Search

Background Tools for functional assessment of chronic low back pain (LBP) are lacking. Objective To determine the correlations and the responsiveness of the 400 m comfortable walk test (400 mCWT) and the 200 m fast-walk test (200 mFWT) in the functional assessment of a multimodal program. Methods One hundred and twenty-seven participants (68 females) with LBP and with or without radicular pain completed a Quebec Back Pain Disability Scale, a Sorensen test, a Shirado test, a 400 mCWT and a 200 mFWT, at baseline and at the end of the program. Results No significant side effect was reported during walk tests. Walking speed was significantly increased after the program (0.18 ± 0.15 m.s-1 for the 400 mCWT and 0.17 ± 0.17 m.s-1 for the 200 mFWT). Clinical parameters were also significantly improved (82.02 ± 83.1 seconds for the Shirado, 92.1 ± 100.1 seconds for the Sorensen, -14.0 ± 12.9 for the Quebec scale). A significant relationship was found between the increase in walking speed for the two walk tests and the improvement of the Quebec scale. The gait speed improvement was close to the minimal clinically important change (95% confidence interval: 0.14-0.22) determined from the Quebec scale threshold (minimum detectable change). Conclusions Both 400 mCWT and 200 mFWT are correlated with functional parameters and are responsive for the functional assessment of LBP.

Resume Introduction Peu de donnees recentes existent en France concernant l’epidemiologie de la traumatologie rachidienne. Les therapeutiques ont pourtant evolue par une meilleure connaissance de l’equilibre sagittal et grâce aux techniques mini-invasives. Objectif Decrire l’epidemiologie de la traumatologie rachidienne et sa prise en charge. Analyser l’evolution a 1 an et les facteurs de risque de mauvais resultats fonctionnels. Materiel et methode Etude de cohorte francaise, prospective, multicentrique conduite pendant 6 mois en 2011. Toutes les fractures rachidiennes operees etaient incluses. Les donnees etaient recueillies par un questionnaire informatique via internet. Les caracteristiques demographiques, le type de lesion et les modalites de l’intervention etaient renseignes. Une evaluation clinique, fonctionnelle et radiologique etaient realisees a 1 an. Resultats Cinq cent dix-huit patients d’âge moyen 47 ans ont ete inclus. Soixante-sept pour cent des fractures interessaient le segment thoracique ou lombaire. Trente pour cent des patients ont ete hospitalises dans le cadre d’un polytraumatisme et 28 % presentaient une atteinte neurologique. Une technique mini-invasive a ete realisee dans 20 % des cas et une liberation neurologique pour 25 % des patients. Quarante-deux breches durales (8 %) peroperatoires ont ete constatees. A 1 an, 70 % des patients ont ete revus. Sur le plan fonctionnel, une deterioration du score SF-36 etait observee pour toutes les dimensions, associee significativement a l’âge, au deficit neurologique persistant, aux lesions associees, et au desequilibre anterieur. Enfin, 38 % des patients actifs n’ont pas repris leur travail. Sur le plan radiologique 74 % presentaient un rachis equilibre et 70 % une consolidation osseuse certaine. Discussion Malgre l’evolution de la prise en charge, les traumatismes rachidiens restent en 2011 la source d’une morbidite importante. Une preservation de l’equilibre sagittal semble etre associee a une meilleure evolution fonctionnelle.

Resume Introduction La mise en commun des connaissances et des pratiques lors des Congres francais sur la chirurgie du rachis a mis en evidence une variabilite entre les differentes « ecoles » de chirurgie et entre les deux specialites (orthopedie et neurochirurgie). Cette variabilite semble maximale dans le cadre de la traumatologie rachidienne. Objectifs Objectiver cette difference de pratiques par la mise en place d’un questionnaire base sur un cas fictif de traumatologie du rachis. Evaluer l’etat de la litterature pour les pratiques les plus variables. L’hypothese etant que cette variabilite est due a une absence de recommandations forte dans le domaine de la chirurgie du rachis. Methodes Le cas presentait un homme de 31 ans qui avait une fracture de L1, avec comme seul symptome neurologique, des paresthesies dans les cuisses. Les chirurgiens recevaient le cas suivi de quatorze questions sur la prise en charge du malade de son entree a son suivi tardif. Pour chaque question, le chirurgien avait a choisir parmi 5 possibilites de reponses. L’index de variabilite qualitative (IQV) objectivait les differences (IQV = 0 : pas de variabilite, IQV = 1 : maximum de variabilite). Le chirurgien remplissait a la fin un petit questionnaire sur ses caracteristiques personnelles (sexe, âge, niveau, volume d’activite, type de centre). Resultats Sur 405 chirurgiens invites a participer, 200 chirurgiens ont participe. Les variabilites les plus importantes (IQV > 0,9) etaient retrouvees pour les questions : sur la necessite de faire un IRM en urgence (IQV = 0,93), sur le degre d’urgence a operer le patient (IQV = 0,93), sur la necessite de rechercher un fusion osseuse avec une greffe (IQV = 0,93), sur l’interet d’un corset en postoperatoire (IQV = 0,93) et sur l’interet d’enlever le materiel chez un patient asymptomatique (IQV = 0,93). Deux questions etaient, en revanche, peu debattues (IQV Conclusion La variabilite des pratiques entre les chirurgiens du rachis francais en traumatologie est importante. Peu de recommandations dans ce domaine peuvent expliquer ces variabilites.

Background In France, attempts to define common ground during spine surgery meetings have revealed significant variability in clinical practices across different schools of surgery and the two specialities involved in spine surgery, namely, neurosurgery and orthopaedic surgery. Objectives To objectively characterise this variability by performing a survey based on a fictitious spine trauma case. Our working hypothesis was that significant variability existed in trauma practices and that this variability was related to a lack of strong scientific evidence in spine trauma care. Methods We performed a cross-sectional survey based on a clinical vignette describing a 31-year-old male with an L1 burst fracture and neurologic symptoms (numbness). Surgeons received the vignette and a 14-item questionnaire on the management of this patient. For each question, surgeons had to choose among five possible answers. Differences in answers across surgeons were assessed using the Index of Qualitative Variability (IQV), in which 0 indicates no variability and 1 maximal variability. Surgeons also received a questionnaire about their demographics and surgical experience. Results Of 405 invited spine surgeons, 200 responded to the survey. Five questions had an IQV greater than 0.9, seven an IQV between 0.5 and 0.9, and two an IQV lower than 0.5. Variability was greatest about the need for MRI (IQV = 0.93), degree of urgency (IQV = 0.93), need for fusion (IQV = 0.92), need for post-operative bracing (IQV = 0.91), and routine removal of instrumentation (IQV = 0.94). Variability was lowest for questions about the need for surgery (IQV = 0.42) and use of the posterior approach (IQV = 0.36). Answers were influenced by surgeon specialty, age, experience level, and type of centre. Conclusion Clinical practice regarding spine trauma varies widely in France. Little published evidence is available on which to base recommendations that would diminish this variability.

Introduction Recent epidemiological data for spinal trauma in France are sparse. However, increased knowledge of sagittal balance and the development of minimally invasive techniques have greatly improved surgical management. Objectives To describe the epidemiology and management of traumatic vertebral fracture, and to analyze evolution and risk factors for poor functional outcome at 1 year's follow-up. Materials and methods A prospective multicenter French cohort study was performed over a 6-month period in 2011, including all cases of vertebral fracture surgery. Data were collected by online questionnaire over the Internet. Demographic characteristics, lesion type and surgical procedures were collected. Clinical, functional and radiological assessment was carried out at 1 year. Results Five hundred and eighteen patients, with a mean age of 47 years, were included. Sixty-seven percent of fractures involved the thoracic or lumbar segment. Thirty percent of patients had multiple fractures and 28% neurological impairment. A minimally invasive technique was performed in 20% of cases and neurological decompression in 25%. Dural tear was observed in 42 patients (8%). Seventy percent of patients were followed up at 1 year. Functionally, SF-36 scores decreased on all dimensions, significantly associated with age, persistent neurological deficit and previous spine imbalance. Thirty-eight percent of working patients had returned to work. Radiologically, sagittal balance was good in 74% of cases, with fracture consolidation in 70%. Discussion Despite progress in management, spinal trauma was still a source of significant morbidity in 2011, with pronounced decrease in quality of life. Conserved sagittal balance appeared to be associated with better functional outcome.