CV] = 0.32) and CBVA (p = 0.04, CV = 0.22) modifiers. The HRQOL, global alignment, and segmental alignment parameters were similar among the subjects with different modifier grades (p > 0.05).CONCLUSIONSThe CBVA and TS-CL radiographic modifiers of the Ames-ISSG classification do not seem to be specific to subjects with cervical deformities and can occur in asymptomatic subjects without alteration in HRQOL.
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Affiliation(s)
| | | | | | | | | | | | | | - Ismat Ghanem
- 1Faculty of Medicine and.,2Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon; and
| | - Khalil Kharrat
- 1Faculty of Medicine and.,2Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon; and
| | - Gaby Kreichati
- 1Faculty of Medicine and.,2Hôtel-Dieu de France Hospital, University of Saint-Joseph, Beirut, Lebanon; and
| | - Renaud Lafage
- 3Spine Division, Hospital for Special Surgery, New York, New York
| | - Virginie Lafage
- 3Spine Division, Hospital for Special Surgery, New York, New York
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Karam JA, Eid R, Kreichati G, Abiad R, Kharrat K, Ghanem IB. Optimizing the vertical position of the brace thoracic pad: Apical rib or apical vertebra? Orthop Traumatol Surg Res 2019; 105:727-731. [PMID: 30956156 DOI: 10.1016/j.otsr.2019.03.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 03/07/2019] [Accepted: 03/14/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The vertical position of the thoracic pad is a subject of controversy in brace design. Traditional recommendations dictate a maximal force applied at the level of the apical rib, about 2 levels below the apical vertebra. We sought to evaluate the optimal vertical position of the brace thoracic pad using fulcrum bending radiographs. HYPOTHESIS A lateral force applied at the apical vertebra of a thoracic curve is more efficient at correcting coronal deformity than a force placed the apical rib. PATIENTS AND METHODS In this prospective study, we recruited patients presenting with adolescent idiopathic scoliosis (AIS) and Risser stage 0-2 over a period of 12 months. Patients with a history of spine or thoracic surgery were excluded. Two fulcrum bending radiographs were performed for each patient: one with the center of the fulcrum placed under the most lateral part of the apical rib and another with the fulcrum centered below the apical vertebra. Cobb angles were measured on each fulcrum radiograph and compared using a paired t test. RESULTS Fifty-two patients were included, with a mean age of 12.4 years and mean thoracic Cobb angle of 39.4˚. Placing a fulcrum under the apical vertebra reduced the Cobb angle to a mean of 11.5˚, which was significantly lower than a fulcrum placed under the apical rib (14.3˚, p=0.001). This corresponded to a 20% relative loss in the absolute correction angle when placing the fulcrum under the apical rib. The difference between the 2 Cobb angles was not significantly correlated to patient age (p=0.896) or curve apex (p=0.813). DISCUSSION This is the first clinical study addressing the vertical position of the thoracic pad in braces for AIS. A lateral force applied at the level of the apical vertebra was significantly more efficient at reducing thoracic curve deformities than one applied at the apical rib. Our results provide clinical support to finite element studies that refute traditional recommendations of brace design, advocating for a revision of these guidelines to optimize non-operative treatment of AIS. LEVEL OF EVIDENCE II, prospective comparative study.
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Affiliation(s)
- Joseph A Karam
- Department of Orthopaedic Surgery, 835 S. Wolcott Ave, Room E-270, University of Illinois at Chicago, Chicago, IL 60612, United States.
| | - Roy Eid
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Saint-Joseph University, Alfred Naccache Street, Ashrafieh, Beirut, Lebanon
| | - Gabi Kreichati
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Saint-Joseph University, Alfred Naccache Street, Ashrafieh, Beirut, Lebanon
| | - Rami Abiad
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Saint-Joseph University, Alfred Naccache Street, Ashrafieh, Beirut, Lebanon
| | - Khalil Kharrat
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Saint-Joseph University, Alfred Naccache Street, Ashrafieh, Beirut, Lebanon
| | - Ismat B Ghanem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Saint-Joseph University, Alfred Naccache Street, Ashrafieh, Beirut, Lebanon
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Fahed E, Grelat M, Younes P, Madkouri R, Kreichati G, Kharrat K, Rizk T. Cervical Hyperextension Deformity After Sagittal Balance Correction in Patient with Congenital Limb-Girdle Myopathy: Surgical Technique and Review of Literature. World Neurosurg 2018; 123:265-271. [PMID: 30415053 DOI: 10.1016/j.wneu.2018.10.211] [Citation(s) in RCA: 2] [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: 04/08/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is no gold standard surgical treatment for cervical hyperextension deformity, especially in case of muscular dystrophy. Special considerations and caution should be taken as they carry a high risk of early mortality and spinal cord injury. Only a few case reports are available in the literature. CASE DESCRIPTION We report a case of surgical correction of an iatrogenic cervical hyperextension deformity following sagittal balance correction in a patient with congenital limb-girdle myopathy. The patient was successfully treated by posterior cervical release and fusion after verification of the range of motion, reducibility of the deformity, and absence of any positional spinal cord compression with dynamic radiographic examination and preoperative magnetic resonance imaging in the desired postoperative position. CONCLUSIONS We suggest posterior cervical release and fusion in case of a radiologically and clinically reducible cervical hyperextension deformity under both motor and sensory spinal evoked potential monitoring. In cases of longstanding, rigid, nonreducible cervical hyperextension, laminectomy and concomitant duroplasty could be considered.
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Affiliation(s)
- Elie Fahed
- Department of Neurosurgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Michael Grelat
- Department of Neurosurgery, University Hospital, Dijon, France
| | - Philippe Younes
- Department of Neurosurgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Rachid Madkouri
- Department of Neurosurgery, University Hospital, Dijon, France
| | - Gaby Kreichati
- Department of Orthopedics, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Khalil Kharrat
- Department of Orthopedics, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Toni Rizk
- Department of Neurosurgery, Hotel Dieu de France Hospital, Beirut, Lebanon.
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Rizkallah M, Sebaaly A, Kharrat K, Kreichati G. Selecting the lowest instrumented vertebra in adolescent idiopathic scoliosis: Comparison of the Lenke, Suk, and Dubousset criteria. Orthop Traumatol Surg Res 2018; 104:631-635. [PMID: 29292125 DOI: 10.1016/j.otsr.2017.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 04/15/2017] [Revised: 12/04/2017] [Accepted: 12/07/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Selection of the lowest instrumented vertebra (LIV) in patients undergoing selective fusion for Lenke type 1 or 2 adolescent idiopathic scoliosis (AIS) varies widely across centres around the world. HYPOTHESIS Lenke, Suk, and Dubousset criteria show moderate agreement for LIV selection. METHODS Sixty-eight patients with Lenke type 1 or 2 AIS managed by selective posterior fusion and followed-up for at least 2 years were included in a retrospective observational study. Agreement among Lenke, Suk, and Dubousset criteria for LIV selection was assessed. For surgery, the LIV was selected based on Dubousset criteria. Retrospectively, in each patient, the LIV selected by the Lenke and Suk criteria sets was identified on the preoperative images. The patients were then divided into two groups based on whether the Dubousset LIV was identical versus more distal than the LIV identified retrospectively by the Lenke or Suk criteria. The primary evaluation criterion was coronal balance. RESULTS The LIVs selected by the Lenke, Suk, and Dubousset criteria were identical in 57% of cases. The LIV selected by the Dubousset criteria were identical to that selected by the Lenke or Suk criteria in 70% of patients. No significant between-group differences were found for any of the evaluation criteria assessed preoperatively, postoperatively, or at last follow-up. DISCUSSION Agreement among the Lenke, Suk, and Dubousset criteria was moderate, confirming the working hypothesis. No coronal malalignment developed in the patients whose actual LIV was distal to the LIV selected by the Lenke or Suk criteria, supporting the validity of Dubousset criteria for LIV selection. When selecting the LIV, all three criteria sets should be assessed. The LIV is the vertebra selected by all three if they agree or by the Dubousset criteria if they do not. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- M Rizkallah
- Département de chirurgie orthopédique, Hôtel-Dieu de France, faculté de médecine, université Saint-Joseph, Beyrouth, Lebanon
| | - A Sebaaly
- Département de chirurgie orthopédique, Hôtel-Dieu de France, faculté de médecine, université Saint-Joseph, Beyrouth, Lebanon.
| | - K Kharrat
- Département de chirurgie orthopédique, Hôtel-Dieu de France, faculté de médecine, université Saint-Joseph, Beyrouth, Lebanon
| | - G Kreichati
- Département de chirurgie orthopédique, Hôtel-Dieu de France, faculté de médecine, université Saint-Joseph, Beyrouth, Lebanon
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Hachache B, Eid T, Ghosn E, Sebaaly A, Kharrat K, Ghanem I. Is percutaneous proximal gracilis tenotomy as effective and safe as the open procedure? J Child Orthop 2015; 9:477-81. [PMID: 26499454 PMCID: PMC4661155 DOI: 10.1007/s11832-015-0699-z] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/06/2015] [Indexed: 02/03/2023] Open
Abstract
PURPOSE There is currently an increasing trend for percutaneous surgical interventions mainly in children with cerebral palsy (CP). The purpose of this study was to evaluate the effectiveness and safety of percutaneous proximal gracilis tenotomy (PPGT) in children with CP scheduled for hip adductor tenotomy. METHODS This is a prospective study of 59 hips in 31 consecutive patients with CP scheduled for hip adductor tenotomy in the setting of multilevel tenotomies or hip osteotomy (femoral or Dega). A pediatric orthopedic surgeon conducted a percutaneous adductor longus and gracilis tenotomy through the same stab wound. Another surgeon extended the wound to explore what had been cut during the PPGT, and completed the tenotomy if necessary (open proximal gracilis tenotomy; OPGT). Hip abduction with the hip and knee extended (HA) was assessed by a third surgeon (1) immediately before PPGT, i.e., directly after percutaneous adductor longus tenotomy (prePPGT), (2) after PPGT (postPPGT), and (3) following OPGT (postOPGT), using a goniometer, in a standardized reproducible manner. All three surgeons were blinded to each other's findings. Primary end-points included the percentage of muscle portion sectioned percutaneously and the improvement of HA angle. Comparison between HA before and after PPGT was performed using a paired t test with 95 % confidence interval (CI), and comparison between HA after PPGT and OPGT was performed using a Student's t-test with 95 % CI. The bleeding was assessed and other iatrogenic lesions were identified. The relationship between HA after PPGT and the percentage of muscle portion sectioned percutaneously was evaluated by calculating the Pearson correlation coefficient (p < 0.01). RESULTS Mean HA measured 33.71 degrees prePPGT and increased to 45.90 degrees postPPGT (p < 0.0001). The postOPGT HA averaged 48.71 degrees with no statistically significant gain compared with postPPGT (p = 0.21). The muscular portion of gracilis origin was cut to an average of 91.95 %; completely in only 14 hips, between 90 and 100 % in 35 hips, between 70 and 90 % in 9 hips, and between 60 and 70 % in 1 hip. The gain in HA did not correlate with the extent of the muscular portion sectioned percutaneously (R = -0.043). Minimal accidental section of adductor brevis postPPGT was encountered in 39 hips. Considerable bleeding postPPGT with hematoma formation requiring hemostasis during the open control procedure occurred in 30 hips. Partial iatrogenic injury of the anterior branch of the obturator nerve was encountered in one patient bilaterally with severe adductor contracture, due to an anatomic too medial variant. CONCLUSIONS This is the only prospective study concerning the outcome of PPGT. Although PPGT is fast, simple and effective, it is not as safe as the open procedure even when performed correctly by an experienced surgeon, mainly because of the increased risk of bleeding. The findings of the current study do not support its use as a 'standard-of-care' technique in children with hip adductor contracture. LEVEL OF EVIDENCE Level II therapeutic study-prospective comparative study.
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Affiliation(s)
- Bilal Hachache
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Saint-Joseph University, Alfred Naccache Street, Ashrafieh, Beirut, Lebanon
| | - Tony Eid
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Saint-Joseph University, Alfred Naccache Street, Ashrafieh, Beirut, Lebanon
| | - Elias Ghosn
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Saint-Joseph University, Alfred Naccache Street, Ashrafieh, Beirut, Lebanon
| | - Amer Sebaaly
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Saint-Joseph University, Alfred Naccache Street, Ashrafieh, Beirut, Lebanon
| | - Khalil Kharrat
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Saint-Joseph University, Alfred Naccache Street, Ashrafieh, Beirut, Lebanon
| | - Ismat Ghanem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Saint-Joseph University, Alfred Naccache Street, Ashrafieh, Beirut, Lebanon
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Odent T, Ilharreborde B, Miladi L, Khouri N, Violas P, Ouellet J, Cunin V, Kieffer J, Kharrat K, Accadbled F. Fusionless surgery in early-onset scoliosis. Orthop Traumatol Surg Res 2015; 101:S281-8. [PMID: 26386889 DOI: 10.1016/j.otsr.2015.07.004] [Citation(s) in RCA: 24] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Surgical treatment of early-onset scoliosis has greatly developed in recent years. Early-onset scoliosis covers a variety of etiologies (idiopathic, neurologic, dystrophic, malformative, etc.) with onset before the age of 5 years. Progression and severity threaten respiratory development and may result in respiratory failure in adulthood. Many surgical techniques have been developed in recent years, aiming to protect spinal and thoracic development. MATERIAL AND METHODS Present techniques are based on one of two main principles. The first consists in posterior distraction of the spine in its concavity (single growing rod, or vertical expandable prosthetic titanium rib [VEPTR]), or on either side (dual rod); this requires iterative surgery, for lengthening, unless motorized using energy provided by a magnetic system. The second option is to use spinal growth force to lengthen the assembly; these techniques (Luque Trolley, Shilla), using a sliding assembly, are known as growth guidance. RESULTS These techniques are effective in controlling early scoliotic deformity, and to some extent restore spinal growth. However, they show a high rate of complications: infection, rod breakage, spinal fixation pull out and, above all, progressive spinal stiffness, reducing long-term efficacy. Respiratory gain is harder to assess, as thoracic expansion does not systematically improve respiratory function, particularly due to impaired compliance of the thoracic cage.
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Affiliation(s)
- T Odent
- Service de chirurgie orthopédique pédiatrique, CHRU de Tours, université François-Rabelais de Tours, PRES Centre-Val de Loire université, 49, boulevard Béranger, 37044 Tours, France.
| | - B Ilharreborde
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Robert-Debré, université Paris-Diderot, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - L Miladi
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-Malades, université Paris-Descartes, Sorbonne Paris-Cité, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - N Khouri
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-Malades, université Paris-Descartes, Sorbonne Paris-Cité, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - P Violas
- Service de chirurgie pédiatrique, hôpital Sud, université Rennes 1, boulevard de Bulgarie, 35000 Rennes, France
| | - J Ouellet
- Shriner's Hospital, McGill University, Montreal, Canada
| | - V Cunin
- Service d'orthopédie pédiatrique, hôpital Femme-Mère-Enfant, université Lyon 1, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - J Kieffer
- Pediatric clinic, Luxembourg, Luxembourg
| | - K Kharrat
- Hôpital hôtel-Dieu, B.P. 166830, Beirut, Lebanon
| | - F Accadbled
- Service d'orthopédie, hôpital des Enfants, CHU de Toulouse, Toulouse, France
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Masmoudi M, Ghorbel H, Kharrat K, Abdennadher Y, Hachicha W, Ellouze T, Zouari C, Djemaa A. Évaluation des mesures prises face au risque chimique enquête auprès de 70 entreprises de la région de Sfax. ARCH MAL PROF ENVIRO 2012. [DOI: 10.1016/j.admp.2012.03.705] [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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Masmoudi M, Abdennadher Y, Ghorbel H, Kharrat K, Djemaa A. Évaluation du risque chimique dans une entreprise de fabrication de peinture. ARCH MAL PROF ENVIRO 2012. [DOI: 10.1016/j.admp.2012.03.706] [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: 10/28/2022]
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Masmoudi M, Masmoudi M, Hajjaji Derouiche M, Sallami H, Kharrat K, Ghorbel H, Djemaa A, Jmal Hammami K, Ayadi A. Dépistage de parasitisme intestinal chez les manipulateurs de denrées alimentaires : à propos de 417 cas. ARCH MAL PROF ENVIRO 2012. [DOI: 10.1016/j.admp.2012.03.424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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El Hage S, Ghanem I, Baradhi A, Mourani C, Mallat S, Dagher F, Kharrat K. Skeletal features of primary hyperoxaluria type 1, revisited. J Child Orthop 2008; 2:205-10. [PMID: 19308578 PMCID: PMC2656805 DOI: 10.1007/s11832-008-0082-4] [Citation(s) in RCA: 22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 01/19/2008] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to describe the skeletal manifestations of primary hyperoxaluria type 1 (PH1), the most common of the primary hyperoxalurias. METHODS We clinically and radiographically reviewed 12 consecutive patients diagnosed with PH1, aged between 2 and 17 years. All patients had evidence of some type of renal involvement, 4 of whom were at end-stage renal disease (ESRD) and were under dialysis. RESULTS The main symptom was skeletal pain and was present only in the 4 severely involved patients and appeared during the second year of dialysis. The 2 most severely involved patients had evidence of pathological fractures. Radiological signs were present in patients with or without symptoms. These radiological signs were of two distinct types: those almost specific of oxalosis, such as dense and radiolucent metaphyseal bands and vertebral osteocondensations, which are found mainly in the severely involved individuals, and those less specific, such as signs of renal osteodystrophy, which are also found in less severely involved patients. Interestingly, our study revealed the presence of spondylolysis in 25% of cases. This latter finding is unique and has not previously been reported in the literature. CONCLUSIONS The skeletal manifestations of PH1 include specific and less specific radiological signs, with some patients being asymptomatic, and others presenting with bone pain and pathological fractures, as well as spondylolysis.
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Affiliation(s)
- Samer El Hage
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Boulevard Alfred Naccache, Achrafieh, Beirut, Lebanon
| | - Ismat Ghanem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Boulevard Alfred Naccache, Achrafieh, Beirut, Lebanon
| | - André Baradhi
- Department of General Surgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Chebel Mourani
- Department of Paediatrics, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Samir Mallat
- Department of Nephrology, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Fernand Dagher
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Boulevard Alfred Naccache, Achrafieh, Beirut, Lebanon
| | - Khalil Kharrat
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Boulevard Alfred Naccache, Achrafieh, Beirut, Lebanon
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Kheireddine W, Ghanem I, Dagher F, Kharrat K. [Adolescent bicipitoradial bursitis: a rare disease that can simulate a malignant tumor]. ACTA ACUST UNITED AC 2008; 94:308-10. [PMID: 18456068 DOI: 10.1016/j.rco.2007.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2007] [Indexed: 11/28/2022]
Abstract
Bicipitoradial bursitis is a rare condition: we found 36 cases reported in the literature, none in children. The main manifestation is a painful tumefaction. We report a case observed in an adolescent whose magnetic resonance imaging findings were compatible with a malignant tumor. Surgical biopsy enabled the correct diagnosis of inflammatory synovium without signs of malignancy compatible with bicipitoradial bursitis. Complete cure was achieved without resection.
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Affiliation(s)
- W Kheireddine
- Service de chirurgie orthopédique, hôpital Hôtel-Dieu de France, université Saint-Joseph, boulevard Alfred-Naccache, Achrafieh, Beyrouth, Lebanon
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Abstract
Cervical spine instability in children is rare but not exceptional and may be due to many factors. Although it mostly occurs at the upper cervical spine, all vertebrae from the occiput to T1 may be involved. It may be acute or chronic, occurring secondary to trauma or due to congenital anomaly, skeletal or metabolic dystrophy or rheumatoid arthritis. It can be isolated or associated with other musculoskeletal or visceral anomalies. A thorough knowledge of embryology, anatomy, physiology and physiopathology of the cervical spine in children is essential to avoid pitfalls, recognize normal variants and identify children at risk of developing cervical spine instability and undertake the appropriate treatment.
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Affiliation(s)
- Ismat Ghanem
- Department of Orthopaedic Surgery, Hotel Dieu de France Hospital, Boulevard Alfred Naccache, Achrafieh, Beirut, Lebanon,
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Rachkidi R, Ghanem I, Dagher F, Kharrat K. Fibrodysplasie ossifiante progressive : écueils orthopédiques et controverses. Arch Pediatr 2008; 15:286-90. [DOI: 10.1016/j.arcped.2008.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Revised: 09/20/2007] [Accepted: 01/06/2008] [Indexed: 10/22/2022]
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Madi-Jebara S, El-Hajj C, Jawish D, Ayoub E, Kharrat K, Antakly MC. Anesthetic management of a patient with Freeman-Sheldon syndrome: case report. J Clin Anesth 2007; 19:460-2. [PMID: 17967677 DOI: 10.1016/j.jclinane.2006.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 10/10/2006] [Accepted: 10/10/2006] [Indexed: 10/22/2022]
Abstract
The Freeman-Sheldon syndrome (FSS) is a rare congenital myopathy and dysplasia. The musculoskeletal and soft-tissue manifestations of FSS often require orthopedic and plastic reconstructive surgery. We report a case of a 7-year-old girl with FSS operated for lower limb malformation during spinal anesthesia.
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Affiliation(s)
- Samia Madi-Jebara
- Department of Anesthesiology, Hotel Dieu de France Hospital, 166830 Beirut, Lebanon.
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Mechelany E, Ghanem I, Rachkidi R, Kharrat K. [Changing surgical treatment for congenital hip dislocation in children and adolescents in a referral hospital in Lebanon]. ACTA ACUST UNITED AC 2007; 93:746-9. [PMID: 18065888 DOI: 10.1016/s0035-1040(07)73262-2] [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: 11/24/2022]
Affiliation(s)
- E Mechelany
- Service de Chirurgie Orthopédique, Hôpital Hôtel-Dieu de France, Beyrouth, Lebanon
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Romanos E, Ghanem I, Khalifé R, Dagher F, Kharrat K. Atlantoaxial rotatory fixation owing to neck burn. J Pediatr Orthop B 2007; 16:437-41. [PMID: 17909343 DOI: 10.1097/bpb.0b013e3282f1049d] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this paper is to present a case of severe atlantoaxial rotatory fixation owing to a previously unreported etiology, and to discuss its pathogenesis and management. Conservative measures were unable to prevent progression, thus requiring surgical intervention.
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Affiliation(s)
- Elie Romanos
- Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon.
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Kharrat K, Assante M, Chossegros C, Cheynet F, Blanc JL, Guyot L, Richard O. [Patient perception of functional and cosmetic outcome of orthognathic surgery. Retrospective analysis of 45 patients]. ACTA ACUST UNITED AC 2006; 107:9-14; discussion 15-6. [PMID: 16523170 DOI: 10.1016/s0035-1768(06)76974-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Orthognathic surgery is generally indicated for the treatment of maxillo-mandibular deformities. Surgery is performed to repair functional abnormalities, but also has a cosmetic impact. MATERIAL AND METHODS We conducted a retrospective study of 60 patients who underwent orthognathic surgery in 1996 and 1997 in order to assess patient perception of functional and cosmetic outcome. A questionnaire was sent to all patients one year after their surgery; 45 responded. RESULTS We noted cosmetic, functional, and psychological changes. Patients considered that the changes were for the better. For functional abnormalities, 88.9% considered their occlusion had improved and 80% their chewing; 73.4% reported psychological improvement stating they had more self-confidence; 97.8% considered their cosmetic aspect had improved. DISCUSSION This study enabled us to assess patients' perception of surgical outcome. It must be recalled that the patient basically decides to undertake surgery for cosmetic reasons while the surgeon proposes surgery to improve function. The psychological consequences of orthognathic surgery must be taken into account because the impact is considerable.
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Affiliation(s)
- K Kharrat
- Service de Stomatologie et Chirurgie Maxillo-Faciale, CHU de la Timone, Marseille
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36
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Abstract
The purpose of this study was to assess the risk of neuro-orthopaedic malformations after in-vitro fertilization. We compared the prevalence of neuro-orthopaedic malformations in two groups of pregnancies conceived either naturally or by in-vitro fertilization, and used multivariate analysis to study the impact of each variable. The results showed a prevalence of 0.89% neuro-orthopaedic malformations in the in-vitro fertilization cohort and 0.32% in the natural conception cohort. The three times greater risk of malformations in the in-vitro fertilization cohort was reduced after adjustment to other variables. We concluded that the increased risk of neuro-orthopaedic malformations after in-vitro fertilization is not due to the technique itself but rather to factors associated with it.
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Affiliation(s)
- Samer El Hage
- Department of Orthopaedic Surgery, Hotel-Dieu de France Hospital, Beirut, Lebanon
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37
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Abstract
Linear scleroderma is a subtype of localized scleroderma generally observed in children, and may produce secondary bone and joint deformities. Its localization at the foot or ankle is rarely reported. A complete review of the literature reveals 21 cases of foot or ankle deformity due to linear scleroderma to which we add one case. The clinical and radiological aspects of the deformity, its pathogenesis, histological findings as well as orthopaedic management are presented and discussed.
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Affiliation(s)
- F El Masri
- Département de Chirurgie Orthopédique, Hôpital Hôtel-Dieu de France, Université Saint-Joseph, boulevard Alfred-Naccache, Achrafieh, Beyrouth, Liban
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Abstract
The objective of this study was to assess the course, the epidemiologic features and the prognosis of recurrent Legg-Calvé-Perthes disease. We reviewed seven reported cases and one personal case of recurrent Perthes' disease. In all cases, complete recovery from the previous episode was documented, and a thorough diagnostic work-up to rule out other diseases was undertaken. There were five boys. Age at onset ranged from 2 to 6 years. Five patients had bilateral involvement. Recurrence took place 1-5 years after complete healing of the initial one. Clinical and radiological pictures were similar to those found in primary Perthes' disease of the adolescent and consisted in a greater epiphyseal involvement. Recurrent Perthes' disease is very rare. We did not identify any risk factors for recurrence. A worse outcome is more closely related to an older age of the patient at recurrence than to recurrence itself.
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Affiliation(s)
- Ismat Ghanem
- Department of Orthopaedic Surgery, Hotel-Dieu de France Hospital, Saint Joseph University, Achrafieh, Beirut, Lebanon.
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39
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Abstract
Rib osteomyelitis is a rare disease. We present a previously unreported case of Streptococcus pneumoniae osteomyelitis of the rib. A 4-month-old-infant presented with fever, irritability and abdominal tenderness. Pericostal collection was discovered incidentally on ultrasound; it was first drained by needle aspiration and appropriate antibiotic therapy was given, with resolution of fever in 24 h, but recurrence of symptoms 4 days later, with swelling over the affected rib. Surgical drainage with resection of the infected portion of the rib were done followed by a prolonged course of intravenous and then oral antibiotics, without any recurrence at 6 months follow-up. A review of the pertinent literature was made. This case demonstrates that the spectrum of pathogens potentially responsible for rib osteomyelitis may be broader than previously reported. The management and outcome are similar to rib osteomyelitis due to any other bacteria.
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Affiliation(s)
- Ibrahim Kalouche
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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40
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Abstract
PURPOSE OF THE STUDY Progress in medical imaging has improved recognition and management of osteoid osteoma. The purpose of this study was to assess the efficacy of computed tomography (CT)-guided percutaneous thermal ablation and discuss the advantages and disadvantages. MATERIAL AND METHODS We reviewed retrospectively 33 consecutive patients with osteoid osteoma who had undergone CT-guided radiofrequency ablation. The diagnosis was established on the basis of the clinical presentation and pathognomonic radiographic findings (CT and bone scintigram) without histological proof. We recorded patient age and gender, tumor location, clinical signs and duration, imaging findings, duration of the ablation procedure, type of anesthesia, hospital stay, and complications. We evaluated their effect on final outcome. RESULTS Weight-bearing was possible in all patients with a lesion of the lower limb a few hours after surgery. Patients resumed their normal activities in 24-48 hours. Pain resolved immediately after radiofrequency ablation in 26 patients and limping, when present, disappeared within 24 hours. At mean follow-up of 34 months (minimum 12 months) there was one case of recurrent pain. Clinical cure was confirmed by CT and bone scintigraphy in twelve patients. DISCUSSION AND CONCLUSION This precise and minimally invasive method is an effective and safe way to reduce healthcare expenditures. It can be recommended as the primary treatment for osteoid osteoma.
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Affiliation(s)
- E Haddad
- Département de Chirurgie Orthopédique, Hôpital Hôtel-Dieu de France, Université Saint-Joseph, boulevard Alfred-Naccache, Achrafieh-Beyrouth, Liban
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41
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Ghoussoub K, Kreichati G, Azzi L, Awada H, Kharrat K. [The particularities of the adult Scheuermann's disease: study about 45 patients]. J Med Liban 2004; 52:19-24. [PMID: 15881697] [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] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Our aim was to find out which factors favor the occurrence of pain in adult patients with Scheuermann's disease--a juvenile manifestation of osteochondrosis of the spine, to study the clinical and radiological signs, the role of rehabilitation and the means to avoid the recurrence of pain. PATIENTS AND METHODS Descriptive and retrospective study about 45 adults treated by rehabilitation. A data sheet listed the patient's occupation, current practice of sport, antecedents (violent sport, traumatism, pain), presence of a family form, motive of consultation, clinical and paraclinical examinations and immediate and long-term results of rehabilitation. RESULTS Average age 35 years (18 to 65), male predominance (1.8:1), occupational risk factors: 16%; only 24% practiced sports currently. ANTECEDENTS sports 49%, spinal column traumatism 13%, dorsal and lumbar pain during adolescence 16%. Consultation motive: abnormal posture 4% and pain 96%. According to the examination: abnormal spinal column in 80% of cases. According to radiography, our patients were divided into 49% who were carriers of growth vertebral dystrophy and 51% who were carriers of the real Scheuermann's disease. The immediate results of rehabilitation were satisfactory, 75% of the results were very good and good. Between six months and four years, 70% of the results were very satisfactory. Exercises were observed in only 11% of the cases, and stopped after two months on average. CONCLUSION Scheuermann's disease in adults is a different entity from that of the teenager for the major manifestation is pain and not aesthetic quality. The patient's occupation is rather sedentary; sport is beneficial. The functional rehabilitation is the basic treatment and recourse to surgery or dorso-lumbar braces is rare.
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Affiliation(s)
- Khalil Ghoussoub
- Service de Médecine physique, CHU Hôtel-Dieu de France, Beyrouth, Liban.
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42
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Ghoussoub K, Ghanem I, Sabbagh S, Hassane A, Kharrat K, Dagher F. [Results of long-term rehabilitation in the treatment of patellofemoral syndrome: retrospective study about 63 patients]. J Med Liban 2003; 51:198-205. [PMID: 15623134] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Rehabilitation plays a primordial role in the treatment of the patellofemoral syndrome. We wanted to seek in a sample of population suffering from this problem, the factors favoring the occurrence of this syndrome, the rehabilitation result and the continuation of exercises. PATIENTS AND METHODS Prospective descriptive study on the rehabilitated patients in a questionnaire form divided in two parts. The first one seeks the information of the patient's file: demographical, social and professional data, risk factors, clinical assessment and imaging, medical treatment, immediate rehabilitation results. The second part seeks the long-term effect of rehabilitation, the perseverance to exercises and the resumption of professional and sports activities. RESULTS 78 patients, feminine prevalence 59%; average age: 32.7 years (between 12 and 60 years). Occurrence favoring factors found: intensive sports 47.4%, profession presenting a risk 14%, traumatism 24.5%, hypermobility 30,7%. ETIOLOGY patellar instability 18/78, dysplasia 2, chondromalacia 14, femoropatellar osteoarthritis 4, non-marked 40. Previous treatment AINS: 45%, efficient in third of cases ; previous physical therapy 9/78 (50% failure). The evaluated results of short-term rehabilitation according to Ficat criteria, regardless of etiology, were satisfying (good or very good) in 77% of cases. Very good: 20.5 %; good: 56.5%; acceptable: 19.2% and bad 3.8%. At long term on 63 patients with an average recession of 18 months (6 months to 3 years) we had very good results: 22.2 %, good: 55.5%, acceptable 20.6% and bad 1.7%. Average duration of carry on of exercises: 4 months. CONCLUSION The functional rehabilitation has confirmed its efficiency in the treatment of young patients suffering from patellofemoral syndrome. The education, the life hygiene, the preparation to sports as well as carry on of exercises prevent recurrences.
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Affiliation(s)
- Khalil Ghoussoub
- Services de Médecine physique, CHU Hôtel-Dieu de France, Beyrouth, Liban.
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Ghanem I, Collet LM, Kharrat K, Samaha E, Deramon H, Mertl P, Dagher F. Percutaneous radiofrequency coagulation of osteoid osteoma in children and adolescents. J Pediatr Orthop B 2003; 12:244-52. [PMID: 12821840 DOI: 10.1097/01.bpb.0000049571.52224.81] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this paper was to evaluate the effectiveness of percutaneous radiofrequency ablation of osteoid osteoma in children and adolescents. Twenty-three patients aged 4.5-19.5 years were retrospectively reviewed. All patients with lower limb lesions were able to bear full weight on their operated limb immediately after the procedure, and to resume their daily activities within 24-48 h. Pain disappeared immediately after surgery in 21 cases, and in lower limb lesions the gait was back to normal after an average of 5 days. No septic or neurovascular complications were observed. At an average follow-up of 3.5 years, all the patients including two cases of initial failure were free of pain and had a normal gait. Clinical healing was confirmed by computed tomography and bone scan performed in 12 cases. This precise and minimally invasive method is safe, effective and associated with reduced health care resources. It could be recommended as the treatment of choice for osteoid osteoma of the limbs in children and adolescents.
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Affiliation(s)
- Ismat Ghanem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon.
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44
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Dagher F, Ghanem I, Abiad R, Haykal G, Kharrat K, Phares A. [Bernese periacetabular osteotomy for the treatment of the degenerative dysplasic hip]. Rev Chir Orthop Reparatrice Appar Mot 2003; 89:125-33. [PMID: 12844056] [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] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
PURPOSE OF THE STUDY Appropriate management of degenerative joint disease in patients with dysplasic hips is a controversial issue. Non-surgical treatment is generally insufficient to achieve good long-term results and, in young patients, indications for total hip replacement, arthrodesis, or salvage procedures (Chiari, bone block) are limited. The most physiological option is to re-orient the acetabulum to cover the femoral head with a sufficient amount of joint cartilage. Several types of redirection osteotomy have been described. In the present work, we assess the clinical and radiological outcome after Ganz periacetabular osteotomy in patients with dysplastic hips who developed degenerative joints. We searched for factors influencing outcome. MATERIAL AND METHODS This retrospective analysis was conducted in 57 patients with hip dysplasia who had undergone 64 peri-acetabular osteotomies for joint degeneration. Mean age at surgery was 31 years. The preoperative diagnosis was primary osteochondritis of the hip in 9 patients. The Merle d'Aubigné scores and VCE, VCA, HTE angles on standard x-rays were obtained before surgery and at last follow-up. The Tönnis grade for the severity of the joint degeneration was determined. In 19 patients, inter-trochanteric femoral osteotomy was performed to improve joint congruency in addition to peri-acetabular osteotomy. Clinical and radiological results were assessed at a mean follow-up of 3.5 years (range 2-6 years). The effects of age, cause of dysplasia, surgical history of the hip, severity of joint degeneration, association with femoral osteotomy, and learning curve were studied. Complications were recorded. RESULTS On the average, the Merle d'Aubigné score improved from 13 points preoperatively to 16.5 points at last follow-up. Limping was observed for a longer period after surgery in patients who had an associated inter-trochanteric osteotomy. At last follow-up, the overall score was lower in grade 3 hips than in grade 1 and 2 hips. Serious complications were observed in the first 15 patients. There was no statistical relationship between age at surgery or surgical history of the hip and final outcome. Comparing the preoperative x-rays with those obtained at last follow-up demonstrated an improvement in the mean value for VCE (2 degrees preoperatively to 25 degrees at last follow-up), VCA (- 6 degrees to 39.5 degrees ), and HTE (25 degrees to 15 degrees ). Radiologically, the severity of joints degeneration was improved or remained unchanged in 83% of the hips (especially for grade 1 and 2 hips). DISCUSSION In our hands, peri-acetabular osteotomy has provided good results, especially in terms of improved function and control of joint degeneration. Although this procedure is basically indicated for young patients with hip dysplasia free of joint degeneration, it would also be a useful alternative for those who have developed only moderately extensive joint degeneration (Tönnis grades 1 and 2) and a moderately excentric femoral head. Success in these patients depends on surgical experience, correct indications, and careful attention to technical details. Nevertheless, complications are not exceptional and the learning curve may be long. In our series, the main factor predictive of outcome was the Tönnis grade of joint degeneration.
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Affiliation(s)
- F Dagher
- Département de Chirurgie Orthopédique, Hôpital Hôtel-Dieu de France, Université Saint-Joseph, boulevard Alfred-Naccache, Achrafieh, Beyrouth, Liban
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45
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Besbes M, Makni F, Cheikh-Rouhou F, Sellami H, Kharrat K, Ayadi A. [Otomycosis due to Scopulariopsis brevicaulis]. Rev Laryngol Otol Rhinol (Bord) 2002; 123:77-8. [PMID: 12360726] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
We report a case of otomycosis due to Scopulariopsis brevicaulis in a patient with left cholesteatomatous chronic otitis media who presented with otorrhea associated with left otalgia. Scopulariopsis brevicaulis is a fungus which is rarely described as causing otomycosis although it is a saprophyte and widespread in the environment. In this case the contamination could be due to intensive gardening with poor hygiene. Its mycologic diagnosis is relatively easy and nystatin remains the most effective treatment in this region.
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Affiliation(s)
- M Besbes
- CHU H. Bourguiba, Laboratoire de Parasitologie-mycologie, Sfax, Tunis.
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46
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Ghanem I, Abou Jaoude S, Kharrat K, Dagher F. Is MRI effective in detecting intraarticular abnormalities of the injured knee? J Med Liban 2002; 50:168-74. [PMID: 15298477] [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] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND DATA Magnetic resonance imaging (MRI) is widely used for the diagnosis of intraarticular anomalies of the knee. Its reliability is controversial mainly in the pediatric population, and its results may vary from one center to the other. The purpose of this study was to assess the validity of MRI in detecting intraarticular abnormalities in patients who sustained an injury of their knee, by comparing its findings to those of arthroscopy. MATERIAL AND METHODS Two hundred and seventeen traumatic knees underwent MRI followed by arthroscopy. Findings of MRI and arthroscopy were statistically compared. RESULTS Accuracy of MRI was 95.39% and 99.08% for anterior and posterior cruciate ligament ruptures respectively, 85.25% and 90.78% for medial and lateral meniscal tears respectively, and 91.24% for injury of the articular cartilage. There was not a significant difference between the pediatric and the adult populations, except for a greater sensitivity to detect lateral meniscal tears and a better specificity and accuracy to identify chondral lesions in the first group. Variability between centers was significant for the diagnosis of chondral defects. CONCLUSION The good MRI reliability in detecting intraarticular abnormalities as demonstrated in this report, underlines its importance in the assessment of the injured knee before arthroscopy.
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Affiliation(s)
- Ismat Ghanem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital-Saint-Joseph University, Beirut, Lebanon.
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47
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Hmani-Aifa M, Ben Arab S, Kharrat K, Orten DJ, Boulila-Elgaied A, Drira M, Hachicha S, Kimberling WJ, Ayadi H. Distinctive audiometric features between USH2A and USH2B subtypes of Usher syndrome. J Med Genet 2002; 39:281-3. [PMID: 11950859 PMCID: PMC1735096 DOI: 10.1136/jmg.39.4.281] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mégarbané A, Kharrat K, Kreichati G. Four sibs with dislocated elbows, bowed tibiae, scoliosis, deafness, cataract, microcephaly, and mental retardation: a new MCA/MR syndrome. J Med Genet 1998; 35:755-8. [PMID: 9733034 PMCID: PMC1051428 DOI: 10.1136/jmg.35.9.755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We report four sibs with an MCA/MR syndrome whose parents were first cousins. The sibs had mental retardation, microcephaly, hearing problems, cataract, and multiple osseous malformations, such as dislocated elbows, bowed tibiae, and scoliosis. Review of published reports and the use of the London Dysmorphology Database suggest that this family presents a new syndrome.
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Affiliation(s)
- A Mégarbané
- Unité de Génétique Médicale, Laboratoire de Biologie Moléculaire et Cytogénétique, Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
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49
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Moe JH, Kharrat K, Winter RB, Cummine JL. Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children. Clin Orthop Relat Res 1984:35-45. [PMID: 6705397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In selected patients a method of rod insertion without fusion combined with use of a full-time external orthotic support, e.g., the Milwaukee brace, is effective. The orthopedic surgeon confronted with young children who have curves that do not respond to conservative treatment alone or in which bracing is contraindicated should find this procedure particularly suitable. The method allows for the expression of full growth potential while maintaining curve correction.
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50
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Cauchoix J, Lassale B, Deburge A, Kharrat K, Benoist M. [Degenerative lumbar stenosis (author's transl)]. Rev Chir Orthop Reparatrice Appar Mot 1981; 67:407-420. [PMID: 6456519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Sixty eight patients with degenerative lumbar stenosis have been operated on: 42 presented a degenerative spondylolisthesis (S.D) with predominantly central stenosis; while in 36 with arthrosic sciatica (S.A.), stenosis was rather lateral. In most cases clinical symptoms are different from those of disc herniation. Myelography with "amipaque" appears necessary to allow a really planified operation, with liberation of all the roots involved by bony compression. In these conditions, a high percentage of good results is obtained. Consequently, after failure of conservative treatment, open release of the compression is advisable, even in elderly patients. In some cases postero-lateral fusion should be performed in addition.
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