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A Deburge

Publications and source records attributed to A Deburge.

At least 37 records · Page 2Linked to original sources
PubMed1996

Cervical pseudarthrosis in ankylosing spondylitis. A case report.

STUDY DESIGN: This report illustrates two different cases of cervical pseudarthrosis in ankylosing spondylitis. OBJECTIVES: To point out the extreme rarity of this condition at cervical level, to discuss the pathogenesis, and to stress the necessity of surgical management. SUMMARY AND BACKGROUND DATA: Pathogenesis of pseudarthrosis in ankylosing spondylitis is discussed. Several factors are involved: trauma, which may be major or minor and undetected; stress fracture; and inflammatory changes. Major trauma was the cause of pseudarthrosis in the first patient, whereas stress fracture and inflammatory changes were the probable causes in patient 2. In patient 1 there were signs and symptoms of cord compression. Patient 2 was referred because of functional disability resulting from kyphosis and because of potential neurologic risk. METHODS: Cervical fusion was performed in both patients. Patient 1 underwent posterior fusion; patient 2 had combined fusion. Patient 1 also underwent a lamineotomy. RESULTS: The course of the disorder after surgery was uneventful in both patients. Neurologic symptoms subsided in patient 1; kyphosis was corrected in patient 2. Both patients resumed their preoperative activities. Follow-up evaluation was done 6 years after surgery in patient 1 and 2 years after surgery in patient 2. CONCLUSIONS: Pseudarthrosis of the cervical spine in ankylosing spondylitis is extremely rare. Presentation of the two patients was different in terms of pathogenesis and signs and symptoms. Surgical treatment is advocated for this disorder.

Cervical Vertebrae↗
PubMed1996

Posterolateral fusion for radicular pain in isthmic spondylolisthesis.

Reported is the outcome for 25 patients in whom spondylolisthesis with radicular pain was treated by posterolateral fusion alone (Group A). These outcomes are compared with those obtained in 23 other patients with the same symptomatology and spondylolisthesis treated by root release and posterolateral fusion (Group B). Most patients had Grade I or II isthmic spondylolisthesis. Results were assessed functionally and radiographically with an average followup of 32 months. Posterolateral fusion in situ provided excellent or good results in 88% of patients according to the modified classification of Stauffer and Coventry. In Group A, radicular pain at exertion disappeared in 92% of patients, and radicular pain at rest disappeared in 88%. In Group B, radicular pain at exertion disappeared in 65% of patients, and radicular pain at rest disappeared in 70%. There was no significant statistical difference between the 2 groups. Resection of the loose lamina and root decompression do not seem to be mandatory. The overall fusion rate was 81%. Instrumentation in case of instability and the use of allografts are advised.

Adolescent↗
PubMed1995

Chemonucleolysis: correlation of results with the size of the herniation and the dimensions of the spinal canal.

The aim of this study was to determine whether the results of chemonucleolysis are related to the size of the disc herniation and to the dimensions of the spinal canal. Short and long-term results (average follow-up 4 and a half years) of 148 patients were evaluated. Measurements made with a divider included the size of the disc herniation related to the sagittal diameter of the spinal canal at the discal level and the transverse interligamentous diameter at the level of the facet joints. The morphology of the lateral recess was also assessed. Measurements were initially made by five observers and were repeated eight times and on eight computed tomography (CT) scans in order to assess intra- and interobserver variability. Measurements of the entire series were then made by the two observers demonstrating a good intra- and interobserver reproducibility. Of the 148 patients 74% had an overall successful result. No significant difference was disclosed when comparing the various parameters of the clinical results with the size of the herniation. Similarly, a lack of correlation was also found between the clinical results and the dimensions of the spinal canal and of the lateral recess. In this series, the results were not significantly influenced by the size of the herniation or the morphology of the spinal canal.

Humans↗
PubMed1995

Traumatic atlantooccipital dislocation with survival: case report and review of the literature.

We present the case of a patient with traumatic atlantooccipital dislocation. The initial neurological examination showed no abnormalities. Dislocation was the result of rapid deceleration in a motor vehicle accident. The mechanism of injury was hyperextension/rotation, probably combined with a distraction force. Only a few cases of atlantooccipital dislocation without neurological involvement have been reported. Every report pointed out difficulties of initial diagnosis. Special attention should be directed toward the atlanto-odontoid-basion relationships as seen on lateral radiographs. Prompt recognition and surgical stabilization are essential to avoid further neurological injury.

Adult↗
PubMed1995

Unstable degenerative spondylolisthesis of the cervical spine.

Unstable degenerative spondylolisthesis of the cervical spine is very rare. Slip usually occurs at the C3 on C4 or C4 on C5 levels, immediately above a stiff lower cervical spine. There are two clinical patterns: that with neurological involvement causing cervicobrachial pain or myelopathy and that with neck pain alone. The diagnosis can be made by flexion/extension radiography. All of our eight patients had localised fusion, three anterior and five posterior, and all had satisfactory results one to seven years after operation.

Aged↗
PubMed1995

[Reoperations after surgical treatment of lumbar stenosis].

UNLABELLED: PURPOSE THE STUDY: The aim of this study was to determine the causes of failure following surgical treatment of lumbar spinal stenosis, indications for redo surgery and factors influencing the final result. MATERIAL AND METHODS: Between 1975 and 1992, 38 patients were reoperated after a surgical treatment of lumbar spinal stenosis. The mean follow-up was 34 months. All of these patients had had at least one previous lumbar spinal operation. Second operation was performed 35 months on average following the previous surgery. CLINICAL EVALUATION: The grading scale used in this review assessed walking ability, radicular pain at rest and at exersion, back pain, motor deficit and sphincter dysfunction. Patients were evaluated before and after the 2 surgeries and at last follow-up. Radiological study was done from CT-scan, MRI, myelograms, static and dynamic standard X-rays before the first surgery and following the revision surgery. RESULTS AND DISCUSSION: According to our grading scale the final result was very good for 36 per cent of the patients, good for 24 per cent, fair for 24 per cent and poor for 16 per cent. The main causes of failure were post-operative destabilization and incomplete neurological decompression. In 56 per cent of our cases initial nerve roots decompression was incomplete: disc excision without bone resection in case of lumbar stenosis associated with disc herniation, incomplete lateral release, decompression of the symptomatic nerve roots only and not of all of them that were compressed. In these cases revision surgery was comprised by a new decompression. In 25 per cent of our cases post-operative destabilization was the cause of failure. During the previous surgery bone resection had been extensive: total bilateral facetectomy without fusion, wide laminectomy extended into the pars inter-articularis, resulting in isthmic fracture. Revision surgery was a posterolateral fusion with or without instrumentation generally associated with a new decompression. Two patients were reoperated on without evidence of inadequate decompression or destabilization. Result was poor in both. Final results were statistically better when the cause of revision surgery was a post-operative destabilization and when redo surgery was performed on surgically untouched levels. CONCLUSION: Final results were disappointed since only 60 per cent were good or very good results. Revision surgery should be avoided, by using pre-operative planning of the neural decompression, and by adding a fusion if a wide bone resection is necessary.

Adult↗
PubMed1994

The iatrogenic spine.

Explore the source record for details and available documents.

Fracture Fixation, Internal↗
PubMed1993

A randomized, double-blind study to compare low-dose with standard-dose chymopapain in the treatment of herniated lumbar intervertebral discs.

Postoperative low-back pain and spasm are the main drawbacks of chymopapain chemonucleolysis. To investigate if low-dose chymopapain could reduce this adverse reaction, without modifying the efficacy, 118 patients with persistent low-back and radicular pain due to a lumbar disc herniation underwent chemonucleolysis. 60 patients were randomly selected to receive 2 mL of standard-dose chymopapain (4,000 units) and 58 to receive 2 mL of low dose (2,000 units). The clinical outcome was assessed on study days 1, 30, and 60, and after 1 year by physicians who were unaware of the treatment, and on the basis of the patients' self evaluation. At day 60, Chemonucleolysis was rated as successful in 81% of the cases by the investigator and in 80% by the patient's self assessment. The percentage of good results was remarkably similar in the two treatment groups and this finding was confirmed after 1 year. There was some evidence that the low-dose treatment resulted in less frequent postoperative back pain but the difference was not statistically significant. Moreover, a comparable incidence of acute low-back pain and spasm was observed in the two treatment groups. Low-dose chemonucleolysis appears to be as effective as the standard dose, but the use of 2,000 units does not significantly lower the postoperative back pain.

Adult↗
PubMed1993

[Herniation of a lumbar disk in the elderly. Results of chemonucleolysis].

The purpose of this study was to evaluate the outcome after chymopapain chemonucleolysis in elderly patients with low back pain and sciatica due to lumbar disc herniation without concomitant stenosis, unresponsive to conservative therapy. In the 42 study patients, aged 60 years or older, clinical manifestations were similar to those usually seen in younger patients. Evidence of nerve root tension, including a positive straight-leg raising test seen in 67% of our patients, proved valuable for outruling sciatica due to bony impingement. Outcome was favorable in 78% of cases after a mean follow-up of 2.5 years. This findings is consistent with previous studies performed without age restrictions. Chemonucleolysis had no adverse effects. Despite the biochemical changes which occur in the aging disc, chemonucleolysis is an effective tool for the treatment of sciatica due to disc herniation in elderly patients.

Aged↗
PubMed1992

[Cotrel-Dubousset instrumentation in the treatment of thoracolumbar and lumbar spine fractures].

Thirty-three thoracolumbar and lumbar spine fractures have been operated on using Cotrel-Dubousset instrumentation. Most were thoracolumbar burst fractures. Regional kyphosis at follow-up was 4 degrees, vertebral kyphosis was 8 degrees. Secondary loss of regional kyphosis was 1 degree, and 10 degrees of vertebral kyphosis. This construct with screws varies according to the level (thoraco-lumbar or lumbar); it seems reliable, as compared with other kinds of internal fixation. Restoring the height of the vertebral body is essential and is the key to a good final result. Addition of a postero-lateral fusion and or a brace did not improve the results.

Adolescent↗
PubMed1992

[Remodeling of the spinal canal after comminuted fracture of the spine. Apropos of a case].

A burst fracture of T 12, without neurological impairment, was treated by plaster cast. Prior to treatment, there was a significant narrowing of the spinal canal, due to posterior displacement of a bone fragment. This was not modified by treatment, as the narrowing was unchanged on the second CT scan, done eight days later. At 17 months, there was no more narrowing on the CT scan, as a consequence of vertebral body remodeling. The patient had no pain and performed several sport activities.

Adult↗
PubMed1991

[Lateral stenosis of the lumbar canal].

The authors report about 139 cases of nerve root compression due to a lumbar stenosis of the lateral recess. Saccoradiculography seems to be the best examination technique, and the radioclinical agreement is satisfactory. The technique for the surgical treatment and the extent of the release are described. Decompression must involve the symptomatic nerve roots, as well as those who appear to be displaced or amputated on radiculography. The only prognostic element noted in this study is the duration of evolution of preoperative symptoms. Thus the results may be less good for radicular pain lasting for more than one year.

Adult↗
PubMed1991

[Reoperation in failure of surgical treatment of sciatica].

39 patients have been reoperated on for failed lumbar discs. In this series enhanced MRI, enhanced CT scan and disco-CT have been used. These modern imaging means allowed a better assessment for the causes of failure; thus, only in 4 patients was a pure periradicular fibrosis disclosed. The results of reoperations are significantly better than those of a previous series of the same institution, where these imaging devices could not been used. 76% of the patients benefited from reoperation.

Adult↗
PubMed1990

[Lateral lumbar disk hernia].

Lateral lumbar disc herniations (L.D.H.) develop in the foramen, and compress the nerve root against the overlying vertebral pedicle. In our study of L.D.H. from the clinical, radiographical, and therapeutical aspects, we reviewed 23 cases selected from the 590 patients treated for discal herniation from 1984 to 1987. The frequency of L.D.H. in this series was 3.8 per cent. The clinical pattern brings out some suggestive signs of L.D.H. (frequency of cruralgia, a seldom very positive Lasegue's test, the paucity of spinal signs, non impulsive pain). Saccoradiculography and discography rarely evidenced the L.D.H.. The T.D.M. was the investigation of choice on condition that it was correctly used. When the image was doubtful, disco-CT confirmation should be proceeded too. This latter method of investigation enabled the possibility of sequestration to be explored. 14 patients were treated by chemonucleolysis, with 9 successful outcomes. The 5 failures were cases where chemonucleolysis should not have been indicated, mainly due to associated osseous stenosis. 9 patients underwent immediate surgery with good results in each case.

Female↗
PubMed1989

[Sciatica caused by lateral stenosis of the spinal canal].

Eighty-eight patients (52 men, 36 women) were operated on for lateral recess syndrome, during the 1970-1986 period. 7 had priorly a disc excision; in 11 a chemonucleolysis had been performed. The pain affected one nerve root in 41 cases, two in 8, three in 1. In 33 patients the pain pattern was incomplete. Myelography was used in 77 cases, and was positive in 68. CT scan was used in 43 cases. A posterolateral fusion was added to the unroofing of the nerve in 9 patients, who had severe low back pain before surgery. The results were assessed with a special rating scale of 20 points. They were considered excellent or good in 70 per cent. 6 patients were reoperated from 3 months to 2 years post-operatively mainly for recurrent pain at another level or side.

Adult↗
PubMed1988

[Postoperative analgesia: epidural injection of dexamethasone sodium phosphate].

Epidural administration of steroids has been suggested for the prevention of postoperative epidural fibrosis after lumbar lamino-arthrectomy. In order to assess the efficacy of this technique on pain occurring after such surgery, the demand of pentazocine during the first 24 postoperative hours was studied in 39 patients randomly assigned to two groups. Pain intensity was assessed by a five-point verbal scale (0: none; 1: poor; 2: moderate; 3: severe; 4: very severe) at five intervals (0-4, 5-8, 9-12, 13-16 and 17-24 h). The patients in group T (n = 20) did not receive any steroid, whereas those in group C (n = 19) were given, just after the end of surgery, a single dose of dexamethasone (4 mg) via an epidural lumbar catheter previously inserted by the surgeon. In group T, 18 patients required one or several intramuscular injections of pentazocine, whereas only three patients of group C (p less than 0.001) did so. Patients in group T expressed more severe pain (4 moderate, 12 severe, 3 unbearable) than those patients who had received steroids (1 moderate, 1 severe, 1 unbearable). As a consequence, they requested more pain killer (30 injections vs 8 injections, respectively; p less than 0.001) and sooner than patients of the steroid group (8 h vs 12 h; p less than 0.05). It was concluded that epidural administration of dexamethasone was helpful in preventing postoperative pain after lumbar lamino-arthrectomy.

Adult↗