Spinal instability: fact or fiction.
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Biomechanical Phenomena↗
Biomedical subjects
G Saillant
Publications and source records attributed to G Saillant.
[Dislocation of the femoral component of an unicondylar knee prosthesis. Apropos of a case].
INTRODUCTION: Femoral component dislocation in unicondylar knee arthroplasty is rare. One case is reported. MATERIAL AND METHODS: A 59 years old man required revision of his unicondylar knee arthroplasty for loosening and dislocation of the femoral component 3 years after its insertion. Revision was performed and we found a technical error: distal and posterior femoral cut was too thin, and with components in place, there was a tendancy for the components to "rock" as the knee was flexed. The implants were too tight in flexion. A new unicondylar knee arthroplasty was performed. DISCUSSION: The posterior condylar bone resection should reach at least the thickness of the metal implant. It is better to resect slightly too much of the posterior condyle than too little in order to avoid tightening of the knee in flexion. The femoral component must accurately reproduces the anterior-posterior dimension of the femoral condyle. CONCLUSION: With better selection of patients and surgeons who are more familiar to this type of procedure loosening and dislocation of an unicondylar knee arthroplasty should be avoided.
Arthroplasty, Replacement, Knee↗
[Evaluation of the direct cost of trochanteric fractures in the elderly].
PURPOSE OF THE STUDY: The cost effectiveness of trochanteric hip fractures in 1995 at Pitié-Salpétrière Hospital in Paris has been thoroughly analysed. The aim of this retrospective study was to identify the factors responsible for the variation in the treatment cost of those fractures. MATERIAL AND METHODS: Cost, Hospital stay, functional status, ASA score, mental status and surgical treatment were analysed in 74 patients aged over 60 years old. RESULTS: The mean cost per patient was 23,901 FF divided as follows: 8.5 per cent for preoperative care, 40.5 per cent for surgical procedures, 51 per cent for post-operative care. The mean hospital stay was 18 days. The cost of hospital personnel (44 per cent) and medical materiel (26 per cent) were the two main sources of hospital expenses beside medical investigations (11 per cent), hostelry (8 per cent), blood transfusion (6 per cent) and drugs (5 per cent). DISCUSSION: The duration of hospital stay was the only factor that affected statistically the mean cost per patient. Furthermore, factors related to the patient as age, sex, place of residence prior to admission, functional status, ASA score, mental status, had no influence on cost variation. CONCLUSION: Therefore, the best way to reduce the cost of trochanteric fractures treatment is to develop convalescence structures to avoid a lengthy and costly hospital stay and to minimize the abuse utilization of medical materials.
Age Factors↗
[Possibilities of anterior approach to the lumbar spine by minimal retroperitoneal access. Anatomical bases. Technical principles and initial results].
Anterolateral approach to the lumbar spine using a retroperitoneal approach is a common technique. But conventional approaches are performed laterally, resulting in parietal muscular damage, which may alter functional results. The authors present their experience about a minimized pararectal retroperitoneal approach from T12 to S1. Some anatomical aspects are important for a safe and reproductive procedure. The authors used mainly this technique in association with posterior correction and fixation in traumatic and degenerative pathologies. They point out the simplicity of this technique which is performed without special equipment. It seems a real alternative to laparoscopic techniques and micro-surgical antero-lateral interbody fusion, especially because of minimal potential complications and low post operative morbidity.
Humans↗
[Surgically treated chronic bilateral Achilles tendon disease, without spontaneous rupture, caused by perfloxacin].
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Achilles Tendon↗
[Injuries of the spine. Diagnosis, development, prognosis].
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Humans↗
[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.
Female↗
[Surgical treatment of deformities of the thoracic and lumbar spine by posterior spinal osteotomy].
From 1987 to 1993, we performed spinal osteotomy with posterior closing-wedge using a single-operation technique in 20 patients with kyphosis. Spinal deformity resulted from mal union after spinal injury in 13 patients and from ankylosing spondylarthritis in 7. Mean duration of the procedure was 4 h 15 min (range 2 h 30 min to 7 h) for mal union and 3 hours (2 h 30 to 4 h) for ankylosing spondylarthritis. Intraoperative blood loss was estimated at 1.8 liters (0.5-4) and 1 liter (0.5-1.5) respectively. Osteotomy was performed at L3 in all cases of spondylarthritis with a mean 30 degrees correction (24-37 degrees) which was maintained after 5 to 18 months follow-up (mean 10 months). For mal union, the mean angular correction was better and more stable after 3 to 84 months (mean 23 months) for the thoracic or thoraco-lumbar segments than for the lumbar spine. Functional results were excellent or good for 11 patients, acceptable for 1 and poor for 1. Three patients with recurrent radiculalgia with mal union were cured after the operation while the neurological status of the paraplegic patients remained unchanged. There were no fatal complications nor neurological or vascular complications among the 20 patients. There were 4 complications in patients with an abnormal callus including 3 mechanical complications and one deep infection. For spondylarthritis, there were no complications at maximum follow-up.
Adult↗
[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 14.5 years. The anterior atlanto-axial dislocation was most frequent (25 times), 1 posterior dislocation and 2 vertical dislocations. Odontoid lysis was noted 19 times. A subluxation of the lower cervical spine was present in 12 patients. SURGICAL TECHNIQUE: C1-C2 arthrodesis was performed 12 times (9 times with a loop wire and 3 isthmo-pedicular screws C2-C1), occipito-cervical arthrodesis with plates 16 times. Operative traction was necessary 5 times. The associated surgical gestures included 3 times a laminectomy, 2 times an enlargement of the occipital foramen, 1 section of the Arnold nerve. In 2 patients was associated a fixation of the lower cervical spine. RESULTS: With an average of 27 months follow-up, functional results (classified according to Ranawat's criteria) were satisfactory in 14 patients, improved in 7 patients, unchanged in 4 and bad in 3. The reduction of the anterior displacement in 25 patients was complete 11 times, partial 17 times and null 3 times. The reduction of the vertical displacement was complete once, partial 3 times. Arthrodesis fusion was obtained in 19 cases, 5 times it was a fibrous union and 4 pseudarthrosis occurred, all with C1-C2 loop wire. The rate of complications was high: 2 infections on bone site grafting requiring reoperation, 2 infections with secondary septicemia after lack of reduction. DISCUSSION AND CONCLUSION: Occipito-cervical arthrodesis is necessary as soon as the patient presents neurological signs. When there is an anterior dislocation associated with vertical dislocation, if there is posterior dislocation in case of osteoporosis of the posterior C1-C2 arc, or destabilisation of the lower cervical spine. C1-C2 arthrodesis is suggested when there is no important neurological signs, when displacement is limited to a pure anterior dislocation and in young patient with good bone quality.
Adult↗
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. Surgical treatment was deferred because of spontaneous recovery. This fracture should be considered whenever a trauma patient presents neck pain and plain cervical spine radiographs show no abnormalities.
Adult↗
[Combination of propofol-sufentanil on somatosensory evoked potentials in surgery of the spine].
OBJECTIVES: Most anaesthetics depress cortical somatosensory evoked potentials (CSEPs). However, the modification of CSEPs during total intravenous anaesthesia using propofol remaining still unknown, justified this trial. TYPE OF STUDY: Open, prospective, clinical study. METHODS: Nine consecutive patients requiring CSEPs monitoring for spine surgery, were studied. Anaesthesia was induced with propofol (2.5 mg.kg-1 then 10 mg.kg-1.h-1) and sufentanil (0.50 micrograms.kg-1 then 0.25 micrograms.kg-1.h-1). Maximum positive (P40) and negative (N50) waweform latencies, and the peak to peak amplitude of CSEPs (posterior tibial nerve stimulation, cortical recording), were recorded before induction, 30 min, 1 and 2 h after induction, and at the end of surgery. Data are means +/- SD. RESULTS: Duration of anaesthesia was 260 +/- 73 min. Propofol induced significant lengthening of CSEPS (P40: from 37 +/- 10 up to 41 +/- 11 ms; N50: from 45 +/- 11 up to 51 +/- 14 ms), and a significant decrease in amplitude (from 1.9 +/- 0.9 down to 0.8 +/- 0.4 microV), but these changes were stable from 30 min after the induction to the end of spine surgery. A motor response was obtained 29 +/- 14 min after the end of anaesthetic administration. CONCLUSIONS: Total intravenous anaesthesia with propofol and sufentanil induces a small but stable lengthening of CSEPs latency and a stable decrease of its amplitude, which enable an appropriate monitoring of CSEPs during spine surgery.
Adult↗
[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 59.5. The prevalent histology has a vesicular type (19 cases which represents 51 per cent). The metastasis are mostly found at the dorsal level (48.6). METHODS: The different parameters analysed for this study of 37 patients were: invaded segment of the vertebra (anterior, middle, posterior or total), Tokuhashi score, epiduritis extent, patient age, histological type and iodiosensibility. RESULTS: Out of 37 patients, 3 were lost for follow-up, 7 metastasis were treated carcinologically ("en bloc" resection). 30 were treated palliatively depending on the clinical symptoms: neurological, mechanical, or pain. The osseous metastasis exists in 56 per cent of the cases at the time the primitive neoplasy was discovered, and their presence burdens the final prognostic. 21 patients died with an average survival of 21 months, 13 patients survived with a mean follow-up of 50 months, 50 per cent of the patients had a vertebra totally involved with only 13 patients with neurological signs (4 Frankel A, 3 Frankel B, 4 Frankel C and 2 Frankel D). DISCUSSION: The analysis of the results shows that the pejorative criteria in case of vertebral metastasis of thyroidal cancer are the score of Tokuhashi inferior to 7, the whole affected vertebra, the epiduritis on 3 levels, the age of the patient superior to 65 and the idiosensibility of the metastase. The surgery do called carcinological gives very good results with 5 surviving patients out of 7. CONCLUSION: When reading this study it seems that, in front of vertebral metastasis from thyroidal origin, we should choose the most radical therapeutic attitude as much as possible. This strategy finds its justification by the fact that the thyroidal cancer spreads out slowly giving a survivorship superior to 12 months in case of metastatic vertebral affection. The importance of the tumoral reduction is connected with the efficiency of the iodiotherapy (for differentiated histological types). This is a considerable adjuvant treatment for this kind of cancer.
Actuarial Analysis↗
[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. RESULTS: Final radiographic results showed the same proportion (75 per cent) of anatomic reduction in both groups. There were 21.4 per cent (6/28) hyporeductions in group K, and 23.5 per cent (8/34) hypereducations in group P. Hyporeduction was moderate with good functional results. Hypereduction in group P was often associated with bad functional results, 5 out of the 6 bad results of all the cases. The functional result, with a follow up of 7 months (4 to 10), was 76 per cent of excellent and good results, 85 per cent in group K, 70 per cent in group P. DISCUSSION: Kapandji's technique seemed more reliable than Py's technique. We propose a technical variation to minimize hyporeduction in Kapandji's technic: increasing the pin's angulation. CONCLUSION: Py's technic conserves one indication: intra operative failure of Kapandji's technique in very osteoporotic bone.
Adolescent↗
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. A detailed anatomical study of the arrangement of the intercostal vessels shows that this strictly median approach presents no risk to the medullary vessels thanks to the abundant anastomoses in this region. However, the use of this method may be limited if the aortic vessels have an anomalous origin. Pre-operative angiography is therefore necessary each time T3 must be reached. This approach has already been successfully used in tumor surgery for excision and reconstruction of lesions involving the cervicothoracic region.
Humans↗
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. Of 221 cases of lower cervical spine injuries, posterior stabilization was accomplished in 89%. There was no secondary displacement in 85% of cases.
Cervical Vertebrae↗
[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). The lesion was not always visible on X-rays of the foot in supination and dorsal flexion (only 10 out of 20 in this series). Use of tomography and tomodensitometry was essential. Treatment was based on compressing the fracture with a screw without grafting or freshening, followed by immobilization of the foot with a cast and no weight bearing for 45 days. Union occurred in 19 out of the 20 cases. Thirteen patients were able to practice their sport without a loss of performance after a period ranging from 3 to 14 months. Treatment varied given the risk of spontaneous non union: incomplete fractures discovered early often responded to orthopedic treatment; fractures associated with large intra-osseous lytic lesions required addition of bone grafting. These fractures can be prevented through the use of inner arch supports especially if a predisposing factor exists such as a short first metatarsal bone.
Adolescent↗
[The dangers of sports doping].
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Doping in Sports↗
[Achilles tendinitis].
Achilles tendinitis is particularly frequent in athletes. In fact, this entity is made up of various anatomical lesions located in Achilles tendon or at the point where it is attached to the calcaneum. The diagnosis is basically clinical, and it is confirmed by carefully selected paraclinical examinations. Management essentially relies on rest associated with adequate physiotherapy and, when required, with other adjuvant treatments. Management also rests on the prevention of recurrences and on the suppression of the frequently found sport-related causal agent. Surgical treatment is seldom indicated, and only when medical treatment has failed, usually in high-level athletes.
Achilles Tendon↗