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Germaneau A, Vendeuvre T, Delmotte A, D'Houtaud S, Brèque C, Petureau L, Doumalin P, Dupré JC, Brémand F, Maxy P, Richer JP, Rigoard P. Should we recommend occipital plate fixation using bicortical screws or inverted occipital hooks to optimize occipito-cervical junction fusion? A biomechanical study combining an experimental and analytical approach. Clin Biomech (Bristol, Avon) 2020; 80:105173. [PMID: 33010700 DOI: 10.1016/j.clinbiomech.2020.105173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Occipito-cervical fusion can be necessary in case of cranio-cervical junction instability. Proximal stabilisation is usually ensured by bi-cortical occipital screws implanted through one median or two lateral occipital plate(s). Bone thickness variability as well as the proximity of vasculo-nervous elements can induce substantial morbidity. The choice of site and implant type remains difficult for surgeons and is often empirically based. Given this challenge, implants with smaller pitch to increase bone interfacing are being developed, as is a surgical technique consisting in inverted occipital hook clamps, a potential alternative to plate/screws association. We present here a biomechanical comparison of the different occipito-cervical fusion devices. METHODS We have developed a 3D mark tracking technique to measure experimental mechanical data on implants and occipital bone. Biomechanical tests were performed to study the mechanical stiffness of the occipito-cervical instrumentation on human skulls. Four occipital implant systems were analysed: lateral plates+large pitch screws, lateral plates+hooks, lateral plates+small pitch screws and median plate+small pitch screws. Mechanical responses were analysed using 3D displacement field measurements from optical methods and compared with an analytical model. FINDINGS Paradoxical mechanical responses were observed among the four types of fixations. Lateral plates+small pitch screws appear to show the best accordance of displacement field between bone/implant/system interface providing higher stiffness and an average maximum moment around 50 N.m before fracture. INTERPRETATION Stability of occipito-cervical fixation depends not only on the site of screws implantation and occipital bone thickness but is also directly influenced by the type of occipital implant.
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Affiliation(s)
- Arnaud Germaneau
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France; Spine & Neuromodulation Functional Unit, Department of Neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France.
| | - Tanguy Vendeuvre
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France; Spine & Neuromodulation Functional Unit, Department of Neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France
| | - Alexandre Delmotte
- Spine & Neuromodulation Functional Unit, Department of Neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France; Centre du Rachis de la Sauvergarde, 69009 Lyon, France
| | - Samuel D'Houtaud
- Spine & Neuromodulation Functional Unit, Department of Neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France; Service de Neurochirurgie Clinique, La Rochelle, France
| | - Cyril Brèque
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France; ABS Lab, Université de Poitiers, France
| | - Louis Petureau
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France
| | - Pascal Doumalin
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France
| | | | - Fabrice Brémand
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France
| | - Philippe Maxy
- Medtronic, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | - Philippe Rigoard
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France; Spine & Neuromodulation Functional Unit, Department of Neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France
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Germaneau A, D'Houtaud S, Delmotte A, Doumalin P, Dupré JC, Brémand F, Hesser F, Brèque C, Rigoard P. Experimental analysis of biomechanical behaviour of stabilised occipitocervical junctions. Comput Methods Biomech Biomed Engin 2013; 16 Suppl 1:244-5. [PMID: 23923926 DOI: 10.1080/10255842.2013.815901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A Germaneau
- Institut Pprime UPR 3346, Université de Poitiers, CNRS, ENSMA, Poitiers, France.
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Rigoard P, Delmotte A, D'Houtaud S, Misbert L, Diallo B, Roy-Moreau A, Durand S, Royoux S, Giot JP, Bataille B. Back Pain: A Real Target for Spinal Cord Stimulation? Neurosurgery 2011; 70:574-84; discussion 584-5. [DOI: 10.1227/neu.0b013e318236a57c] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background:
Failed back surgery syndrome represents one of the most frequent etiologies of chronic back pain and is a major public health issue. Neurostimulation has currently not been validated in the treatment of back pain because of technological limitations in implantable spinal cord stimulation (SCS) systems. New-generation leads using several columns of stimulation can generate longitudinal and/or transverse stimulation fields into the spinal cord.
Objective:
To investigate, through extensive stimulation testing, the capacity of multicolumn tripolar leads to achieve back territory paresthesia coverage in refractory failed back surgery syndrome patients.
Methods:
Eleven patients implanted with a 16-contact spinal cord stimulation lead (Specify 5-6-5, Medtronic Inc) were assessed with a systematic exploration of 43 selected stimulation configurations to generate bilateral back paresthesia in addition to leg territory coverage.
Results:
The tripolar lead successfully generated paresthesia in both bilateral back and leg territories in 9 patients (81.8%). Success rates of multicolumn stimulation patterns were significantly higher than for longitudinal configurations for lombodorsal paresthesia coverage. Six months after implantation, significant pain relief was obtained compared with preoperative evaluation for global pain (Visual Analog Scale, 2.25 vs 8.2 preoperatively; P < .05), leg pain (Visual Analog Scale, 0.5 vs 7.6 preoperatively; P < .05), and back pain (Visual Analog Scale, 1.5 vs 7.8 preoperatively; P < .05).
Conclusion:
These results suggest that multicolumn leads can reliably generate back pain coverage and favor pain relief outcomes. This may lead physicians to reconsider new indications for spinal cord stimulation. Expanding neurostimulation perspectives to intractable back pain syndromes could become realistic in the near future.
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Affiliation(s)
- Philippe Rigoard
- Department of Neurosurgery, Poitiers University School of Medicine, Poitiers, France
| | - Alexandre Delmotte
- Department of Neurosurgery, Poitiers University School of Medicine, Poitiers, France
| | - Samuel D'Houtaud
- Department of Neurosurgery, Poitiers University School of Medicine, Poitiers, France
| | - Lorraine Misbert
- Pain Management and Research Centre, Poitiers University School of Medicine, Poitiers, France
| | - Bakari Diallo
- Pain Management and Research Centre, Poitiers University School of Medicine, Poitiers, France
| | | | | | - Solène Royoux
- Neurophysiological and Technological Institute, Faculty of Science, Poitiers, France
| | | | - Benoit Bataille
- Department of Neurosurgery, Poitiers University School of Medicine, Poitiers, France
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Rigoard P, Tartarin F, Buffenoir K, Chaillou M, Fares M, D'Houtaud S, Wager M, Giot JP, Quellard N, Fernandez B, Lapierre F, Maixent JM. The Na, K-ATPase alpha3-isoform specifically localizes in the Schmidt-Lanterman incisures of human nerve. Cell Mol Biol (Noisy-le-grand) 2007; 53 Suppl:OL1003-OL1009. [PMID: 18184478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Accepted: 11/16/2007] [Indexed: 05/25/2023]
Abstract
INTRODUCTION To our knowledge, there is little reference in literature with regards to alpha3-isoform of Na+,K+-ATPase in human peripheral nerves. The aim of this study was to determine the expression of the neuronal alpha3-isoform of Na+,K+-ATPase in human sural nerves from patients with a permanent medullary central nervous system injury. MATERIALS AND METHODS We studied the immunolocalization of alpha3-isoform of Na+,K+-ATPase using a polyclonal antibody against the amino sequence near the phosphorylation site of the alpha3-isoforms of Na+,K+-ATPase using immunohistochemistry and confocal laser scanning microscopy. An antibody specific for alpha2-isoform of Na+,K+-ATPase was used to label the Schwann cells. RESULTS Morphometric analysis of longitudinal section of human sural nerves showed that the alpha3-isoform of Na+,K+-ATPase was distributed along the length of axolemma. The myelin sheath of the Schwann cells showed clearly a distribution of alpha3- but not alpha2-isoforms of Na+,K+-ATPase at the level of Schmidt-Lanterman incisures. CONCLUSION The human sural nerve shows a specific localization of the Na+,K+-ATPase alpha3-isoform in the Schmidt-Lanterman incisures of Schwann cells in addition to its localization in axonal membranes.
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Affiliation(s)
- P Rigoard
- Inserm U927, Faculté de Médecine, Université de Poitiers France
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