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Solla F, Ilharreborde B, Blondel B, Prost S, Bauduin E, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Lamas V, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Kerckhove MV, Lebhar J, Giorgi H, Faure A, Sauleau EA, Pesenti S, Charles YP. Can Lumbopelvic Parameters Be Used to Predict Thoracic Kyphosis at all Ages? A National Cross-Sectional Study. Global Spine J 2024; 14:1116-1124. [PMID: 36282728 DOI: 10.1177/21925682221134039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN National cross-sectional study. OBJECTIVE Thoracic kyphosis (TK) is related to sagittal parameters as pelvic tilt (PT), lumbar lordosis (LL) and pelvic incidence (PI). The equation TK = 2 (PT+LL-PI) was validated for adolescents. The purpose of this study was to investigate if this equation correctly predicts TK regardless of age. METHODS Sagittal alignment parameters were assessed on full spine radiographs of 2599 individuals without spine pathology (1488 females, 1111 males). Calculated TK (CTK) = 2 (PT+LL-PI) and measured TK (MTK) were compared by calculating the gap and using a linear regression between both parameters. Subgroup analyses were performed for gender, age, TK groups (≤20°, 21°-40°, 41°-60°, >60°), and PI groups (<45°, 45°-60°, >60°). RESULTS Average values in the total population were: MTK 45.0°, CTK 36.9°. Average TK gap was 8.1°, 5.2° in females (intercept 11.7, slope .61) and 11.9° in males (intercept 7.1, slope .58). The mean gap was 3.6° for 15-34 years, 5.7° under 15 years and it increased progressively after 35 years with a maximum of 19.9° over 80 years. The gap also increased with the amount of MTK: -3.5° for TK<20° up to 17.3° for TK >60°. Differences in gaps were minor between PI groups. The intercept was smallest and slopes >.6 for PI <45° and TK ≤20°. CONCLUSION The formula TK=2 (PT+LL-PI) yielded moderate accuracy for adolescents and young adults, but did not fit for over 35 years and under 15. The amount and variance in TK increased in elderly subjects, which made the formula less accurate.
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Affiliation(s)
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Île-de-France, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Solène Prost
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Vincent Lamas
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, France
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Georges Naïm Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Vincent Fière
- Unité du Rachis, Centre Orthopédique Santy, Hôpital privé Jean Mermoz Ramsay Santé, Lyon, France
| | - Michiel Vande Kerckhove
- Unité du Rachis, Centre Orthopédique Santy, Hôpital privé Jean Mermoz Ramsay Santé, Lyon, France
| | - Jonathan Lebhar
- Institut Locomoteur de l'Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, France
| | | | | | - Erik A Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, France
| | - Sébastien Pesenti
- Service d'Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
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Pizones J, Moreno-Manzanaro L, Pupak A, Núñez-Pereira S, Larrieu D, Boissiere L, Richner-Wunderlin S, Loibl M, Zulemyan T, Yücekul A, Zgheib S, Charles YP, Chang DG, Kleinstueck F, Obeid I, Alanay A, Sánchez Pérez-Grueso FJ, Pellisé F. Reliability of a New Digital Tool for Photographic Analysis in Quantifying Body Asymmetry in Scoliosis. J Clin Med 2024; 13:2114. [PMID: 38610880 PMCID: PMC11012662 DOI: 10.3390/jcm13072114] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Advancements in non-ionizing methods for quantifying spinal deformities are crucial for assessing and monitoring scoliosis. In this study, we analyzed the observer variability of a newly developed digital tool for quantifying body asymmetry from clinical photographs. Methods: Prospective observational multicenter study. Initially, a digital tool was developed using image analysis software, calculating quantitative measures of body asymmetry. This tool was integrated into an online platform that exports data to a database. The tool calculated 10 parameters, including angles (shoulder height, axilla height, waist height, right and left waistline angles, and their difference) and surfaces of the left and right hemitrunks (shoulders, waists, pelvises, and total). Subsequently, an online training course on the tool was conducted for twelve observers not involved in its development (six research coordinators and six spine surgeons). Finally, 15 standardized back photographs of adolescent idiopathic scoliosis patients were selected from a multicenter image bank, representing various clinical scenarios (different age, gender, curve type, BMI, and pre- and postoperative images). The 12 observers measured the photographs at two different times with a three-week interval. For the second round, the images were randomly mixed. Inter- and intra-observer variabilities of the measurements were analyzed using intraclass correlation coefficients (ICCs), and reliability was measured by the standard error of measurement (SEM). Group comparisons were made using Student's t-test. Results: The mean inter-observer ICC for the ten measurements was 0.981, the mean intra-observer ICC was 0.937, and SEM was 0.3-1.3°. The parameter with the strongest inter- and intra-observer validity was the difference in waistline angles 0.994 and 0.974, respectively, while the highest variability was found with the waist height angle 0.963 and 0.845, respectively. No test-retest differences (p > 0.05) were observed between researchers (0.948 ± 0.04) and surgeons (0.925 ± 0.05). Conclusion: We developed a new digital tool integrated into an online platform demonstrating excellent reliability and inter- and intra-observer variabilities for quantifying body asymmetry in scoliosis patients from a simple clinical photograph. The method could be used for assessing and monitoring scoliosis and body asymmetry without radiation.
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Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.M.-M.); (F.J.S.P.-G.)
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.M.-M.); (F.J.S.P.-G.)
| | - Anika Pupak
- Spine Research Unit, Vall d’Hebron Institute of Research, 08035 Barcelona, Spain;
| | - Susana Núñez-Pereira
- Spine Surgery Unit, Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain (F.P.)
| | - Daniel Larrieu
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | - Louis Boissiere
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | | | - Markus Loibl
- Department of Orthopedics, Schulthess Klinik, 8008 Zurich, Switzerland (M.L.); (F.K.)
| | - Tais Zulemyan
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | - Altug Yücekul
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | - Sara Zgheib
- Spine Surgery Unit, University Hospital Strasbourg, 67000 Strasbourg, France; (S.Z.); (Y.P.C.)
| | - Yann Philippe Charles
- Spine Surgery Unit, University Hospital Strasbourg, 67000 Strasbourg, France; (S.Z.); (Y.P.C.)
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, 01757 Seoul, Republic of Korea;
| | - Frank Kleinstueck
- Department of Orthopedics, Schulthess Klinik, 8008 Zurich, Switzerland (M.L.); (F.K.)
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain (F.P.)
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Baroncini A, Boissiere L, Yilgor C, Larrieu D, Alanay A, Pellisé F, Kleinstueck F, Pizones J, Charles YP, Roscop C, Bourghli A, Obeid I. Primary Pelvic Anteversion: Definition, Relevance And History After Surgery for Adult Spine Deformity. Spine (Phila Pa 1976) 2024:00007632-990000000-00604. [PMID: 38407226 DOI: 10.1097/brs.0000000000004971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVE To identify the best definition of primary anteverted pelvis in the setting of adult spine deformity (ASD), and to investigate whether this is a pathologic setting that requires surgical correction. SUMMARY OF BACKGROUND DATA While pelvic retroversion has been thoroughly investigated, pelvic anteversion (AP) is a far lesser discussed topic. Four different AP definitions have been proposed, and AP has been described as a normal or pathologic entity by different authors. METHODS All patients consulting for ASD at the five participating sites were included. Firstly, the four definitions of AP were compared with descriptive statistics (anatomic method - Pelvic Tilt <0°; Relative Pelvic Version method - RPV >5°; Roussouly method - Pelvic Incidence (PI)<50° and Sacral Slope (SS)>35°); low PT method - PT/PI <25th percentile). Secondly a subgroup analysis among operated AP patients with a two-year follow-up was performed. Complication rate, radiographic parameters and clinical scores (ODI, SF-36) were compared in a multivariate analysis between patients who did and did not maintain an AP at the 2-year follow-up. RESULTS 1163 patients were available for the first analysis. The RPV method appeared to be the most appropriate to define AP in ASD patient. For the second analysis, data on 410 subjects were available, and most of them were young adults with idiopathic scoliosis that did not require pelvic fixation. AP patients who maintained an AP after ASD surgery presented comparable radiographic and clinical outcomes to the patients who presented a normo/retroverted pelvis after surgery. CONCLUSIONS According to the results of the presented study, the RPV method is the most appropriate to define primary AP, which is not a pathologic condition and is most often observed in young adults with idiopathic scoliosis. Anteverted pelvis does not require direct surgical correction in this patient group.
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Affiliation(s)
- Alice Baroncini
- Department of Orthopaedics and Trauma Surgery, RWTH Uniklinik Aachen, Germany
| | - Louis Boissiere
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Bruges Cedex, France
| | - Caglar Yilgor
- Spine Center, Acibadem University School of Medicine, Istanbul, Turkey
| | - Daniel Larrieu
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Ahmet Alanay
- Spine Center, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Vall D'Hebron Hospital, Barcelona, Spain
| | | | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | - Cecile Roscop
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Anouar Bourghli
- Spine surgery department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Bruges Cedex, France
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Gavotto A, Risser A, Séverac F, Charles YP. Influence of age and severity of Lenke 5 or 6 idiopathic scoliosis on postoperative quality of life in adult patients. Orthop Traumatol Surg Res 2023:103742. [PMID: 37913868 DOI: 10.1016/j.otsr.2023.103742] [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: 03/04/2023] [Revised: 07/26/2023] [Accepted: 08/25/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Thoracolumbar adolescent idiopathic scoliosis can continue to progress beyond skeletal maturity. Ideal timing of surgery remains undefined. Earlier intervention, with shorter instrumentation, incurs early partial loss of lumbar motion. Waiting for progression incurs a greater risk of extensive arthrodesis. The aim of the present study was to assess the quality-of-life impact of age and scoliosis severity at surgery. MATERIAL AND METHODS Patients with Lenke 5 or 6 adolescent idiopathic scoliosis, aged 16-45years, were analyzed based on a prospective clinical registry. Oswestry Disability Index (ODI) and Scoliosis Research Society (SRS)-22 scores were collected preoperatively and at 6months, 1year and 2years. Coronal and sagittal alignments were measured on full-spine radiographs, and curve flexibility was assessed on bending radiographs. A mixed linear model was used to assess the impact of age, Cobb angle and flexibility on quality of life. RESULTS Thirty-six patients were included. Mean ODI was 20.5% preoperatively and 13.8% at 2years (p=0.017). Mean SRS-22 was 3.2 preoperatively and 3.9 at 2years (p<0.001). Mean Cobb angle was 56.6° preoperatively and 23.2° at 2years (p<0.001), with mean preoperative reducibility of 68.1%. Age and ODI correlated preoperatively (r=0.6; p<0.001) and at 6months (r=0.5; p=0.002), as did age and SRS-22 (r=-0.6; p<0.001 and r=-0.6; p<0.001, respectively). Linear regression found a significant negative correlation between thoracolumbar Cobb angle and change in SRS-22 at 6months. DISCUSSION In 16-45 year-olds with Lenke 5 or 6 idiopathic scoliosis, age influenced SRS-22 score. Younger patients had better quality of life both pre- and post-operatively. Curve magnitude influenced postoperative score. The present study suggests that early surgical correction in younger patients, where instrumentation can be shorter, does not impair quality of life. LEVEL OF EVIDENCE IV; prospective registry study.
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Affiliation(s)
- Amandine Gavotto
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Faculté de Médecine, Maïeutique et Sciences de la Santé, Université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Service de Neurochirurgie, Hôpital Pasteur 2, Université Nice Côte d'Azur, 30, voie Romaine, 06000 Nice, France.
| | - Anthony Risser
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Faculté de Médecine, Maïeutique et Sciences de la Santé, Université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - François Séverac
- Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg Cedex, France
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Faculté de Médecine, Maïeutique et Sciences de la Santé, Université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
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Pereira P, Park Y, Arzoglou V, Charles YP, Krutko A, Senker W, Park SW, Franke J, Fuentes S, Bordon G, Song Y, He S, Vialle E, Mlyavykh S, Varanda P, Hosszu T, Bhagat S, Hong JY, Vanhauwaert D, de la Dehesa P. Anterolateral versus posterior minimally invasive lumbar interbody fusion surgery for spondylolisthesis: comparison of outcomes from a global, multicenter study at 12-months follow-up. Spine J 2023; 23:1494-1505. [PMID: 37236367 DOI: 10.1016/j.spinee.2023.05.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/30/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND CONTEXT Several minimally invasive lumbar interbody fusion techniques may be used as a treatment for spondylolisthesis to alleviate back and leg pain, improve function and provide stability to the spine. Surgeons may choose an anterolateral or posterior approach for the surgery however, there remains a lack of real-world evidence from comparative, prospective studies on effectiveness and safety with relatively large, geographically diverse samples and involving multiple surgical approaches. PURPOSE To test the hypothesis that anterolateral and posterior minimally invasive approaches are equally effective in treating patients with spondylolisthesis affecting one or two segments at 3-months follow-up and to report and compare patient reported outcomes and safety profiles between patients at 12-months post-surgery. DESIGN Prospective, multicenter, international, observational cohort study. PATIENT SAMPLE Patients with degenerative or isthmic spondylolisthesis who underwent 1- or 2-level minimally invasive lumbar interbody fusion. OUTCOME MEASURES Patient reported outcomes assessing disability (ODI), back pain (VAS), leg pain (VAS) and quality of life (EuroQol 5D-3L) at 4-weeks, 3-months and 12-months follow-up; adverse events up to 12-months; and fusion status at 12-months post-surgery using X-ray and/or CT-scan. The primary study outcome is improvement in ODI score at 3-months. METHODS Eligible patients from 26 sites across Europe, Latin America and Asia were consecutively enrolled. Surgeons with experience in minimally invasive lumbar interbody fusion procedures used, according to clinical judgement, either an anterolateral (ie, ALIF, DLIF, OLIF) or posterior (MIDLF, PLIF, TLIF) approach. Mean improvement in disability (ODI) was compared between groups using ANCOVA with baseline ODI score used as a covariate. Paired t-tests were used to examine change from baseline in PRO for both surgical approaches at each timepoint after surgery. A secondary ANCOVA using a propensity score as a covariate was used to test the robustness of conclusions drawn from the between group comparison. RESULTS Participants receiving an anterolateral approach (n=114) compared to those receiving a posterior approach (n=112) were younger (56.9 vs 62.0 years, p <.001), more likely to be employed (49.1% vs 25.0%, p<.001), have isthmic spondylolisthesis (38.6% vs 16.1%, p<.001) and less likely to only have central or lateral recess stenosis (44.9% vs 68.4%, p=.004). There were no statistically significant differences between the groups for gender, BMI, tobacco use, duration of conservative care, grade of spondylolisthesis, or the presence of stenosis. At 3-months follow-up there was no difference in the amount of improvement in ODI between the anterolateral and posterior groups (23.2 ± 21.3 vs 25.8 ± 19.5, p=.521). There were no clinically meaningful differences between the groups on mean improvement for back- and leg-pain, disability, or quality of life until the 12-months follow-up. Fusion rates of those assessed (n=158; 70% of the sample), were equivalent between groups (anterolateral, 72/88 [81.8%] fused vs posterior, 61/70 [87.1%] fused; p=.390). CONCLUSIONS Patients with degenerative lumbar disease and spondylolisthesis who underwent minimally invasive lumbar interbody fusion presented statistically significant and clinically meaningful improvements from baseline up to 12-months follow-up. There were no clinically relevant differences between patients operated on using an anterolateral or posterior approach.
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Affiliation(s)
- Paulo Pereira
- Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Portugal; Department of Neurosurgery, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Rd, Hull HU3 2JZ, United Kingdom.
| | - Yung Park
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsangdong-gu, Goyang-si, Gyeonggi, 410-719, South Korea
| | - Vasileios Arzoglou
- Department of Neurosurgery, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Rd, Hull HU3 2JZ, United Kingdom
| | - Yann Philippe Charles
- Department of Spine Surgery, Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1 Avenue Molière, 67200 Strasbourg, France
| | - Aleksandr Krutko
- Department of Neurosurgery, Scientific Research Institute of Traumatology and Orthopedics, Academician Baykova house 8, 195427, St. Petersburg, Russia
| | - Wolfgang Senker
- Department of Neurosurgery, Kepler Universitätsklinikum Linz, Hospital Road 9, 4021, Linz, Upper Austria, Austria
| | - Seung Won Park
- Department of Neurological Surgery, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, South Korea
| | - Jörg Franke
- Department of Spine Surgery, Klinikum Magdeburg, Birkenallee 34, 39130 Magdeburg, Saxony-Aanhalt, Germany
| | - Stephane Fuentes
- Service de Neurochirurgie, La Timone, AP-HM, Rue Saint Pierre, 13005 Marseille, Bouches-du-Rhône, France
| | - Gerd Bordon
- Servicio Cirugia Ortopédica y Traumatología, Hospital de Manises, Avenida Generalitat Valenciana 50, 46940 Manises, Valencia, Spain
| | - Yueming Song
- Department of Orthopedics, West China Hospital Sichuan University, No.37 Guoxue Alley, Chengdu, Sichuan Province, PR. China
| | - Shisheng He
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301# Yanchang Road, Shanghai, 200072, PR China
| | - Emiliano Vialle
- Department of Orthopedics, Hospital Universitario Cajuru, Av. São José, 300 - Cristo Rei, Curitiba, PR 80050-350, Brazil
| | - Sergey Mlyavykh
- Trauma and Orthopedics Institute, Volga Research Medical University, Verhne-Voljskaya naberejnaya18, 603155 Nizhnii Novgorod, Russia
| | - Pedro Varanda
- Orthopedics Department, Hospital de Braga, R. das Comunidades Lusíadas 133, Braga, 4710-311 Portugal
| | - Tomáš Hosszu
- Department of Neurosurgery, Fakultní nemocnice Hradec Králové, Sokolská 581, 500 05 Hradec Králové - Nový, Hradec Králové, Czech Republic
| | - Shaishav Bhagat
- Department of Orthopaedic Surgery, East Suffolk and North Essex NHS Foundation Trust, Heath Road, Ipswich, IP4 5PD, Suffolk, United Kingdom
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, Gojan Dong, Danwon Gu, Ansan 425-707, South Korea
| | - Dimitri Vanhauwaert
- Department of neurosurgery, AZ Delta Roeselare-Menen-Torhout, Deltalaan 1, 8800 Roeselare, Belgium
| | - Paloma de la Dehesa
- Department of Neurosurgery-Spine Unit, Hospital Marqués de Valdecilla, Av. de Valdecilla, s/n, 39008 Santander, Cantabria, Spain
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Prost S, Blondel B, Bauduin E, Pesenti S, Ilharreborde B, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, Charles YP. Do Age-Related Variations Of Sagittal Alignment Rely On SpinoPelvic Organization? An Observational Study Of 1540 Subjects. Global Spine J 2023; 13:2144-2154. [PMID: 35191731 PMCID: PMC10538341 DOI: 10.1177/21925682221074660] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Descriptive radiographic analysis of a prospective multi-center database. OBJECTIVE This study aims to provide normative values of spinopelvic parameters and their correlations according to age and pelvic incidence (PI) of subjects without spinal deformity. METHODS After Institutional Review Board (IRB) approval, 1540 full spine radiographs were analyzed. Subjects were divided into 3 groups of PI: low PI < 45°, intermediate PI 45-60°, high PI > 60°, and then stratified by age (20-34, 35-49, 50-64, > 65 Y.O). Pelvic and spinal parameters were measured. Statistical analysis between parameters was performed using Bayesian inference and correlation. RESULTS Mean age was 53.5 years (845 females, 695 males, range 20-93 years).In low PI group, lumbar lordosis (LL) decrease was mainly observed in the 2 younger age groups.In medium and high PI groups, loss of lordosis was linear during aging and occurred mainly on the distal arch of lordosis. Moderate PI group had a stable lordosis apex and thoracolumbar inflection point. High PI group had a stable thoracolumbar inflection point and a more distal lordosis apex in elderly subjects.For all subjects, kyphosis and pelvic tilt (PT) increased with age.There was a constant chain of correlation between PI and age groups. Proximal lumbar lordosis (PLL) was correlated with kyphosis and sagittal vertical axis (SVA C7), while the distal lumbar lordosis (DLL) was correlated with PI and PT. CONCLUSION This study provides a detailed repository of sagittal spinopelvic parameters normative values with detailed analysis of segmental kyphosis and lordosis distribution according to gender, age, and PI.
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Affiliation(s)
- Solène Prost
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de chirurgie rachidienne, France
| | - Benjamin Blondel
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de chirurgie rachidienne, France
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, France
| | - Sébastien Pesenti
- Service d’Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, France
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, France
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, France
| | - Federico Solla
- Service d’Orthopédie Pédiatrique, Fondation Lenval, Nice, France
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, France
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Georges Naïm Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Vincent Fière
- Unité du Rachis, Centre Orthopédique Santy, Lyon, France
| | | | - Matthieu Campana
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, France
| | - Jonathan Lebhar
- Institut Locomoteur de l’Ouest Rachis,Centre Hospitalier Privé Saint-Grégoire, France
| | | | | | - Erik A. Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, France
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - The French Spine Surgery Society (SFCR)
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de chirurgie rachidienne, France
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, France
- Service d’Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, France
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, France
- Hôpital Privé de l’Est Lyonnais, Saint-Priest, France
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Hôpital Privé du Dos Francheville, Périgueux, France
- Clinique du Dos Jean Villar, Bruges, France
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, France
- Service d’Orthopédie Pédiatrique, Fondation Lenval, Nice, France
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, France
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
- Unité du Rachis, Centre Orthopédique Santy, Lyon, France
- Institut Locomoteur de l’Ouest Rachis,Centre Hospitalier Privé Saint-Grégoire, France
- Institut Méditerranéen du Dos, Marseille, France
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, France
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
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Prost S, Giorgi H, Ould-Slimane M, Zairi F, Collinet A, D'astorg H, Szadkowski M, Litrico S, Gennari A, Grelat M, Parent H, Fuentes S, Charles YP, Blondel B. Surgical management of isthmic spondylolisthesis: A comparative study of postoperative outcomes between ALIF and TLIF. Orthop Traumatol Surg Res 2023; 109:103560. [PMID: 36702299 DOI: 10.1016/j.otsr.2023.103560] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 11/18/2022] [Accepted: 12/05/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Circumferential fusion by the anterior (ALIF) or transforaminal (TLIF) approach combined with posterior instrumentation is currently used for the surgical treatment of low-grade isthmic spondylolisthesis. But few studies have compared the clinical and radiological outcomes of various interbody fusion techniques. The objective of this study was to compare the clinical and radiological results at 2 years postoperative of two fusion techniques-TLIF versus ALIF plus posterior instrumentation-for low-grade isthmic spondylolisthesis in adults. MATERIALS AND METHODS This was an observational multicenter study done at nine French healthcare facilities specialized in spine surgery. The inclusion criteria were minimum age of 18 years, grade 1-3 isthmic spondylolisthesis, ALIF+posterior fixation (ALIF+PS) or TLIF, minimum follow-up of 2 years. Clinical and radiological evaluations were done preoperatively and at 2 years of follow-up. A lumbar CT scan was done at 1 year postoperative to evaluate fusion. RESULTS The cohort consisted of 89 patients (50 women, 39 men) with a mean age of 47.7±12.3 (18-79) years. The patients in the ALIF groups (n=71) had a significantly longer hospital stay than those in the TLIF group (n=18): 5.7 days versus 4.6 days (p=.04). However, their medical leave from work was significantly shorter: 31.0 weeks versus 40.7 (p=.003). Lumbar pain VAS diminished faster in the ALIF groups, with a significantly larger drop than the TLIF group in the first 3 months postoperative. Only the increase in lumbar disc lordosis was larger in the ALIF group: 11.7°±12.0° versus 6.0°±11.7° (p=.036). There was a significant correlation between the increase in global lordosis and reduction in lumbar VAS at 2 years postoperative (ρ=-0.3295; p=.021). CONCLUSION ALIF+PS provides a faster relief of postoperative low back pain than TLIF but there are no significant clinical differences between techniques at 2 years of follow-up. Despite better restoration of disc lordosis in the ALIF+PS group, there was no difference in the restoration of global lordosis. LEVEL OF EVIDENCE III; multicenter comparative study.
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Affiliation(s)
- Solène Prost
- Aix-Marseille université, AP-HM, CNRS, ISM, CHU Timone, unité de chirurgie rachidienne, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Hadrien Giorgi
- Institut méditerranéen du Dos, 232, avenue du Prado, 13008 Marseille, France
| | - Mourad Ould-Slimane
- Service de chirurgie orthopédique, CHU de Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - Fahed Zairi
- Centre de neurochirurgie du bois, 44, avenue Marx Dormoy, 59000 Lille, France
| | - Arnaud Collinet
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, université de Strasbourg, 5, avenue Molière, 67200 Strasbourg, France
| | - Henri D'astorg
- Centre orthopédique Santy, 24, avenue Paul Santy, 69008 Lyon, France
| | - Marc Szadkowski
- Centre orthopédique Santy, 24, avenue Paul Santy, 69008 Lyon, France
| | - Stéphane Litrico
- Service de neurochirurgie, CHU de Nice, 30, voie Romaine, 06000 Nice, France
| | - Antoine Gennari
- Service de neurochirurgie, CHU de Nice, 30, voie Romaine, 06000 Nice, France
| | - Michael Grelat
- Clinique du parc, 155, boulevard de Stalingrad, 69006 Lyon, France
| | - Henry Parent
- Centre du rachis, clinique Saint Léonard, 6, rue de Bellinière, 49800 Trélazé, France
| | - Stéphane Fuentes
- Aix-Marseille université, AP-HM, CNRS, ISM, CHU Timone, unité de chirurgie rachidienne, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Yann Philippe Charles
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, université de Strasbourg, 5, avenue Molière, 67200 Strasbourg, France
| | - Benjamin Blondel
- Aix-Marseille université, AP-HM, CNRS, ISM, CHU Timone, unité de chirurgie rachidienne, 264, rue Saint-Pierre, 13005 Marseille, France.
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Lamas V, Chapon R, Prost S, Blondel B, Fuentes S, Sauleau EA, Charles YP. Variation of cervical sagittal alignment parameters according to age and pelvic incidence in degenerative spinal deformity patients. Eur Spine J 2023; 32:3624-3633. [PMID: 37505278 DOI: 10.1007/s00586-023-07861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/05/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION In asymptomatic subjects, variations of cervical sagittal alignment parameters according to age and spinopelvic organization have been reported. A large range of compensation phenomena has been observed in degenerative spinal deformity in order to maintain horizontal gaze, but it remains unclear how age and spinopelvic morphology could additionally influence cervical alignment. The aim of this observational retrospective study was to describe the distribution of cervical sagittal alignment parameters according to age and pelvic incidence in subjects with and without degenerative spinal deformity in order to precisely evaluate cervical compensation phenomena in adult spinal deformity (ASD). MATERIAL AND METHODS Radiographs of 478 subjects (327 females and 151 males) were distributed into 235 asymptomatic and 243 deformed subjects. Occipito-cervical parameters were McGregor-C1, McGregor-C2, C1-C2 and occipito-C2 angles. The cervicothoracic inflection point (CTIP) was determined. Caudal cervical sagittal alignment parameters were: C2-C7 lordosis, C2-apex (superior arch), apex-CTIP (inferior arch), occipito-C3 and occipito-C4 angles, C7-slope and T1-slope. The distribution of parameters was analyzed using a Bayesian inference (significant when Pr > 0.975 or Pr < 0.025). Comparisons between asymptomatic and deformed subjects were done after matching on age (40-60 years; > 60 years) and on PI (< 45°; 45-60°; > 60°). RESULTS Among occipito-cervical parameters, there was no significant change in McGregor-C1 angle. However, McGregor-C2 angle was significantly higher in the ASD group (Pr = 0.0029), with influence of age (Pr = 0.023), but PI influence. C1-C2 lordosis was significantly higher in the ASD group compared to the asymptomatic group (Pr < 0.0007), without influence of age or PI noticed. C2-C7 lordosis was also higher in the ASD group (Pr < 0.025) with a role of age and PI (Pr < 0.025). Cervical lordosis in the superior arch was significantly higher in the ASD group (Pr > 0.999), without influence of age or PI. In the inferior arch, the lordosis angle was not modified according to the group, but there was an influence of age (Pr < 0.0007). C7-slope and T1-slope were higher according the age group (Pr < 0.0012), without influence of the group or PI. CONCLUSION This observational study highlights cervical sagittal alignment adaptations in degenerative spinal deformity, matched on age and pelvic incidence. The inferior cervical spine seemed to be modified with a higher lordosis, increasing with age responding to the age-related thoracic kyphosis increase. In addition to that, the superior cervical spine hyperextends more in adult degenerative deformity to maintain horizontal gaze. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vincent Lamas
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France.
| | - Renan Chapon
- Service de Neurochirurgie, Centre Hospitalier Universitaire Dijon-Bourgogne, Dijon, France
| | - Solène Prost
- Unité de Chirurgie Rachidienne, Centre Hospitalier Universitaire de La Timone, Aix-Marseille Université, Marseille, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, Centre Hospitalier Universitaire de La Timone, Aix-Marseille Université, Marseille, France
| | - Stéphane Fuentes
- Service de Neurochirurgie, Centre Hospitalier Universitaire de La Timone, Aix-Marseille Université, Marseille, France
| | - Erik André Sauleau
- Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
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Saad M, Arfa M, Attia A, Lamas V, Sauleau EA, Charles YP. Proximal and distal mechanical repercussions of instrumentation by double rods and interbody grafts in adult scoliosis. Orthop Traumatol Surg Res 2023; 109:103544. [PMID: 36621636 DOI: 10.1016/j.otsr.2023.103544] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/08/2022] [Accepted: 09/22/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Correction of adult scoliosis by instrumentation with double rods and interbody grafts aims to reduce the risk of pseudarthrosis with rod fracture. An increase in instrumentation rigidity can lead to an increase in stresses at the proximal and distal ends of the construct. The aim of this study was to analyze the incidence and clinical repercussions of proximal junctional kyphosis (PJK), proximal junctional failure (PJF) and iliac screw loosening. MATERIEL AND METHODS An analysis of patients operated on for adult scoliosis with instrumentation to the pelvis using 4 rods and interbody cages was carried out from a prospective register. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Scoliosis Research Society 22 (SRS-22) clinical scores and radiological parameters were collected preoperatively, postoperatively at 3 months, 1 year and 2 years. The appearance of PJK, PJF or distal screw loosening was sought; the clinical impact and the risk factors were analyzed by Bayesian inference. RESULTS Fifty-one patients with a mean age of 64.5 years were included. The clinical scores improved significantly (Pr>0.95) at 2 years: VAS back 6.9 versus 2.6, VAS leg 4.9 versus 2.5, ODI 48.2 versus 25.4, SRS-22 2.4 versus 3.5. The radiological parameters were corrected (Pr>0.95): Cobb angle 63.9° versus 22.8°, spinosacral angle (SSA) 112.4° versus 118.8°, T1-pelvic angle (TPA) 24, 8° versus 20.8°, lumbar lordosis 43.8° versus 51.0°, thoracic kyphosis 45.2° versus 53.6°. Thirteen patients (25.5%) presented with PJK and 11 (21.6%) with PJF. Seven patients (13.7%) presented with iliac screw loosening. None of these complications was associated with a significant deterioration in clinical scores. Cranial migration of the lumbar apex increased the risk of distal screw loosening: Odds-Ratio 10.31 (Pr>0.999). Two patients were re-operated on for PJF and one patient for iliac screw loosening (5.9%). No rod fracture with pseudarthrosis was found. CONCLUSION Instrumentation with double rods and interbody grafts was associated with a rate of 47.1% of mechanical repercussions at the extremity of the construct. However, these complications were not associated with a significant deterioration in clinical scores. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Maxime Saad
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, hôpital Nord, boulevard de la Chantourne, université Grenoble Alpes, 38700 la Tronche, Grenoble, France.
| | - Maher Arfa
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Aymen Attia
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Vincent Lamas
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Erik André Sauleau
- Service de santé publique, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, Place de l'hôpital, 67091 Strasbourg cedex, France
| | - Yann Philippe Charles
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
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Collinet A, Ntilikina Y, Romani A, Schuller S, Sauleau EA, Charles YP. Psychopathological profile and sagittal alignment in low-back pain. Orthop Traumatol Surg Res 2023; 109:103474. [PMID: 36347460 DOI: 10.1016/j.otsr.2022.103474] [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: 09/29/2021] [Revised: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Low-back pain requires comprehensive care using a biopsychosocial model. The psychologic dimension plays an important role, but the link between sagittal alignment and a given psychopathological profile is little studied. The aim of this study was to analyze the psychopathological profiles and sagittal parameters of a population with low-back pain and to assess the link. MATERIAL AND METHODS 205 patients, with a mean age of 49.6 years (range, 18-70 years), presenting chronic common low-back pain without radicular involvement, were included prospectively. Mood scores comprised: the self-administered "Hospital Anxiety and Depression Scale" (HAD), Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D) and Young Mania Rating Scale (YMRS). Radiological parameters, measured on lateral full-spine radiographs, included: L1-S1 lordosis, T1-T12 kyphosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA), T1 slope, and Roussouly type. RESULTS Mean HAM-A score was 16.1; 54% of patients had scores ≥14, indicating anxiety disorder. Mean HAM-D score was 10.8; 55% of patients had scores ≥10, indicating depressive disorder. Mean YMRS score was 2.6; only 1 patient had a score ≥20, indicating manic disorder. The 112 patients with HAM-A score >14 showed mean 51.6° L1-S1 lordosis (p=0.356), 48.3° T1-T12 kyphosis (p=0.590), -4.3mm C7 SVA (p=0.900), and 29.3° T1 slope (p=0.451). In case of HAM-A <14, there were no significant differences. The 113 patients with HAM-D score >10 showed significant differences in T1-T12 kyphosis (mean 49.0°; p<0.05) and T1 slope (30.2°; p<0.05); mean L1-S1 lordosis was 50.5° (p=0.861) and C7 SVA 1.6mm (p=0.462). In case of HAM-D <10, T1-T12 kyphosis was 45.5° (p<0.05) and T1 slope 26.2° (p<0.05); mean lordosis was 50.9° (p=0.861) and mean C7 SVA -7.1mm (p=0.259). Multivariate analysis found no significant link between Roussouly type and psychiatric scores: HAD (p=0.715), HAM-A (p=0.652), and HAM-D (p=0.902). CONCLUSION More than 50% of patients with common low-back pain presented a mood disorder. Depressive disorder was associated with greater T1-T12 kyphosis and T1 slope. There was no relationship between psychiatric scores and overall sagittal alignment. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Arnaud Collinet
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, université de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France.
| | - Yves Ntilikina
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, université de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
| | - Aude Romani
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, université de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
| | - Sébastien Schuller
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, université de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
| | - Erik-André Sauleau
- Pôle santé publique, hôpitaux universitaires de Strasbourg, université de Strasbourg, Strasbourg, France
| | - Yann Philippe Charles
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, université de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
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Pesenti S, Charles YP, Prost S, Solla F, Blondel B, Ilharreborde B. Spinal Sagittal Alignment Changes During Childhood: Results of a National Cohort Analysis of 1,059 Healthy Children. J Bone Joint Surg Am 2023; 105:676-686. [PMID: 36947631 DOI: 10.2106/jbjs.22.00977] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND In the past decades, it has been recognized that sagittal alignment of the spine is crucial. Although the evolution of spinal alignment with growth has previously been described, there are no data for key parameters such as the exact shapes (extent and magnitude) of spinal curvatures. The goals of this study were therefore to determine normative values of spinopelvic sagittal parameters and to explore their variation during growth, based on the analysis of a large national cohort of healthy children. METHODS The radiographic data of 1,059 healthy children were analyzed in a retrospective, multicenter study. Full spine radiographs were used to measure several sagittal parameters, such as pelvic parameters, T1-T12 thoracic kyphosis (TK), and L1-S1 lumbar lordosis (LL). TK was divided into proximal, middle, and distal parts, and LL was divided into proximal and distal parts. Patients were stratified into 5 groups according to skeletal maturity (based on age, Risser stage, and triradiate cartilage status). RESULTS During growth, pelvic incidence increased from 40° to 46° and pelvic tilt increased from 4° to 9° (p < 0.05), whereas sacral slope remained constant. The peak of change in pelvic parameters occurred at the beginning of pubertal growth in Group 2 (the first part of the pubertal growth spurt). TK slightly increased among groups from 39° to 41° (p = 0.005), with the peak of change occurring in Group 4 (pubertal growth deceleration). LL increased from 51° to 56° (p < 0.001), with the peak of change occurring in Group 3 (the second part of the pubertal growth spurt). Segmental analysis revealed that most of the TK and LL changes occurred in the distal TK and proximal LL, with the other parts remaining constant. CONCLUSIONS This is one of the largest studies showing changes in sagittal alignment with growth in normal children and adolescents. We found that changes in spinal shape were cascading phenomena. At the beginning of the growth peak, pelvic incidence increased. This change in pelvic morphology led to an increase in LL, involving its proximal part. Finally, TK increased, in its distal part, at the end of pubertal growth. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sébastien Pesenti
- Service d'Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Solène Prost
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Federico Solla
- Service d'Orthopédie Pédiatrique, Fondation Lenval, Nice, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Infantile, CHU Robert Debré, AP-HP, Université de Paris, Paris, France
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Charles YP, Lamas V, Ntilikina Y. Artificial intelligence and treatment algorithms in spine surgery. Orthop Traumatol Surg Res 2023; 109:103456. [PMID: 36302452 DOI: 10.1016/j.otsr.2022.103456] [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: 11/28/2021] [Revised: 05/12/2022] [Accepted: 05/25/2022] [Indexed: 12/24/2022]
Abstract
Artificial intelligence (AI) is a set of theories and techniques in which machines are used to simulate human intelligence with complex computer programs. The various machine learning (ML) methods are a subtype of AI. They originate from computer science and use algorithms established from analyzing a database to accomplish certain tasks. Among these methods are decision trees or random forests, support vector machines along with artificial neural networks. Convolutive neural networks were inspired from the visual cortex; they process combinations of information used in image or voice recognition. Deep learning (DL) groups together a set of ML methods and is useful for modeling complex relationships with a high degree of abstraction by using multiple layers of artificial neurons. ML techniques have a growing role in spine surgery. The main applications are the segmentation of intraoperative images for surgical navigation or robotics used for pedicle screw placement, the interpretation of images of intervertebral discs or full spine radiographs, which can be automated using ML algorithms. ML techniques can also be used as aids for surgical decision-making in complex fields, such as preoperative evaluation of adult spinal deformity. ML algorithms "learn" from large clinical databases. They make it possible to establish the intraoperative risk level and make a prognosis on how the postoperative functional scores will change over time as a function of the patient profile. These applications open a new path relative to standard statistical analyses. They make it possible to explore more complex relationships with multiple indirect interactions. In the future, AI algorithms could have a greater role in clinical research, evaluating clinical and surgical practices, and conducting health economics analyses.
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Affiliation(s)
- Yann Philippe Charles
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France.
| | - Vincent Lamas
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Yves Ntilikina
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
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Smajic S, Vujadinovic A, Kasapovic A, Aldakheel DA, Charles YP, Walter A, Steib JP, Maffulli N, Migliorini F, Baroncini A. The influence of total disc arthroplasty with Mobidisc prosthesis on lumbar spine and pelvic parameters: a prospective in vivo biomechanical study with a minimum 3 year of follow-up. J Orthop Surg Res 2022; 17:456. [PMID: 36243710 PMCID: PMC9571419 DOI: 10.1186/s13018-022-03352-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/06/2022] [Indexed: 11/22/2022] Open
Abstract
Background This study examined the impact of Mobidisc implant on spinopelvic parameters, with particular focus on the preservation of the lumbar lordosis (LL) and on the segmental lordosis (SL) of the treated and adjacent segments.
Methods A prospective study was conducted on 63 consecutive patients with symptomatic degenerative disc disease who underwent Mobidisc implantation at the Clinic for Spinal Diseases in Strasbourg, France. Based on the profile images of the whole, the following static spinopelvic parameters were measured and analysed: lumbar lordosis L1-S1 (LL), SL for L3-L4, L4-L5 and L5-S1, sacral slope (SS), pelvic tilt (PT) and pelvic incidence. In the lumbar spine images, the anterior (ADH) and posterior disc height (PDH) were measured prior to surgery and at the different follow-up appointments. The preoperative and postoperative values were compared and statistically analysed at different time intervals.
Results Sixty-three patients were included in the study. The average age of the patients was 41.4 years (range 27–59 years). The mean follow-up was 44 months (range 36–71 months). Overall, total disc replacement (TDR) led to an increase in LL which increased TED over time. The preoperative LL measured 48.9° ± 10.1° and 53.4° ± 9.9° at 3 years follow-up (p < 0.0001). In the cohort of patients who underwent TDR at L4-5, the LL increased from 51.6° ± 10° to 56.2° ± 9.2° at the last FU (p = 0.006). All other spinopelvic parameters remained stable between the preoperative values and the last follow-up. In the patients who underwent L5-S1 TDR, a significant increase in LL was also observed between preoperative data and at the last FU (from 47.8° ± 10.1° to 53.3° ± 10.1°, p < 0.0001). Following L5-S1 TDR, the SS increased from 32.9° ± 8.3° to 35.6° ± 7.4° (p = 0.05) and the PT decreased from 15.4° ± 6.2° to 11.6° ± 5.7° between preoperative values and the last follow-up. Considering the entire cohort, the SL L5-S1 increased significantly from 5.9° ± 4.2° preoperatively to 8.1° ± 4.4° (p < 0.01) at the last FU, while at the L4-L5 level, the SL remained stable from 9.9 ± 4.5° to 10.7° ± 3.8° (p = 0.3). After L4-5 TDR, an increase in ADH and PDH at the treated level was observed, while these parameters progressively decreased in the adjacent segment. In patients who underwent L5-S1 TDR, a significant increase in L5-S1 ADH and PDH was observed from 18.8 ± 9.1 to 28.4 ± 11.1 and from 9.5 ± 3.8 to 17.6 ± 9.5 pixels, respectively. ADH and PDH at the proximal adjacent levels L3-4 and L4-5 were reduced. We did not observe any case of implant failure or damage to the bone/implant interface. Conclusion TDR with Mobidisc allows for an improvement of LL and SL at the treated level. An increase in both anterior and posterior disc height was observed at the treated level. While disc height decreased at the adjacent level, further studies are required to investigate whether these changes are clinically relevant.
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Affiliation(s)
- Samir Smajic
- Department of Orthopedic, Trauma and Spine Surgery, St. Josef Hospital, Linnich, Germany
| | - Aleksandar Vujadinovic
- Department of Orthopedic and Trauma Surgery, Tuzla University Hospital, Tuzla, Bosnia and Herzegovina.,Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France.,Department of Orthopedic Surgery, Imam Abdulrahman Bin Faisal University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - Adnan Kasapovic
- Department of Orthopedic and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | - Dakheel A Aldakheel
- Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France.,Department of Orthopedic Surgery, Imam Abdulrahman Bin Faisal University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - Yann Philippe Charles
- Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - Axel Walter
- Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - Jean-Paul Steib
- Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, ST4 7QB, England, UK.,Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, England, UK
| | - Filippo Migliorini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany. .,Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany.
| | - Alice Baroncini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
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Ntilikina Y, Collinet A, Tigan LV, Fabacher T, Steib JP, Charles YP. Comparison of open versus minimally invasive surgery in the treatment of thoracolumbar metastases. Orthop Traumatol Surg Res 2022; 108:103274. [PMID: 35331924 DOI: 10.1016/j.otsr.2022.103274] [Citation(s) in RCA: 3] [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: 11/13/2020] [Revised: 04/12/2021] [Accepted: 07/07/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Minimally invasive surgery (MIS) techniques have been developed for the surgical treatment of thoracolumbar spinal metastases to reduce the morbidity associated with the operation. The purpose of our study was to compare the mean length of stay, change in pain levels, neurological symptoms, complications and survival after open versus MIS surgery. MATERIAL AND METHODS This is a single-center retrospective study based on a register of patients treated for vertebral metastases between January 2014 and October 2016. The collection included demographic data, cancer-related data, clinical data, the characteristics of the surgery, the length of stay, assessment of pain and the occurrence of death. These data were compared between open and MIS surgery groups. RESULTS Out of 59 patients, 35 were treated with open surgery and 24 were treated with MIS surgery. The two groups were comparable in terms of age, gender and body mass index. Breast, kidney, prostate and lung cancers were the most frequent primary tumors. Prognostic and instability scores were comparable. Short- and medium-term pain assessment showed comparable results. Median survival was 208 days in the open surgery group and 224days in the MIS group (p=0.5299). CONCLUSION MIS techniques aim to limit the surgical approach and allow a faster introduction of adjuvant treatments than after open surgery. Our study did not find any differences between open and MIS surgery in terms of pain, neurological evolution or survival time in patients treated for thoracolumbar spinal metastases. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Yves Ntilikina
- Spine Surgery Department, Hôpitaux Universitaires de Strasbourg, Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France.
| | - Arnaud Collinet
- Spine Surgery Department, Hôpitaux Universitaires de Strasbourg, Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France; Faculty of Medicine, Midwifery and Health Sciences, Université of Strasbourg, 4, rue Kirschleger, 67085 Strasbourg Cedex, France
| | - Leonardo Viorel Tigan
- Spine Surgery Department, Hôpitaux Universitaires de Strasbourg, Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
| | - Thibault Fabacher
- Public Health Department, Hôpitaux Universitaires de Strasbourg, 1, place de l'hôpital, B.P. 426, 67091 Strasbourg Cedex, France
| | - Jean-Paul Steib
- Spine Surgery Department, Hôpitaux Universitaires de Strasbourg, Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France; Faculty of Medicine, Midwifery and Health Sciences, Université of Strasbourg, 4, rue Kirschleger, 67085 Strasbourg Cedex, France
| | - Yann Philippe Charles
- Spine Surgery Department, Hôpitaux Universitaires de Strasbourg, Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France; Faculty of Medicine, Midwifery and Health Sciences, Université of Strasbourg, 4, rue Kirschleger, 67085 Strasbourg Cedex, France
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Charles YP, Prost S, Pesenti S, Ilharreborde B, Bauduin E, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, Blondel B. Variation of cervical sagittal alignment parameters according to gender, pelvic incidence and age. Eur Spine J 2022; 31:1228-1240. [PMID: 34989876 DOI: 10.1007/s00586-021-07102-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 09/30/2021] [Revised: 12/03/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim was to describe radiographic cervical sagittal alignment variations according to age, gender and pelvic incidence (PI) and to investigate relationships with thoracic alignment. METHODS A total of 2599 individuals (5-93 years) without spinal deformity were studied. Cranial cervical parameters were: McGregor slope, occipita-C2 angle, McGregor-C2 lordosis and C1-C2 lordosis. Caudal cervical parameters were: C2-C7, cranial arch and caudal arch lordosis and C7- and T1-slope. A Bayesian inference compared parameter distributions. Correlations with spinopelvic and global alignment parameters were investigated. RESULTS Among cranial cervical parameters, variations of McGregor slope were non-significant. McGregor-C2 lordosis and C1-C2 lordosis were smaller in males and increased significantly during growth, whereas the occipito-C2 angle decreased (Pr > 0.95). The occipito-C2 angle was larger and McGregor-C2 lordosis was smaller in low PI (Pr > 0.95). Among caudal cervical parameters, C2-C7 lordosis and C7- and T1-slope were larger in males and increased after 50 years (Pr > 0.95). Lordosis changes were non-significant in the cranial arch, whereas values increased in the caudal arch after 35 years (Pr > 0.95). Caudal parameter differences were non-significant between PI groups. Strong correlations existed between C2-C7, caudal arch lordosis, C7-slope, T1-slope and thoracic kyphosis. The sagittal vertical axis C2 correlated with caudal arch lordosis and T1-slope (ρ > 0.5; Pr > 0.95). CONCLUSION Cervical alignment parameters vary according to age, gender and PI. In the cranial cervical spine, changes occur mainly during growth. In the caudal cervical spine, lordosis increases in the caudal arch, which is related to thoracic kyphosis increase with age. The caudal cervical arch acts as a compensatory segment by progressive extension, allowing horizontal gaze.
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Affiliation(s)
- Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France.
| | - Solène Prost
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Sébastien Pesenti
- Service d'Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris, France
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Federico Solla
- Service d'Orthopédie Pédiatrique, Fondation Lenval, Nice, France
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, Bordeaux, France
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Georges Naïm Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Vincent Fière
- Centre Orthopédique Santy, Unité du Rachis, Lyon, France
| | | | - Matthieu Campana
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris, France
| | - Jonathan Lebhar
- Institut Locomoteur de L'Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire, France
| | | | | | - Erik André Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
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Charles YP, Prost S, Pesenti S, Ilharreborde B, Bauduin E, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, Blondel B. Correction to: Variation of cervical sagittal alignment parameters according to gender, pelvic incidence and age. Eur Spine J 2022; 31:1330. [PMID: 35301583 DOI: 10.1007/s00586-022-07170-6] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France.
| | - Solène Prost
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Sébastien Pesenti
- Service d'Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris, France
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Federico Solla
- Service d'Orthopédie Pédiatrique, Fondation Lenval, Nice, France
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, Bordeaux, France
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Georges Naïm Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Vincent Fière
- Centre Orthopédique Santy, Unité du Rachis, Lyon, France
| | | | - Matthieu Campana
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris, France
| | - Jonathan Lebhar
- Institut Locomoteur de L'Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire, France
| | | | | | - Erik André Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
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Ludwig J, Jakobsen RB, Charles YP, Seifert J, Incoll I, Wood ML, Parmar D, Canter R. What it takes to become an orthopaedic surgeon: A comparison of orthopaedic surgical training programmes in 10 countries focusing on structure and fellowship requirements. Int J Surg 2021; 95:106150. [PMID: 34715383 DOI: 10.1016/j.ijsu.2021.106150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/28/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The quality of surgical training has been highlighted as one of the most important patient safety issues in the future. Training surgeons and supporting them to do their best should be considered integral in providing optimum and safe care for the individual patient and the best possible return on investment in training medical professionals. In 2011, an international consensus statement defined fundamental principles for surgical training. PURPOSE This study examines orthopaedic surgical training to explore the similarities and differences in the requirements for trainees to obtain board certification in ten countries. METHODS Countries of the Commonwealth Health Care Comparison: Canada, the United Kingdom, the United States of America, Australia, New Zealand, Germany, France, the Netherlands, Norway and Switzerland were chosen to be compared. The relevant information was extracted from official information from authorities and administrative bodies. RESULTS The study revealed significant differences in duration, organisation and assessment of training. So-called "competency-based" training is not featured in every country, and the manner of its implementation is variable. In particular, the numbers in surgical cases required to be accredited varies by country ranging from 1260 (UK) to 340 (Norway). CONCLUSION Despite the recommendation in 2011 for some degree of uniformity across surgical training in industrialised countries, evidence suggests wide variation in the training programmes which is likely to be a concern in both quality of training as well as present and future patient safety.
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Affiliation(s)
- Johanna Ludwig
- BG Klinikum, Unfallkrankenhaus Berlin, Germany Kellogg College, University of Oxford, Oxford, United Kingdom Department of orthopedic surgery, Department of Health Management and Health Economics, Akershus University hospital and Institute of Health and Society, University Oslo, OSLO, Norway Hôpitaux Universitaires de Strasbourg, Department of Spine Surgery, Faculté de Médecine, Université de Strasbourg, France Department of Traumatology, University medicine, Universitätsmedizin Greifswald, University Greifswald, Greifswald, Germany University of Newcastle, District Clinical Director of Surgery; Clinical Lead, Quality & Innovation - Central Coast Local Health District, Graduate Programs in Surgical Education -University of Melbourne, Australia Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
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Baldairon F, Charles YP, Eichler D, Ntilikina Y, Sauleau EA, Steib JP. Analysis of factors associated with sagittal alignment deterioration after correction of degenerative scoliosis by in situ contouring. Orthop Traumatol Surg Res 2021; 107:103023. [PMID: 34332144 DOI: 10.1016/j.otsr.2021.103023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/18/2020] [Accepted: 06/01/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In situ contouring is one of the surgical techniques used for scoliosis reduction. The initial correction could change over time, with deterioration of the sagittal balance. The purpose of this study was to analyze the loss of correction after degenerative lumbar scoliosis surgery using in situ contouring. MATERIALS AND METHODS Full spine radiographs of 73 patients (mean age 63.3 years, mean follow-up 27 months) were analyzed before surgery, after surgery, and at the final follow-up. The following radiographic parameters were measured: C2-C7 lordosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic tilt, pelvic incidence, sacral slope, SVA C7, SVA C2, Cobb angle. Bayesian inference was used to compare the changes in these parameters. A probability>0.95 was considered as a significant change. RESULTS After surgery, lumbar lordosis increased from -28.4° to -37.8° (probability 0.999), then decreased to -32.1° at the final follow-up (probability 0.953). Thoracic kyphosis increased from 29.6° to 37.4° after surgery (probability 1.00) and continued to increase to 41.6° at the final follow-up (probability 0.999). SVA C7 increased from 38.5mm to 62.3mm (probability 0.999) and pelvic tilt from 19.4° to 25.1° (probability 1.00) during the follow-up period. Ten patients had to be reoperated because of a surgical site infection. Infection (14%) was associated with an increase of SVA C7 (probability 0.989) and thoracic kyphosis (probability 0.987). Nonunion (16%) was associated with a decrease in lumbar lordosis (probability 0.756). CONCLUSION Correction of degenerative lumbar scoliosis by in situ contouring resulted in sagittal balance correction; however, some of this correction was lost during the follow-up period. The main risk factors were deep wound infection and nonunion. LEVEL OF EVIDENCE IV, Retrospective study.
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Affiliation(s)
- Florent Baldairon
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, Avenue Molière, 67200 Strasbourg, France.
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, Avenue Molière, 67200 Strasbourg, France
| | - David Eichler
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, Avenue Molière, 67200 Strasbourg, France
| | - Yves Ntilikina
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, Avenue Molière, 67200 Strasbourg, France
| | - Erik André Sauleau
- Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, Place de l'hôpital, B.P. 426, 67091 Strasbourg Cedex, France
| | - Jean-Paul Steib
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, Avenue Molière, 67200 Strasbourg, France
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Lamas V, Charles YP, Tuzin N, Steib JP. Comparison of degenerative lumbar scoliosis correction and risk for mechanical failure using posterior 2-rod instrumentation versus 4-rod instrumentation and interbody fusion. Eur Spine J 2021; 30:1965-1977. [PMID: 33993350 DOI: 10.1007/s00586-021-06870-9] [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: 11/19/2020] [Accepted: 05/02/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Four-rod instrumentation and interbody fusion may reduce mechanical complications in degenerative scoliosis surgery compared to 2-rod instrumentation. The purpose was to compare clinical results, sagittal alignment and mechanical complications with both techniques. METHODS Full spine radiographs were analysed in 97 patients instrumented to the pelvis: 58 2-rod constructs (2R) and 39 4-rod constructs (4R). Clinical scores (VAS, ODI, SRS-22, EQ-5D-3L) were assessed preoperatively, at 3 months, 1 year and last follow-up (average 4.2 years). Radiographic measurements were: thoracic kyphosis, lumbar lordosis, spinopelvic parameters, segmental lordosis distribution. The incidence of non-union and PJK were investigated. RESULTS All clinical scores improved significantly in both groups between preoperative and last follow-up. In the 2R-group, lumbar lordosis increased to 52.8° postoperatively and decreased to 47.0° at follow-up (p = 0.008). In the 4R-group, lumbar lordosis increased from 46.4 to 52.5° postoperatively and remained at 53.4° at follow-up. There were 8 (13.8%) PJK in the 2R-group versus 6 (15.4%) in the 4R-group, with a mismatch between lumbar apex and theoretic lumbar shape according to pelvic incidence. Non-union requiring revision surgery occurred on average at 26.9 months in 28 patients (48.3%) of the 2R-group. No rod fracture was diagnosed in the 4R-group. CONCLUSION Multi-level interbody fusion combined with 4-rod instrumentation decreased risk for non-union and revision surgery compared to select interbody fusion and 2-rod instrumentation. The role of additional rods on load sharing still needs to be determined when multiple cages are used. Despite revision surgery in the 2R group, final clinical outcomes were similar in both groups. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vincent Lamas
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France.
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
| | - Nicolas Tuzin
- Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
| | - Jean-Paul Steib
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
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Barrey CY, di Bartolomeo A, Barresi L, Bronsard N, Allia J, Blondel B, Fuentes S, Nicot B, Challier V, Godard J, Marinho P, Kouyoumdjian P, Lleu M, Lonjon N, Freitas E, Berthiller J, Charles YP. C1-C2 Injury: Factors influencing mortality, outcome, and fracture healing. Eur Spine J 2021; 30:1574-1584. [PMID: 33635376 DOI: 10.1007/s00586-021-06763-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND C1-C2 injury represents 25-40% of cervical injuries and predominantly occurs in the geriatric population. METHODS A prospective multicentre study was conducted under the aegis of the french spine surgery society (SFCR) investigating the impact of age, comorbidities, lesion type, and treatment option on mortality, complications, and fusion rates. RESULTS A total of 417 patients were recruited from 11 participating centres. The mean ± SD age was 66.6 ± 22 years, and there were 228 men (55%); 5.4% presented a neurological deficit at initial presentation. The most frequent traumatic lesion was C2 fracture (n = 308). Overall mortality was 8.4%; it was 2.3% among those aged ≤ 60 years, 5.0% 61-80 years, and 16.0% > 80 years (p < 0.001). Regarding complications, 17.8% of patients ≤ 70 years of age presented with ≥ 1 complication versus 32.3% > 70 years (p = 0.0009). The type of fracture did not condition the onset of complications and/or mortality (p > 0.05). The presence of a comorbidity was associated with a risk factor for both death (p = 0.0001) and general complication (p = 0.008). Age and comorbidities were found to be independently associated with death (p < 0.005). The frequency of pseudoarthrosis ranged from 0 to 12.5% up to 70 years of age and then constantly and progressively increased to reach 58.6% after 90 years of age. CONCLUSIONS C1-C2 injury represents a serious concern, possibly life-threatening, especially in the elderly. We found a major impact of age and comorbidities on mortality, complications, and pseudarthrosis; injury pattern or treatment option seem to have a minimal effect.
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Affiliation(s)
- C Y Barrey
- Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France.
- Laboratory of Biomechanics, ENSAM, Arts et Metiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France.
| | - A di Bartolomeo
- Division of Neurosurgery, Department of Neurology and Psychiatry, Sapienza University, Roma, Italy
| | - L Barresi
- Department of Spine Surgery, Institut Universitaire de L'appareil Locomoteur Et du Sport, CHU de Nice, Hopital Pasteur 2, 30 voie Romaine, 06001, Nice, France
| | - N Bronsard
- Department of Spine Surgery, Institut Universitaire de L'appareil Locomoteur Et du Sport, CHU de Nice, Hopital Pasteur 2, 30 voie Romaine, 06001, Nice, France
| | - J Allia
- Department of Spine Surgery, Institut Universitaire de L'appareil Locomoteur Et du Sport, CHU de Nice, Hopital Pasteur 2, 30 voie Romaine, 06001, Nice, France
| | - B Blondel
- Department of Spine Surgery, CHU Timone, AP-HM, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - S Fuentes
- Department of Spine Surgery, CHU Timone, AP-HM, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - B Nicot
- Department of Neurosurgery, CHU de Grenoble, Avenue Maquis-du-Grésivaudan, 38700, Grenoble-La Tronche, France
| | - V Challier
- Department of Orthopaedic Surgery, Hôpital Tripode, CHU de Bordeaux, Place Amélie-Raba-Léon, 33076, Bordeaux cedex, France
| | - J Godard
- Department of Spine Surgery, Hôpital Jean-Minjoz, 3 boulevard A Fleming, 25030, Besançon, France
| | - P Marinho
- Department of Neurosurgery, Hôpital Roger-Salengro, CHRU de Lille, Rue Emile-Laine, 59037, Lille, France
| | - P Kouyoumdjian
- Department of Orthopaedic Surgery, CHU de Nîmes, Avenue du Pr Debré, 30000, Nîmes, France
| | - M Lleu
- Department of Neurosurgery, CHU de Dijon, 14 rue Paul Gaffarel, 21000, Dijon, France
| | - N Lonjon
- Department of Neurosurgery, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34090, Montpellier, France
| | - E Freitas
- Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France
| | - J Berthiller
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 Avenue Lacassagne, 69424, Lyon, France
| | - Y P Charles
- Department of Spine Surgery, Hopitaux Universitaires de Strasbourg, 1 place de l'Hopital, BP 426, 67091, Strasbourg, France
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Collinet A, Charles YP, Ntilikina Y, Tuzin N, Steib JP. Analysis of intervertebral discs adjacent to thoracolumbar A3 fractures treated by percutaneous instrumentation and kyphoplasty. Orthop Traumatol Surg Res 2020; 106:1221-1226. [PMID: 32888918 DOI: 10.1016/j.otsr.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 04/29/2020] [Accepted: 05/20/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Percutaneous instrumentation and kyphoplasty can be used to treat A3 fractures at T12-L1. However, the effect on adjacent intervertebral discs remains controversial. The purpose of this retrospective study was to analyze the degeneration of the discs adjacent to the fracture and to determine its relationship with age, vertebral body deformity and clinical scores. MATERIALS AND METHODS Twenty-nine patients (11 females, 18 males; average age 47 years, 27-63 years) were examined at 2.2 years' follow-up (2.0-2.5). Radiographic measurements were taken preoperatively, postoperatively, at follow-up: regional and local kyphosis, sagittal index, vertebral body compression ratio, and disc height index. The Pfirrmann grade was determined on an MRI taken at the final assessment. Clinical scores were the pain level (VAS), EQ-5D-3L, and ODI. The relationships between Pfirrmann grades, age and radiographic parameters were analyzed. RESULTS Local kyphosis decreased from 12.4° to 7.3° postoperatively (p<0.0001), increased to 8.4° after instrumentation removal (p=0.139) and remained stable at the last follow-up (p=0.891). The sagittal index decreased from 12.3° to 7.3° postoperatively (p<0.0001) increased to 8.3° before the instrumentation was removed (p=0.764) and increased to 10.6° (p<0.05) at the last follow-up. The vertebral body compression ratio decreased from 23% to 14% postoperatively (p<0.0001) and remained stable at 17% at the last follow-up (p=0.310). The cranial disc height index was 32% preoperatively, 31% postoperatively (p=0.073), 29% at 1year (p=0.650), and decreased again to 23% at 2 years (p<0.0001). There was a significant relationship between disc degeneration and age (p=0.015), local kyphosis (p=0.008) and vertebral body compression ratio (p=0.002). The disc adjacent to the fracture was more likely to have a higher Pfirrmann grade than the control disc above it (OR=269.5). At the final assessment, the average pain level was 2.3, the EQ-5D-3L was 0.862, and the ODI was 11.8%. There was no significant relationship between the Pfirrmann grades and the clinical scores. CONCLUSION The risk for cranial disc degeneration after percutaneous instrumentation and kyphoplasty of A3 fractures is low. The height of the cranial disc decreased after the instrumentation was removed. The risk for disc degeneration is related to age and vertebral body deformity. Disc degeneration does not appear to impact quality of life.
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Affiliation(s)
- Arnaud Collinet
- Spine surgery department, hôpitaux universitaires de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France.
| | - Yann Philippe Charles
- Spine surgery department, hôpitaux universitaires de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
| | - Yves Ntilikina
- Spine surgery department, hôpitaux universitaires de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
| | - Nicolas Tuzin
- Public health department, hôpitaux universitaires de Strasbourg Strasbourg, France
| | - Jean-Paul Steib
- Spine surgery department, hôpitaux universitaires de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
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Ntilikina Y, Charles YP, Persohn S, Skalli W. Influence of double rods and interbody cages on quasistatic range of motion of the spine after lumbopelvic instrumentation. Eur Spine J 2020; 29:2980-2989. [DOI: 10.1007/s00586-020-06594-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 12/19/2022]
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Prost S, Charles YP, Allain J, Barat JL, d'Astorg H, Delhaye M, Eap C, Zairi F, Guigui P, Ilharreborde B, Meyblum J, Le Huec JC, Lonjon N, Lot G, Hamel O, Riouallon G, Litrico S, Tropiano P, Blondel B. French Spine Surgery Society guidelines for management of spinal surgeries during COVID-19 pandemic. World J Clin Cases 2020; 8:1756-1762. [PMID: 32518767 PMCID: PMC7262704 DOI: 10.12998/wjcc.v8.i10.1756] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/27/2020] [Accepted: 05/16/2020] [Indexed: 02/05/2023] Open
Abstract
Since the outbreak of coronavirus disease 2019 (COVID-19) in December 2019 in China, various measures have been adopted in order to attenuate the impact of the virus on the population. With regard to spine surgery, French physicians are devoted to take place in the national plan against COVID-19, the French Spine Surgery Society therefore decided to elaborate specific guidelines for management of spinal disorders during COVID-19 pandemic in order to prioritize management of patients. A three levels stratification was elaborated with Level I: Urgent surgical indications, Level II: Surgical indications associated to a potential loss of chance for the patient and Level III: Non-urgent surgical indications. We also report French experience in a COVID-19 cluster region illustrated by two clinical cases. We hope that the guidelines formulated by the French Spine Surgery Society and the experience of spine surgeons from a cluster region will be helpful in order optimizing the management of patients with urgent spinal conditions during the pandemic.
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Affiliation(s)
- Solène Prost
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de Chirurgie Rachidienne, Marseille 13005, France
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Strasbourg 67200, France
| | | | - Jean-Luc Barat
- Service de Neurochirurgie, Hôpital privé Clairval – Ramsay santé, Marseille 13009, France
| | - Henri d'Astorg
- Unité de Chirurgie du Rachis, Centre Orthopédique Santy, Lyon 69008, France
| | | | - Chistophe Eap
- CHU Reims, Hôpital Maison Blanche, Neurochirurgie, Reims 51100, France
| | - Fahed Zairi
- Hôpital Privé Le Bois Ramsay Santé, Lille 59000, France
| | - Pierre Guigui
- Hôpital Européen Georges-Pompidou HEGP, Paris 75015, France
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, CHU Robert Debré, AP-HP, Université de Paris, Paris 75019, France
| | - Jean Meyblum
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint-Joseph, Paris 75014, France
| | | | - Nicolas Lonjon
- Service de Neurochirurgie, Hôpital Gui de Chauliac, Montpellier 34090, France
| | - Guillaume Lot
- Hôpital - Fondation Rothschild, Service de Neurochirurgie, Paris 75019, France
| | - Olivier Hamel
- Clinique Des Cèdres Service de Neurochirurgie, Château D’Alliez, Cornebarrieu 31700, France
| | | | - Stéphane Litrico
- Unité de Chirurgie Rachidienne, Hôpital Pasteur 2, CHU de Nice, Nice 06001, France
| | - Patrick Tropiano
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de Chirurgie Rachidienne, Marseille 13005, France
| | - Benjamin Blondel
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de Chirurgie Rachidienne, Marseille 13005, France
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Abstract
Adolescent idiopathic scoliosis that has progressed over time, de novo scoliosis, and degenerative scoliosis represent different types of adult spinal deformity (ASD). Functional impairment and muscular fatigue are due to sagittal and coronal imbalance of the trunk. Surgical treatment can provide a significant improvement of three-dimensional (3D) thoracolumbar alignment, function, and health-related quality of life (QoL). A patient-specific benefit-risk assessment, including clinical expectations, comorbidities, and the spinal deformity itself, has to be done preoperatively since the risk for mechanical complications is relatively high. Minimal invasive techniques combine posterior percutaneous instrumentation and lateral interbody fusion cages which enables vertebral realignment and indirect foraminal stenosis decompression. This strategy seems appropriate in mild and moderate ASD with a limited number of degenerated segments in the lumbar spine and remaining curve flexibility. Severe ASD needs to be addressed by open surgery, which combines posterior instrumentation, interbody fusion, and osteotomies in stiff deformities. Longer posterior instrumentation of the thoracolumbar spine, the sacrum, and the pelvis carries a risk for mechanical complications such as non-union and proximal junctional kyphosis (PJK). Modern surgical techniques including circumferential lumbosacral fusion and double rods might lower the risk for non-union. Accurate sagittal alignment planning, setting the lumbar sagittal apex according to pelvic incidence, and segmental lordosis distribution, are mandatory for minimizing the risk of PJK.
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Affiliation(s)
- Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
| | - Yves Ntilikina
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
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Bouthors C, Prost S, Court C, Blondel B, Charles YP, Fuentes S, Mousselard HP, Mazel C, Flouzat-Lachaniette CH, Bonnevialle P, Sailhan F. Correction to: Outcomes of surgical treatments of spinal metastases: a prospective study. Support Care Cancer 2019; 28:2137. [PMID: 31811488 DOI: 10.1007/s00520-019-05213-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The correct name of F. Saihlan should be F. Sailhan.
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Affiliation(s)
- C Bouthors
- Orthopedic and Traumatology Surgery Department, Bicetre University Hospital, AP-HP, Paris XI University, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
| | - S Prost
- Orthopedic and Traumatology Surgery Department, La Timone Hospital, AP-HM, Aix Marseille University, CNRS ISM, 264 rue Saint Pierre, 13005, Marseille, France
| | - C Court
- Orthopedic and Traumatology Surgery Department, Bicetre University Hospital, AP-HP, Paris XI University, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
| | - B Blondel
- Orthopedic and Traumatology Surgery Department, La Timone Hospital, AP-HM, Aix Marseille University, CNRS ISM, 264 rue Saint Pierre, 13005, Marseille, France
| | - Y P Charles
- Orthopedic and Traumatology Surgery Department, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - S Fuentes
- Neurosurgery Department, La Timone Hospital, AP-HM, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
| | - H P Mousselard
- Orthopedic and traumatology surgery department, La Pitié-Salpétrière Hospital, AP-HP, Parix VI University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - C Mazel
- Orthopedic and traumatology surgery department, Institut Mutualiste Montsouris, Paris V University, 42 Boulevard Jourdan, 75014, Paris, France
| | - C H Flouzat-Lachaniette
- Orthopedic and traumatology surgery department, Mondor Hospital, APHP, Paris XII University, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - P Bonnevialle
- Orthopedic and traumatology surgery department, Riquet Pierre-Paul Hospital, Place du Docteur Baylac,, TSA 40031-31059, Toulouse cedex 9, France
| | - F Sailhan
- Orthopedic and traumatology surgery department, Cochin Hospital, APHP, Paris V University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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Cantogrel P, Schuller S, Lefebvre F, Charles YP, Steib JP. Lower lumbar vertebra size and anatomic variation: An Anatomo-Radiologic Study. Orthop Traumatol Surg Res 2019; 105:1137-1141. [PMID: 31471259 DOI: 10.1016/j.otsr.2019.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/23/2018] [Revised: 05/22/2019] [Accepted: 06/17/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In routine practice, it is often necessary to use shorter screws in L5 than L4. The present study measured L5 versus L4 vertebral pedicles, to guide surgical strategy. MATERIAL AND METHOD CT or MRI scans for 95 patients were analyzed. Radiographic measurements (anteroposterior diameter (APD), pedicle length (PL) and pedicle width (PW)) were taken by a spine surgeon. Statistical analysis used R 3.4.3 software. RESULTS Ninety-five patients were included: 48 female (50.53%), 47 male (49.47%); mean age, 57 years (range, 19-85 years). Univariate analysis found a strong correlation between right and left PL values in L4 and L5. Right and left values were pooled, obtaining a mean L4 PL of 55.34mm (range, 54.23-56.45mm) and L5 PL of 51.80mm (44.81-58.80) and L4 PW of 10.48mm (10.06-10.91) and L5 PW of 9.90mm (7.43-12.39). Multivariate analysis disclosed significant effects of age and gender, with greater age and male gender associated with greater anteroposterior vertebral diameter. Mean anteroposterior vertebral length was significantly shorter in L5 than L4 by 3.57mm (range, 4.08-3.06mm). DISCUSSION Anteroposterior pedicle length was shorter in L5 than L4, in line with the literature. This answers the surgeon's question: "Should pedicle screws be shorter in L5 than L4?". From these results, it seems logical to use an L5 screw that is 5mm shorter than in L4, to secure good intra-body screw fixation.
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Affiliation(s)
- Pauline Cantogrel
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, B.P. 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France; Service d'orthopédie, institut régional du Rachis, centre hospitalier Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
| | - Sébastien Schuller
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, B.P. 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - François Lefebvre
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, B.P. 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France; Service méthodologie et biostatistiques, hôpitaux universitaires de Strasbourg, B.P. 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - Yann Philippe Charles
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, B.P. 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - Jean-Paul Steib
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, B.P. 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
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Lambert A, Charles YP, Ntilikina Y, Lefebvre N, Hansmann Y, Sauleau EA, Steib JP. Safety and efficacy of percutaneous instrumentation combined with antibiotic treatment in spondylodiscitis. Orthop Traumatol Surg Res 2019; 105:1165-1170. [PMID: 31471258 DOI: 10.1016/j.otsr.2019.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with spondylodiscitis are treated with antibiotics and braces for 6 to 12 weeks. Braces aim to decrease pain and prevent kyphotic deformity due to vertebral body collapse. Percutaneous instrumentation could be an alternative to influence pain and patient's autonomy. PURPOSE The purpose of this study was to analyze back pain, quality of life, sagittal deformity, and complications after percutaneous instrumentation in spondylodiscitis. PATIENTS AND METHODS VAS for back pain, EQ-5D, radiographic sagittal index were assessed retrospectively for 28 patients who had a standardized follow-up at 5 days, 6 weeks, 3 months, 1 and 2 years. Probabilities>0.95 indicated significant changes (Bayesian model). RESULTS VAS was 7.0 preoperatively, 3.2 (day 5), 2.2 (6 weeks), 1.9 (3 months), 1.6 (1 year), 1.4 (2 years): probabilities>0.95 within 6 weeks. EQ-5D was 0.229 preoperatively, 0.563 (6 weeks), 0.687 (3 months), 0.755 (1 year), 0.787 (2 years): probabilities>0.95 within 1 year. Sagittal index was 15.1° preoperatively, 9.6° postoperatively: probability>0.95. Inter-body fusion was: complete 60.7%, partial 17.9%, and nonunion 21.4%. Antibiotic treatment was stopped at 6 weeks in 82.1%, at 3 months in 17.9%, without septic complication. CONCLUSION Percutaneous instrumentation improved pain control, quality of life and prevented kyphosis. Antibiotic treatment was not influenced. Septic complications were not observed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Arnauld Lambert
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, 67200 Strasbourg, France.
| | - Yann Philippe Charles
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, 67200 Strasbourg, France
| | - Yves Ntilikina
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, 67200 Strasbourg, France
| | - Nicolas Lefebvre
- Service de maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, 67200 Strasbourg, France
| | - Yves Hansmann
- Service de maladies infectieuses et tropicales, hôpitaux universitaires de Strasbourg, 67200 Strasbourg, France
| | - Erik André Sauleau
- Département de santé publique, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67200 Strasbourg, France
| | - Jean-Paul Steib
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, 67200 Strasbourg, France
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Bouthors C, Prost S, Court C, Blondel B, Charles YP, Fuentes S, Mousselard HP, Mazel C, Flouzat-Lachaniette CH, Bonnevialle P, Saihlan F. Outcomes of surgical treatments of spinal metastases: a prospective study. Support Care Cancer 2019; 28:2127-2135. [PMID: 31396747 DOI: 10.1007/s00520-019-05015-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 05/28/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Owing to recent advances in cancer therapy, updated data are required for clinicians counselling patients on treatment of spinal metastases. OBJECTIVE To analyse the outcomes of surgical treatments of spinal metastases. METHODS Prospective and multicentric study that included consecutively patients operated on for spinal metastases between January 2016 and January 2017. Overall survival was calculated with the Kaplan-Meier method. Cox proportional hazard model was used to calculate hazard ratio (HR) analysing mortality risk according to preoperative Karnofsky performance status (KPS), mobility level and neurological status. RESULTS A total of 252 patients were included (145 males, 107 females) aged a mean 63.3 years. Median survival was 450 days. Primary cancer sites were lung (21%) and breast (19%). Multiple spinal metastases involved 122 patients (48%). Concomitant skeletal and visceral metastases were noted in 90 patients (36%). Main procedure was laminectomy and posterior fixation (57%). Overall, pain and mobility level were improved postoperatively. Most patients had normal preoperative motor function (50%) and remained so postoperatively. Patients "bedbound" on admission were the less likely to recover. In-hospital death rate was 2.4% (three disease progression, one septic shock, one pneumonia, one pulmonary embolism). Complication rate was 33%, deep wound infection was the most frequent aetiology. Higher mortality was observed in patients with poorest preoperative KPS (KPS 0-40%, HR = 3.1, p < 0.001) and mobility level ("bedbound", HR = 2.16, p < 0.001). Survival seemed also to be linked to preoperative neurological function. CONCLUSION Surgical treatments helped maintain reasonable condition for patients with spinal metastases. Intervention should be offered before patients' condition worsen to ensure better outcomes.
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Affiliation(s)
- C Bouthors
- Orthopedic and Traumatology Surgery Department, Bicetre University Hospital, AP-HP, Paris XI University, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
| | - S Prost
- Orthopedic and Traumatology Surgery Department, La Timone Hospital, AP-HM, Aix Marseille University, CNRS ISM, 264 rue Saint Pierre, 13005, Marseille, France
| | - C Court
- Orthopedic and Traumatology Surgery Department, Bicetre University Hospital, AP-HP, Paris XI University, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
| | - B Blondel
- Orthopedic and Traumatology Surgery Department, La Timone Hospital, AP-HM, Aix Marseille University, CNRS ISM, 264 rue Saint Pierre, 13005, Marseille, France
| | - Y P Charles
- Orthopedic and Traumatology Surgery Department, Hautepierre Hospital, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - S Fuentes
- Neurosurgery Department, La Timone Hospital, AP-HM, Aix Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
| | - H P Mousselard
- Orthopedic and traumatology surgery department, La Pitié-Salpétrière Hospital, AP-HP, Parix VI University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - C Mazel
- Orthopedic and traumatology surgery department, Institut Mutualiste Montsouris, Paris V University, 42 Boulevard Jourdan, 75014, Paris, France
| | - C H Flouzat-Lachaniette
- Orthopedic and traumatology surgery department, Mondor Hospital, APHP, Paris XII University, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - P Bonnevialle
- Orthopedic and traumatology surgery department, Riquet Pierre-Paul Hospital, Place du Docteur Baylac,, TSA 40031-31059, Toulouse cedex 9, France
| | - F Saihlan
- Orthopedic and traumatology surgery department, Cochin Hospital, APHP, Paris V University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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Prost S, Barrey C, Blondel B, Fuentes S, Barresi L, Nicot B, Challier V, Lleu M, Godard J, Kouyoumdjian P, Lonjon N, Marinho P, Freitas E, Schuller S, Allia J, Berthiller J, Charles YP. Hangman's fracture: Management strategy and healing rate in a prospective multi-centre observational study of 34 patients. Orthop Traumatol Surg Res 2019; 105:703-707. [PMID: 31005699 DOI: 10.1016/j.otsr.2019.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/27/2019] [Accepted: 03/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hangman's fractures account for 15% to 20% of all cervical spine fractures. The grading system developed by Effendi and modified by Levine and Edwards is generally used as the basis for management decisions. Nonetheless, the optimal management remains controversial. The objective of this study was to describe the treatments used in France in patients with hangman's fractures. The complications and healing rates were analysed according to the fracture type and treatment used. HYPOTHESIS Among patients with hangman's fracture, those with disc damage must be treated surgically. MATERIAL AND METHODS A prospective, multi-centre, observational study was conducted under the aegis of the French Society for Spine Surgery (SociétéFrançaisedeChirurgieRachidienne, SFCR). Patients were included if they had computed tomography (CT) evidence of hangman's fracture. Follow-up data were collected prospectively. Fracture healing was assessed on CT scans obtained 3 and 12 months after the injury. The type of treatment and complications were recorded routinely. RESULTS We included 34 patients. The fracture type according to Effendi modified by Levine and Edwards was I in 68% of patients, II in 29% of patients, and III in a single patient (3%). The treatment was non-operative in 21 (62%) patients and surgical in 11 (32%). All 28 patients re-evaluated after 1 year had evidence of fracture healing. The remaining 6 patients were lost to follow-up. CONCLUSION Hangman's fracture is associated with low rates of mortality and neurological complications. Non-operative treatment is appropriate in Type I hangman's fracture, with a 100% healing rate in our study. Types II and III are characterised by damage to the ligaments and discs requiring either anterior C2-C3 fusion or posterior C1-C3 screw fixation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Solène Prost
- ISM, CNRS, unité de chirurgie rachidienne, Aix-Marseille université, CHU de Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Cédric Barrey
- Service de neurochirurgie C et chirurgie du rachis, université Claude-Bernard Lyon 1, hôpital P. Wertheimer, 59, boulevard Pinel, 69003 Lyon, France
| | - Benjamin Blondel
- ISM, CNRS, unité de chirurgie rachidienne, Aix-Marseille université, CHU de Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - Stéphane Fuentes
- ISM, CNRS, unité de chirurgie rachidienne, Aix-Marseille université, CHU de Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Laurent Barresi
- Unité de chirurgie rachidienne, CHU de Nice, Institut universitaire de l'appareil Locomoteur et du sport, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Benjamin Nicot
- Département de neurochirurgie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Vincent Challier
- Unité d'orthopédie-traumatologie rachis I, CHU de Bordeaux, hôpital Tripode, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - Maxime Lleu
- Service de neurochirurgie, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon cedex, France
| | - Joël Godard
- Service de neurochirurgie, hôpital Jean-Minjoz, 3, boulevard A. Fleming, 25030 Besançon cedex, France
| | - Pascal Kouyoumdjian
- Service d'orthopédie-traumatologie, CHU de Nîmes, avenue du Pr. Debré, 30000 Nîmes, France
| | - Nicolas Lonjon
- Service de neurochirurgie, hôpital Gui de Chauliac, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - Paulo Marinho
- Service de neurochirurgie, CHRU de Lille, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
| | - Eurico Freitas
- Service de neurochirurgie C et chirurgie du rachis, université Claude-Bernard Lyon 1, hôpital P. Wertheimer, 59, boulevard Pinel, 69003 Lyon, France
| | - Sébastien Schuller
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - Jérémy Allia
- Unité de chirurgie rachidienne, CHU de Nice, Institut universitaire de l'appareil Locomoteur et du sport, hôpital Pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Julien Berthiller
- Pôle IMER, hospices civils de Lyon, 162, avenue Lacassagne, 69424 Lyon cedex 03, France
| | - Yann Philippe Charles
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
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- Société Française de Chirurgie Rachidienne, 56, rue Boisonnade, 75014 Paris, France
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Charles YP. Expert's comment concerning Grand Rounds case entitled "Pure distraction injury of T1-2 with quad fever" by Jun-Yeong Seo et al. (Eur Spine J [2017]: doi:10.1007/s00586-017-5232-2). Eur Spine J 2019; 28:1051-1052. [PMID: 28821970 DOI: 10.1007/s00586-017-5254-9] [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: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, Place de l'Hôpital, B.P. 426, 67091, Strasbourg Cedex, France.
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Canavese F, Charles YP, Dimeglio A. Evaluation of kinematic changes of intervertebral discs and the space available for the cord. Ann Transl Med 2019; 6:S22. [PMID: 30613597 DOI: 10.21037/atm.2018.09.15] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Federico Canavese
- Department of Pediatric Orthopedic Surgery, University Hospital Estaing, Clermont Ferrand, France
| | | | - Alain Dimeglio
- Faculty of Medicine, University of Montpellier, Montpellier, France
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Canavese F, Dimeglio A, Bonnel F, Corradin M, Pereira B, Marcoul A, Charles YP. Thoracic cage volume and dimension assessment by optoelectronic molding in normal children and adolescents during growth. Surg Radiol Anat 2018; 41:287-296. [PMID: 30560403 DOI: 10.1007/s00276-018-2164-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 12/08/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The thoracic spine, the chondral and osseous ribs, and the sternum together make up the thoracic cage. These elements are strictly correlated, although their growth is not synchronous. The purpose of this study is to provide a comprehensive data set of thoracic dimensions and non-invasive volumetric assessment in a large cohort of males and females from early childhood to young adult age. METHODS In all, 622 healthy individuals (406 girls, 216 boys) aged 6-18 years were consecutively enrolled between 2006 and 2016. All had to be healthy with no history of spinal deformity, or any lung, cardiovascular, systemic or neuromuscular disease. The optical ORTEN system for trunk surface data acquisition was used to calculate thoracic cage volume (V) and perimeter (Pe), anterior-posterior depth (AP) and transverse diameter (TD), AP/TD ratio, sternal length (St), and T1-T12 distance (Tle) in all patients. RESULTS The overall average age was 11.1 ± 2.5 years (4-18) for girls and 11.0 ± 3.1 years (4-18) for boys. Average growth parameters were: standing height 146.2 ± 14.6 cm (103-172) for girls and 146.4 ± 20.0 cm (94-192) for boys, sitting height 75.4 ± 8.6 cm (61-91) for girls and 75.5 ± 10.3 cm (60-99) for boys, weight 37.6 ± 10.4 kg (16-65) for girls and 38.3 ± 14.3 kg (13.7-104) for boys, BMI 16.7 ± 3.7 (18.5-26) for girls and 17.0 ± 3.3 (18.7-34.3) for boys. At age 6-8 years: V was 52.5% of its final size in girls and 44.9% in boys; Pe was 80.2% its final length in girls and 76.8% in boys; St reached 68% of its final size in girls and 66.9% in boys; Tle reached 73.3% of its final length in girls and 71.2% in boys. At skeletal maturity, thoracic cage volume in boys was 19.4% greater than in girls (p < 0.05). AP/TD ratio remained < 1 in all age groups and did not differ between genders (p > 0.05). CONCLUSION Growth of the thoracic cage is shown to be a gradual process that is more linear than previously reported. Only small increases in annual growth rates were observed during the pubertal growth spurt. The most important events characterizing thoracic cage development occurred during the first few years of postnatal growth. The circular cross-section of the very young child's thorax reached adult-like proportions together with its ovoid shape before age 6 years.
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Affiliation(s)
- Federico Canavese
- Service de Chirurgie Infantile, CHU Estaing Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.
- Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie-et-Raymond-Aubrac, 63003, Clermont-Ferrand, France.
| | - Alain Dimeglio
- Faculté de Médicine, Université de Montpellier, 2 rue de l'école de Médecine, 34060, Montpellier, France
| | - François Bonnel
- Faculté de Médicine, Université de Montpellier, 2 rue de l'école de Médecine, 34060, Montpellier, France
| | - Marco Corradin
- Service de Chirurgie Infantile, CHU Estaing Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France
| | - Bruno Pereira
- Marcenac-Ducros, 1277 Avenue de Toulouse, 34070, Montpellier, France
| | - Amélie Marcoul
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, 58 Place Henri Dunant, 63003, Clermont-Ferrand, France
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), 1 Place de l'hôpital, BP 426, 67091, Strasbourg Cedex, France
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Lleu M, Charles YP, Blondel B, Barresi L, Nicot B, Challier V, Godard J, Kouyoumdjian P, Lonjon N, Marinho P, Freitas E, Schuller S, Fuentes S, Allia J, Berthiller J, Barrey C. C1 fracture: Analysis of consolidation and complications rates in a prospective multicenter series. Orthop Traumatol Surg Res 2018; 104:1049-1054. [PMID: 30193984 DOI: 10.1016/j.otsr.2018.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/14/2018] [Accepted: 06/04/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Three types of C1 fracture have been described, according to location: type 1 (anterior or posterior arc), type 2 (Jefferson: anterior and posterior arc), and type 3 (lateral mass). Stability depends on transverse ligament integrity. The main aim of the present study was to analyze complications and consolidation rates according to fracture type, age and treatment. MATERIAL AND METHODS The French Society of Spinal Surgery (SFCR) performed a multicenter prospective study on C1-C2 trauma. All patients with recent fracture diagnosed on CT were included. Consolidation on CT was studied at 3 months and 1 year. Medical, neurologic, infectious and mechanical complications were inventoried using the KEOPS data-base. RESULTS Sixty-three of the 417 patients (15.1%) had C1 fracture: type 1 (33.3%), type 2 (38.1%), or type 3 (28.6%). The transverse ligament was intact in 53.9% of cases. Treatment was non-operative in 63.5% of cases, surgical in 27.0%, and surgical after failure of non-operative treatment in 9.5%. There were 8 medical complications, more frequently in patients aged >70 years, following surgery (p<0.0001). The consolidation rate was 84.2% with non-operative treatment, 100% for primary surgery, and 33.3% for secondary surgery (p=0.002). There were 10 cases of non-union, in 4.8% of type 1, 13.6% of type 2 and 33.3% of type 3 fractures (p=0.001). CONCLUSION Medical complications showed association with age and with type of treatment. Non-operative treatment was suited to types 1, 2 and 3 with minimal displacement and intact transverse ligament. C1-C2 fusion was suited to displaced unstable type 2 fracture. Displaced type 3 fracture incurred risk of non-union. Early surgery may be recommended. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Maxime Lleu
- Service de neurochirurgie, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon cedex, France.
| | - Yann Philippe Charles
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, BP 426, 67091 Strasbourg cedex, France
| | - Benjamin Blondel
- Unité de chirurgie du Rachis, université Aix-Marseille, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Laurent Barresi
- Unité de chirurgie rachidienne, CHU de Nice, institut universitaire de l'appareil locomoteur et du sport, hôpital pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Benjamin Nicot
- Département de neurochirurgie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - Vincent Challier
- Unité d'orthopédie-traumatologie Rachis I, CHU de Bordeaux, hôpital Tripode, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - Joël Godard
- Service de neurochirurgie, hôpital Jean-Minjoz, 3, boulevard A. Fleming, 25030 Besançon cedex, France
| | - Pascal Kouyoumdjian
- Service d'orthopédie-traumatologie, CHU de Nîmes, avenue du Pr. Debré, 30000 Nîmes, France
| | - Nicolas Lonjon
- Service de neurochirurgie, hôpital Gui de Chauliac, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - Paulo Marinho
- Service de neurochirurgie, CHRU de Lille, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
| | - Eurico Freitas
- Service de neurochirurgie C et chirurgie du Rachis, université Claude-Bernard Lyon 1, hôpital P. Wertheimer, 59, boulevard Pinel, 69003 Lyon, France
| | - Sébastien Schuller
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, BP 426, 67091 Strasbourg cedex, France
| | - Stéphane Fuentes
- Unité de chirurgie du Rachis, université Aix-Marseille, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Jérémy Allia
- Unité de chirurgie rachidienne, CHU de Nice, institut universitaire de l'appareil locomoteur et du sport, hôpital pasteur 2, 30, voie Romaine, 06001 Nice, France
| | - Julien Berthiller
- Hospices civils de Lyon, pôle IMER, 162, avenue Lacassagne, 69424 Lyon cedex 03, France
| | - Cédric Barrey
- Service de neurochirurgie C et chirurgie du Rachis, université Claude-Bernard Lyon 1, hôpital P. Wertheimer, 59, boulevard Pinel, 69003 Lyon, France
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Lima LVPC, Charles YP, Rouch P, Skalli W. Limiting interpedicular screw displacement increases shear forces in screws: A finite element study. Orthop Traumatol Surg Res 2017; 103:721-726. [PMID: 28554810 DOI: 10.1016/j.otsr.2017.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 07/08/2016] [Revised: 03/30/2017] [Accepted: 05/18/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND CONTEXT Screw loosening has been reported for non-fusion devices. Forces on pedicle screws could be related to kinematic parameters as the interpedicular displacement (ID), which consists of the displacement between superior and inferior screw heads from full extension to full flexion. PURPOSE To investigate the relationship between ID and screw loosening for different designs of posterior implants using a finite element model. METHODS An L3-sacrum previously validated spine FE model was used. Three-rod designs were considered in L4-L5 segment: a rigid screw-rod implant, a flexible one and a specific design with a sliding rod providing limited restrain in ID. In order to simulate intermediate configurations, the friction coefficient between the sliding rods and connectors were varied. The sacrum was rigidly fixed. Rotations (flexion-extension, lateral bending and axial rotation) were applied to L3, for each modeled configuration: intact, injured, injured with different implants. Model consistency was checked with existing experimental in vitro data on intact and instrumented segments. Screw loads were computed as well as ID. RESULTS In flexion-extension, the ID was less than 2mm for rigid (R) and flexible (F) constructs and 5.5mm for intact spine and the sliding implant (S3). Screw's shear forces were 272N, 153N, 43N respectively for R, F and S3 constructs. CONCLUSIONS Implants that allow ID presented lower screws loads. A compromise between the ability of the implant to withstand compressive forces, which requires longitudinal stiffness, and its ability to allow ID could be important for future implant designs in order to prevent screw loosening.
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Affiliation(s)
- L V P C Lima
- Institut de biomécanique humaine Georges-Charpak/LBM, arts et métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France; Universidade Estadual do Rio de Janeiro, Instituto Politécnico Rua Bonfim, 25, Vila Amélia, 28.625-570 Nova Friburgo, RJ, Brazil.
| | - Y P Charles
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, clinique chirurgicale B, 1, place de l'Hôpital BP 426, 67091 Strasbourg, France
| | - P Rouch
- Institut de biomécanique humaine Georges-Charpak/LBM, arts et métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - W Skalli
- Institut de biomécanique humaine Georges-Charpak/LBM, arts et métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France.
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Ntilikina Y, Bahlau D, Garnon J, Schuller S, Walter A, Schaeffer M, Steib JP, Charles YP. Open versus percutaneous instrumentation in thoracolumbar fractures: magnetic resonance imaging comparison of paravertebral muscles after implant removal. J Neurosurg Spine 2017; 27:235-241. [DOI: 10.3171/2017.1.spine16886] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVEPercutaneous instrumentation in thoracolumbar fractures is intended to decrease paravertebral muscle damage by avoiding dissection. The aim of this study was to compare muscles at instrumented levels in patients who were treated by open or percutaneous surgery.METHODSTwenty-seven patients underwent open instrumentation, and 65 were treated percutaneously. A standardized MRI protocol using axial T1-weighted sequences was performed at a minimum 1-year follow-up after implant removal. Two independent observers measured cross-sectional areas (CSAs, in cm2) and region of interest (ROI) signal intensity (in pixels) of paravertebral muscles by using OsiriX at the fracture level, and at cranial and caudal instrumented pedicle levels. An interobserver comparison was made using the Bland-Altman method. Reference ROI muscle was assessed in the psoas and ROI fat subcutaneously. The ratio ROI-CSA/ROI-fat was compared for patients treated with open versus percutaneous procedures by using a linear mixed model. A linear regression analyzed additional factors: age, sex, body mass index (BMI), Pfirrmann grade of adjacent discs, and duration of instrumentation in situ.RESULTSThe interobserver agreement was good for all CSAs. The average CSA for the entire spine was 15.7 cm2 in the open surgery group and 18.5 cm2 in the percutaneous group (p = 0.0234). The average ROI-fat and ROI-muscle signal intensities were comparable: 497.1 versus 483.9 pixels for ROI-fat and 120.4 versus 111.7 pixels for ROI-muscle in open versus percutaneous groups. The ROI-CSA varied between 154 and 226 for open, and between 154 and 195 for percutaneous procedures, depending on instrumented levels. A significant difference of the ROI-CSA/ROI-fat ratio (0.4 vs 0.3) was present at fracture levels T12–L1 (p = 0.0329) and at adjacent cranial (p = 0.0139) and caudal (p = 0.0100) instrumented levels. Differences were not significant at thoracic levels. When adjusting based on age, BMI, and Pfirrmann grade, a significant difference between open and percutaneous procedures regarding the ROI-CSA/ROI-fat ratio was present in the lumbar spine (p < 0.01). Sex and duration of instrumentation had no significant influence.CONCLUSIONSPercutaneous instrumentation decreased muscle atrophy compared with open surgery. The MRI signal differences for T-12 and L-1 fractures indicated less fat infiltration within CSAs in patients who received percutaneous treatment. Differences were not evidenced at thoracic levels, where CSAs were smaller. Fat infiltration was not significantly different at lumbar levels with either procedure in elderly patients with associated discopathy and higher BMI. In younger patients, there was less fat infiltration of lumbar paravertebral muscles with percutaneous procedures.
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Paternostre F, Charles YP, Sauleau EA, Steib JP. Cervical sagittal alignment in adult hyperkyphosis treated by posterior instrumentation and in situ bending. Orthop Traumatol Surg Res 2017; 103:53-59. [PMID: 27889355 DOI: 10.1016/j.otsr.2016.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 09/13/2015] [Revised: 07/14/2016] [Accepted: 10/12/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the normal adult spine, a link between thoracolumbar and cervical sagittal alignment exists, suggesting adaptive cervical positional changes allowing horizontal gaze. In patients with thoracic hyperkyphosis, cervical adaptation to sagittal global alignment might be different from healthy individuals. However, this relationship has not clearly been reported in hyperkyphotic deformity. PURPOSE The purpose of this study was to identify cervical sagittal alignment types observed on radiographs in young adults with thoracic hyperkyphosis. The relationship between cervical and thoracolumbar alignment as well as the effect of posterior instrumentation and adaptive positional changes of the mobile cervical segment were retrospectively analyzed. PATIENTS AND METHODS Twenty-three patients (32.7 years; 5-year follow-up) were included. Full spine radiographic measurements were: T1 slope, T1-T4 kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, SVA C7, SVA C2, lordosis between C0-C2, C2-C7, C2-C4 and C4-C7. A Bayesian model and Spearman correlation were used. RESULTS Two alignment types existed: cervical lordosis (group A) and cervical kyphosis (group B). Preoperatively, T4-T12 kyphosis and L1-S1 lordosis were significantly higher in group A: 76.6° versus 59.4° and -72.8° versus -65.8° (probability of>5° difference P (β>5)>0.95). Pelvic incidence was higher in group A (49.8° versus 44.2°) and C0-C2 lordosis in group B (-29.4° versus -21.6°). A significant correlation existed between: T4-T12 kyphosis and C2-C7 lordosis, L1-S1 lordosis and pelvic incidence, C2-C7 lordosis and T1 slope, C2-C7 lordosis and T1-T4 kyphosis. Postoperatively, T4-T12 kyphosis decreased by 33.1° P (β>5)=0.9995), L1-S1 lordosis decreased by 17.7° (P (β>5)=0.961), T1-T4 kyphosis increased by 14.1° (P (β>5)=0.973). SVA C2 (translation) increased by 13.8mm. C0-C2 lordosis (head rotation) remained unchanged. Six patients changed cervical alignment. PJK occurred in 15 patients, unrelated to cervical alignment or proximal instrumentation level. DISCUSSION Two cervical alignment types, lordotic or kyphotic, were observed thoracic hyperkyphosis patients. This alignment was mainly triggered by the amount of thoracic kyphosis and lumbar lordosis, linked to pelvic incidence. Moreover, the inclination of the C7-T1 junctional area plays a key role in the amount of cervical lordosis. The correction of T4-T12 kyphosis induced compensatory modifications at adjacent segments: T1-T4 kyphosis increase (PJK) and L1-S1 lordosis decrease. Global spino-pelvic alignment and head position did not change in the sagittal plane. The cervical spine tented to keep in its preoperative position in most patients. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- F Paternostre
- Service de chirurgie du rachis, fédération de médecine translationnelle (FMTS), université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - Y P Charles
- Service de chirurgie du rachis, fédération de médecine translationnelle (FMTS), université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
| | - E A Sauleau
- Service de santé publique, fédération de médecine translationnelle (FMTS), université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg, France
| | - J-P Steib
- Service de chirurgie du rachis, fédération de médecine translationnelle (FMTS), université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
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Charles YP, Pelletier H, Hydier P, Schuller S, Garnon J, Sauleau EA, Steib JP, Clavert P. Pullout characteristics of percutaneous pedicle screws with different cement augmentation methods in elderly spines: An in vitro biomechanical study. Orthop Traumatol Surg Res 2015; 101:369-74. [PMID: 25755067 DOI: 10.1016/j.otsr.2015.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 03/25/2014] [Revised: 09/18/2014] [Accepted: 01/05/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Vertebroplasty prefilling or fenestrated pedicle screw augmentation can be used to enhance pullout resistance in elderly patients. It is not clear which method offers the most reliable fixation strength if axial pullout and a bending moment is applied. The purpose of this study is to validate a new in vitro model aimed to reproduce a cut out mechanism of lumbar pedicle screws, to compare fixation strength in elderly spines with different cement augmentation techniques and to analyze factors that might influence the failure pattern. MATERIALS AND METHODS Six human specimens (82-100 years) were instrumented percutaneously at L2, L3 and L4 by non-augmented screws, vertebroplasty augmentation and fenestrated screws. Cement distribution (2 ml PMMA) was analyzed on CT. Vertebral endplates and the rod were oriented at 45° to the horizontal plane. The vertebral body was held by resin in a cylinder, linked to an unconstrained pivot, on which traction (10 N/s) was applied until rupture. Load-displacement curves were compared to simultaneous video recordings. RESULTS Median pullout forces were 488.5 N (195-500) for non-augmented screws, 643.5 N (270-1050) for vertebroplasty augmentation and 943.5 N (750-1084) for fenestrated screws. Cement augmentation through fenestrated screws led to significantly higher rupture forces compared to non-augmented screws (P=0.0039). The pullout force after vertebroplasty was variable and linked to cement distribution. A cement bolus around the distal screw tip led to pullout forces similar to non-augmented screws. A proximal cement bolus, as it was observed in fenestrated screws, led to higher pullout resistance. This cement distribution led to vertebral body fractures prior to screw pullout. CONCLUSION The experimental setup tended to reproduce a pullout mechanism observed on radiographs, combining axial pullout and a bending moment. Cement augmentation with fenestrated screws increased pullout resistance significantly, whereas the fixation strength with the vertebroplasty prefilling method was linked to the cement distribution.
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Affiliation(s)
- Y P Charles
- Groupe d'étude de biomécanique ostéo-articulaire de Strasbourg (GEBOAS), fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
| | - H Pelletier
- Institut national des sciences appliquées (INSA), université de Strasbourg, 24, boulevard de la Victoire, 67000 Strasbourg, France; Institut Charles-Sadron, UPR 22 CNRS, université de Strasbourg, 23, rue du Loess, 67000 Strasbourg, France
| | - P Hydier
- Institut national des sciences appliquées (INSA), université de Strasbourg, 24, boulevard de la Victoire, 67000 Strasbourg, France
| | - S Schuller
- Groupe d'étude de biomécanique ostéo-articulaire de Strasbourg (GEBOAS), fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - J Garnon
- Service de radiologie interventionnelle, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - E A Sauleau
- Département de santé publique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - J-P Steib
- Groupe d'étude de biomécanique ostéo-articulaire de Strasbourg (GEBOAS), fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - P Clavert
- Groupe d'étude de biomécanique ostéo-articulaire de Strasbourg (GEBOAS), fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Institut national des sciences appliquées (INSA), université de Strasbourg, 24, boulevard de la Victoire, 67000 Strasbourg, France; Institut d'anatomie normale, faculté de médecine, université de Strasbourg, 4, rue Kirschleger, 67085 Strasbourg cedex, France
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Charles YP. Response to the letter by Safak Ekinci et al. Orthop Traumatol Surg Res 2015; 101:263. [PMID: 25748219 DOI: 10.1016/j.otsr.2015.01.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/26/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Y P Charles
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
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Charles YP, Steib JP. Management of thoracolumbar spine fractures with neurologic disorder. Orthop Traumatol Surg Res 2015; 101:S31-40. [PMID: 25577599 DOI: 10.1016/j.otsr.2014.06.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 06/13/2014] [Accepted: 06/23/2014] [Indexed: 02/02/2023]
Abstract
Thoracic and lumbar fractures represent approximately 50% of neurologic spinal trauma. They lead to paraplegia or cauda equina syndrome depending on the level injured. In the acute phase, the extension of spinal cord lesions should be limited by immediately treating secondary systemic injury factors. Quick recovery of hemodynamic stability, with mean arterial blood pressure>85 mm Hg, appears essential. There is no clinical evidence in favor of high-dose corticosteroid protocols. Their effect on neurologic recovery is unproven, whereas they lead to a higher rate of secondary septic and pulmonary complications. Incomplete deficits (ASIA B-D) require urgent surgery. There is no consensus with regard to complete paraplegia (ASIA A), but early surgery can enable neurologic recovery in some cases. The principle of surgical treatment is based on spinal cord decompression, instrumentation and fracture reduction. Early stabilization of the spine improves respiratory function and shortens the duration of mechanical ventilation and thus intensive care unit stay. Depending on the severity of associated lesions, early surgery within 48 hours is beneficial in polytrauma patients. Percutaneous instrumentation combined with mini-open posterior decompression stabilizes the spine, limiting approach-related morbidity.
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Affiliation(s)
- Y P Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg Cedex, France.
| | - J-P Steib
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg Cedex, France
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Affiliation(s)
- Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, Place de l'Hôpital, B.P. 426, 67091, Strasbourg Cedex, France,
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Lengert R, Charles YP, Walter A, Schuller S, Godet J, Steib JP. Posterior surgery in high-grade spondylolisthesis. Orthop Traumatol Surg Res 2014; 100:481-4. [PMID: 25002197 DOI: 10.1016/j.otsr.2014.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 06/12/2013] [Revised: 01/06/2014] [Accepted: 03/27/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION High-grade L5-S1 spondylolisthesis alters sagittal spinopelvic balance, which can cause low back pain and progressive neurologic disorder. The present study assessed spondylolisthesis reduction and maintenance over time with L4-S1 versus L5-S1 fusion using a lever-arm system and posterior fusion combined with lumbosacral graft. MATERIALS AND METHODS Forty patients were operated on for symptomatic high-grade spondylolisthesis, 34 of whom had full pre- and post-operative radiological analysis, with a mean follow-up of 5.4years. There were 9 L5-S1 and 25 L4-S1 instrumentations. Analysis of spinopelvic and slipping parameters and the evolution of segmental lordosis compared results between L5-S1 and L4-S1 instrumentation. RESULTS Mean Taillard spondylolisthesis index decreased from 64% to 37% (P=0.0001). Overall sagittal spinopelvic balance was not significantly changed. Overall L1-S1 and segmental L4-L5 lordosis were not affected by instrumentation. Mean L5-S1 segmental lordosis increased from 11° to 18°. There was loss of reduction from 19° to 14° with L5-S1 instrumentation, in contrast to maintained reduction with L4-S1 instrumentation (P=0.006). CONCLUSION The lever-arm system provided anterior-posterior reduction of spondylolisthesis and corrected slippage. Postoperative change in overall sagittal spinopelvic balance was slight and constant. Posterior L4-S1 fusion provided better long-term control of L5-S1 lordosis reduction than the shorter L5-S1 fusion. Retrospective study of level IV.
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Affiliation(s)
- R Lengert
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
| | - Y P Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - A Walter
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - S Schuller
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - J Godet
- Département de Santé Publique, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - J-P Steib
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
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Charles YP, Schuller S, Sfeir G, Steib JP. Mini open tumor resection and percutaneous instrumentation for T11 renal cell carcinoma metastasis. Eur Spine J 2014; 22:1440-2. [PMID: 23901398 DOI: 10.1007/s00586-013-2814-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, 1, Place de L'Hôpital, BP 426, Strasbourg Cedex 67091, France.
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Charles YP, Lima LVPC, Persohn S, Rouch P, Steib JP, Skalli W. Influence of an auxiliary facet system on intervertebral discs and adjacent facet joints. Spine J 2013; 13:1293-300. [PMID: 23988459 DOI: 10.1016/j.spinee.2013.06.019] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 11/16/2012] [Accepted: 06/01/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Facet supplementation stabilizes after facetectomy and undercutting laminectomy. It is indicated in degenerative spondylolisthesis with moderate disc degeneration and dynamic stenosis. PURPOSE To determine the influence of an auxiliary facet system (AFS) on the instrumented disc, adjacent levels' discs, and facet joints and to compare it with fusion. STUDY DESIGN Finite element study. METHODS L3-L4, L4-L5, and L5-S1 were studied using a validated finite element model with prescribed displacements for an intact spine, lesion by facetectomy and undercutting laminectomy, AFS, and fusion at L4-L5. The distribution of segmental range of motion (ROM) and applied moments, von Mises stress at the annulus, and facet joint contact forces were calculated with rotations in all planes. Institutional support for implant evaluation and modeling was received by Clariance. RESULTS In flexion-extension and lateral bending, fusion decreased L4-L5 ROM and increased adjacent levels' ROM. Range of motion was similarly distributed with intact lesion and AFS. In axial rotation, L4-L5 ROM represented 33% with intact, 55% after lesion, 25% with AFS, and 21% with fusion. Fusion increased annulus stress at adjacent levels in flexion-extension and lateral bending, but decreased stress at L4-L5 compared with AFS. In axial rotation, von Mises stress was similar with fusion and AFS. Facet loading increased in extension and lateral bending with fusion. It was comparable for fusion and AFS in axial rotation. CONCLUSIONS This study suggests that the AFS stabilizes L4-L5 in axial rotation after facetectomy and undercutting laminectomy as fusion does. This is because of the cross-link that generates an increased annulus stress in axial rotation at adjacent levels. With imposed displacements, without in vivo compensation of the hips, the solicitation at adjacent levels' discs and facet joints is higher with fusion compared with AFS. Fusion decreases intradiscal stress at the instrumented level.
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Affiliation(s)
- Yann Philippe Charles
- Laboratoire de Biomécanique, Arts et Métiers ParisTech, Paris, France; Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle, Université de Strasbourg, 1, Place de l'hôpital, B.P. 426, 67091 Strasbourg Cedex, France.
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Affiliation(s)
- Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, 1, Place de l'Hôpital, B.P. 426, 67091, Strasbourg Cedex, France,
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Charles YP, Schuller S, Sfeir G, Steib JP. Anterior corpectomy and fusion for two adjacent levels of cervical stenosis. Eur Spine J 2013; 22:1443-5. [PMID: 23901399 DOI: 10.1007/s00586-013-2816-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, 1, Place de L'Hôpital, BP 426, Strasbourg Cedex 67091, France.
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Charles YP, Buy X, Gangi A, Steib JP. Fracture in ankylosing spondylitis after minor trauma: radiological pitfalls and treatment by percutaneous instrumentation. A case report. Orthop Traumatol Surg Res 2013; 99:115-9. [PMID: 23270725 DOI: 10.1016/j.otsr.2012.09.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 08/10/2012] [Accepted: 09/07/2012] [Indexed: 02/02/2023]
Abstract
Patients with ankylosing spondylitis may experience spinal fractures even after minor injuries. The diagnosis of non-dislocated spinal fracture is based on clinical symptoms and radiological findings. Difficulties in interpreting the imaging studies can result in considerable diagnostic delays. We describe the steps of the radiological diagnosis in a patient with a fracture of L2 that was not visible on standard lumbar spine radiographs. Magnetic resonance imaging (MRI) T2 STIR sequences allowed determining the location and showed signs of a recent fracture. Then, MRI T1 images and computed tomography provided a detailed evaluation of the fracture line. In patients with ankylosing spondylitis, fracture instability is common, making surgical treatment mandatory. Open surgery is associated with substantial rates of infection and implant loosening. Percutaneous instrumentation has not yet been evaluated for the treatment of spinal fractures in patients with ankylosing spondylitis. This minimally invasive surgical technique enables multilevel internal fixation and may constitute an interesting alternative to open surgery.
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Affiliation(s)
- Y P Charles
- Spine Surgery Department, Strasbourg Academic Hospitals, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
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Zairi F, Court C, Tropiano P, Charles YP, Tonetti J, Fuentes S, Litrico S, Deramond H, Beaurain J, Orcel P, Delecrin J, Aebi M, Assaker R. Minimally invasive management of thoraco-lumbar fractures: combined percutaneous fixation and balloon kyphoplasty. Orthop Traumatol Surg Res 2012; 98:S105-11. [PMID: 22901522 DOI: 10.1016/j.otsr.2012.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 06/21/2012] [Indexed: 02/02/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. BACKGROUND There is no consensus regarding the ideal treatment of thoraco-lumbar spine fractures without neurological compromise. Many surgical techniques have been described but none has proved its definite superiority. The main drawback of these procedures is directly related to the morbidity of the approach. As minimally invasive fixation combined with balloon kyphoplasty for treatment of thoraco-lumbar fractures is gaining popularity, its efficacy has yet to be established. PURPOSE The purpose of this study is to report operative data, clinical and radiological outcomes of patients undergoing minimally invasive management of thoraco-lumbar fracture at our institutions. METHODS Forty-one patients underwent percutaneous kyphoplasty and stabilization for treatment of single-level fracture of the thoracic or lumbar spine. All patients were neurologically intact. There were 20 males and 21 females with an average age of 50 years. RESULTS The mean follow-up was 15 months (3-90 months). The mean operative time was 102 minutes (range 35-240 minutes) and the mean blood loss was <100mL. VAS was significantly improved from 6.7 to 0.7 at last follow-up. Vertebral kyphosis decreased by 16° to 7.8° postoperatively (P<0.001). Local kyphosis and percentage of collapse were also significantly improved from 8° to 5.6° and from 35% to 16% at last follow-up. Fifteen leaks have been identified, three of which were posterior; all remained asymptomatic. No patient worsened his or her neurological condition postoperatively. CONCLUSION Percutaneous stabilization plus balloon kyphoplasty seems to be a safe and effective technique to manage thoraco-lumbar fractures without neurological impairment.
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Affiliation(s)
- F Zairi
- Department of Neurosurgery, Lille University Hospital, rue Emile-Laine, 59037 Lille, France.
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Launay O, Charles YP, Steib JP. Should post-traumatic thoracolumbar Frankel A paraplegia be operated as an emergency? Report of three cases and review of the literature. Orthop Traumatol Surg Res 2012; 98:352-8. [PMID: 22441106 DOI: 10.1016/j.otsr.2011.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 05/02/2011] [Revised: 08/09/2011] [Accepted: 08/22/2011] [Indexed: 02/02/2023]
Abstract
Spinal cord injury is an important contributing factor to morbidity. The thoracolumbar junction is a highly vulnerable axial region due to the biomechanical stresses and the risk of conus medullaris injuries in some cases. In the event of an incomplete neurological injury and if the patient's condition is stable, emergency surgical treatment should be considered. Yet, no clear consensus has emerged regarding the treatment modalities of complete injuries but surgical management is advocated to maximize neurological recovery and reduce the risk of decubitus ulcer formation. We report on the cases of three patients with L1 Frankel A paraplegia resulting from injury to the conus medullaris, treated within the first 6 hours from injury and demonstrating a very satisfactory neurological recovery since independent walking could be resumed at 2.5 years follow-up. Persistent urinary sphincter dysfunctions were observed in two of these patients. Early surgical management appears as an important predictive factor for neurological recovery in conus medullaris injuries. We believe that delayed surgical management in patients with complete paraplegia could be an inappropriate treatment option, which should be further studied.
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Affiliation(s)
- O Launay
- Department of spine surgery, Strasbourg university hospital, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
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Charles YP, Walter A, Schuller S, Steib JP. [Dynamic instrumentation of the lumbar spine. Clinical and biomechanical analysis of success factors]. Orthopade 2012; 40:703-12. [PMID: 21681502 DOI: 10.1007/s00132-011-1800-z] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Total disc replacement and posterior dynamic stabilization represent alternatives to lumbar spinal fusion which should reduce the risk of adjacent segment degeneration. Disc replacement is indicated for pure discopathy without facet joint degeneration. Spinopelvic balance influences the implant's biomechanics. Therefore pelvic incidence, sacral slope, segmental lordosis and the mean axis of rotation need to be considered. Dynamic stabilization is indicated in moderate discopathy and facet joint degeneration, in degenerative spondylolisthesis grade I with a hypermobile segment and in dynamic lumbar stenosis. The combination of caudal fusion and cranial dynamic stabilization allows a better maintenance of lordosis with multiple level instrumentation and prevents adjacent segment degeneration. If pelvic incidence and sacral slope are high, L5-S1 should be fused because of elevated shear forces.
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Affiliation(s)
- Y P Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, Frankreich.
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Charles YP, Schuller S, Walter A, Steib JP. Anterior osteotomy and percutaneous in situ contouring for correction of rigid posttraumatic T12-L1 malunion. Eur Spine J 2011; 20:2288-90. [PMID: 22105309 DOI: 10.1007/s00586-011-2079-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, 1, Place de l'Hôpital, B.P. 426, 67091 Strasbourg Cedex, France.
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