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Marty-Diloy T, Rougereau G, Mary P, Vialle R, Fitoussi F, Pietton R, Langlais T. Induced-membrane technique for lower limb reconstruction after malignant bone tumour resection in paediatric patients: Complication and re-operation rates. Orthop Traumatol Surg Res 2024:103875. [PMID: 38556207 DOI: 10.1016/j.otsr.2024.103875] [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: 04/28/2022] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 04/02/2024]
Abstract
BACKGROUND The objective of this study was to assess the complication and re-operation rates, evaluate the risk of non-union, and describe the functional outcomes at last follow-up in children and adolescents after lower-limb malignant tumour resection and reconstruction using the induced-membrane technique. HYPOTHESIS Weight-bearing resumption 6 weeks after the second stage of the induced-membrane procedure promotes bone healing. MATERIAL AND METHODS The study included 13 patients (9 with osteosarcoma, 3 with Ewing's sarcomas, and 1 with alveolar sarcoma) managed between 2000 and 2020 by oncological femoral or tibial resection followed, at a distance from adjuvant chemotherapy, by reconstruction using the induced-membrane technique. Non-union was the primary outcome measure and the MusculoSkeletal Tumor Society (MSTS) lower-limb functional score was the secondary outcome measure. Mean follow-up was 6.1 years (range, 2.0-12.7). At last follow-up, mean age was 18.1 years (range, 11.0-26.0) and the mean MSTS score was 66.6% (37.0-93.0%). RESULTS After the second reconstruction stage, 8 complications developed in 6 patients (46%). Either a complication or limb-length inequality required 12 re-operations in 8 patients (61.5%). Non-union occurred after reconstruction in 5 (38.5%) patients. Early resumption of 50% weight-bearing 6 weeks after reconstruction was associated with bone healing (p=0.02). CONCLUSION The non-union rate was 38.5%. Partial, 50% weight-bearing with two elbow crutches and an orthosis, if allowed by construct stability, may promote bone healing. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Thibault Marty-Diloy
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Grégoire Rougereau
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Service de chirurgie orthopédique et traumatologique, hôpital Pitié Salpêtrière, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Pierre Mary
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Raphael Vialle
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département hospitalo-universitaire MAMUTH pour les thérapies innovantes dans les maladies musculo-squelettiques, université de la Sorbonne, Paris, France
| | - Franck Fitoussi
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Raphael Pietton
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Service de chirurgie orthopédique et traumatologique, hôpital Pitié Salpêtrière, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Tristan Langlais
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département d'orthopédie pédiatrique, hôpital des enfants, Purpan, université de Toulouse, Toulouse, France.
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Marie-Hardy L, Alvarez D, Pietton R, Mohsinaly Y, Bonaccorsi R, Pascal-Moussellard H. Kappa: Preliminary Results on a Novel Technique for Pelvic Fixation in Adult Spinal Deformity Correction. Indian J Orthop 2023; 57:1826-1832. [PMID: 37881294 PMCID: PMC10593650 DOI: 10.1007/s43465-023-00959-7] [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: 12/16/2022] [Accepted: 07/20/2023] [Indexed: 10/27/2023]
Abstract
Study Design Retrospective cohort study. Objectives Pelvic fixation in degenerative spinal deformation is as crucial as demanding. Several pelvic anchoring technics have been described, but loosening rates remain high for most solutions. Here is described the "Kappa" technic, combining ilio-sacral screws to S2A1 screws at 2 years of follow-up. Methods Thirteen patients that underwent a spinal deformity correction with "Kappa" fixation to the pelvis and with more than 2 years of follow-up were prospectively included in this study. The surgical technic is described, and clinical and radiographic data have been collected for all patients. Results The population exhibited an important pre-operative sagittal imbalance (mean SVA of 104,4 mm, mean PI-LL mismatch of 22,8°) that had improved significatively after surgery (mean SVA of 75,5 mm and mean PI-LL mismatch of 4,9°). No loosening of pull-out of the implants was to deplore at 2 years of follow-up. Conclusions The association of ilio-sacral screw, resistant to pull-out because of the traction axis perpendicular to the construct, to S2A1 screws, known to be effective in sagittal balance restoration seems to be an effective and safe option to pelvic fixation for adult spinal deformity correction. Level of Evidence IV.
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Affiliation(s)
- L. Marie-Hardy
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - D. Alvarez
- Department of Orthopaedic and Trauma Surgery, Dr. Exequiel Gonzales Cortez Hospital, Santiago, Chile
| | - R. Pietton
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Y. Mohsinaly
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - R. Bonaccorsi
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - H. Pascal-Moussellard
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Khalifé M, Marie-Hardy L, Vafadar S, Pietton R, Duray C, Guigui P, Ferrero E. Validation of the Total Disability Index (TDI) in French Version. Orthop Traumatol Surg Res 2023; 109:103311. [PMID: 35523373 DOI: 10.1016/j.otsr.2022.103311] [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: 05/13/2021] [Revised: 08/24/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The Total Disability Index (TDI) questionnaire has been developed to provide a more complete assessment of low back and neck pain, as they frequently co-occur. This study aimed at validating the TDI questionnaire in French, to determine if it could be used in France. HYPOTHESIS The TDI French version is valid, reproducible and comparable to the English version. METHODS This multicentric study prospectively included French-speaking volunteers, both patients admitted for spine surgery in two specialized spine centers and healthy individuals. Healthy subjects were recruited among students of an engineering school and medical staff. A booklet was given to the participants containing a Lumbar and Cervical Visual Analog Scale (respectively LVAS and CVAS), and the French versions of Oswestry Disability Index (ODI), Neck Disability Index (NDI) and TDI questionnaires. Statistical analysis included Cronbach's α calculation for internal consistency assessment, correlation analysis with ODI and NDI items for convergent validity, principal component analyses and factor analysis. Discriminant validity was assessed by comparing healthy subjects and patients using Student's t tests, and floor and ceiling effects search. RESULTS 71 participants were included, with 34 (48%) healthy volunteers and 37 (52%) patients. Mean age was 45.2±19.6 years and 57% of the cohort were males. Internal consistency was good: Cronbach's α was calculated at 0.96 (95%CI: [0.95-0.98]). For each TDI item, a high correlation was found with ODI corresponding items, between 0.81 and 0.97 (p<0.001), and good correlation with NDI items, ranging from 0.65 to 0.96 (p<0.001). TDI correlated also with LVAS and CVAS (respectively 0.70 and 0.65, p<0.001). Principal component analyses indicated good correlation between the TDI items and between each item and TDI total score. Factor analysis indicated two main factors explaining 77% of TDI variance, constituted by all TDI items. Regarding discriminative validity, healthy subjects and patients presented significantly different TDI scores (p-values ≤0.01 for each item). Barplot representations of each TDI item revealed no major floor nor ceiling effects. CONCLUSION This study confirms the reliability, feasibility and validity of the Total Disability Index questionnaire in its French version. Its validation allows its use in France. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Marc Khalifé
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université de Paris, Paris, France.
| | - Laura Marie-Hardy
- Orthopaedic Surgery Unit, Pitié-Salpêtrière University Hospital, Assistance Publique - Hôpitaux de Paris, 47, Boulevard de l'hôpital, 75013 Paris, France; Faculté de Médecine, Sorbonne Université, Paris, France
| | - Saman Vafadar
- Institut de Biomécanique Humaine Georges Charpak Arts et Métiers Institute of Technology, Paris, France
| | - Raphael Pietton
- Orthopaedic Surgery Unit, Pitié-Salpêtrière University Hospital, Assistance Publique - Hôpitaux de Paris, 47, Boulevard de l'hôpital, 75013 Paris, France; Faculté de Médecine, Sorbonne Université, Paris, France
| | - Cédric Duray
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université de Paris, Paris, France
| | - Pierre Guigui
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université de Paris, Paris, France
| | - Emmanuelle Ferrero
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université de Paris, Paris, France
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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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Rougereau G, Marty-Diloy T, Pietton R, Koneazny C, Fitoussi F, Vialle R, Mary P, Langlais T. Forearm reconstruction by induced-membrane technique after sarcoma resection in children: technique and functional outcome in three cases. Hand Surg Rehabil 2021; 40:799-803. [PMID: 34171528 DOI: 10.1016/j.hansur.2021.06.007] [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: 02/23/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
Forearm sarcoma is rare in children. Here, we report three cases. One child presented undifferentiated soft-tissue sarcoma involving the ulna, another had Ewing's sarcoma of the ulna, and the third had Ewing's sarcoma of the proximal radius. In the first case, there were episodes of iterative aseptic nonunion, treated surgically. At last follow-up (respectively 11, 9 and 8 years postoperatively), the mean Musculoskeletal Tumor Society (MSTS) score was 80%, 90% and 77% respectively, and all cases were in remission. The induced membrane technique to reconstruct bone defect after sarcoma resection in children is a possible limb-salvage strategy.
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Affiliation(s)
- G Rougereau
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - T Marty-Diloy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - R Pietton
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - C Koneazny
- The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - F Fitoussi
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - R Vialle
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - P Mary
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - T Langlais
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Department of Pediatric Orthopedics, Purpan Hospital, 330 Avenue de Grande Bretagne, 31300 Toulouse, France.
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Gaume M, Pietton R, Vialle R, Chaves C, Langlais T. Is daily walking distance affected in adolescent idiopathic scoliosis? An original prospective study using the pedometer on smartphones. Arch Pediatr 2020; 27:333-337. [PMID: 32563619 DOI: 10.1016/j.arcped.2020.04.002] [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: 10/23/2019] [Revised: 12/02/2019] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND DATA Little is known about daily walking distance levels, which accounts for approximately 80% of overall physical activity per day, in adolescents with idiopathic scoliosis (AIS). OBJECTIVE The aim of this study was to assess the level of walking distance in AIS treated by bracing or not, comparing this activity with that of a control group. We used an original method based on smartphone pedometers for studying walking distance in everyday life. METHODS Nineteen AIS patients, aged 14.1 (13-17) years, and 25 asymptomatic patients, aged 12.9 (12-14) years were included prospectively. The 19 AIS cases comprised 9 untreated individuals and 10 with ongoing night brace treatment. The mean walking distance per day as estimated by the pedometer application on smartphones for 2 months was assessed. Weekly sports activities (hours per week) were also reported. RESULTS During the first month, the mean walking distance was 2.58±0.65 km/day for control patients, 2.31±1.38 km/day for untreated AIS, and 3.65±0.72 km/day for AIS patients treated with a night brace. During the second month, the mean walking distance was 2.60±0.73 km/day for control patients, 2.40±1.41 km/day for untreated AIS, and 3.70±0.72 km/day for AIS patients treated with a night brace. Statistical analysis between groups showed a statistically significant difference with a higher level of daily walking distance in adolescents treated with a night brace compared with other groups. CONCLUSION The pedometer on smartphones is a cost-effective and friendly tool to assess adolescents' level of walking distance. Our results indicate no restriction in terms of daily walking distance between adolescents without scoliosis and those with idiopathic scoliosis. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- M Gaume
- Sorbonne Médecine University, Department of Pediatric Orthopaedics, Armand Trousseau Hospital, 26, avenue du Dr Arnold Netter, 75571 Paris cedex 12, France
| | - R Pietton
- Sorbonne Médecine University, Department of Pediatric Orthopaedics, Armand Trousseau Hospital, 26, avenue du Dr Arnold Netter, 75571 Paris cedex 12, France
| | - R Vialle
- Sorbonne Médecine University, Department of Pediatric Orthopaedics, Armand Trousseau Hospital, 26, avenue du Dr Arnold Netter, 75571 Paris cedex 12, France; The MAMUTH Hospital-University Department for Innovative Therapies in Musculoskeletal Diseases - Armand Trousseau Hospital, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - C Chaves
- Sorbonne Médecine University, Department of Pediatric Orthopaedics, Armand Trousseau Hospital, 26, avenue du Dr Arnold Netter, 75571 Paris cedex 12, France
| | - T Langlais
- Sorbonne Médecine University, Department of Pediatric Orthopaedics, Armand Trousseau Hospital, 26, avenue du Dr Arnold Netter, 75571 Paris cedex 12, France; University of Toulouse, Paul Sabatier, Department of Orthopedics, Children's Hospital, CHU de Toulouse, France.
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Pietton R, Bouloussa H, Vergari C, Skalli W, Vialle R. Rib Cage Measurement Reproducibility Using Biplanar Stereoradiographic 3D Reconstructions in Adolescent Idiopathic Scoliosis. J Pediatr Orthop 2020; 40:36-41. [PMID: 31815860 DOI: 10.1097/bpo.0000000000001095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 02/07/2023]
Abstract
BACKGROUND A reproducibility study of preoperative rib cage three-dimensional (3D) measurements was conducted for patients with Adolescent Idiopathic Scoliosis (AIS). No prior reliability study has been performed for preoperative 3D reconstructions of the rib cage by using stereoradiography in patients with preoperative AIS. Our objective was to assess the reliability of rib cage 3D reconstructions using biplanar stereoradiography in patients with AIS before surgery. METHODS This series includes 21 patients with Lenke 1 or 2 scoliosis (74±20 degrees). All patients underwent low-dose standing biplanar radiographs. Two operators performed reconstructions twice each. Intraoperator repeatability, interoperator reproducibility, and intraclass coefficients (ICC) were calculated and compared between groups. RESULTS The average rib cage volume was 4.71 L (SD±0.75 L). Two SD was 0.19 L with a coefficient of variation of 4.1%; ICC was 0.968. The thoracic index was 0.6 (SD±0.1). Two SD was 0.03 with a coefficient of variation of 4.7% and a ICC of 0.820. As for the Spinal Penetration Index (6.4%; SD±2.4), 2SD was 0.9% with a coefficient of variation of 14.3% and a ICC of 0.901. The 3D rib hump 2SD (average 27±8 degrees) was 1.4 degrees. The coefficient of variation and ICC were respectively 5.1% and 0.991. CONCLUSIONS Three-dimensional reconstruction of the rib cage using biplanar stereoradiography is a reliable method to estimate preoperative thoracic parameters in patients with AIS. LEVEL OF EVIDENCE Level IV-diagnostic study.
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Affiliation(s)
- Raphael Pietton
- Department of Pediatric Orthopedic, Armand Trousseau Hospital, Paris 6 University, France
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, Paris, France
| | - Houssam Bouloussa
- Department of Pediatric Orthopedic, Armand Trousseau Hospital, Paris 6 University, France
| | - Claudio Vergari
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, Paris, France
- School of Physics and Astronomy, University of Exeter, Exeter, UK
| | - Wafa Skalli
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, Paris, France
| | - Raphael Vialle
- Department of Pediatric Orthopedic, Armand Trousseau Hospital, Paris 6 University, France
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Vergari C, Chanteux L, Pietton R, Langlais T, Vialle R, Skalli W. Shear wave elastography of lumbar annulus fibrosus in adolescent idiopathic scoliosis before and after surgical intervention. Eur Radiol 2019; 30:1980-1985. [PMID: 31834510 DOI: 10.1007/s00330-019-06563-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To determine lumbar intervertebral disc properties with shear wave elastography in adolescent idiopathic scoliotic (AIS) patients before and after surgery, and compare them with asymptomatic controls. METHODS Twenty-five severe AIS patients with an indication for fusion surgery (15 ± 1.5 years old, the Cobb angle ranging between 40 and 93°) and fifty-nine asymptomatic adolescents (13 ± 2 years old) were included prospectively. Shear wave speed (SWS) was measured in the annulus fibrosus of L3-L4, L4-L5, and L5-S1 discs of each subject. In AIS patients, measurements took place before surgery, and 3 months (N = 13) or 1 year after (N = 12). RESULTS No difference was observed between disc levels in any group. When pooling disc levels, SWS was significantly higher in preop AIS patients (4.0 ± 0.5 m/s) than in asymptomatic subjects (3.1 ± 0.5 m/s, p < 0.0001). SWS decreased 3 months postop (3.5 ± 0.3 m/s), and it decreased further towards normal values 1 year after (3.3 ± 0.4 m/s). SWS in preop AIS patients tended to decrease with the Cobb angle (Spearman's rho = - 0.4, p = 0.05). CONCLUSION Shear wave elastography measurements showed that discs in AIS patients were altered relative to asymptomatic ones, and this alteration tended to normalize 1 year post fusion surgery. Further studies should aim at determining if bracing of mild scoliosis has an effect on disc properties. KEY POINTS • Shear wave elastography shows alteration of annulus fibrosus in adolescent idiopathic scoliosis. • Disc elastography tends to normalize 1 year after surgery.
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Affiliation(s)
- Claudio Vergari
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France.
| | - Lucas Chanteux
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France.,Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, 75571, Paris, France
| | - Raphael Pietton
- Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, 75571, Paris, France
| | - Tristan Langlais
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France.,Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, 75571, Paris, France
| | - Raphael Vialle
- Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris 6, 75571, Paris, France
| | - Wafa Skalli
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
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Le Hanneur M, Pfister G, Bachy M, Pietton R, Vialle R, Fitoussi F. Magnetically controlled growing rods in severe radial club hand congenital deformities. Hand Surg Rehabil 2019; 39:72-74. [PMID: 31730915 DOI: 10.1016/j.hansur.2019.10.194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/14/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Affiliation(s)
- M Le Hanneur
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - G Pfister
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - M Bachy
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - R Pietton
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - R Vialle
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - F Fitoussi
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
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Vergari C, Courtois I, Ebermeyer E, Pietton R, Bouloussa H, Vialle R, Skalli W. Answer to the Letter to the Editor of Weiss HR et al. concerning "Head to pelvis alignment of adolescent idiopathic scoliosis patients both in and out of brace" by Vergari C, Courtois I, Ebermeyer E, Pietton R, Bouloussa H, Vialle R, Skalli W (Eur Spine J; 2019: https://doi.org/10.1007/s00586-019-05981-8). Eur Spine J 2019; 28:2226. [PMID: 31321543 DOI: 10.1007/s00586-019-06070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Claudio Vergari
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Isabelle Courtois
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
| | - Eric Ebermeyer
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
| | - Raphael Pietton
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
| | - Houssam Bouloussa
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
| | - Raphael Vialle
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
| | - Wafa Skalli
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France
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Debono B, Corniola MV, Pietton R, Sabatier P, Hamel O, Tessitore E. Benefits of Enhanced Recovery After Surgery for fusion in degenerative spine surgery: impact on outcome, length of stay, and patient satisfaction. Neurosurg Focus 2019; 46:E6. [DOI: 10.3171/2019.1.focus18669] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/17/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVEEnhanced Recovery After Surgery (ERAS) proposes a multimodal, evidence-based approach to perioperative care. Thanks to the improvement in care protocols and the fluidity of the patient pathway, the first goal of ERAS is the improvement of surgical outcomes and patient experience, with a final impact on a reduction in the hospital length of stay (LOS). The implementation of ERAS in spinal surgery is in the early stages. The authors report on their initial experience in applying an ERAS program to several degenerative spinal fusion procedures.METHODSThe authors selected two 2-year periods: the first from before any implementation of ERAS principles (pre-ERAS years 2012–2013) and the second corresponding to a period when the paradigm was applied widely (post-ERAS years 2016–2017). Patient groups in these periods were retrospectively compared according to three degenerative conditions requiring fusion: anterior cervical discectomy and fusion (ACDF), anterior lumbar interbody fusion (ALIF), and posterior lumbar fusion. Data were collected on patient demographics, operative and perioperative data, LOSs, 90-day readmissions, and morbidity. ERAS-trained nurses were involved to support patients at each pre-, intra-, and postoperative step with the help of a mobile application (app). A satisfaction survey was included in the app.RESULTSThe pre-ERAS group included 1563 patients (159 ALIF, 749 ACDF, and 655 posterior fusion), and the post-ERAS group included 1920 patients (202 ALIF, 612 ACDF, and 1106 posterior fusion). The mean LOS was significantly shorter in the post-ERAS group than in the pre-ERAS group for all three conditions. It was reduced from 6.06 ± 1.1 to 3.33 ± 0.8 days for the ALIF group (p < 0.001), from 3.08 ± 0.9 to 1.3 ± 0.7 days for the ACDF group (p < 0.001), and from 6.7 ± 4.8 to 4.8 ± 2.3 days for posterior fusion cases (p < 0.001). There was no significant difference in overall complications between the two periods for the ALIF (11.9% pre-ERAS vs 11.4% post-ERAS, p = 0.86) and ACDF (6.0% vs 8.2%, p = 0.12) cases, but they decreased significantly for lumbar fusions (14.8% vs 10.9%, p = 0.02). Regarding satisfaction with overall care among 808 available responses, 699 patients (86.5%) were satisfied or very satisfied, and regarding appreciation of the mobile e-health app in the perceived optimization of care management, 665 patients (82.3%) were satisfied or very satisfied.CONCLUSIONSThe introduction of the ERAS approach at the authors’ institution for spinal fusion for three studied conditions resulted in a significant decrease in LOS without causing increased postoperative complications. Patient satisfaction with overall management, upstream organization of hospitalization, and the use of e-health was high. According to the study results, which are consistent with those in other studies, the whole concept of ERAS (primarily reducing complications and pain, and then reducing LOS) seems applicable to spinal surgery.
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Affiliation(s)
- Bertrand Debono
- 1Department of Neurosurgery, CAPIO-Clinique des Cèdres, Cornebarrieu, France; and
| | - Marco V. Corniola
- 2Department of Neurosurgery, Spine Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Raphael Pietton
- 1Department of Neurosurgery, CAPIO-Clinique des Cèdres, Cornebarrieu, France; and
| | - Pascal Sabatier
- 1Department of Neurosurgery, CAPIO-Clinique des Cèdres, Cornebarrieu, France; and
| | - Olivier Hamel
- 1Department of Neurosurgery, CAPIO-Clinique des Cèdres, Cornebarrieu, France; and
| | - Enrico Tessitore
- 2Department of Neurosurgery, Spine Unit, Geneva University Hospitals, Geneva, Switzerland
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Bouloussa H, Pietton R, Vergari C, Haen TX, Skalli W, Vialle R. Biplanar stereoradiography predicts pulmonary function tests in adolescent idiopathic scoliosis: a cross-sectional study. Eur Spine J 2019; 28:1962-1969. [DOI: 10.1007/s00586-019-05940-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/02/2019] [Indexed: 11/25/2022]
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