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BACKGROUND: Lumbar decompression can result in postsurgical instability and spondylolisthesis in patients with lumbar spinal stenosis (LSS). While pedicle screw (PS) constructs improve stability and support fusion, their use can lead to adjacent level degeneration due to rigidity and resultant overload of anatomical structures. The FFX device is a facet spacer designed to be a less invasive alternative for obtaining fusion compared with PS. OBJECTIVE: The present study aimed to compare biomechanical performance of the FFX device to different lumbar spine procedures using the finite element (FE) method. STUDY DESIGN: Comparative biomechanical study by FE method. METHODS: An FE model for the lumbar spine was developed and validated to assess vertebral displacement and stress variations in the facet joints and discs following surgery. Modeled scenarios included a healthy spine as a reference model, laminectomy (LAM), and prior to/following L4-L5 fusion for LAM + FFX and LAM + PS. RESULTS: LAM increased displacement compared with the healthy spine and both instrumented spine procedures. Facet joint stress at adjacent levels for LAM + PS was significantly higher than with LAM + FFX prior to fusion (+13.5% for L3-L4; +15.7% for L5-S1). Adjacent level disc stress at L5-S1 was 7.7% higher for LAM + PS vs LAM + FFX. Adjacent level facet joint and disc stresses for LAM + FFX were equivalent to LAM + PS once fusion occurred. CONCLUSIONS: Instrumented spine fixation prevents the risk of lumbar instability associated with LAM alone. Compared with PS, the FFX device is a less invasive alternative for the treatment of LSS, which potentially lowers the risk of adjacent segment degeneration prior to fusion that provides equivalent stability once fusion is achieved. LEVEL OF EVIDENCE: 5.

Introduction: Influenza is a frequent condition that can cause death among high-risk patients. Each year in Reunion, it causes severe cases leading to admission to ICU and fatalities. Our objective is to describe severe cases of influenza infections admitted in ICU in Reunion in 2014 and to draw attention to the flaws in the preventive measures. Patients: A retrospective, observational case report study was conducted in hospitalized patients with severe influenza confirmed by RT-PCR in ICUs in Reunion Island in 2014. Results: Thirty-one cases of severe influenza were reported in 2014. Twenty-four patients (77,4%) had at least one risk factor for complication from influenza infections. Among them, eleven (35,5%) people were 65 years-old or older. Main risk factors were respiratory diseases (41,9%), diabetes mellitus (32,3%) and cardiac diseases (25,8%). The most common organ failures were respiratory (80,6%) – including 10 acute! respiratory distress syndromes – and hemodynamic (61,3%). Influenza virus B was identified in most cases (51,6%). Sub-types A(H1N1)pdm09 and A(H3N2) viruses were identified respectively in 38,7% and 9,6%. Not a single patient had been immunized prior to hospitalization. Neuraminidase inhibitors were prescribed to 14 patients with a 4 days delay (extremes=[1-14]) after onset of illness. To our knowledge, no antivirals were prescribed in ambulatory care before hospitalization. Conclusion: In Reunion, influenza vaccination coverage of high-risk patients is very low and the antiviral medications are under prescribed in ICU as well as at the primary care level. Enhancing these measures would help avoiding influenza-related severe illnesses and fatalities. Information to the public and to health care providers, especially GP, seems to be the best measures to achieve it. The role of the GP in preventing severe cases of influenza must be emphasised., La grippe est fréquente et potentiellement mortelle chez les personnes à risque. L’objectif de cette étude est de décrire les cas de grippe grave hospitalisés en réanimation en 2014 à La Réunion et d’identifier d’éventuels défauts dans la prise en charge, notamment préventive, pour en tirer des enseignements. Patients : Une étude observationnelle rétrospective de type série de cas a été menée au sein d’une population de patients adultes hospitalisés dans les services de réanimation de La Réunion avec un diagnostic de grippe confirmé par RT-PCR. Résultats : Trente-et-un patients ont été inclus. Vingt-quatre patients (77,4%) présentaient au moins un facteur de risque de complication de la grippe. Parmi eux, onze (35,5%) étaient âgés de 65 ans et plus. Les principales comorbidités à risque étaient les pathologies respiratoires (41,9%), le diabète (32,3%) et les pathologies cardiaques (25,8%). Les défaillances d’organe les plus fréquentes étaient respiratoire (80,6%) dont 10 syndromes de détresse respiratoire aiguë et hémodynamique. Le virus B était majoritairement en cause (51,6% des cas). Les sous-types viraux A(H1N1)pdm09 et A(H3N2) représentaient respectivement 38,7% et 9,6% des cas. Aucun patient n’était vacciné contre la grippe. Les médicaments antiviraux ont été prescrits chez 14 patients en moyenne 4 jours [1-14] après le début des symptômes. À notre connaissance, ils n’ont pas été prescrits en médecine ambulatoire avant l’hospitalisation. Discussion : À La Réunion, la couverture vaccinale contre la grippe des patients à risque est faible et les traitements antiviraux sont sous-utilisés en service de réanimation et en soins primaires. Une amélioration de ces mesures pourrait permettre d’éviter la survenue de cas graves et de décès en lien avec la grippe. L’information du public et surtout des médecins traitants est certainement le meilleur moyen d’y parvenir. Le rôle des médecins traitants dans la prévention de ces cas graves doit être souligné et renforcé.