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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. [ABSTRACT FROM AUTHOR]

Introduction: The life expectancy increased significantly during last four decades and is associated with an increasing quality of life. The purpose of this study was to determine morbidity and mortality of degenerative lumbar spine surgery in patients 80 years of age or older. Methods: A consecutive retrospective review evaluated 121 consecutive patients, who had undergone posterior decompression associated or not with lumbar instrumentation. The average age at the time of surgery was 83.2 ± 2.4 years. The study analyzed the comorbidities, the operative procedure and postoperative morbidity and mortality. Results: Blood loss increased significantly with instrumentation (538 vs. 280 mL, p < 0.0001). The average operative time was 103 ± 38 min and increased significantly with instrumentation (131.2 vs. 84 min, p = 0.003), blood loss ( p < 0.0001) and dural tears ( p = 0.05). Dural tears occurred in 19 patients (15.7 %) and were associated significantly with previous lumbar surgery (33.3 vs. 12.4 %, p = 0.017) and major complications (30 vs. 9.9 %, p = 0.01). Major complications occurred in 16 patients (13 %). Minor complications occurred in 36 patients (29.7 %). The delirium was associated with instrumentation (22 vs. 7 %, p = 0.017) and blood loss (520 vs. 348 mL, p = 0.034). The average hospital stay was 11.3 ± 8.1 days. No patients died after a postoperative period of 1 year. The average follow-up was 24.3 ± 16.5 months. Conclusions: The morbidity of degenerative lumbar spine surgery in patients 80 years of age or older was high. Blood loss, operative time, instrumentation, previous surgery and dural tears increased significantly the morbidity. This surgery must be decided very carefully and requires to inform the patient and his family of the high rate of complications. [ABSTRACT FROM AUTHOR]

After a short introduction of the meeting by the President 2015, Wilco Peul, the opening lecture was delivered by Bart Koes, who dealt with Health Technology Assessment and Guidelines. Then, it was the turn of Carmen Vleggert to show whether there was any Evidence for the Use of Implants in Spinal Stenosis. The final presentation of this session was delivered by Björn Strömqvist who dealt with Surgery for Lumbar Disc Herniation, patients' selection and outcomes. Developing the subject of 'Do Not's', Jeremy Fairbank described the UK experience for Low Back Pain. Yves Coppens then took over and further elaborated on 'Lucy's legacy'. Prof. Coppens recalled that Lucy is a partial skeleton of a pre-human found in Ethiopia among other remains. Prof. Alan Crockard offered what he called 'a whimsical view' of his practice of Craniocervical Surgery. Wafa Skalli was asked to speak about Finite Element Analysis of the Spine and Arts et Métiers Paris Tech where there is a long tradition of close collaboration between engineers and clinicians. Rune Hedlund, who will serve as 2016 Symposium President, further elaborated on Scoliosis with a focus on Unsolved Issues in Adolescent Idiopathic Scoliosis Treatment. [ABSTRACT FROM AUTHOR]

Ostracods collected from shallow coral reefs in the Bahamas were found to exhibit blue light-stimulated orange fluorescence at night. Fluorescent spectra revealed the presence of orange fluorescence with a maximum emission at ~595 nm on the carapace of these ostracods, while scanning electron microscopy revealed a morphologically diverse microbial community covering the entire carapace of these ostracods. Pyrosequencing and cyanobacterial-specific 16S rRNA sequencing reveals that this epibiont community is highly diverse and highly variable between individual ostracods. Many species of Cyanobacteria in the orders Oscillatoriales and Chroococcales, as well as other Proteobacteria and diatom chloroplast sequences, were identified using the cyanobacterial-specific primers. While no fluorescent proteins or phycoerythrin were detected in these ostracods, it is possible that the observed orange fluorescence is the result of carotenoid fluorescence from Cyanobacteria. The microbial consortium forms an epibiotic biofilm on the carapace of these ostracods whose functions are unknown. [ABSTRACT FROM AUTHOR]

Choosing the right operation for metastatic spinal tumours is often difficult, and depends on many factors, including life expectancy and the balance of the risk of surgery against the likelihood of improving quality of life. Several prognostic scores have been devised to help the clinician decide the most appropriate course of action, but there still remains controversy over how to choose the best option; more often the decision is influenced by habit, belief and subjective experience. The purpose of this article is to review the present systems available for classifying spinal metastases, how these classifications can be used to help surgical planning, discuss surgical outcomes, and make suggestions for future research. It is important for spinal surgeons to reach a consensus regarding the classification of spinal metastases and surgical strategies. The authors of this article constitute the Global Spine Tumour Study Group: an international group of spinal surgeons who are dedicated to studying the techniques and outcomes of surgery for spinal tumours, to build on the existing evidence base for the surgical treatment of spinal tumours. [ABSTRACT FROM AUTHOR]

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The objective of this study was to evaluate an X-ray films analysis software, i.e. to estimate the reliability and validity of clinical measurements by means of this software. The authors first performed tests of precision and reproducibility of measures. The precision for dynamic modules was estimated at +/-2 degrees for the lumbar analysis and +/-3 degrees for the cervical one. Mean reproducibility coefficients calculated for postural modules are about 4 degrees for the angular parameters and 3 mm for the linear ones. We also evaluated clinical applicability of the software through its validity. Reference values calculated on a population of healthy subjects showed agreement with the literature. Then, when analysing postural X-ray films of severe scoliotic patients, we found that inter-observer reproducibility coefficients show a lower reliability of measurements; the main cause seems to be the low visibility of anatomic landmarks due to the quality of X-ray films and to the degree of deformity. This study allowed to better estimate the reliability and the usefulness of this tool, allowing for multicentric studies and exchanges. [ABSTRACT FROM AUTHOR]

Background: Thoracoscopy is fast becoming the standard approach for the removal of neurogenic mediastinal tumors. However, there are risks for adjacent nervous structures (stellate ganglion, spinal cord). The aim of this study was to review the technical features of this approach.Methods: Between December 1999 and January 2003, nine patients underwent thoracoscopic resection of a mediastinal neurogenic tumor at our hospital. Five of these patients were asymptomatic with incidentally found tumor; the other four patients had compression-related syndromes. Two tumors had developed in the superior sulcus, and one had a spinal canal component (dumbell-type tumor).Results: Thoracoscopic dissection was possible in all cases. In one patient, resection of the tumor was performed via a combined neurosurgical and thoracoscopic approach. Seven tumors were benign nerve sheath tumors (schwannoma), and 2 were nerve cell tumors (ganglioneuroma). The postoperative course was uncomplicated in all patients.Conclusion: The thoracoscopic resection of mediastinal neurogenic tumors is technically easy, except for bulky tumors of the superior sulcus and dumbbell tumors, which require a combined thoracoscopic and neurosurgical approach. [ABSTRACT FROM AUTHOR]

Exeter technique is accompanied by significant prosthesis subsidence, in about 20% to 38% of cases leading to 6 to 11% of early re-revision. This migration may break up the cement and thus yield to particle generation which may induce osteolysis. The goal of the modified technique is to obtain stem stability by limiting reconstruction to it proximal 4/5th, and cementing distal fifth directly to the host bone. Twenty one hips (20 patients) were reviewed. (Average follow-up: 18 months, range: 6–29 months). Radiographic assessment revealed stem stability in 18 cases. Allograft remodeling or cortical reconstitution occurred in 17 cases. Thus loading of the graft consecutive to stem migration is not the sole factor accounting for both allograft remodeling and host bone corticalization. Inversely, this stability protects the cement from possible fractures and their consequences. La reconstruction des pertes de substance osseuse fémorales lors de la chirurgie de reprise de prothèses totales de hanche, constitue un problème difficile. La technique d’Exeter, qui utilise des greffons spongieux morcelés et impactés dans la cavité fémorale, décrite par Simon et Gie apparaît très séduisante. Mais la migration précoce de la pièce fémorale constatée par les promoteurs de la technique et par d’autres reste préoccupante. Gie et Simon considèrent cette migration comme sans risque, puisque la prothèse se stabilise secondairement. Nous restons toutefois soucieux des conséquences de cette migration sur un manteau de ciment fin et irrégulier qui peut se fragmenter. Nous avons donc modifié la technique originale dans le but de donner à la prothèse une stabilité primaire satisfaisante. Une fois la prothèse descellée enlevée, le fémur est alésé pour permettre l’insertion aisée du canon d’un «pistolet à greffon». Celui-ci permet de descendre dans le fémur préalablement obstrué, un cylindre creux de greffons spongieux. Le canon est recouvert d’un treillis de mersylène qui permet de stabiliser le cylindre de greffe en regard du défect à reconstruire mais aussi d’éviter la dispersion de l’os spongieux lors du passage des impacteurs en particulier au travers de pertes de substance segmentaires quand elles existent. Le façonnage et la compaction de la greffe sont obtenus par le passage d’impacteurs de tailles progressivement croissantes, jusqu’à ce qu’ils tiennent fermement dans la greffe. La tige est ensuite scellée de manière rétrograde, directement au contact de l’os du patient pour le cinquième distal et dans la greffe pour les 4/5e proximaux. 21 hanches chez 20 patients ont été opérées selon cette technique entre octobre 1996 et février 1998. Le recul moyen et la médiane de suivie sont de 18 mois (Minimum 6 et maximum 29). La perte de substance osseuse fémorale était souvent sévère, (Cinq type 3A et 5 type 3B selon la classification de Paproski) mais limitée en hauteur. (Pas de type 4 selon la classification de l’Endo Klinik). Elles sont au nombre de 8 et intéressent 7 patients. Deux sont majeures. Une patiente a présenté, à la suite d’une chute, une fracture du fémur sous la queue de la prothèse, 6 mois après l’intervention, reprise par prothèse longue queue pontant la zone de fracture. Un autre patient a présenté une récidive infectieuse qui a conduit à l’ablation de la prothèse et la mise en résection tête... [ABSTRACT FROM AUTHOR]

Orthopedic surgeons and neurosurgeons gathered in Paris on January 29 for the third annual meeting of the ARGOS association, presided over by Dr. Christian Mazel from the Montsouris Medical Center (IMM Site Choisy) in Paris, Prof. Pierre Kehr of the Strasbourg-Illkirch Center of Traumatology and Orthopedics (CTO), and Dr. Jean-Paul Forthomme from the Saint-Joseph Clinic in Mons (Belgium). The day focused on the theme of lumbar canal stenosis. From its diagnosis to the choice of surgical technique — root canal enlargement, laminectomy, or other — or the role played by arthrodesis, this vast subject allowed substantial room for debate. We present here a synopsis of the day. [ABSTRACT FROM AUTHOR]

We examined eight patients with primary spinal epidural non-Hodgkin's lymphoma presenting with spinal cord compression and proven histologically after laminectomy (7 cases) or biopsy (1 case) by MRI. The most common findings were an isointense or low signal relative to the spinal cord on T1-weighted images (T1WI) and high signal on T2-weighted images (T2WI). Spinal cord compression, vertebral bone marrow and paravertebral extension were assessed. Contrast enhancement was intense in seven of the eight cases and homogeneous in all of them. T2WI (performed in 2 cases) may be useful to distinguish metastatic carcinomas and sarcomas. T1WI demonstrated the full extent of the epidural lesion, which was well-delineated in all cases. When the paravertebral extension is not well-defined, a study with contrast medium should be performed. [ABSTRACT FROM AUTHOR]

The aim of that study was to evaluate the place of arthrography for component loosening and of hip aspiration for diagnosing infection. 52 arthrograms were done under local anesthesia in radiology suites under fluoroscopic guidance. If no fluid was aspirated a non bacteriostatic saline solution was injected and reaspirated. Liquid was then analized. Component loosening was evaluated by plain films and by arthrography and compared to the surgical findings in all cases. The sensitivity of arthrography (94.5%) was better than that of plain films (83%) for evaluating socket loosening, but was worse (77% vs 92%) for femoral component evaluation. They were no false positive evaluations in socket loosening, but false negatives occurred in 2 cases with supporting material such as screws and plates. Results for femoral loosening are more difficult to analyse. The sensitivity (77%) and the specificity (81%) of arthrography are lower than plain films (92% and 88%). Most authors consider that the femoral component is loose when more than one third of the stem has a lucent line. 4 patients had such findings and were operated on. In each case the stem was found to be stable at operation. We removed the stem in two cases and left it in place in two old patients. We simply cleaned the granuloma from the proximal part of the femur. It means that arthrography did not really fail to make the diagnosis. But surgical procedures in case of incomplete radiolucent lines are not mandatory and depend on the individual surgeon's philosophy. Sensitivity of hip aspiration to identify periprosthetic germ was 66% and a specificity was 100%. No false positives were found. Only one patient over 41 without any sign of active infection had a positive hip aspiration. This test is not sensitive enough to be a prerequiste test before total hip revision but has to be done in cases of clinical or suspected sepsis. [ABSTRACT FROM AUTHOR]

The present study is a numerical comparison using finite-element analysis (FEA) of two different concepts of spinal fixation devices when implanted. These implants are 1) the Easy®, “rigid” Screw/Rod (ø 6mm) system; 2) the Twinflex®, “dynamic” system (ø 2 X 2.5 mm ELF). A parameterised 3D FEA model of an L3-sacrum segment, developed by Lavaste, Skalli & Robin, was used. Geometric and mechanical models of each implant were then constructed, before being inserted in the spinal segment model. Then, for model validation, these two L3-S2 instrumented segmental models were submitted to similar boundary conditions as used in a previous in vitro comparison of the same implants. Flexion loaddisplacement curves were then controlled using experimental results. Loads acting on screws and longitudinal elements were calculated and analysed for a better understanding of the intrinsic differences between both constructs. Load-displacement responses of both constructs were quite similar (L3 sagittal rotation at 10 N.m = ~1.5°), while loads in the implant were not. For example, the axial push-in forces at the S1 screws were equal to 30 N for the Twinflex®, and 150 N for the Easy® Screw/Rod system. The pull-out forces at the S2 screws were respectively 100N and 200 N for the Twinflex and Screw/Rod Concept. At other levels, axial forces were all lower than 60 N, the Twinflex®, values being higher than the Easy® ones. Bending moments along screws were respectively 0.7 N.m and 1.4 N.m at the L3 level for the Twinflex® and the Easy® systems. At lower levels, values were all below 0.6 N.m, again with a reversed proportion. Bending moments calculated along longitudinal elements were always lower than 0.3 Nm for the Twinflex®, and up to 2 N.m for the Easy® system. Axial forces in the Twinflex® longitudinal elements were about 160 N, and about 100 N in the Easy® rods. Although the numerical approach mainly provides tendencies, it clearly seems that reducing flexural stiffness of lumbar fixation induces more homogeneous load transmission along the construct, and greatly reduces axial push-in/pull-out forces at the S1/S2 levels, and all this without reducing the rigidity of the whole construct. Conversely, it has been shown that “rigid” longitudinal elements may concentrate stresses at the construct extremities, relieving loads at intermediate levels at the same time, which may be the sign of a stress-shielding-like phenomenon. These differences arise from a fundamental difference between both kinds of longitudinal elements in the way they transmit loads. The ø 6 mm rods mainly oppose a bending reaction torque to the applied flexion moment, whereas the Twinflex® construct mainly balances the applied flexion torque by an anterior compression of the anterior column, combined with posterior traction on its longitudinal elements (ELF). [ABSTRACT FROM AUTHOR]

The correct name of F. Saihlan should be F. Sailhan. [ABSTRACT FROM AUTHOR]