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To assess the risk of developing thoracogenic scoliosis (THS) in paediatric patients, depending on the side of lateral thoracotomy (LT) and of spine deviation in the coronal plane by means of logistic regression and scoliosis-free survival analyses.A total of 307 consecutive patients undergoing LT were retrospectively reviewed; 32 patients met the inclusion criteria: 1) underwent LT and developed THS; 2) age 15 years at LT; 3) clinical and radiographic follow-up ≥ 5 years. Patients were divided into ipsilateral group (convexity ipsilateral to LT) and contralateral group (convexity contralateral to LT).The mean follow-up was 10 ± 4.7 in the ipsilateral group (n = 13) and 12 ± 4.8 years in the contralateral group (n = 19). The contralateral group underwent LT at a younger age (4.4 vs 6.4 years, p = 0.55), developed more severe coronal deformity (27.8° vs 18.9°, p = 0.15), had higher rate of THS 20° (47.5% vs 38.4%; p = 0.34) and 45° (21.1% vs 0%; p = 0.99). The mean time from LT to THS diagnosis was 4.2 ± 2.9 in ipsilateral group and 5.5 ± 4.2 years in contralateral group. Left-side LT (p = 0.03) and age 5 years (p = 0.01) showed a lower risk of THS diagnosis. The group variable had a statistically significant effect on the risk of developing THS 45° (p = 0.03).In this series, children that developed THS with a convexity contralateral to the side of LT had more severe and progressive coronal spine deformity.III.

Resume Introduction La chirurgie des deformations rachidiennes pediatriques peut necessiter la realisation d’osteotomies vertebrales dans les cas complexes. Les resections vertebrales completes (VCR) sont les plus exigeantes techniquement et les plus morbides. Elles peuvent etre realisees par double abord (APVCR), mais les approches posterieures uniques (PVCR) gagnent en popularite. Hypothese Les PVCR permettent une correction efficace avec une morbidite acceptable chez l’enfant. Methode Cette serie monocentrique retrospective inclue des deformations rachidiennes operees par PVCR. Les donnees chirurgicales et les parametres de l’equilibre pelvi-rachidien global ont ete analyses. Resultats Seize PVCR ont ete realisees chez 13 patients avec un âge moyen de 14,1 ± 2,8 ans. La duree operatoire moyenne etait de 411 minutes (± 54). Le Cobb principal rigide etait en moyenne de 74,3° en preoperatoire. La correction postoperatoire moyenne a ete de 64,3 %, sans perte significative au dernier recul. Les pertes sanguines moyennes ont ete de 941 mL (± 221). Le cell-saver a permis 92,3 % de transfusions autologues, pour 53,4 % de transfusions homologues. Une monoplegie transitoire et un deficit du psoas sont apparus dans la periode postoperatoire. Le suivi radiologique a identifie 4 pseudarthroses justifiant des revisions. Conclusion Les PVCR permettent une correction majeure des deformations rachidiennes pediatriques rigides. Les complications comprennent essentiellement des incidents mecaniques et neurologiques. Niveau de preuve IV ; etude de cohorte non comparative.

A 68-year-old female presented acute neck pain and incomplete tetraplegia following a fall on the stairs. Radiographs, contrast enhanced computed tomography scan and magnetic resonance of the cervical spine revealed a C5-C6 bi-articular dislocation. A detailed preoperative assessment of the images discovered a medialization of the left common carotid artery. An external reduction and a left anterior cervical approach allowed a careful management of the vascular malformation and an anterior C5C6 arthrodesis. At six months, a full neurological recovery was assessed and radiographs demonstrated successful fusion of the cervical arthrodesis.Anatomical features such as medialization of the common carotid artery may affect patients with traumatic cervical spine injuries. The severity of the traumatic bone lesions should not overshadow the preoperative analysis of the adjacent anatomical structures encountered during the surgical approach, even in an emergency situation.

To describe the management of the discovery of a retropharyngeal carotid artery in the context of a cervical dislocation.A 68-year-old female presented acute neck pain and incomplete tetraplegia following a fall on the stairs. Radiographs, contrast-enhanced computed tomography scan and magnetic resonance of the cervical spine revealed a C5-C6 bi-articular dislocation. A detailed preoperative assessment of the images discovered a medialization of the left common carotid artery. An external reduction and a left anterior cervical approach allowed a careful management of the vascular variation and an anterior C5-C6 arthrodesis. At six months, a full neurological recovery was assessed and radiographs demonstrated successful fusion of the cervical arthrodesis.Anatomical features such as medialization of the common carotid artery may affect patients with traumatic cervical spine injuries. The severity of the traumatic bone lesions should not overshadow the preoperative analysis of the adjacent anatomical structures encountered during the surgical approach, even in an emergency situation.

Resume Introduction Les arthrodeses lombaires inter-somatiques par voie anterieure trouvent une place dans le traitement des spondylolisthesis L5-S1 par lyse isthmique (SPLL). L’extension de cette arthrodese au niveau L4-L5 est parfois requise. L’abord anterieur de ce disque est repute difficile du fait des rapports anatomiques de la jonction ilio-cave (JIC) avec le rachis. Hypothese La deformation lombo-sacree induite par SPLL peut permettre un abord chirurgical du disque L4-L5 entre les veines iliaques. Design d’etude Etude retrospective d’une serie continue de patients. Materiel et methode Cette etude d’imagerie retrospective d’une serie continue de 97 patients, traites pour un SPLL L5-S1, a concerne des parametres radiologiques propres au SPLL et a l’equilibre sagittal pelvi-rachidien. La distance entre la JIC et le plateau inferieur de L4 etait mesuree en millimetres. Les facteurs influencant cette position ont ete recherches afin d’identifier un modele predictif de JIC haute. Resultats La JIC prenait une position crâniale par rapport au disque L4-L5 avec une distance relative moyenne de 1,8 mm ± 16,4. Cette distance etait statistiquement plus importante en cas de SPLL de haut grade (p 0,30). Conclusion Le SPLL induit une deformation geometrique de la charniere lombo-sacree qui modifie ses rapports anatomiques avec la JIC. La technique d’approche anterieure du disque L4-L5 des SPLL L5-S1 est realisable entre les veines iliaques pour les formes a grand deplacement et a faible LSA. Niveau de preuve IV, analyse retrospective.

The approach to the sciatic plexus and lateral part of the sacrum is difficult. A subperitoneal anterolateral approach can be extended by sectioning the iliac bone above the acetabulum and lowering it toward the external part of the iliac wing and buttock. This transiliac anterolateral approach exposes the lumbosacral trunk, first sacral foramina and sciatic plexus to the origin of the sciatic trunk. Exposure can be extended upward by subperitoneal lumbotomy, downward by opening the ischiorectal fossa, or outward by trochanterotomy. This approach was used 18 times by one of the authors (FHD) for resection of 13 malignant tumors and 5 plexus releases. Procedure time was 3-6hours, with 500-4,000ml blood loss. The approach systematically enabled surgical objectives to be met. There was 1 septic complication that healed after debridement.

Resume L’abord du plexus sciatique et de la partie laterale du sacrum est difficile. Une voie anterolaterale sous-peritoneale peut etre agrandie par la section de l’os coxal au-dessus de l’acetabulum et l’abaissement vers le dehors de l’aile iliaque et de la fesse. Cet abord trans-iliaque antero-lateral permet d’exposer le tronc lombo-sacre, les premiers foramens sacres et le plexus sciatique jusqu’a la constitution du tronc sciatique. L’exposition peut etre agrandie en haut par une lombotomie sous-peritoneale, en bas par l’ouverture de l’espace ischio-rectal ou en dehors par une trochanterotomie. Cette voie a ete effectuee 18 fois par un des auteurs (FHD) pour la resection de tumeurs malignes (13 cas) ou la liberation du plexus (5 cas). Les interventions ont dure de 3 a 6 h, avec des pertes sanguines totales de 500 a 4000 ml. Cet abord a permis d’atteindre constamment les objectifs chirurgicaux. Il y a eu une complication septique.

BackgroundTargeted therapies are a standard of care for first-line treatment of Anaplastic lymphoma kinase (ALK)-rearranged non small cell lung cancer (NSCLC). Giving the rapid pace of drug discovery and development in this area, reporting of adverse effects of ALK inhibitors is crucial. Here, we report a case of osteitis induced by an ALK inhibitor mimicking bone metastasis, a previously undescribed side effect of crizotinib.Case presentationA 31-year-old woman with stage IVALK-rearranged NSCLC presented with back pain after 3 months of crizotinib treatment. Diagnostic work-up showed osteitis on the 4th and 5th thoracic vertebrae, anterior soft tissue infiltration and epiduritis, without any sign of infection. Spinal cord decompression, histological removal and osteosynthesis were performed. Histologic examination showed necrosis with abundant peripheral neutrophils, no microorganism nor malignant cell. Symptoms and Computarized Tomography-abnormalities rapidly diseappeared after crizotinib withdrawal and did not recur after ceritinib onset.ConclusionsThis is the first report of crizotinib-induced osteitis. Crizotinib differs from other ALK inhibitors as it targets other kinases as well, which may have been responsible for the osteitis. Crizotinib can induce rapidly extensive osteitis, which can mimic tumor progression.

Low-grade isthmic spondylolisthesis (ISPL) is generally treated by circumferential fusion with interbody graft, although there is no consensus on technique.The various interbody fusion strategies provide satisfactory fusion rates and clinical results.A multicenter retrospective study analyzed lumbar interbody fusion for low-grade ISPL performed between March 2016 and March 2019. Techniques comprised: circumferential fusion on a posterior or a transforaminal approach (PLIF, TLIF: n=57), combined anterior (ALIF) + posterolateral fusion (ALIF+PLF: n=60), and ALIF + percutaneous posterior fixation (ALIF+PPF: n=55). Function was assessed on a lumbar and a radicular visual analog scale (AVS-L, VAS-R, Oswestry Disability Index (ODI) and Short Form 12 (SF12).85.3% of the 129 patients showed fusion (Lenke 1 or 2), with no significant differences between the ALIF-PLF or ALIF-PPF groups and the PLIF or TLIF groups (p=0.3). Likewise, there was no difference in fusion rates between the ALIF-PPF and ALIF-PLF subgroups (p=0.28). VAS-L (p0.001) and VAS-R (p0.0001), ODI (p0.001) and SF12 physical (PCS) (p0.01) and mental component sores (MCS) (p0.001) all showed significant improvement at 12 months. Combined approaches provided greater clinical efficacy than TLIF or PLIF for lumbar (p0.0001) and radicular pain (p0.05), ODI (p0.0001) and SF12 PCS (p0.01). At 12 months, there was no clinical difference between the ALIF-PPF and ALIF-PLF subgroups. However, patents with interbody non-union (Lenke 3 or 4) had lower SF12 PCS scores (p0.004) and VAS-L ratings (p0.001) than Lenke 1-2 patients.Low-grade ISPL treated by circumferential arthrodesis and interbody graft showed 85.3% consolidation at 2 years, with equivalent outcomes between anterior and posterior techniques. Successful fusion was associated with better clinical results.IV.

To determine the midterm outcome of lateral thoracotomy (LT) in skeletally immature patients concerning thoracogenic scoliosis development and lung parenchyma resection (LPR) extent.In total, 129 children met the inclusion criteria: (1) LT during the study period; (2) skeletally immature at the time of LT; (3) clinical and radiographic follow-up of at least 3 years; and (4) no spinal or thoracic deformity on radiographs before LT. Patients were grouped according to their underlying disease, age at LT, and LPR extent. Radiographic parameters were assessed. Kaplan-Meier survival curves and univariate and multivariate analysis were performed.Of 129, 108 patients underwent pneumonectomy (9; 9.1%), lobectomy (79; 61.2%), segmentectomy (20; 15.5%) and 21 patients LT without LPR. The mean age at LT and at last radiological follow-up was 5.5 years (birth-17.8) and 15.2 years (3.4-33.2). The mean follow-up was 10 years (3-28.1). Scoliosis developed on average 5.3 years after LT. The mean Cobb angle was 22.1° (11-90°); 10° in 37/129 patients (28.7%), of whom 5/129 (3.9%) had 45°. The average vertebral rotation was 16.2° (2-43°; grade 0-II). RVAD was 26.5° (8°-33°) and 15.3° (2-43°) in patients with Cobb 45° and ≤ 45°. Gender, age at surgery, and extent of LPR were not risk factors for post-thoracotomy scoliosis (p 0.05), although younger patients developed a more severe deformity.Although post-thoracotomy scoliosis is not associated with significant rotation, the risk of curve progression 45° is relatively high. Regular follow-up is required as scoliosis may develop several years after LT with or without LPR.

Objective: To evaluate the clinical and radiological outcomes of patients undergoing one-level oblique lumbar interbody fusion (OLIF) combined with posterolateral fusion (PLF) with pedicle screws for the treatment of degenerative lumbar spondylolisthesis (DS) with a minimum follow-up of 1 year. Methods: A retrospective analysis of prospectively collected data was performed. Patients who underwent combined OLIF and PLF between March 2013 and December 2019 were considered for study eligibility. Patients were evaluated using the Oswestry Disability Index (ODI) and the Short Form-12 (SF-12) (physical PCS, mental MCS), self-evaluation of pain with a Visual Analog Scale (VAS) and walking distance. Compensation and sagittal balance were assessed using the Gille classification by full spine stereoradiography (EOS Imaging, Paris, France). Mechanical complications were also collected. Results: A total of 131 patients were included (mean (SD) age: 64.2 ± 10.4 years), and 127 patients were evaluated after a mean follow-up of 22 ± 12.3 months. The mean ODI at the last follow-up was 13.8 ± 12.9% (gain of 32.3 ± 15.5%; p 40 mm) had a significant improvement in SVA of 19.8 ± 32 mm (p = 0.025). Sagittal imbalance (Gille type 3) was not associated with a change in postoperative functional score (p = 0.52). Conclusions: OLIF improved functional scores at 1 year, with excellent outcomes in 80% of our patients with a low morbidity. Sagittal imbalance did not adversely affect the clinical outcomes. Level of evidence: 4 (cohort study).

International audience; Background: During gait, the braking index represents postural control, and consequently, the risk of falls. Previous studies based their determination of the braking index during the first step on kinetic methods using force platforms, which are highly variable. This study aimed to investigate whether determining the braking index with a kinematic method, through 3D motion capture, provides more precise results. Methods: Fifty participants (20 to 40 years) performed ten trials in natural and fast gait conditions. Their braking index was estimated from their first step simultaneously using a force platform and VICON motion capture system. The reliability of each braking index acquisition method was assessed by intraclass correlation coefficients, standard error measurements, and the minimal detectable change. Results: Both kinetic and kinematic methods allowed good to excellent reliability and similar minimum detectable changes (10%). Conclusion: Estimating the braking index through a kinetic or a kinematic method was highly reliable.

Anterior sagittal imbalance (ASI) is a severity factor in spinal pathology. Stabilometric study of the dynamic position of the center of pressure (CoP) assesses orthostatic control. These analyses provide the energy expenditure used for this control.Stabilometric signs are associated with ASI indicate increased energy expenditure.Healthy male volunteers were subjected to reversible ASI induced by wearing a kyphotic thermoformed thoracolumbar corset. The deformation was assessed by C7 tilt on EOS whole-spine views. Static and dynamic posturographic force platform study was performed under conditions of anteroposterior and mediolateral instability. Mean CoP position (XThe corset significantly increased C7 tilt (p0.0001). This did not significantly change mean CoP positions (XPosturographic parameters were impacted by inducing ASI in healthy subjects. Significant differences were seen in stabilography, CE and LAS, were greater on dynamic testing, and correlated with radiologic sagittal balance. Force platforms can reveal increased energy expenditure in maintaining posture.II; Single-center prospective study involving healthy volunteers.

Introduction Surgery for pediatric spinal deformity may involve vertebral osteotomies in complex cases. Vertebral column resection (VCR) is the most technically demanding procedure, with the severest morbidity. It can use a double anterior and posterior approach (APVCR), though a single posterior approach (PVCR) is gaining in popularity. Hypothesis PVCR provides effective correction with acceptable morbidity in children. Method A single-center retrospective series included spinal deformities treated by PVCR. Surgical data and global pelvic-spinal balance parameters were analyzed. Results Sixteen PVCRs were performed in 13 patients, with a mean age of 14.1 ± 2.8 years. Mean operative time was 411 ± 54 minutes. Mean preoperative rigid principal Cobb angle was 74.3°. Mean correction was 64.3% postoperatively, without significant correction loss at last follow-up. Mean blood loss was 941 ± 221 ml. The cell-saver enabled 92.3% autologous transfusions, with 53.4% homologous transfusions. Transient monoplegia and permanent psoas deficit were observed during the postoperative period. Radiologic follow-up found 4 non-unions requiring revision. Conclusion PVCR provided major correction of rigid spinal deformity in children. Complications mainly comprised mechanical or neurological incidents. Level of evidence IV, non-comparative cohort study.

Degenerative processes induce loss of lumbar lordosis and anterior sagittal imbalance (ASI). Optoelectronic study provides kinematic analysis of movement and can also detect ASI. The aim of the present study was to assess gait kinematic modifications induced by ASI.Thirty-five healthy male volunteers were subjected to reversible ASI induced by wearing a kyphotic thermoformed thoracolumbar corset. The deformation was assessed by C7 tilt on EOS (EOS Imaging, Paris, France) full-spine views. Ten optoelectronic gait recordings were made with corset and 10 without. Gait kinematic parameters (stride length, walking speed, rhythm), gait balance parameters (center of mass braking index, stride width, double support time) and spinal sagittal balance parameters (C7T10S1, C7´S1' and spinal angles) were averaged. Adjusted analysis distinguished direct ASI impact from locomotor factors.The corset-induced ASI produced +15° change in C7 tilt (P0.0001), -7.4° in C7T10S1 (P0.0001), +66.2 mm in C7´S1' (P0.0001), and +13.1° in spinal angle (P0.0001). Radiographic and optoelectronic data correlated significantly. Stride length (P0.0001) and rhythm (P = 0.0003) were significantly reduced, contributing to a reduction in walking speed (P0.0001), and strongly influencing double support time (β = -0.38; 95% confidence interval [CI]: -0.69; -0.06). Center of mass braking index was significantly reduced (P0.0001) and significantly influenced by ASI (β = -0.51; 95% CI: -0.78; -0.28). Stride width was significantly increased by ASI (P0.0001), independently of rhythm and stride length.ASI induced by a kyphotic corset was detectable on the optoelectronic system, leading to significant changes in gait kinematics. Locomotor parameters were significantly reduced. Balance parameters were significantly and directly altered by ASI.

Background and objective: There is absence of data on the prevalence of osteoporosis before corrective surgery of the lumbar spine. We do not know the impact of bone assessment before corrective spine surgery, regarding the prevalence of osteoporosis, risk factors for osteoporosis, and prescription of osteoporotic treatment. Our objective was to evaluate the impact of assessment of bone status before corrective surgery of the lumbar spine. Methods: This retrospective study was conducted over a period of 30 months. Patients included were over 50 years old and had been referred to rheumatology consultation prior to corrective surgery of the lumbar spine with osteosynthesis, for scoliosis or spondylolisthesis. Assessment of bone status consisted in looking for risk factors for osteoporotic fracture, performing bone densitometry with the calculation of TBS (trabecular bone score) and the possible introduction of treatment for osteoporosis. Data were collected on complications related to bone fragility during follow-up. Results: Twenty-eight patients with a median age of 71.2 years (55.5–84.8) were included; 89% were women. T score was

Cage impactions (CI) of Oblique Lumbar Interbody Fusion (OLIF) appear to be a frequent mechanical complication with a potential functional impact.To determine the rate of CI occurrence, their risk factors and clinical implications in the case of combined single-level arthrodesis.A retrospective analysis of prospectively collected data was performed. All our patients with degenerative spondylolisthesis initially underwent OLIF combined with pedicle screw fixation (PSF). Intraoperative control with an image intensifier and a standard radiograph in the immediate postoperative period made it possible to assess the occurrence of CI, depending on the position of the implant. Secondary subsidence was sought on the standing radiological examination using EOS biplanar radiography during follow-up. The pelvic parameters were analyzed, as well as the occurrence of bone fusion. The clinical evaluation was made at≥1 year, by the Oswestry Disability Index (ODI), the walking distance (WD) and the Visual Analogue Scale (VAS).In all, 130 patients out of the 131 included were analyzed. A CI occurred in 25.3% (n=33) of cases and of these, 94% (n=32) occurred intraoperatively. Postmenopausal women had more CI with an odds ratio (OR) of 5.8 (P=0.034). The "CI" group had a 9.5% lower ODI score than the "non-CI" group (P=0.0040), but both provided excellent ODI gains of 30.8±16 and 32.9±15.5% (P0.0001). An "anterior" position of the implant allowed a greater gain in lumbar lordosis (P0.001) but was associated with greater CI occurrence (P0.001), with an OR of 6.75 (P=0.0018).The occurrence of intraoperative cage impaction is a frequent event when performing OLIF. Postmenopausal women have an approximately 6 times greater risk of impaction than men, and patients with an "anterior" implant placement have a 7 times greater risk than with central placement. The negative impact of cage impactions on the clinical score (ODI) was significant after one year of follow-up.IV, non-comparative cohort study.

Spinal osteochondroma (or exostosis) is a rare benign tumour whose clinical manifestations are delayed due to their slow growth and location. Few studies have addressed the characteristics and the diagnostic and therapeutic peculiarities of spinal osteochondroma in children. The objective of this multicentre observational study was to assess the outcomes of a cohort of children after surgery for spinal osteochondroma.Surgical excision of spinal osteochondroma in children is not followed by complications or recurrences.We included consecutive children who had surgery between 2010 and 2018 at any of eight participating centres to remove spinal osteochondromas. The cause, clinical manifestations, and location of the lesions were collected. The surgical outcomes were evaluated after at least 2 years' follow-up.We identified 22 patients who had surgery to remove 26 spinal osteochondromas at a mean age of 12.8±2.6 years. Among them, 7 had a solitary osteochondroma (SO group) and 15 had hereditary multiple osteochondromas (HMO group). At diagnosis, 72% of patients had clinical signs (spinal pain, n=4; one or more lumps, n=5; and neurological manifestations, n=3). In the HMO group, the diagnosis was made during routine MRI screening for tumours involving the spinal canal. Most osteochondromas involved the cervical spine (n=13), with no difference between the two groups (p=0.9). The lamina was the most common location but 54% of the tumours were growing within the canal (92% in the HMO group). After a mean follow-up of 5.2±4.4 years, no patients had experienced any recurrences or complications related to the disease or treatment.Surgical excision of spinal osteochondromas in children is effective, with no medium-term recurrences. Our results also confirm the low peri-operative morbidity, even when the canal is involved, and the absence of any effect at last follow-up on spinal alignment. All patients with neurological manifestations at diagnosis made a full recovery.IV, retrospective observational cohort study.

Posterior hinge fixation (PHF) is a sacroiliac joint fixation method indicated for the surgical treatment of unstable pelvic ring fractures (tile C).PHF yields good functional outcomes based on the Majeed score at more than 1 year of follow-up.A single-center, retrospective study of patients who had a Tile C pelvic ring fracture, who were operated by PHF and who were evaluated at a minimum follow-up of 1 year. The functional outcome was determined using the Majeed score and pain was evaluated by the patients using a visual analog scale (VAS). The preoperative, intraoperative and postoperative data, complications and sequelae were documented. A CT-scan was done at least 1 year after the surgical treatment to determine the SI joint's reduction and fusion.Included were 22 patients (59% men) who had a mean age of 37.3±11.9 years; 21 of these patients were reviewed at a mean of 4.8±4 years. The mean Majeed score at the final assessment was 76.4 points±15.3, with 24% of patients having excellent results (n=5), 53% having good results (n=11), 19% having average results (n=4) and 5% having poor results (n=1). The mean pain level on VAS was 28±23mm. Of the eight surgical site infections, seven occurred in the PHF (88%). CT-scans taken at 1 year postoperative were compared to the preoperative scans. The pelvic opening was reduced by -9±6 (p0.01), SI diastasis by -11mm±9 (p0.001), vertical displacement by-7mm±8 (p0.001), symphysis opening by -15mm±15 (p0.001), median transverse diameter by -10mm±9 (p0.001) and bispinal diameter by -5mm±7 (p0.001). SI fusion was confirmed in 43% of patients (n=9).PHF is a surgical instrumentation method that provides satisfactory long-term reduction of Tile C pelvic ring fractures. The clinical outcomes are good or excellent in 77% of cases. The perioperative morbidity is marked by surgical site infections, all of which healed.IV; retrospective, non-comparative cohort study.

Background Anterior lumbar interbody fusion finds a place in L5-S1 isthmic spondylolisthesis (ISPL) treatment. Extension of this arthrodesis at L4-L5 level is sometimes required. Anterior approach of the L4L5 disc is considered difficult due to the anatomical relationship between the iliocava junction (ICJ) and the spine. Hypothesis Does the lumbosacral deformation induced by ISPL allows anterior approach of L4-L5 disc between the iliac? Study design Retrospective radiographic analysis of consecutive patients. Methods This retrospective imaging study of a continuous series of 97 patients treated for an L5-S1 ISPL involved radiological parameters specific to ISPL and pelvic-sagittal balance. The distance between the ICJ and the L4 lower endplate was measured in millimeters. The factors influencing this distance were sought in order to identify a predictive model of high ICJ. Results The ICJ took a cranial position with respect to the L4-L5 disc with an average distance of 1.8mm±16.4. This distance was statistically higher in the case of high-grade ISPL (p 0.30). Conclusion ISPL induces a geometric deformation of the lumbosacral hinge which modifies its anatomical relations with the ICJ. The anterior approach technique of L4-L5 disc in the presence of an L5-S1 ISPL is possible between the iliac veins for the large displacement and low LSA forms. Level of evidence IV, retrospective analysis.

In lumbar stenosis, surgery aims to improve quality of life in increasingly elderly patients. Minimally invasive techniques better suit the requirements of elderly patients with increasing functional demand.The UNILIF unilateral lumbar interbody fusion technique improves functional scores at 1 year in over-80 year-olds, with low morbidity.Patients undergoing minimally invasive decompression with transforaminal lumbar interbody fusion (TLIF) associated to unilateral pedicle screwing for degenerative lumbar stenosis were analyzed at a minimum 1 year's follow-up. SF12, Oswestry Disability Index (ODI) and Quebec scores and sagittal spinopelvic radiographic parameters were assessed at follow-up. Surgical and general complications were also collated.In all, 42 patients (64.3% female; mean age, 83.7±2.9 years) were treated by UNILIF at levels L2-L3 (3.8%), L3-L4 (15.4%), L4-L5 (71.2%) and L5-S1 (9.6%). Mean follow-up was 520±226 days (range, 340-1166 days). Mean preoperative SF12 score was 77.5±10.9, with significant improvement at last follow-up: 81.9±138 (p0.05). Mean preoperative ODI was 44.4%±14.0, with significant improvement at last follow-up: 32.4%±13.3 (p0.001). Mean preoperative Quebec score was 42.9±19.9, with significant improvement at last follow-up: 28.5±21.9 (p0.001). Spinopelvic sagittal balance was not affected by the UNILIF procedure. There were no cases of infection or severe general complications during follow-up, although 2 cases of non-union required revision surgery.Lumbar stenosis surgery by UNILIF improved functional scores at 1 year, with low morbidity. It is a suitable strategy for degenerative lumbar stenosis in elderly patients.IV, non-comparative cohort study.

Resume Introduction La chirurgie des stenoses lombaires vise a ameliorer la qualite de vie de patients dont l’âge tend a s’accroitre. L’utilisation de techniques mini-invasives semble correspondre aux besoins des sujets âges dont la demande fonctionnelle est croissante. Hypothese La technique UNILIF permet une amelioration des scores fonctionnels a 1 an dans une population âgee de plus de 80 ans avec une faible morbidite. Methode Une serie de patients operes de stenose lombaire degenerative par decompression mini invasive avec arthrodese associant TLIF et vissage pediculaire unilateral (UNILIF) a ete etudiee pendant au moins un an. Le score SF12, l’Oswestry disability index (ODI), le score de Quebec et les parametres radiographiques sagittaux spino-pelviens ont ete evalues au cours du suivi. Les complications chirurgicales et generales ont egalement ete recherchees. Resultats 42 patients (64,3 % de femmes) âges en moyenne de 83,7 ans (± 2,9) ont ete traites par UNILIF des etages L2–L3 (3,8 %), L3–L4 (15,4 %), L4–L5 (71,2 %) et L5–S1 (9,6 %). Le suivi moyen etait de 520 jours ± 226 [340 ; 1166]. Le SF12 preoperatoire moyen etait de 77,5 ± 10,9 statistiquement ameliore au dernier recul a 81,9 ± 13,8 (p Conclusion La chirurgie de stenose lombaire par technique UNILIF permet une amelioration des scores fonctionnels a 1 an avec une faible morbidite. Cette strategie constitue un traitement adapte aux stenoses lombaires degeneratives des patients âges. Niveau de preuve IV, etude de cohorte non comparative.

Resume Plusieurs types d’instabilite atlanto-axoidienne peuvent justifier une fixation chirurgicale. L’arthrodese instrumentee par vissage des masses laterales de C1 et des isthmes de C2 decrite par Harms est une technique exigeante mais qui permet une stabilisation perenne. Elle est associee a des complications nerveuses ou vasculaires liees a la configuration des rapports anatomiques locaux. Les technologies de navigation per-operatoire permettent d’ameliorer la precision technique. Cette serie presente 11 cas d’arthrodese C1C2 type Harms realisees sous navigation et controle peroperatoire 3D. Toutes les procedures ont pu etre menees a leur terme avec une disposition adequate des implants. Aucun evenement indesirable propre a l’arthrodese n’est survenu dans la periode peri-operatoire. Aucune effraction corticale n’a ete constatee sur le controle tomodensitometrique cone bean (Oarm®) realise en fin d’intervention. Les difficultes techniques et les risques des arthrodeses C1C2 type Harms conduisent a utiliser les controles d’imagerie 3D peroperatoires lorsqu’ils sont disponibles.

Several types of atlantoaxial instability can justify surgical fixation. The instrumented fusion procedure described by Harms with screw fixation of the C1 lateral masses and C2 pedicles is a demanding technique that provides lasting stabilization. However, it has been associated with nerve and vascular complications due to the local anatomical configuration. Surgical navigation systems can help improve the procedure's accuracy. We describe a series of 11 cases of C1C2 Harms fusion performed with surgical navigation and intraoperative 3D imaging checks. All procedures were carried out completely with satisfactory implant placement. There were no adverse events related to the procedure during the peri-operative period. No cortical breach was detected using cone-beam CT at the end of the procedure. The technical challenges and risks associated with C1C2 Harms fusion have led to the use of 3D intraoperative imaging systems, when available.

Background Clips implanted during intracranial neurosurgical procedures sometimes migrate intradurally with rare cases of spinal migration. The appearance of radicular symptoms of topography concordant with the position of the foreign body leads to discussion about the optimal therapeutic strategy. Case Description We report the case of a 52-year-old woman suffering from L5 radicular pain resistant to medical treatment in the presence of L4L5 lumbar stenosis and a neurosurgical clip migrated to the L5S1 level. This clip had been implanted 19 years earlier during a surgical procedure in the posterior fossa, for resection of a juvenile astrocytoma. The imputability of this clip was deemed low given its location and history. A laminarthrectomy associated with circumferential arthrodesis of the L4L5 level was performed allowing complete improvement of radiculopathy. Surgical removal of the clip was not performed. Conclusion Craniospinal migrations of neurosurgical clips are rare. Their imputability in the appearance of root symptoms is random and is based on a bundle of clinical, radiologic, and neurophysiologic arguments. Surgical removal should not be the standard treatment, especially if there is another cause of root compression.

Background The anterior approach to lumbar spine surgery has grown in popularity in the past few years; spinal fusion of the last 2 lumbar levels is often required. Although alternatives to bone grafting are available, including recombinant human bone morphogenetic protein 2 or bone substitutes, only cancellous autologous bone has all the required factors for bone growth. To avoid the use of bone substitutes, remote iliac crest bone harvesting remains the gold standard. However, this technique may lead to some unfavorable outcomes. Case Description The patient was a 46-year-old man with severe back and left leg pain. Magnetic resonance imaging showed an inflammatory discopathy of L5-S1 associated with a left posterior lateral herniated disc. Conservative treatment failed, and surgical treatment of the lumbar disk disease and the herniated disc was scheduled. A novel iliac crest bone harvesting method was performed during the retroperitoneal approach to the anterior lumbar interbody fusion. The patient's postoperative course was uneventful. There were no adverse outcomes related to the bone donor site. Conclusions This is the first in vivo report of endopelvic iliac crest bone harvesting. This technique allows bone graft harvesting to be performed with the same retroperitoneal approach used for anterior lumbar interbody fusion. It avoids many common complications associated with the remote approach to the iliac crest.

To report the radiologic and functional results of a multicenter, prospective case series of patients with comminuted lumbar fractures treated with 2-stage circumferential arthrodesis.A multicenter prospective case series of 74 patients with comminuted lumbar fractures was analyzed. The strategy entailed initial posterior osteosynthesis, followed by physical replacement with an expandable titanium cage filled with autologous bone via retroperitoneal lumbotomy. The mechanism of lesion formation and epidemiologic characteristics were recorded. Clinical and quality-of-life analyses (visual analog scale [VAS], Oswesty Disability Index [ODI], Short Form 12 [SF-12]) were performed over a minimum observation period of 1 year. Radiologic parameters, including deformity measurements, were recorded at each evaluation. Fusion was analyzed by means of a 1-year monitoring scan.The mean patient age was 38.1 years, and median duration of follow-up was 2.1 years (interquartile range, 1.3-2.9). The distribution of fractures according to the Magerl classification scheme was as follows: A, 64.8%; B, 16.7%; C, 18.5%. At the last follow-up, fusion was considered certain in 57 cases (77%). The mean VAS score was 2.1 ± 1.3, mean ODI was 14.7 ± 8.0, mean SF-12 Physical Component Summary score was 43.2 ± 9.3, and mean SF-12 Mental Component Summary score was 50.8 ± 5.9. Correction of the regional sagittal deformity was significant during the postoperative period, with a mean increase in lordosis of 9.0° (P0.0001). The loss of mean correction at the last follow-up (-2.9°) was not significant.Circumferential arthrodesis, including posterior osteosynthesis and physical replacement with an expandable cage and autologous graft, is applicable to the treatment of comminuted lumbar fractures. A high rate of fusion was obtained with significant and long-lasting correction of the sagittal deformity. Functional scores measured at 1 year suggest mild disability. The ODI, SF-12, and VAS scores were positively correlated with fusion at the last follow-up.

Tranexamic acid (TXA) has been shown to reduce bleeding. Patients with spinal tumors are fragile and acute anemia may be harmful. Tumor excision surgery is reputed to be hemorrhagic and treatment may increase thromboembolic complications. The aim of this study was to compare blood loss with or without perioperative TXA injection. The transfusion-related and postoperative complications were documents.This retrospective analysis of prospectively collected data involved 83 patients with spinal tumors who underwent decompressive surgery associated with bone fixation. Tranexamic acid was used arbitrarily in 36 of them, while the other 47 did not receive TXA. The overall, intraoperative and postoperative blood loss was recorded. Blood loss was reported relative to the number of fixed levels and the number of levels decompressed by laminectomy. Transfusions were quantified in number of red blood cell packets and erythrocyte volume. Postoperative complications were documented.Epidemiological and morphological data were similar between groups. There were no significant differences between the two groups in the overall, intraoperative, and postoperative blood loss. A significant reduction in postoperative bleeding was found in the TXA group when the volume was related to the number of decompressed levels. A significant reduction (P0.05) in the volume of transfused blood was identified in the treated group. No predictor of blood loss was identified, and no additional complications occurred.The efficacy of TXA appears to be moderate during spinal tumor surgery since it does not lead to a reduction in perioperative bleeding. However, a significant reduction in transfusion volume was found without an increase in complications.

Resume Introduction Il existe dans la litterature des variations individuelles importantes d’usure du polyethylene (PE) des protheses totales de hanche (PTH) de type Charnley. Une part de cette usure pourrait etre liee aux variations de la cinematique coxofemorale avec un echauffement anormal a l’interface metal/PE. Les objectifs de cette etude experimentale sur simulateur etaient de mesurer l’usure du PE en fonction de la cinematique coxale et des variations thermiques a l’interface et de comparer un PE ultra high molecular weight polyethylene (UHMWPE) a un PE de derniere generation hautement reticule (HR). Hypothese Notre hypothese principale etait que l’usure du PE pouvait etre correlee a l’elevation de la temperature a l’interface et donc a la cinematique coxofemorale. Materiel et methode Une etude sur simulateur avec 5 millions de cycles a ete realisee en testant 4 cupules PE UHMWPE (Initial™/Amplitude, Valence, France) et 2 cupules en PE HR (X3™/Stryker Kalamazoo Michigan, Etats-Unis). La temperature a l’interface etait mesuree tous les 400 cycles et un releve dimensionnel des implants etait realise tous les millions de cycles. Resultats La temperature moyenne etait de 42 degres pour les frequences de 1 Hz et de 50° C pour 1,5 Hz, quel que soit le type de PE. Il existait une difference importante de rugosite entre le PE UHMWPE et HR sans influence sur les variations thermiques ou l’usure. La penetration de la tete femorale etait entre 0 et 1 million de cycles en moyenne de 0,18 mm pour le PE HR et de 0,075 mm pour le PE UHMWPE. Entre 1 et 5 millions de cycles, la vitesse de penetration etait inferieure a 0,1 mm par million de cycles, sans superiorite du PE HR. Discussion Notre etude a valide une augmentation significative de la temperature a l’interface prothetique en fonction de la frequence. Elle n’a pas montre de correlation entre les variations de temperatures et la degradation du PE. Les contraintes en cisaillement etaient cependant sous evaluees car notre simulateur ne reproduisait pas les mouvements d’abduction et d’adduction. Notre hypothese n’etait pas validee car la deformation du PE n’etait pas correlee aux variations de temperature. Il n’existait pas de superiorite du PE HR. Notre etude pointe cependant les limites des etudes sur simulateurs en l’absence de normes sur le cyclage et le bain du simulateur. Niveau de preuve Niveau III : etude prospective in vitro cas temoin ?

Resume L’imagerie 3D interventionnelle est souvent utilisee en chirurgie rachidienne. Ce travail a pour objectif de detailler la technique et les premiers resultats de l’imagerie 3D operatoire (O-Arm, Medtronic, Louisville, CO) en chirurgie pelvienne. Six patients ont ete inclus dont cinq souffrant de tumeurs osseuses primitives et un d’un cal vicieux post-traumatique. Toutes les procedures tomodensitometriques ont ete poursuivies a leur terme sans modifier la technique chirurgicale sauf dans un cas justifiant une reinstallation peroperatoire. Les durees operatoires n’ont pas ete allongees avec une duree moyenne de 224 mins (min = 96 ; max = 380). L’irradiation enregistree variait de 450 a 1125 mGrey.cm. Toutes les procedures ont pu etre menees selon les planifications preoperatoires aboutissant a des resections systematiquement en marge saine (R0). Une infection de site operatoire est survenue. Ces interventions auraient pu etre realisees sans imagerie 3-D ni navigation, mais ce systeme a apporte un controle et une securite operatoire continue. Niveau de preuve IV.

Resume Introduction Les arthrodeses cervicales posterieures necessitent l’utilisation de materiel d’osteosynthese. Lorsqu’elles concernent C2, le vissage pediculaire apporte de bonnes conditions d’ancrage. Ce geste est associe a des risques neurovasculaires lies aux structures anatomiques locales. Objectif Determiner sur une serie scannographique la faisabilite du vissage pediculaire de C2. Decrire des parametres anatomiques identifiables en peroperatoire pour planifier et securiser le geste. Materiel et methodes Une serie continue retrospective de 100 scanners du rachis cervical a ete analysee. Les patients ayant une fracture de C1 ou C2 ont ete exclus. L’anatomie chirurgicale de C2 ete etudiee selon la longueur maximale, la largeur minimale, et la hauteur minimale du pedicule. Des parametres angulaires tel que l’angle pediculo-transverse et l’angle sagittal ont ete mesures. Un angle original pediculo-lamaire independant de la position du patient a ete decrit. La faisabilite du vissage pediculaire a ete recensee, determinee arbitrairement par un calibre minimal Resultats Deux cent pedicules ont ete analyses. Le taux de pedicule non vissable etait de 7,5 %. La longueur moyenne des pedicules etait de 26,2 mm, leur largeur minimale moyenne etait de 5,2 mm, leur hauteur moyenne etait de 9,2 mm. L’angle pediculo-transverse moyen etait de 36,2°, l’angle sagittal moyen etait de 25,8°. La moyenne de l’angle pediculo-lamaire etait de 81,3°. Conclusion Il existe des variabilites anatomiques de C2 qui rendent la faisabilite du vissage pediculaire inconstante. En effet, 13 % des patients avaient au moins un pedicule non vissable. La planification scannographique preoperatoire est necessaire pour la realisation de cette technique. Elle peut utiliser l’angle pediculo-lamaire qui reste independant de la position du patient.

Background and objective: There is absence of data on the prevalence of osteoporosis before corrective surgery of the lumbar spine. We do not know the impact of bone assessment before corrective spine surgery, regarding the prevalence of osteoporosis, risk factors for osteoporosis, and prescription of osteoporotic treatment. Our objective was to evaluate the impact of assessment of bone status before corrective surgery of the lumbar spine. Methods: This retrospective study was conducted over a period of 30 months. Patients included were over 50 years old and had been referred to rheumatology consultation prior to corrective surgery of the lumbar spine with osteosynthesis, for scoliosis or spondylolisthesis. Assessment of bone status consisted in looking for risk factors for osteoporotic fracture, performing bone densitometry with the calculation of TBS (trabecular bone score) and the possible introduction of treatment for osteoporosis. Data were collected on complications related to bone fragility during follow-up. Results: Twenty-eight patients with a median age of 71.2 years (55.5–84.8) were included; 89% were women. T score was

International audience; no abstract

Chronic ulnar nerve entrapment worsened by elbow flexion is the most common injury, but rare painful conditions may also be related to ulnar nerve instability. The posterior bundle of the medial collateral ligament (pMCL) and the retinaculum, respectively form a soft floor and a ceiling for the cubital tunnel. The aim of our study was to dynamically assess these soft structures of the cubital tunnel focusing on those involved in the biomechanics of the ulnar nerve. Forty healthy volunteers had a bilateral ultrasonography of the cubital tunnel. Elbows were scanned in full extension, 45° and 90°, and maximal passive flexion. Morphological changes of the nerve and related structures were dynamically assessed on transverse views. Both the pMCL and the retinaculum tightened with flexion. During elbow flexion, the tightening of the pMCL superficially moved the ulnar nerve remote from the osseous floor of the retroepicondylar groove. A retinaculum was visible in all 69 tunnels with stable nerves (86.3%), tightened in flexion, but absent in 11 tunnels with unstable nerves (13.7%). The retinaculum was fibrous in 60 elbows and muscular in nine, the nine muscular variants did not significantly influence the biomechanics of stable nerves. Stable nerves flattened in late flexion between the tightened pMCL and retinaculum, whereas unstable nerves transiently flattened when translating against the anterior osseous edge of the groove. The retinaculum and the pMCL are key structures in the biomechanics of the ulnar nerve in the cubital tunnel of the elbow.

The use of fluoroscopy is necessary during proximal femoral fracture (PFF) osteosynthesis. The frequency of these procedures justifies a description of radiation exposure and comparisons between different techniques and between the different surgical team members. This observational prospective and comparative study includes a series of 68 patients with PFF receiving osteosynthesis. Radiation exposure was assessed for all members of the operating team. The radiation dose measurements for the different members of the surgical team during PFF osteosynthesis were compared. The factors affecting the radiation dose were investigated. The mean active dosimeter readings for each operation were 7.39 µSv for the primary surgeon, 3.93 µSv for the assistant surgeon, 1.92 µSv for the instrument nurse, 1.25 µSv for the circulating nurse, and 0.64 µSv for the anaesthesiologist, respectively. Doses decreased significantly between these different members of the medical team (all p

Spinal diseases often induce gait disorders with multifactorial origins such as lumbar pain, radicular pain, neurologic complications, or spinal deformities. However, radiography does not permit an analysis of spinal dynamics; therefore, sagittal balance dynamics during gait remain largely unexplored. This prospective and controlled pilot study assessed the Vicon system for detecting sagittal spinopelvic imbalance, to determine the correlations between optoelectronic and radiographic parameters.Reversible anterior sagittal imbalance was induced in 24 healthy men using a thoracolumbar corset. Radiographic, optoelectronic, and comparative analyses were conducted.Corset wearing induced significant variations in radiographic parameters indicative of imbalance; the mean C7-tilt and d/D ratio increased by 15° ± 7.4° and 359%, respectively, whereas the mean spinosacral angle decreased by 16.8° ± 8° (all P0.001). The Vicon system detected the imbalance; the mean spinal angle increased by 15.4° ± 5.6° (P 0.01), the mean floor projection of the C7S1 vector (C7'S1') increased by 126.3 ± 51.9 mm (P 0.001), and the mean C7-T10-S1 angle decreased by 9.8° ± 3° (P0.001). Variations in C7'S1' were significantly correlated with d/D ratio (ρ = 0.58; P0.05) and C7-tilt (ρ = 0.636; P0.05) variations.Corset wearing induced radiographically confirmed anterior sagittal imbalance detected using the Vicon system. Optoelectronic C7'S1' correlated with radiographic C7-tilt and d/D ratio.

Introduction La cimentoplastie, apres expansion corporeale au moyen d’implants intravertebraux type SpineJack, est applicable a certaines fractures vertebrales par compression (FCV). Elle vise une reduction de la cyphose fracturaire et une diminution des complications liees aux interventions conventionnelles. L’objectif est ici de confirmer la securite, les performances cliniques et radiologiques de cette methode. Materiel et methodes Etude prospective multicentrique observationnelle dans 14 centres europeens incluant 103 patients, 108 fractures, (52 hommes), d’âge moyen 61,6 ans (± 15,3). 81 presentaient des fractures purement traumatiques et 22 presentaient une osteoporose associee (diagnostiquee par les chercheurs). Les SpineJack (Vexim SA, France) ont ete implantes avec du ciment osseux PMMA de haute viscosite (Cohesion) a un delai moyen de 9,2 (± 7,8) jours du traumatisme. Les parametres cliniques : douleur (EVA), capacite fonctionnelle (ODI), qualite de vie (EQ-EVA), consommation d’antalgiques et parametres radiologiques ont ete evalues : pre- et postoperatoire, a 3, 12 et 24 mois. Les evenements indesirables ont ete recueillis. Resultats Type de fractures (Classification de Magerl) : A.3 : 44,2 % (27,9 % A3.1, 4,8 % A3.2 et 11,5 % A3.3), A.1 : 41,4 % et A2 : 8,7 %.57 patients a 24 mois (13 presentaient une osteoporose). Le score EVA etait ameliore, passant de 6,6 (ET 2,6) au point de reference 1,0 (ET 1,5) a 24 mois (p Conclusion Les resultats cliniques et radiologiques ont confirme la securite et l’efficacite de la procedure SpineJack pour le traitement des FCV traumatiques. Un faible taux de fractures adjacentes a ete rapporte. Les resultats cliniques sont maintenus a 24 mois.

International audience; Pyogenic sacroiliitis is exceptional in very young children. Diagnosis is difficult because clinical examination is misleading. FABER test is rarely helpful in very young children. Inflammatory syndrome is frequent. Bone scintigraphy and MRI are very sensitive for the diagnosis. Joint fluid aspiration and blood cultures are useful to identify the pathogen. Appropriate antibiotic therapy provides rapid regression of symptoms and healing. We report the case of pyogenic sacroiliitis in a 13-month-old child.Clinical, biological, and imaging data of this case were reviewed and reported retrospectively.A 13-month-old girl consulted for decreased weight bearing without fever or trauma. Clinical examination was not helpful. There was an inflammatory syndrome. Bone scintigraphy found a sacroiliitis, confirmed on MRI. Aspiration of the sacroiliac joint was performed. Empiric intravenous biantibiotic therapy was started. Patient rapidly recovered full weight bearing. On the 5th day, clinical examination and biological analysis returned to normal. Intravenous antibiotic therapy was switched for oral. One month later, clinical examination and biological analysis were normal and antibiotic therapy was stopped.Hematogenous osteoarticular infections are common in children but pyogenic sacroiliitis is rare and mainly affects older children. Diagnosis can be difficult because clinical examination is poor. Moreover, limping and decreased weight bearing are very common reasons for consultation. This may delay the diagnosis or refer misdiagnosis. Bone scintigraphy is useful to locate a bone or joint disease responsible for limping. In this observation, bone scintigraphy located the infection at the sacroiliac joint. Given the young age, MRI was performed to confirm the diagnosis. Despite the very young age of the patient, symptoms rapidly disappeared with appropriate antibiotic therapy.We report the case of pyogenic sacroiliitis in a 13-month-old child. It reminds the risk of misdiagnosing pyogenic sacroiliitis in children because it is exceptional and clinical examination is rarely helpful. It also highlights the usefulness of bone scintigraphy and MRI in osteoarticular infections in children.

Producción Científica, This prospective, consecutive, multicentre observational registry aimed to confirm the safety and clinical performance of the SpineJack system for the treatment of vertebral compression fractures (VCF) of traumatic origin. We enrolled 103 patients (median age: 61.6 years) with 108 VCF due to trauma, or traumatic VCF with associated osteoporosis. Primary outcome was back pain intensity (VAS). Secondary outcomes were Oswestry Disability Index (ODI), EuroQol-VAS, and analgesic consumption. 48 hours after surgery, a median relative decrease in pain intensity of 81.5% was observed associated with a significant reduction in analgesic intake. Improvements in disability (91.3% decrease in ODI score) and in quality of life (increase 21.1% of EQ-VAS score) were obtained 3 months after surgery. All results were maintained at 12 months. A reduction in the kyphotic angulation was observed postoperatively (−5.4 ± 6.3∘ ; p< 0.001), remained at 12 months (−4.4 ± 6.0∘ , p = 0.002). No adverse events were implant-related and none required device removal. Three patients (2.9%) experienced procedure-related complications. The overall adjacent fracture rate up to 1 year after surgery was 2.9%. The SpineJack procedure is an effective, low-risk procedure for patients with traumatic VCF allowing a fast and sustained improvement in quality of life over 1 year after surgery.

Introduction Avec 20 % des procedures judiciaires, les chirurgiens representent la specialite la plus exposee un sinistre tous les deux ans par chirurgien. Ils portent principalement sur le risque infectieux ou encore les fautes techniques. Notre travail repose sur une analyse de litiges secondaires a une prise en charge dans un service d’orthopedie au sein d’un inter region. L’objectif de cette etude etait de mettre en evidence les causes sources des contentieux et d’instaurer des mesures preventives adaptees pour ameliorer la prise en charge de nos patients. Materiel et methodes Nous avons inclus des dossiers anonymises sur la periode 2000–2010 au sein d’un inter region francais de 4 centres hospitalo-universitaires. Les criteres d’inclusion etaient : un contentieux concernant l’orthopedie et la traumatologie, provenant d’un CHU de l’inter region, chez des patients majeurs, avec un dossier conclu au moment de l’analyse. Pour chaque dossier, le motif de plainte, le mode de recours (CRCI, TA, DI), les donnees epidemiologiques, l’articulation concernee, le type intervention (traumatologie ou non), les consequences socioeconomiques, le delai de retour a l’emploi ont ete analyses en strate selon la methode de Reason. L’analyse statistique a ete realisee par test binomial exact. Resultats L’âge moyen des plaignants etait de 46 ans, 58 % etait des hommes. La duree moyenne de la procedure etait de 28,16 mois. Vingt-huit pour cent des dossiers concernaient au moins deux modes de recours. Soixante pour cent des dossiers concernaient la traumatologie, dans 85 % des cas les patients ont ete repris chirurgicalement et 54 % des dossiers concernaient des sepsis. Dans 42 % des dossiers, il etait retrouve un defaut de qualite dans la relation patient–soignant. Vingt-huit pour cent des patients ont recu une indemnisation financiere de 48 078 euros en moyenne. Conclusion La gestion des contentieux fait partie de notre activite professionnelle. La mise en lumiere des differentes causes et mecanismes conduisant a ces procedures devrait nous permettre de prevenir ces recours.

Introduction Rapporter les resultats radiologiques et fonctionnels des patients atteints de fractures lombaires comminutives traitees par arthrodese circonferentielle en deux temps. Materiel et methodes Cette serie prospective, multicentrique, regroupe 74 patients atteints de fractures lombaires comminutives. La prise en charge therapeutique comprenait d’une osteosynthese posterieure initiale puis d’une corporectomie avec pose d’une cage extensible en titane remplie d’os autologue posee par lombotomie retroperitoneale. Le mecanisme fracturaire et les caracteristiques epidemiologiques des patients ont ete releves. Les indications ont ete evaluees a partir de la classification de MacCormack. Les scores de qualite de vie (VAS, ODI, SF12) ont ete renseignes au decours d’une periode minimale d’observation d’un an. Les parametres radiologiques incluant la deformation regionale et les parametres de l’equilibre sagittal pelvi-rachidien ont ete evalues a chaque consultation de suivi. La fusion a ete analysee au moyen d’une tomodensitometrie realisee a 1 an postoperatoire. Resultats L’âge moyen des patients etait de 38,1 ans et la duree moyenne de suivi de 2,1 ans (1,3–2,9). La repartition des fractures selon la classification de Magerl etait la suivante : type A (64,8 %), type B (16,7 %) et type C (18,5 %). Toutes les fractures presentaient un score > 6 selon la classification de MacCormack. Au dernier suivi, la fusion a ete jugee certaine dans 57 cas (77 %). Le VAS moyen etait de 2,1 (± 1,3), ODI 14,7 (± 8,0), SF12 PCS 43,2 (± 9,3) et SF12 MCS 50,8 (± 5,9). La correction de la cyphose regionale a ete significative avec une augmentation moyenne de la lordose de 9,0° (p Conclusion Le traitement des fractures lombaires comminutives par arthrodese circonferentielle comprenant une osteosynthese posterieure et une corporectomie par une cage expansible et un greffon autologue ont donne des resultats cliniques et radiologiques satisfaisants. Un taux eleve de fusion a ete obtenu associe a une correction perenne de la cyphose regionale. Les scores fonctionnels (ODI, SF-12 et VAS) a un an sont satisfaisants et sont correles a la fusion evaluee au dernier suivi.

Degenerative spondylolisthesis (DS) is common degenerative spinal disease. Recent studies highlighted relationship between DS and high pelvic incidence (PI). Moreover, impact of spinopelvic alignment on clinical outcomes has been emphasized. We aimed at describing epidemiologic and sagittal spinopelvic parameters in patients with DS, comparing them with asymptomatic volunteers, and determining a classification of DS patients.In this retrospective multicenter study of prospectively collected data, any adult patients treated for lumbar DS were included. Demographic data as well as radiographic parameters such as PI, pelvic tilt (PT), maximal lumbar lordosis (LLmax), lumbosacral lordosis, thoracic kyphosis, and C7tilt were recorded. DS patients were compared to 709 asymptomatic, age-matched volunteers. Cluster analyses were used to classify patients in homogenous groups.654 patients were included (72 % female, 67 years). DS patients had greater PI (58.8° vs. 53.2°, p0.001) and C7tilt (p0.001). LLmax and lumbosacral lordosis were significantly smaller in the DS group. Cluster analysis allowed for the identification of 2 groups of patients according to C7tilt-159 patients with anterior C7tilt and 495 with normal C7tilt. In each group, 3 subgroups were found with different PI and sagittal spinopelvic parameters.Predominance of high PI and female gender was emphasized in DS population. Moreover, these findings highlighted the importance of sagittal alignment analysis in DS with 24 % of patients with anterior malalignment and in the remaining 76 % (normal C7Tilt), more than 50 % had pelvic retroversion. Consequently, DS sagittal malalignment should lead to specific surgical correction adapted to each subgroup of patients.