Surgery of the deformities in ankylosing spondylitis: our experience of lumbar osteotomies in 31 patients.

Corrective surgery for kyphotic deformities of the spine in ankylosing spondylitis is a major surgery for rare indications. The authors report 31 lumbar osteotomies. The goal is to correct the deformity through a posterior limited approach and to minimise the neurological risks.

Dynamic anatomy of the acetabulum: an experimental approach and surgical implications.

The deformations and stresses acting on the acetabular rim have not been very precisely documented. The authors present a study based on an experimental simulation of hip loading with anatomic correlations. 122 dissections were performed in order to define the anatomic aspect of the roof (and especially of Byers's "area 17") and the intermediate area between the anterior and posterior acetabular cornua.

Post operative infections of the spine: technique, indications and results of the surgical treatment - A retrospective study of 90 cases.

Post operative infection in spine surgery is a well known complication. The authors studied a series of 90 patients in accordance with an homogenous strategy based on the excision of necrotic and infected tissues, associated with appropriate antibiotics.The results are analyzed according to the degree of infection (which is based on the type of germs and their associations), and type of patients, the delay in diagnosis and the anatomical extension of the infected lesions.

[Surgery of the upper cervical spine in rheumatoid arthritis. Indications and results apropos of 28 cases].

Purpose Of The Study: The goal of this study was to precise indications and surgical techniques for stabilisation with or without decompression of the upper cervical spine instability in rheumatoid arthritis.

Material And Methods: 28 patients presenting upper cervical spine disease have been reviewed (mean age 57 years). These patients had been suffering from severe diffuse arthritis during an average of 14.

[Surgical treatment of symptomatic thoracic disk hernia: anterior or posterolateral approach?].

From 1981 to 1994, 16 patients with 18 thoracic disk hernias due to degenerative disease (n = 13), trauma (n = 4) or Scheuermann's disease (n = 1) received surgical treatment. Most were situated from T6 to T12. There were 10 medial hernias and 8 lateral hernias.

[Destabilization after surgical treatment of narrow lumbar canal: when should arthrodesis be performed?].

Post-operative spine displacement occurs by excessive or aggravated vertebral sliding. Sex and age, anatomics factors (pre-operative displacement, intersomatic discs quality, hyperlordosis) and operative factors (extensive laminectomy, artherectomy) are predisposing factors. The risk of post-operative vertebral displacement is calculated by a fine pre and per-operative analysis of these pre-disposing factors: Tolerance to post-operative spinal displacement cannot be foreseen and surgical recovery may be difficult whenever.

[Extensive pseudotumoral lumbar spine lesions of vascular origin].

Extensive remodeling of the anterior aspect of the lumbar spine was observed in two patients with a ruptured aneurysm of the abdominal aorta. Both patients survived as the rupture was contained in the first case and involved a false anastomotic aneurysm in the second. The patients presented with a clinical picture compatible with advanced stage cancer and a radiologic aspect showing anterior erosion of the vertebral bodies, suggestive of very advanced spondylodiscitis.

[Spinal metastases of thyroid origin. Apropos of a series of 37 cases].

Purpose Of The Study: Define a specific therapeutic for spinal metastasis from thyroidal origin.

Material: A retrospective series of 37 patients treated between January 1978 and January 1993 was made. The sex ratio was 29 women for 8 men with an average age of 59.

Fracture of the occipital condyle: case report and review of the literature.

Fracture of the occipital condyle is a rare injury that can be easily overlooked. We report a patient with an occipital condyle fracture who presented with pyramidal syndrome and normal plain radiographs. The diagnosis was made by high-resolution computed tomographic scanning with sagittal and coronal reconstructions and magnetic resonance imaging.

Intraoperative autologous transfusion in emergency surgery for spine trauma.

Although numerous studies have reported the use of intraoperative blood salvage in elective spine, cardiac, and vascular surgery, very few have assessed its efficiency during emergency surgery after spine trauma. We therefore retrospectively analyzed 238 cases of patients with spine trauma who had emergency surgery. Three variables were significantly associated with the risk of perioperative blood transfusion: thoracolumbar spine injury, a preoperative hematocrit < 35%, and an Injury Severity Score > 20.

Haematological effects of postoperative autotransfusion in spinal surgery.

A prospective, randomized, controlled study was performed to determine the haematological and biochemical changes and clinical safety of postoperative autotransfusion (Solcotrans Orthopedic Plus system) in patients undergoing spinal surgery. Fifty patients were studied and were randomly allocated to Control (n = 25) and Solcotrans (n = 25) groups. Both groups had their postoperatively drained blood collected into the Solcotrans reservoir but only the Solcotrans group had this salvaged blood considered for reinfusion.

[Neurologic complications of surgery of the spine in adults].

Spine surgery exposes to neurological complications. There were 170 immediate complications of spine surgery at Pitiè-Salpétrière Hospital out of 2,855 reviewed (5.95%) during 9 years.

[Reduction and osteosynthesis with pin fixation of wrist fractures. A comparative study between Kapandji's and Py's techniques].

Material: 62 fractures of the distal radius were treated by pin fixation: Kapandji's intra focal pinning in 28 cases (Group "K") and Py's elastic pinning in 34 cases (group "P"). The two groups were comparable as to the type of fractures (Castaing classification). Theoretical principles were analyzed and compared.

[Somatosensory evoked potentials during spinal orthopedic surgery in adult patients].

Somatosensory evoked potentials (SEPs) were recorded in 165 patients from 185 operations for scoliosis and major spinal distortions, lumbar or cervical stenosis, post-traumatic malunions, or tumors. They were obtained by percutaneous stimulation of right and left median and tibial posterior nerves, and recorded on the scalp as recently, motor potentials (MPs) have also been obtained, by a trans-spinous stimulation rostral to the level of intervention. The protocol consists of pre- and post-operative recordings, as well as a continuous intra-operative monitoring.

Partial cervicosternotomy: a useful anterior surgical approach to the cervicothoracic junction.

Access to the cervicothoracic junction, whether by lower anterior cervical or transthoracic approach, is particularly difficult. The authors propose partial cervicosternotomy which allows the T3-T4 disk to be reached satisfactorily in 50% of cases and in the remaining 50% allows direct anterior control of the upper two thirds of T3. The advantage of this approach is that it provides direct access to the cervicothoracic junction without leading at the same time to the reconstruction problems caused by the uni- or bilateral sternoclaviculotomies proposed until now.

[Effects of postoperative autotransfusion in prosthetic surgery of the hip with the ConstaVac device].

A new device for postoperative autotransfusion (ConstaVac, Stryker) was assessed after total hip replacement in 43 patients, mean age 63 +/- 13 years. Intraoperative blood was administered to 27 patients (63%), autologous blood only in 19, homologous blood only in 6 and both autologous and homologous blood in 2. The blood shed during an average 5-hour postoperative period had an haematocrit of 23 +/- 7% and included only few platelets (72 +/- 83 G.

[Deformations of acetabulum with load before and after prosthetic implantation. An experimental study by extensometry].

Using fresh cadavers pelves, an experimental model of unipodal stance was performed. The skeleton (femurs, pelvis and 2 lumbar vertebrae) was connected to the machine by non constrained junctions. Muscles (gluteus, iliacus and rectus abdominis) were simulated.

Management of fracture separations of the articular mass using posterior cervical plating.

Fracture separations of the articular mass are a specific group of unilateral facet fractures that must be considered separately because of their unique two-level instability. This fracture pattern involves a longitudinal fracture of the lamina and a fracture of the pedicle on the same side of the spine at the same level. It is characterized roentgenographically by horizontalization of the lateral mass, with a mean translation of 4.

Treatment of lower cervical spinal injuries--C3 to C7.

Injuries of the lower cervical spine are categorized according to the morbid anatomy of the lesion. Most often, such injuries are successfully treated by surgery through a posterior approach. After anatomic restoration, internal fixation with plates and screws provides for stability and arthrodesis.

Three-dimensional geometrical and mechanical modelling of the lumbar spine.

The main objective of this study is to design a three-dimensional geometrical and mechanical finite element model of the lumbar spine. The model's geometry is constructed using six parameters per vertebra. These parameters are digitized from two X-rays (anterio-posterior and lateral), thus yielding an individualized model which can be arrived at from the radiographs of a tested specimen.

[Stress fractures of the tarsal navicular. Apropos of 20 cases].

Twenty cases of tarsal navicular stress fractures were observed in 17 patients. These fractures are rare, often go unrecognized, and are reputed to unite with difficulty. A clue to diagnosis was given by the description (young athletic person in sports involving sudden starts and stops).

Symptomatic spinal epidural lipomatosis induced by a long-term steroid treatment. Review of the literature and report of two additional cases.

Spinal epidural lipomatosis associated with Cushing's syndrome is an uncommon complication (11 reported cases). Two additional symptomatic cases with neurologic deficit are described. Steroid treatment was systemic in the first case and local with epidural injections in the second.