Publications by authors named "Nejib Khouri"

Periacetabular osteotomy is the gold standard treatment for acetabular dysplasia. The great variability of acetabular dysplasia requires a personalized preoperative planning improved by 3D reconstruction and computer-assisted surgery. To plan the displacement of the acetabular fragment by a pelvic osteotomy, it is necessary to define a reference plane and a method to characterize 3D acetabular orientation.

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Introduction: Neuromuscular scoliosis (NMS) is associated with an abnormal muscle tone. Traditional conservative treatments, with the historical practice of early posterior fusion, have proven ineffective. Recently, growth-sparing techniques have gained traction owing to their ability to maximize trunk height.

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Surgical procedures to correct hip dysplasia associated with subluxation or dislocation of the femoral head are complex. The 3D geometric abnormalities of the acetabulum and proximal femur vary across patients. We, therefore, suggest a patient-specific surgical treatment involving computer-assisted 3D planning of the peri-acetabular osteotomies, taking into account the femoral head position; 3D printing of patient-specific guides for the cuts, repositioning, and fixation; and intra-operative application of the simulated displacements with their fixation.

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Introduction: In paediatric rehabilitation, fun and motivation are also critical keys to successful therapy. A variety of interventions have shown positive effects, high level of interest, compliance and engagement with active video game (AVG).This seems to be an interesting approach for the postoperative gait rehabilitation of children with cerebral palsy (CP).

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Introduction: The results of hip reconstruction surgery are known for non-walking (GMFCS IV and V) and walking (GMFCS I and II) patients. Few studies deal with GMFCS III patients in isolation. Their intermediate functional status can be deteriorated by asymmetrical contractures, hip dislocation, multi-level deformities of the lower limbs, leading to motor function degradation, and possibly losing their ability to walk.

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Article Synopsis
  • Pelvic fixation in neuromuscular scoliosis patients is challenging due to their weak bone quality, but this study evaluates the effectiveness of ilio-sacral screw fixation.
  • The study analyzed 167 patients who underwent a surgical technique using minimally invasive bipolar fixation with ilio-sacral screws, showing significant reductions in pelvic obliquity and coronal curve angle post-operation.
  • The findings revealed a lower complication rate compared to previous reports, with most patients achieving stable results over an average follow-up period of more than 6 years.
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This review sought to describe and analyze published protocols for rehabilitation after single-event multilevel surgery for people with cerebral palsy, to identify their differences and limits, and to introduce a common step-by-step framework for future descriptions and assessments of postoperative rehabilitation protocols.The MEDLINE, Embase, CINAHL, and the Cochrane Library databases were searched. Inclusion criteria were as follows: (1) single-event multilevel surgery, (2) full-text reports published after 1985, and (3) articles with a method section describing the rehabilitation protocol.

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Gait analysis and physical clinical measures are usually performed in children with cerebral palsy to help the surgeons make therapeutic decision. However, the level of physical activity in daily life is not systematically assessed. The aim of this cross sectional study was to examine the correlations between: three-dimensional gait analysis kinematic and spatiotemporal parameters, clinical measures and physical activity.

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Study Design: A prospective study.

Objective: The aim of this study was to report the results of an alternative technique to growing rods (GR) for neuromuscular scoliosis using a minimally invasive fusionless surgery with a minimum of 5 years' follow-up.

Summary Of Background Data: Conservative treatment is not effective in progressive neuromuscular scoliosis.

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Purpose: Progressive early-onset scoliosis raises major challenges for surgeons, as growth must be preserved. With traditional growing rods, the need for repeated surgery is associated with numerous complications, high costs, and heavy psychosocial burden on the patient and family. We assessed the safety and efficacy of a new one-way self-expanding rod (OWSER).

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Article Synopsis
  • Calcaneus lengthening is a surgical option for children with symptomatic flat feet, showing promising medium-term results based on a study of 20 cases.
  • Most patients (13 out of 20) experienced significant clinical and radiological improvements after an average follow-up of 8.3 years, while 7 patients reported residual pain, particularly those who did not undergo a specific osteotomy.
  • Adequate complementary bone and muscle procedures are crucial, especially if forefoot supination is present, as it can affect overall outcomes.
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Introduction: Femoral derotation osteotomy (FDO) is a treatment option in children and adolescents with cerebral palsy who have transverse plane deviations in their lower limbs. When the transverse kinematic deviations are asymmetric, the osteotomy indication can be unilateral.

Hypothesis: Unilateral FDO has a kinematic effect on ipsilateral transverse plane deviations along with those of the pelvis and contralateral side.

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Background: Various techniques have been proposed for the treatment of cavovarus feet (CVF). The aim of this study was to report outcomes of the revisited Meary's dorsal closing wedge tarsectomy for fixed CVF secondary to Charcot-Marie-Tooth (CMT) disease.

Methods: All CVF operated on between 1977 and 2011 were included.

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Idiopathic pes planus is common and usually physiologic. Decompensation, when it occurs, may be obvious or on the contrary difficult to identify, raising challenges in patient selection for surgical treatment. The physical examination of a child with pes planus must include an evaluation in the supine position, which helps to adjust the amount of correction during surgery.

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Article Synopsis
  • This study evaluated a new minimally invasive fusionless surgery for spinal deformities in patients with neuromuscular diseases.
  • The procedure involved a special double rod system anchored to the pelvis using iliosacral screws, achieving significant corrections in spinal alignment and pelvic obliquity over time.
  • Results showed a 61% improvement in Cobb angle and an 83% correction in pelvic obliquity, with manageable complications, demonstrating the technique's safety and effectiveness for preserving spinal growth.
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In this work, postoperative lower limb kinematics are predicted with respect to preoperative kinematics, physical examination and surgery data. Data of 115 children with cerebral palsy that have undergone single-event multilevel surgery were considered. Preoperative data dimension was reduced utilizing principal component analysis.

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Spasticity of the rectus femoris (RF) is one of the possible causes of stiff knee gait (SKG) in cerebral palsy. Musculoskeletal studies have shown that in SKG, length and speed of the RF are affected. No evaluation had been made to quantify the modifications of those parameters after surgery.

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Background: Proximal femoral osteotomy (PFO) is a widely performed reconstructive surgery in pediatric patients with diagnosis of neurologic abnormalities. Many implants have been used for the fixation of these osteotomies. These devices have been evolved to provide stable fixation.

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Associating musculoskeletal models to motion analysis data enables the determination of the muscular lengths, lengthening rates and moment arms of the muscles during the studied movement. Therefore, those models must be anatomically personalized and able to identify realistic muscular paths. Different kinds of algorithms exist to achieve this last issue, such as the wired models and the finite elements ones.

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Article Synopsis
  • A study on 62 patients with neuromuscular spinal deformities demonstrated effective spinal correction through a technique involving spinopelvic fixation using iliosacral screws.
  • Pelvic obliquity and angular parameters were measured, revealing various types of spinal curves, with an average patient age of 15.2 years.
  • Despite a high incidence of infectious complications, the technique showed significant improvement in spinal correction and stability, especially for patients with pre-existing pelvic imbalances.
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  • Numerous authors emphasize the significance of changes in the posterior arch, vertebral bodies, and intervertebral disks in relation to lumbosacral spondylolisthesis.
  • A detailed morphologic analysis was performed on 100 patients with severe lumbosacral spondylolisthesis, revealing statistical connections between pelvic incidence, sacral slope, and pelvic tilt, mirroring those found in healthy individuals.
  • A specific morphological measure, the "S1 index," was identified as being closely linked to the severity and stiffness of lumbosacral spondylolisthesis.
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  • Lumbar hyperlordosis of neuromuscular origin is a rare condition that often necessitates surgical intervention to maintain proper sitting posture.
  • A study reported on 27 patients (13 to 27 years old) with significant lumbar spine hyperlordosis due to neuromuscular disorders, detailing their surgical treatment outcomes and approaches.
  • Post-surgery, patients experienced a significant reduction in hyperlordosis, enabling better sitting positions, although one patient faced severe complications leading to death six weeks later.
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