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The Spine : So Many Areas Left To Explore ! / Everard MUNTING in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.443 Titre : The Spine : So Many Areas Left To Explore ! Type de document : texte imprimé Auteurs : Everard MUNTING, Auteur Année de publication : 2014 Article en page(s) : p.443 Langues : Anglais (eng) Résumé : The papers that we put together in this issue of Acta Orthopaedica Belgica are all about spine. This is probably the field in Orthopaedic Surgery where most of unresolved problems remain. Many treatments have still unreliable results, at least when compared to what we are accustomed to, for example in hip or knee arthroplasty. Hence, the payers and even public opinion question the validity of many procedures in spinal surgery, in particular regarding degenerative conditions of the spine whereas it appears that close to 80% of surgical procedure in the spine are performed for degenerative pathologies. This ranges from the very common disc hernia to the complex degenerative deformities associated with stenosis and mechanical instability. Even for simple disk hernia the optimal management is still discussed! From pathogenesis to outcome assessment, we are still struggling with a number of unanswered questions : Why does it happen ? What do we want to treat ? When to do it ? Who to treat ? How to do it ? and Now… did our treatments reached the expectations of the patient ? Only research, critical analysis of treatments and outcome studies will help to progress. These can be very ambitious prospective randomized controlled studies, fundamental research, modest case reviews, or reporting on day-to-day registration of treatment with unbiased patient reported outcome assessment. The Spine Society of Belgium (SSBe) units, under one umbrella, orthopaedic surgeons, neurosurgeons, and physiotherapists from both French and Flemish speaking parts of the country involved in the care of back patients. We have chosen to participate to the Spine Tango Registry. This is an international database allowing for the registration of treatments – surgical and conservative – of spinal ailments, sponsored by Eurospine, the Spine Society of Europe. Doing so, our daily work becomes little stones to the building of knowledge about spinal pathology. All bits and pieces of knowledge will finally help to improve the care we give to our patients, as long as we remain aware of the limitations and value of each contribution and subsequent publication. Sharing some of this knowledge is the aim of Acta Orthopaedica Belgica. Permalink : ./index.php?lvl=notice_display&id=34661 [article] The Spine : So Many Areas Left To Explore ! [texte imprimé] / Everard MUNTING, Auteur . - 2014 . - p.443. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.443 Résumé : The papers that we put together in this issue of Acta Orthopaedica Belgica are all about spine. This is probably the field in Orthopaedic Surgery where most of unresolved problems remain. Many treatments have still unreliable results, at least when compared to what we are accustomed to, for example in hip or knee arthroplasty. Hence, the payers and even public opinion question the validity of many procedures in spinal surgery, in particular regarding degenerative conditions of the spine whereas it appears that close to 80% of surgical procedure in the spine are performed for degenerative pathologies. This ranges from the very common disc hernia to the complex degenerative deformities associated with stenosis and mechanical instability. Even for simple disk hernia the optimal management is still discussed! From pathogenesis to outcome assessment, we are still struggling with a number of unanswered questions : Why does it happen ? What do we want to treat ? When to do it ? Who to treat ? How to do it ? and Now… did our treatments reached the expectations of the patient ? Only research, critical analysis of treatments and outcome studies will help to progress. These can be very ambitious prospective randomized controlled studies, fundamental research, modest case reviews, or reporting on day-to-day registration of treatment with unbiased patient reported outcome assessment. The Spine Society of Belgium (SSBe) units, under one umbrella, orthopaedic surgeons, neurosurgeons, and physiotherapists from both French and Flemish speaking parts of the country involved in the care of back patients. We have chosen to participate to the Spine Tango Registry. This is an international database allowing for the registration of treatments – surgical and conservative – of spinal ailments, sponsored by Eurospine, the Spine Society of Europe. Doing so, our daily work becomes little stones to the building of knowledge about spinal pathology. All bits and pieces of knowledge will finally help to improve the care we give to our patients, as long as we remain aware of the limitations and value of each contribution and subsequent publication. Sharing some of this knowledge is the aim of Acta Orthopaedica Belgica. Permalink : ./index.php?lvl=notice_display&id=34661

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Non-Union Of Osteoporotic Vertebral Fractures – Identification And Treatment Of An Underestimated Pathology In Elderly Patients With Persistent Back Pain / Daniel ADLER in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.444-450 Titre : Non-Union Of Osteoporotic Vertebral Fractures – Identification And Treatment Of An Underestimated Pathology In Elderly Patients With Persistent Back Pain Type de document : texte imprimé Auteurs : Daniel ADLER, Auteur Année de publication : 2014 Article en page(s) : p.444-450 Langues : Anglais (eng) Mots-clés : persistent back pain  osteoporosis  vertebral non-union  kyphoplasty  spine surgery Résumé : Objective : Non-union of osteoporotic vertebra fractures are a seldom entity. However, when back pain persists in the course of conservatively treated osteoporotic vertebra fractures, a non-union should be considered. We thus sought to validate our diagnostic algorithm in patients with known osteoporotic vertebra fractures presenting persistent back pain and advert to the diagnosis and treatment of vertebral non-unions. Patients and Methods : Patients admitted with preexisting osteoporotic vertebra fractures and therapyresistant back pain were retrospectively analysed. All admitted patients were subject to standard plain radiographs in erect position and conventional CT or MR imaging of the spine, respectively. In addition, patients with suspected non-union were subject to lateral fulcrum radiographs in supine position. Results : From a total of 172 admitted patients, four patients presented with non-union of a fractured osteoporotic vertebra (2%). The subsequent surgical therapy included cement-augmented rod-and-screw stabilization, with or without additional correction of deformity, and kyphoplasty (N = 3) or kyphoplasty alone (N = 1). All surgical interventions were successful in pain reduction and allowed immediate and improved postoperative mobilisation. Conclusions : Non-union of osteoporotic vertebra fractures must be considered when symptoms outlast conservative treatment. In these cases, plain lateral fulcrum radiographs are a simple and effective adjunct to the conventional diagnostic methods. Surgical stabilization then proves to be the effective treatment of choice. Permalink : ./index.php?lvl=notice_display&id=34662 [article] Non-Union Of Osteoporotic Vertebral Fractures – Identification And Treatment Of An Underestimated Pathology In Elderly Patients With Persistent Back Pain [texte imprimé] / Daniel ADLER, Auteur . - 2014 . - p.444-450. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.444-450 Mots-clés : persistent back pain  osteoporosis  vertebral non-union  kyphoplasty  spine surgery Résumé : Objective : Non-union of osteoporotic vertebra fractures are a seldom entity. However, when back pain persists in the course of conservatively treated osteoporotic vertebra fractures, a non-union should be considered. We thus sought to validate our diagnostic algorithm in patients with known osteoporotic vertebra fractures presenting persistent back pain and advert to the diagnosis and treatment of vertebral non-unions. Patients and Methods : Patients admitted with preexisting osteoporotic vertebra fractures and therapyresistant back pain were retrospectively analysed. All admitted patients were subject to standard plain radiographs in erect position and conventional CT or MR imaging of the spine, respectively. In addition, patients with suspected non-union were subject to lateral fulcrum radiographs in supine position. Results : From a total of 172 admitted patients, four patients presented with non-union of a fractured osteoporotic vertebra (2%). The subsequent surgical therapy included cement-augmented rod-and-screw stabilization, with or without additional correction of deformity, and kyphoplasty (N = 3) or kyphoplasty alone (N = 1). All surgical interventions were successful in pain reduction and allowed immediate and improved postoperative mobilisation. Conclusions : Non-union of osteoporotic vertebra fractures must be considered when symptoms outlast conservative treatment. In these cases, plain lateral fulcrum radiographs are a simple and effective adjunct to the conventional diagnostic methods. Surgical stabilization then proves to be the effective treatment of choice. Permalink : ./index.php?lvl=notice_display&id=34662

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Fate Of Kyphosis In Tuberculosis Of Subaxial Cervical Spine Treated Non-Operatively / Aditya AGGARWAL in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.451-456 Titre : Fate Of Kyphosis In Tuberculosis Of Subaxial Cervical Spine Treated Non-Operatively Type de document : texte imprimé Auteurs : Aditya AGGARWAL, Auteur Année de publication : 2014 Article en page(s) : p.451-456 Langues : Anglais (eng) Mots-clés : cervical  spine  tuberculosis  kyphotic  deformity  non operative  treatment Résumé : Study design : Retrospective study Objective : Observation of post treatment kyphotic angle in patient of cervical spine tuberculosis managed non operatively Background : The incidence of tuberculosis of cervical spine is about 6-9%. The most dreaded complications of spinal tuberculosis are neural involvement and spinal deformity. Due to destruction of the vertebra tuberculosis of spine usually leads to variable amount of kyphotic deformity. Methods : We retrospectively reviewed 13 patients with clinico-radiological diagnosis of cervical spine tuberculosis managed in our centre between 2004 to 2011. The patients were started on antitubercular therapy. Crutchfield tongs traction was applied 8 to 12 weeks followed by mobilization with four post collar. The kyphotic angles were measured by radiograph at presentation and last available follow up radiograph. Observations : The mean age of the patients was 20 years. C3-C4 vertebra was the most commonly involved area. One patient had single vertebra involvement, five patients had two vertebrae involvement, five patients had three vertebrae involvement and two patients had four vertebrae involvement. The average number of vertebrae involved was 2.6 vertebrae. 9 out of 13 patients had neural deficit at the time of initial presentation. The mean follow up was 21.23 months (12 to 42 months). All patients responded favorably and had neural recovery. At final follow up, 10 out of 13 patients had improvement in kyphotic angle, two patients had deterioration of kyphotic angle and one patient had no change in kyphotic angle. Only one patient had significant deterioration in kyphotic angle. Conclusion : Non operative treatment of cervical spine tuberculosis by initial traction and antitubercular therapy improves the pretreatment deformity irrespective of the number of vertebra involved. Permalink : ./index.php?lvl=notice_display&id=34663 [article] Fate Of Kyphosis In Tuberculosis Of Subaxial Cervical Spine Treated Non-Operatively [texte imprimé] / Aditya AGGARWAL, Auteur . - 2014 . - p.451-456. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.451-456 Mots-clés : cervical  spine  tuberculosis  kyphotic  deformity  non operative  treatment Résumé : Study design : Retrospective study Objective : Observation of post treatment kyphotic angle in patient of cervical spine tuberculosis managed non operatively Background : The incidence of tuberculosis of cervical spine is about 6-9%. The most dreaded complications of spinal tuberculosis are neural involvement and spinal deformity. Due to destruction of the vertebra tuberculosis of spine usually leads to variable amount of kyphotic deformity. Methods : We retrospectively reviewed 13 patients with clinico-radiological diagnosis of cervical spine tuberculosis managed in our centre between 2004 to 2011. The patients were started on antitubercular therapy. Crutchfield tongs traction was applied 8 to 12 weeks followed by mobilization with four post collar. The kyphotic angles were measured by radiograph at presentation and last available follow up radiograph. Observations : The mean age of the patients was 20 years. C3-C4 vertebra was the most commonly involved area. One patient had single vertebra involvement, five patients had two vertebrae involvement, five patients had three vertebrae involvement and two patients had four vertebrae involvement. The average number of vertebrae involved was 2.6 vertebrae. 9 out of 13 patients had neural deficit at the time of initial presentation. The mean follow up was 21.23 months (12 to 42 months). All patients responded favorably and had neural recovery. At final follow up, 10 out of 13 patients had improvement in kyphotic angle, two patients had deterioration of kyphotic angle and one patient had no change in kyphotic angle. Only one patient had significant deterioration in kyphotic angle. Conclusion : Non operative treatment of cervical spine tuberculosis by initial traction and antitubercular therapy improves the pretreatment deformity irrespective of the number of vertebra involved. Permalink : ./index.php?lvl=notice_display&id=34663

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Growing Rod Instrumentation In The Treatment Of Early Onset Scoliosis / Turgut AKGUL in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.457-463 Titre : Growing Rod Instrumentation In The Treatment Of Early Onset Scoliosis Type de document : texte imprimé Auteurs : Turgut AKGUL, Auteur Année de publication : 2014 Article en page(s) : p.457-463 Langues : Anglais (eng) Mots-clés : early onset scoliosis  Growing rod  subcutaneous rodding without fusion Résumé : The goal of the treatment of early onset scoliosis (EOS) is correction of the deformity while still allowing for spinal growth. The aim of this study was to determine the safety and effectiveness of the single and dual growing rod techniques and which technique was the most effective in the management of EOS respectively. From 2003 to 2009, 23 patients underwent single (15) or dual (8) growing rod procedures using a pedicle screw construct and tandem connectors. The etiology of the patients’ spinal deformities were as follows ; infantile, juvenile idiopathic, congenital and neuromuscular. Clinical evaluation included age, sex, diagnosis, follow-up, number and frequency of lengthenings, and complications. Radiographic evaluation included measured changes in Cobb angle, kyphosis, lordosis, frontal and sagittal balance. Overall 46 lengthening procedures were performed, the average number of lengthening procedures being 2.1 +/- 1.14 per patient. The average time between two lengthening procedures was 13 (2-28) months. Average follow-up time was 40.8 +/- 20.6 months.The mean coronal Cobb angle was improved from 64.8° +/- 16.6° to 39.7°+/- 16.4°.Statistically, at the final follow-up, early postoperative measurements in the coronal plane were better in the dual growing rod group than in the single rod group. Nine patients underwent fusion surgery. Their mean age was 11 (10-14) years, with a follow-up of 34.6 (14-54) months. The mean Cobb angle before fusion was 58.7° (40°- 75°). There were 0.9 complications per patient in all groups, 0.38 in the dual rod and 1.2 in the single rod group, respectively. Dual growing rods result in better deformity correction and stability of correction with an acceptable complication rate. Permalink : ./index.php?lvl=notice_display&id=34664 [article] Growing Rod Instrumentation In The Treatment Of Early Onset Scoliosis [texte imprimé] / Turgut AKGUL, Auteur . - 2014 . - p.457-463. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.457-463 Mots-clés : early onset scoliosis  Growing rod  subcutaneous rodding without fusion Résumé : The goal of the treatment of early onset scoliosis (EOS) is correction of the deformity while still allowing for spinal growth. The aim of this study was to determine the safety and effectiveness of the single and dual growing rod techniques and which technique was the most effective in the management of EOS respectively. From 2003 to 2009, 23 patients underwent single (15) or dual (8) growing rod procedures using a pedicle screw construct and tandem connectors. The etiology of the patients’ spinal deformities were as follows ; infantile, juvenile idiopathic, congenital and neuromuscular. Clinical evaluation included age, sex, diagnosis, follow-up, number and frequency of lengthenings, and complications. Radiographic evaluation included measured changes in Cobb angle, kyphosis, lordosis, frontal and sagittal balance. Overall 46 lengthening procedures were performed, the average number of lengthening procedures being 2.1 +/- 1.14 per patient. The average time between two lengthening procedures was 13 (2-28) months. Average follow-up time was 40.8 +/- 20.6 months.The mean coronal Cobb angle was improved from 64.8° +/- 16.6° to 39.7°+/- 16.4°.Statistically, at the final follow-up, early postoperative measurements in the coronal plane were better in the dual growing rod group than in the single rod group. Nine patients underwent fusion surgery. Their mean age was 11 (10-14) years, with a follow-up of 34.6 (14-54) months. The mean Cobb angle before fusion was 58.7° (40°- 75°). There were 0.9 complications per patient in all groups, 0.38 in the dual rod and 1.2 in the single rod group, respectively. Dual growing rods result in better deformity correction and stability of correction with an acceptable complication rate. Permalink : ./index.php?lvl=notice_display&id=34664

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Should A Lumbar MRI For Back Pain Routinely Include The Sacro-Iliac Joint ? / Francis BROOKS in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.464-467 Titre : Should A Lumbar MRI For Back Pain Routinely Include The Sacro-Iliac Joint ? Type de document : texte imprimé Auteurs : Francis BROOKS, Auteur Année de publication : 2014 Article en page(s) : p.464-467 Langues : Anglais (eng) Mots-clés : back pain  sacroiliac joint  MRI Résumé : Back pain is a common problem and has been shown to affect approximately 85% of the adult population at any one time. The source of this pain can be difficult to identify and the sacroiliac joint (SIJ) has been proposed as a possible pain source. Its percentage contribution to lower back pain is controversial. Clinical provocative tests for SIJ pathology have been developed but these have high intra and inter-observer variability and the significant of positive findings is unclear. This study proposes that the SIJ should not be imaged as part of a routine MRI lumbar spine series. Method : We retrospectively reviewed the images of 353 patients who had MRI lumbar spine scans. 130 had the SIJ imaged. We recorded the clinical findings and diagnosis at referral. We reviewed the images and documented the radiological findings. Results : SI joint pathology was most frequently identified when clinical suspected. Overall SIJ pathology found on MRI in only 0.02% of patients. Conclusion : We conclude that routinely imaging the SIJ in MRI lumbar spine series is not cost-effective or a useful use of resources. The SIJ should be imaged only if significant clinical findings are demonstrated. Permalink : ./index.php?lvl=notice_display&id=34665 [article] Should A Lumbar MRI For Back Pain Routinely Include The Sacro-Iliac Joint ? [texte imprimé] / Francis BROOKS, Auteur . - 2014 . - p.464-467. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.464-467 Mots-clés : back pain  sacroiliac joint  MRI Résumé : Back pain is a common problem and has been shown to affect approximately 85% of the adult population at any one time. The source of this pain can be difficult to identify and the sacroiliac joint (SIJ) has been proposed as a possible pain source. Its percentage contribution to lower back pain is controversial. Clinical provocative tests for SIJ pathology have been developed but these have high intra and inter-observer variability and the significant of positive findings is unclear. This study proposes that the SIJ should not be imaged as part of a routine MRI lumbar spine series. Method : We retrospectively reviewed the images of 353 patients who had MRI lumbar spine scans. 130 had the SIJ imaged. We recorded the clinical findings and diagnosis at referral. We reviewed the images and documented the radiological findings. Results : SI joint pathology was most frequently identified when clinical suspected. Overall SIJ pathology found on MRI in only 0.02% of patients. Conclusion : We conclude that routinely imaging the SIJ in MRI lumbar spine series is not cost-effective or a useful use of resources. The SIJ should be imaged only if significant clinical findings are demonstrated. Permalink : ./index.php?lvl=notice_display&id=34665

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The Surgical Treatment Of Far Lateral Lumbar Disc Herniation : 33 Cases / Erhan CELIKOGLU in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.468-476 Titre : The Surgical Treatment Of Far Lateral Lumbar Disc Herniation : 33 Cases Type de document : texte imprimé Auteurs : Erhan CELIKOGLU, Auteur Année de publication : 2014 Article en page(s) : p.468-476 Langues : Anglais (eng) Mots-clés : extraforaminal  disc herniation  far lateral disc  intertraverse approach  transforaminal approach Résumé : Surgical approaches to far lateral disc herniation are challenging because of the anatomical limitations in the region. We describe an extraforaminal approach for far lateral lumbar disc herniation (FLLDH) in a group of patients and discuss the results in patients with far lateral disc protrusion or extrusion operated on by an approach to the extraforaminal region via an intertransverse route with median or paramedian incisions. The two methods are compared in terms of the pre- and postoperative visual analogue scale (VAS) pain scores, duration of the operation, amount of bleeding, and long-term functional recovery. In addition, data on age, incidence, radiological features and clinical signs and symptoms are compared with reported series. Between January 2006 and January 2011, 33 patients (18 females, 15 males ; mean age, 51.2 years) underwent surgery for FLLDH. The majority of patients had herniation at disc levels L3-4 (12 patients) or L4-5 (15 patients). All patients were operated on via either median-paramuscular (20 patients, 61%) or paramedian- intermuscular (13 patients, 39%) approaches. Overall, the mean VAS score improved from 7.3 preoperatively to 2.8 in the short-term. Analyzing the long-term functional outcome of surgery according to the MacNab Criteria, the recovery was excellent, good, fair, and poor in 18, 11, 4, and 0 patients, respectively. The far-lateral approach for FLLDH is a safe, effective procedure that avoids the risk of secondary spinal instability. In treating FLLDH, the use of a long median incision together with an extraforaminal approach is safer and less invasive than a laminectomy together with a medial or total facetectomy. Permalink : ./index.php?lvl=notice_display&id=34666 [article] The Surgical Treatment Of Far Lateral Lumbar Disc Herniation : 33 Cases [texte imprimé] / Erhan CELIKOGLU, Auteur . - 2014 . - p.468-476. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.468-476 Mots-clés : extraforaminal  disc herniation  far lateral disc  intertraverse approach  transforaminal approach Résumé : Surgical approaches to far lateral disc herniation are challenging because of the anatomical limitations in the region. We describe an extraforaminal approach for far lateral lumbar disc herniation (FLLDH) in a group of patients and discuss the results in patients with far lateral disc protrusion or extrusion operated on by an approach to the extraforaminal region via an intertransverse route with median or paramedian incisions. The two methods are compared in terms of the pre- and postoperative visual analogue scale (VAS) pain scores, duration of the operation, amount of bleeding, and long-term functional recovery. In addition, data on age, incidence, radiological features and clinical signs and symptoms are compared with reported series. Between January 2006 and January 2011, 33 patients (18 females, 15 males ; mean age, 51.2 years) underwent surgery for FLLDH. The majority of patients had herniation at disc levels L3-4 (12 patients) or L4-5 (15 patients). All patients were operated on via either median-paramuscular (20 patients, 61%) or paramedian- intermuscular (13 patients, 39%) approaches. Overall, the mean VAS score improved from 7.3 preoperatively to 2.8 in the short-term. Analyzing the long-term functional outcome of surgery according to the MacNab Criteria, the recovery was excellent, good, fair, and poor in 18, 11, 4, and 0 patients, respectively. The far-lateral approach for FLLDH is a safe, effective procedure that avoids the risk of secondary spinal instability. In treating FLLDH, the use of a long median incision together with an extraforaminal approach is safer and less invasive than a laminectomy together with a medial or total facetectomy. Permalink : ./index.php?lvl=notice_display&id=34666

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Kyphoplasty Versus Vertebroplasty In The Treatment Of Painful Osteoporotic Vertebral Compression Fractures : Two-Year Follow-Up In A Prospective Controlled Study / Junhua DU in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.477-486 Titre : Kyphoplasty Versus Vertebroplasty In The Treatment Of Painful Osteoporotic Vertebral Compression Fractures : Two-Year Follow-Up In A Prospective Controlled Study Type de document : texte imprimé Auteurs : Junhua DU, Auteur Année de publication : 2014 Article en page(s) : p.477-486 Langues : Anglais (eng) Mots-clés : osteoporotic  vertebral fracture  kyphplasty  vertebroplasty Résumé : A total of 112 patients with a single-level osteoporotic vertebral compression fracture who did not respond to conservative therapy were included and allocated to either kyphoplasty or vertebroplasty treatment. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess back pain and disability. Anterior, midline, posterior vertebral body heights, and kyphotic angle at the fractured vertebra were measured for radiographic evaluation. Clinical and radiographic follow-up examinations were performed postoperatively at 3, 6, 12 and 24 months. Complications and patient satisfaction with the surgical procedure were also recorded. The follow-up rate was 73.3% in the kyphoplasty group and 80.8% in the vertebroplasty group (P = 0.737). There were no significant differences between the 2 groups with regard to improvement in VAS and ODI scores (P > 0.05) at all postoperative intervals. Both treatment groups achieved marked vertebral height restoration and kyphotic angle reduction, but the radiographic parameters were signi?cantly better in the kyphoplasty group (P < 0.05). The incidence of asymptomatic cement leakage per treated vertebrae in the kyphoplasty group was 11.4% versus 31% in the vertebroplasty group (P < 0.001). Three adjacent level fractures in the kyphoplasty group and 2 in the vertebroplasty group occurred during 2-year follow-up, and no difference in patient satisfaction was detected between the 2 groups. Kyphoplasty and vertebroplasty achieved similar improvement of clinical outcomes and patient satisfaction at 2 years after surgery, albeit kyphoplasty had more ability to markedly reduce vertebral deformity and resulted in less cement leaks compared with vertebroplasty. Permalink : ./index.php?lvl=notice_display&id=34667 [article] Kyphoplasty Versus Vertebroplasty In The Treatment Of Painful Osteoporotic Vertebral Compression Fractures : Two-Year Follow-Up In A Prospective Controlled Study [texte imprimé] / Junhua DU, Auteur . - 2014 . - p.477-486. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.477-486 Mots-clés : osteoporotic  vertebral fracture  kyphplasty  vertebroplasty Résumé : A total of 112 patients with a single-level osteoporotic vertebral compression fracture who did not respond to conservative therapy were included and allocated to either kyphoplasty or vertebroplasty treatment. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess back pain and disability. Anterior, midline, posterior vertebral body heights, and kyphotic angle at the fractured vertebra were measured for radiographic evaluation. Clinical and radiographic follow-up examinations were performed postoperatively at 3, 6, 12 and 24 months. Complications and patient satisfaction with the surgical procedure were also recorded. The follow-up rate was 73.3% in the kyphoplasty group and 80.8% in the vertebroplasty group (P = 0.737). There were no significant differences between the 2 groups with regard to improvement in VAS and ODI scores (P > 0.05) at all postoperative intervals. Both treatment groups achieved marked vertebral height restoration and kyphotic angle reduction, but the radiographic parameters were signi?cantly better in the kyphoplasty group (P < 0.05). The incidence of asymptomatic cement leakage per treated vertebrae in the kyphoplasty group was 11.4% versus 31% in the vertebroplasty group (P < 0.001). Three adjacent level fractures in the kyphoplasty group and 2 in the vertebroplasty group occurred during 2-year follow-up, and no difference in patient satisfaction was detected between the 2 groups. Kyphoplasty and vertebroplasty achieved similar improvement of clinical outcomes and patient satisfaction at 2 years after surgery, albeit kyphoplasty had more ability to markedly reduce vertebral deformity and resulted in less cement leaks compared with vertebroplasty. Permalink : ./index.php?lvl=notice_display&id=34667

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Comparison Of Two Treatment Strategy For Lenke I Adolescent Idiopathic Scoliosis / Omer ERSEN in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.487-492 Titre : Comparison Of Two Treatment Strategy For Lenke I Adolescent Idiopathic Scoliosis Type de document : texte imprimé Auteurs : Omer ERSEN, Auteur Année de publication : 2014 Article en page(s) : p.487-492 Langues : Anglais (eng) Mots-clés : adolescent idiopathic scoliosis  Lenke type 1 curve  fusion  radiographical measurement Résumé : The aim of the study study is to determine whether bilateral pedicle screw placement and posterior only spinal fusion improves sagittal correction parameters compared to alternate posterior segmental fixation in adolescent idiopathic scoliosis. 49 patients with Lenke Type 1 main thoracic curves who underwent single stage posterior only instrumentation and spinal fusion at a single center were retrospectively evaluated according to coronal radiological parameters. Patients divided into two groups of treatment strategy. Bilateral segmental fixation group’s results were similar to alternate fixation group. Although quality of life or cosmetic evaluation of patients not involved in this study, alternate fixation provides similar results as bilateral segmental fixation in adolescen idiopathic scoliosis. Permalink : ./index.php?lvl=notice_display&id=34668 [article] Comparison Of Two Treatment Strategy For Lenke I Adolescent Idiopathic Scoliosis [texte imprimé] / Omer ERSEN, Auteur . - 2014 . - p.487-492. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.487-492 Mots-clés : adolescent idiopathic scoliosis  Lenke type 1 curve  fusion  radiographical measurement Résumé : The aim of the study study is to determine whether bilateral pedicle screw placement and posterior only spinal fusion improves sagittal correction parameters compared to alternate posterior segmental fixation in adolescent idiopathic scoliosis. 49 patients with Lenke Type 1 main thoracic curves who underwent single stage posterior only instrumentation and spinal fusion at a single center were retrospectively evaluated according to coronal radiological parameters. Patients divided into two groups of treatment strategy. Bilateral segmental fixation group’s results were similar to alternate fixation group. Although quality of life or cosmetic evaluation of patients not involved in this study, alternate fixation provides similar results as bilateral segmental fixation in adolescen idiopathic scoliosis. Permalink : ./index.php?lvl=notice_display&id=34668

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The Treatment Of Osteoporotic Thoracolumbar Severe Burst Fractures With Short Pedicle Screw Fixation And Vertebroplasty / Shaoqi HE in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.493-500 Titre : The Treatment Of Osteoporotic Thoracolumbar Severe Burst Fractures With Short Pedicle Screw Fixation And Vertebroplasty Type de document : texte imprimé Auteurs : Shaoqi HE, Auteur Année de publication : 2014 Article en page(s) : p.493-500 Langues : Anglais (eng) Mots-clés : spinal fracture  pedicle screw  short internal fixation  vertbroplasty Résumé : Objective : To investigate the clinical and radiological results of short pedicle screw fixation and vertebroplasty in osteoporotic thoracolumbar severe burst fractures. Methods : From September 2006 to August 2010, 19 consecutive patients sustained osteoporotic thoracolumbar severe burst fractures with or without neurologic deficit and were included in this prospective study. All patients underwent short pedicle screw fixation and vertebroplasty. Segmental kyphosis, AVBHr and PVBHr, and Canal compromise were calculated on radiographs pre-operatively, post-operative and at final follow up. VAS, ODI and SF-36 were calculated pre-operatively and at final follow up. Results : Mean operative time was 70.8 min (range 60~100 min) and mean blood loss was 92 ml (range 60~160 ml). The mean duration of their hospital stay was 4.5 days (range 3-7 days). The operative incisions were healing well. Average follow up time was 40.1 months (range 24~72 months). The AVBHr was corrected from preoperative (48.1 ± 6.8) % to postoperative (94.1 ± 1.7) % (P < 0.001). The PVBHr was corrected from preoperative (62.7 ± 4.8) % to postoperative (92.8 ± 1.8) % (P < 0.001). Canal compromise was corrected from preoperative (37.3 ± 5.8) % to postoperative (5.9 ± 2.3) % (P < 0.001). The segmental kyphosis was corrected from preoperative (20.6 ± 5.3) degree to postoperative (2.0 ± 3.2) degree (P < 0.001). VAS scores were reduced from preoperative 7.21 ± 0.86 to 2.21 ± 0.98 at final follow up (P < 0.001). SF-36 Bodily pain was reduced from preoperative 75.31 ± 13.85 to 13.74 ± 13.24 at final follow up (P < 0.001), and SF-36 Role Physical was reduced from preoperative 59.21 ± 26.63 to 19.74 ± 22.94 at final follow up (P < 0.001). The ODI scores were reduced from preoperative 81.68 ± 4.44 to 15.37 ± 5.54 at final follow up (P < 0.001). All 4 patients with partial neurological deficit initially had improvement. Cement leakage was observed in 3 cases (two anterior to vertebral body and one into the disc without sequela). There were no instances of instrumentation failure and no patient had persistent postoperative back pain. Conclusions : Vertebroplasty and short pedicle screw fixation has the advantages of both radiographic and functional results for treating osteoporotic thoracolumbar severe burst fractures using a purely posterior approach. Permalink : ./index.php?lvl=notice_display&id=34669 [article] The Treatment Of Osteoporotic Thoracolumbar Severe Burst Fractures With Short Pedicle Screw Fixation And Vertebroplasty [texte imprimé] / Shaoqi HE, Auteur . - 2014 . - p.493-500. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.493-500 Mots-clés : spinal fracture  pedicle screw  short internal fixation  vertbroplasty Résumé : Objective : To investigate the clinical and radiological results of short pedicle screw fixation and vertebroplasty in osteoporotic thoracolumbar severe burst fractures. Methods : From September 2006 to August 2010, 19 consecutive patients sustained osteoporotic thoracolumbar severe burst fractures with or without neurologic deficit and were included in this prospective study. All patients underwent short pedicle screw fixation and vertebroplasty. Segmental kyphosis, AVBHr and PVBHr, and Canal compromise were calculated on radiographs pre-operatively, post-operative and at final follow up. VAS, ODI and SF-36 were calculated pre-operatively and at final follow up. Results : Mean operative time was 70.8 min (range 60~100 min) and mean blood loss was 92 ml (range 60~160 ml). The mean duration of their hospital stay was 4.5 days (range 3-7 days). The operative incisions were healing well. Average follow up time was 40.1 months (range 24~72 months). The AVBHr was corrected from preoperative (48.1 ± 6.8) % to postoperative (94.1 ± 1.7) % (P < 0.001). The PVBHr was corrected from preoperative (62.7 ± 4.8) % to postoperative (92.8 ± 1.8) % (P < 0.001). Canal compromise was corrected from preoperative (37.3 ± 5.8) % to postoperative (5.9 ± 2.3) % (P < 0.001). The segmental kyphosis was corrected from preoperative (20.6 ± 5.3) degree to postoperative (2.0 ± 3.2) degree (P < 0.001). VAS scores were reduced from preoperative 7.21 ± 0.86 to 2.21 ± 0.98 at final follow up (P < 0.001). SF-36 Bodily pain was reduced from preoperative 75.31 ± 13.85 to 13.74 ± 13.24 at final follow up (P < 0.001), and SF-36 Role Physical was reduced from preoperative 59.21 ± 26.63 to 19.74 ± 22.94 at final follow up (P < 0.001). The ODI scores were reduced from preoperative 81.68 ± 4.44 to 15.37 ± 5.54 at final follow up (P < 0.001). All 4 patients with partial neurological deficit initially had improvement. Cement leakage was observed in 3 cases (two anterior to vertebral body and one into the disc without sequela). There were no instances of instrumentation failure and no patient had persistent postoperative back pain. Conclusions : Vertebroplasty and short pedicle screw fixation has the advantages of both radiographic and functional results for treating osteoporotic thoracolumbar severe burst fractures using a purely posterior approach. Permalink : ./index.php?lvl=notice_display&id=34669

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Computed Tomography-Guided Percutaneous Focal Catheter Infusion In The Treatment Of Spinal Tuberculosis / Xiaohua HOU in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.501-507 Titre : Computed Tomography-Guided Percutaneous Focal Catheter Infusion In The Treatment Of Spinal Tuberculosis Type de document : texte imprimé Auteurs : Xiaohua HOU, Auteur Année de publication : 2014 Article en page(s) : p.501-507 Langues : Anglais (eng) Mots-clés : spinal tuberculosis  CT-guided  spinal minimal invasive surgery Résumé : The study aimed to investigate the efficacy of computed tomography (CT)-guided percutaneous focal catheter infusion for the treatment of spinal tuberculosis. Clinical and follow-up data from 27 spinal tuberculosis patients who underwent CT-guided intervertebral catheterized infusion chemotherapy from May 2008 to October 2011 were retrospectively analyzed ; treatment included pure intervertebral infusion chemotherapy and catheter drainage for continuous abscess washing during infusion chemotherapy. All surgeries were successfully completed under CT guidance without complications. The C-reactive protein levels of most patients rebounded within the first postoperative week but significantly decreased after the second and fourth postoperative weeks. CT-guided percutaneous focal catheter infusion was effective for the treatment of spinal tuberculosis and induced little trauma ; this treatment could also relieve the symptoms and improve the quality of life of elderly patients with poor general conditions. Permalink : ./index.php?lvl=notice_display&id=34670 [article] Computed Tomography-Guided Percutaneous Focal Catheter Infusion In The Treatment Of Spinal Tuberculosis [texte imprimé] / Xiaohua HOU, Auteur . - 2014 . - p.501-507. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.501-507 Mots-clés : spinal tuberculosis  CT-guided  spinal minimal invasive surgery Résumé : The study aimed to investigate the efficacy of computed tomography (CT)-guided percutaneous focal catheter infusion for the treatment of spinal tuberculosis. Clinical and follow-up data from 27 spinal tuberculosis patients who underwent CT-guided intervertebral catheterized infusion chemotherapy from May 2008 to October 2011 were retrospectively analyzed ; treatment included pure intervertebral infusion chemotherapy and catheter drainage for continuous abscess washing during infusion chemotherapy. All surgeries were successfully completed under CT guidance without complications. The C-reactive protein levels of most patients rebounded within the first postoperative week but significantly decreased after the second and fourth postoperative weeks. CT-guided percutaneous focal catheter infusion was effective for the treatment of spinal tuberculosis and induced little trauma ; this treatment could also relieve the symptoms and improve the quality of life of elderly patients with poor general conditions. Permalink : ./index.php?lvl=notice_display&id=34670

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Geographic Origin Of Publications In Major Spine Journals / Christos KOUTRAS in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.508-514 Titre : Geographic Origin Of Publications In Major Spine Journals Type de document : texte imprimé Auteurs : Christos KOUTRAS, Auteur Année de publication : 2014 Article en page(s) : p.508-514 Langues : Anglais (eng) Mots-clés : bibliometrics  spine research  research productivity  contribution  publications by country  population size Résumé : Aim of the present study was to assess the contribution of each country in the field of spine surgery. Three major spine journals were included in our study and the search conducted in PubMed for a 5-year period (2007-2012). Publications on spine surgery were assessed according to the country. A total of 6312 articles were identified and 5842 were included. Fifteen countries generated 86.9% of publications, with 31.7% by the United States, followed by Japan (9.6%), China (8.1%) and Canada (5.2%). After correction for population size Switzerland (19 studies per 106 inhabitants), the Netherlands (10), Sweden (9), Canada (9) and Australia (6) ranked the top. The USA was placed 7th after correction for population size. Small European countries with modest research funding and non-native English speaking population are more productive in relation to their population size, despite the fact that the contribution of USA is the greatest in the field of the major peer-reviewed indexed spine surgery journals. Permalink : ./index.php?lvl=notice_display&id=34671 [article] Geographic Origin Of Publications In Major Spine Journals [texte imprimé] / Christos KOUTRAS, Auteur . - 2014 . - p.508-514. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.508-514 Mots-clés : bibliometrics  spine research  research productivity  contribution  publications by country  population size Résumé : Aim of the present study was to assess the contribution of each country in the field of spine surgery. Three major spine journals were included in our study and the search conducted in PubMed for a 5-year period (2007-2012). Publications on spine surgery were assessed according to the country. A total of 6312 articles were identified and 5842 were included. Fifteen countries generated 86.9% of publications, with 31.7% by the United States, followed by Japan (9.6%), China (8.1%) and Canada (5.2%). After correction for population size Switzerland (19 studies per 106 inhabitants), the Netherlands (10), Sweden (9), Canada (9) and Australia (6) ranked the top. The USA was placed 7th after correction for population size. Small European countries with modest research funding and non-native English speaking population are more productive in relation to their population size, despite the fact that the contribution of USA is the greatest in the field of the major peer-reviewed indexed spine surgery journals. Permalink : ./index.php?lvl=notice_display&id=34671

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Anatomical Assessment Of Iliac Crest Graft Size For Anterior Spondylodesis / D. KUBOSCH in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.515-521 Titre : Anatomical Assessment Of Iliac Crest Graft Size For Anterior Spondylodesis Type de document : texte imprimé Auteurs : D. KUBOSCH, Auteur Année de publication : 2014 Article en page(s) : p.515-521 Langues : Anglais (eng) Mots-clés : spinal fusion  autologous bone graft  spondylodesis  graft failure Résumé : Standard procedure for monosegmental anterior spondylodesis often combines anterior stabilization with autologous iliac crest graft. Recent publications defined a minimum size of the graft as a technical specification for this procedure. The cross sectional area of the graft to be transplanted should be at least 23.9% of the cross sectional area of the vertebral bodies to be fused. We investigated whether the required minimum size of autologous graft, as identified both experimentally and clinically, is compatible with the anatomical conditions in central european patients. Computed tomography scans (n = 348) of polytraumatized patients were obtained in the course of initial diagnosis. The scans were evaluated for vertebral body size and the possible size of autologous bone graft in the region of the anterior superior iliac crest. The evaluation of 348 CT scans demonstrated that 95% of the quantified iliac crest grafts would achieve the size recommended for anterior spinal fusion between T10 and T12. In 90% of all cases the planned iliac crest graft exceeded the size limit of 23,9% between concerning the endplates T10 and L2. In 85% the planned iliac crest graft exceeded the size limit of 23,9% between T10 and L3. The recommendation to take this value into account for monosegmental anterior spondylodesis should gain in importance in clinical practice. Permalink : ./index.php?lvl=notice_display&id=34672 [article] Anatomical Assessment Of Iliac Crest Graft Size For Anterior Spondylodesis [texte imprimé] / D. KUBOSCH, Auteur . - 2014 . - p.515-521. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.515-521 Mots-clés : spinal fusion  autologous bone graft  spondylodesis  graft failure Résumé : Standard procedure for monosegmental anterior spondylodesis often combines anterior stabilization with autologous iliac crest graft. Recent publications defined a minimum size of the graft as a technical specification for this procedure. The cross sectional area of the graft to be transplanted should be at least 23.9% of the cross sectional area of the vertebral bodies to be fused. We investigated whether the required minimum size of autologous graft, as identified both experimentally and clinically, is compatible with the anatomical conditions in central european patients. Computed tomography scans (n = 348) of polytraumatized patients were obtained in the course of initial diagnosis. The scans were evaluated for vertebral body size and the possible size of autologous bone graft in the region of the anterior superior iliac crest. The evaluation of 348 CT scans demonstrated that 95% of the quantified iliac crest grafts would achieve the size recommended for anterior spinal fusion between T10 and T12. In 90% of all cases the planned iliac crest graft exceeded the size limit of 23,9% between concerning the endplates T10 and L2. In 85% the planned iliac crest graft exceeded the size limit of 23,9% between T10 and L3. The recommendation to take this value into account for monosegmental anterior spondylodesis should gain in importance in clinical practice. Permalink : ./index.php?lvl=notice_display&id=34672

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Correlation Between Clinical Outcomes And Spinopelvic Parameters In Osteoporosis / Jung Sub LEE in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.522-528 Titre : Correlation Between Clinical Outcomes And Spinopelvic Parameters In Osteoporosis Type de document : texte imprimé Auteurs : Jung Sub LEE, Auteur Année de publication : 2014 Article en page(s) : p.522-528 Langues : Anglais (eng) Mots-clés : osteoporosis  sagittal parameters  quality of life Résumé : Introduction : Little data is available on the relationship between sagittal spinopelvic parameters and health related quality of life (HRQOL) in osteoporotic patients. The aim of this study was to identify relationships between spinopelvic parameters and HRQOL in osteoporosis. Material and methods : The patient and control groups comprised 138 osteoporotic patients and 40 controls. All underwent anteroposterior and lateral radiography of the whole spine, including hip joints, and completed clinical questionnaires. The radiographic parameters examined were ; sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis. Lumbar spinal bone mineral density (LSBMD) and femoral neck BMD (FNBMD) of the non-dominant proximal femur were measured. A Visual Analogue Scale (VAS : 0-10) was used to assess back pain, and the Oswestry disability index (ODI) questionnaire and the Scoliosis Research Society (SRS-22) questionnaire to evaluate QOL. Statistical analysis was performed to identify significant differences between the patient and control groups. In addition, correlations between radiological parameters and clinical questionnaires were sought. Results : Patients and controls were found to differ significantly in terms of sagittal vertical axis, sacral slope, pelvic tilt, lumbar lordosis, and thoracic kyphosis. However, no significant intergroup difference was observed for pelvic incidence (P > 0.05). Correlation analysis revealed significant relationships between radiographic parameters and clinical outcomes. Multiple regression analysis was performed to identify predictors of clinical outcome, and the results obtained revealed that sagittal vertical axis, sacral slope, and FNBMD significantly predicted VAS, ODI, and SRS- 22 scores and that LSBMD predicted SRS-22 scores. Conclusions : Osteoporotic patients and controls were found to be significantly different in terms of sagittal spinopelvic parameters. Correlation analysis revealed significant relationships between radiographic parameters and clinical outcome variables. In particular, sagittal vertical axis, sacral slope, and FNBMD significantly predicted clinical outcomes in osteoporotic patients. Permalink : ./index.php?lvl=notice_display&id=34673 [article] Correlation Between Clinical Outcomes And Spinopelvic Parameters In Osteoporosis [texte imprimé] / Jung Sub LEE, Auteur . - 2014 . - p.522-528. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.522-528 Mots-clés : osteoporosis  sagittal parameters  quality of life Résumé : Introduction : Little data is available on the relationship between sagittal spinopelvic parameters and health related quality of life (HRQOL) in osteoporotic patients. The aim of this study was to identify relationships between spinopelvic parameters and HRQOL in osteoporosis. Material and methods : The patient and control groups comprised 138 osteoporotic patients and 40 controls. All underwent anteroposterior and lateral radiography of the whole spine, including hip joints, and completed clinical questionnaires. The radiographic parameters examined were ; sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis. Lumbar spinal bone mineral density (LSBMD) and femoral neck BMD (FNBMD) of the non-dominant proximal femur were measured. A Visual Analogue Scale (VAS : 0-10) was used to assess back pain, and the Oswestry disability index (ODI) questionnaire and the Scoliosis Research Society (SRS-22) questionnaire to evaluate QOL. Statistical analysis was performed to identify significant differences between the patient and control groups. In addition, correlations between radiological parameters and clinical questionnaires were sought. Results : Patients and controls were found to differ significantly in terms of sagittal vertical axis, sacral slope, pelvic tilt, lumbar lordosis, and thoracic kyphosis. However, no significant intergroup difference was observed for pelvic incidence (P > 0.05). Correlation analysis revealed significant relationships between radiographic parameters and clinical outcomes. Multiple regression analysis was performed to identify predictors of clinical outcome, and the results obtained revealed that sagittal vertical axis, sacral slope, and FNBMD significantly predicted VAS, ODI, and SRS- 22 scores and that LSBMD predicted SRS-22 scores. Conclusions : Osteoporotic patients and controls were found to be significantly different in terms of sagittal spinopelvic parameters. Correlation analysis revealed significant relationships between radiographic parameters and clinical outcome variables. In particular, sagittal vertical axis, sacral slope, and FNBMD significantly predicted clinical outcomes in osteoporotic patients. Permalink : ./index.php?lvl=notice_display&id=34673

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Comparison Of Microendoscopic Discectomy System And Anterior Open Approach In Treatment Of Unstable Odontoid Fracture With Cannulated Screw Internal Fixation / Ben LIN in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.529-536 Titre : Comparison Of Microendoscopic Discectomy System And Anterior Open Approach In Treatment Of Unstable Odontoid Fracture With Cannulated Screw Internal Fixation Type de document : texte imprimé Auteurs : Ben LIN, Auteur Année de publication : 2014 Article en page(s) : p.529-536 Langues : Anglais (eng) Mots-clés : microendoscopic discectomy system  odontoid fracture  internal fixation  cannulated screw Résumé : This study intended to investigate the safety and efficacy of microendoscopic discectomy system compared with anterior open approach in the treatment of odontoid fracture with cannulated screw internal fiation. Thirty-two patients (25 male and 7 female) were enrolled and randomly assigned to different treatments. 15 patients were treated with microendoscopic discectomy system (Group MED) and 17 patients were treated with anterior open approach (Group AOA). The operating time, volume of blood loss, occurrence of complications, and fracture healing rate were compared. In Group MED, the mean operating time and blood loss volume were significant lower than those in Group AOA (P < 0.05). Nevertheless, all patients in both groups obtained bony union and cervical range of motion without significant difference statistically (P > 0.05). Three patients in Group AOA complained of transient dysphagia. We concluded that microendoscopic discectomy system for odontoid fracture treatment with cannulated screw is a safe, reliable and minimal invasive procedure compared with traditional open surgery. Permalink : ./index.php?lvl=notice_display&id=34674 [article] Comparison Of Microendoscopic Discectomy System And Anterior Open Approach In Treatment Of Unstable Odontoid Fracture With Cannulated Screw Internal Fixation [texte imprimé] / Ben LIN, Auteur . - 2014 . - p.529-536. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.529-536 Mots-clés : microendoscopic discectomy system  odontoid fracture  internal fixation  cannulated screw Résumé : This study intended to investigate the safety and efficacy of microendoscopic discectomy system compared with anterior open approach in the treatment of odontoid fracture with cannulated screw internal fiation. Thirty-two patients (25 male and 7 female) were enrolled and randomly assigned to different treatments. 15 patients were treated with microendoscopic discectomy system (Group MED) and 17 patients were treated with anterior open approach (Group AOA). The operating time, volume of blood loss, occurrence of complications, and fracture healing rate were compared. In Group MED, the mean operating time and blood loss volume were significant lower than those in Group AOA (P < 0.05). Nevertheless, all patients in both groups obtained bony union and cervical range of motion without significant difference statistically (P > 0.05). Three patients in Group AOA complained of transient dysphagia. We concluded that microendoscopic discectomy system for odontoid fracture treatment with cannulated screw is a safe, reliable and minimal invasive procedure compared with traditional open surgery. Permalink : ./index.php?lvl=notice_display&id=34674

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Study On The Anatomy Of The Lumbosacral Anterior Great Vessels Pertinent ToL5/S1 Anterior Interbody Surgery With Computer Tomography Angiography / Liehua LIU in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.537-543 Titre : Study On The Anatomy Of The Lumbosacral Anterior Great Vessels Pertinent ToL5/S1 Anterior Interbody Surgery With Computer Tomography Angiography Type de document : texte imprimé Auteurs : Liehua LIU, Auteur Année de publication : 2014 Article en page(s) : p.537-543 Langues : Anglais (eng) Mots-clés : anatomy  lumbosacral great vessel  anterior interbody surgery  CT angiography Résumé : We investigate the anatomy of the lumbosacral anterior great vessels using computer tomography (CT) angiography before L5/S1 anterior interbody surgery. Sixty-two adult patients were selected. The location of the abdominal aortic bifurcation and common iliac venous confluence in the lumbar vertebrae and the anatomic parameters of the iliac vascular space (e.g., distances from the included angle vertex of the iliac vascular space to the median sagittal plane and to the inferior boundary of L5 and distances between the left and right iliac vessels on the inferior boundary of L5 and on the superior boundary of S1) were analysed. Overall, 67.73% of the 62 cases had an abdominal aortic bifurcation located at L4 and L4/5 intervertebral disc ; 61.29%, the common iliac venous confluence located at L5. The four distances mentioned above were 0.98 cm ± 0.38 cm, 2.01 cm ± 1.26 cm, 3.11 cm ± 1.35 cm and 4.34 cm ± 1.10 cm, respectively. A classification system of types A, B and C was developed. The calculated L5/S1 intervertebral space exposure percentages of types A, B and C were 32.21%, 82.58% and 54.68%, respectively. During L5/S1 anterior interbody surgery, type B intervertebral discs can be exposed conveniently, preventing injury of the iliac vessels, which was also observed in 54.68% and 32.21% of the type C and type A discs, respectively. Because the type A intervertebral disc has minimal exposure, the risk of iliac vascular injury is relatively high in these patients. Permalink : ./index.php?lvl=notice_display&id=34675 [article] Study On The Anatomy Of The Lumbosacral Anterior Great Vessels Pertinent ToL5/S1 Anterior Interbody Surgery With Computer Tomography Angiography [texte imprimé] / Liehua LIU, Auteur . - 2014 . - p.537-543. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.537-543 Mots-clés : anatomy  lumbosacral great vessel  anterior interbody surgery  CT angiography Résumé : We investigate the anatomy of the lumbosacral anterior great vessels using computer tomography (CT) angiography before L5/S1 anterior interbody surgery. Sixty-two adult patients were selected. The location of the abdominal aortic bifurcation and common iliac venous confluence in the lumbar vertebrae and the anatomic parameters of the iliac vascular space (e.g., distances from the included angle vertex of the iliac vascular space to the median sagittal plane and to the inferior boundary of L5 and distances between the left and right iliac vessels on the inferior boundary of L5 and on the superior boundary of S1) were analysed. Overall, 67.73% of the 62 cases had an abdominal aortic bifurcation located at L4 and L4/5 intervertebral disc ; 61.29%, the common iliac venous confluence located at L5. The four distances mentioned above were 0.98 cm ± 0.38 cm, 2.01 cm ± 1.26 cm, 3.11 cm ± 1.35 cm and 4.34 cm ± 1.10 cm, respectively. A classification system of types A, B and C was developed. The calculated L5/S1 intervertebral space exposure percentages of types A, B and C were 32.21%, 82.58% and 54.68%, respectively. During L5/S1 anterior interbody surgery, type B intervertebral discs can be exposed conveniently, preventing injury of the iliac vessels, which was also observed in 54.68% and 32.21% of the type C and type A discs, respectively. Because the type A intervertebral disc has minimal exposure, the risk of iliac vascular injury is relatively high in these patients. Permalink : ./index.php?lvl=notice_display&id=34675

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Validity Of Creatine Kinase As An Indicator Of Muscle Injury In Spine Surgery And Its Relation With Postoperative Pain / Domingo LOMBAO in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.545-550 Titre : Validity Of Creatine Kinase As An Indicator Of Muscle Injury In Spine Surgery And Its Relation With Postoperative Pain Type de document : texte imprimé Auteurs : Domingo LOMBAO, Auteur Année de publication : 2014 Article en page(s) : p.545-550 Langues : Anglais (eng) Mots-clés : creatine kinase  muscle  pain  spine fusion  analgesia Résumé : Purpose : to confirm the validity of postoperative creatine kinase (CK) values as an indicator of muscle lesion, assess the relationship of CK with variables indicating surgical invasiveness and investigate an association between CK values and excessive postoperative pain. Material and Method : The study included 96 patients (mean age 62.8 years) who underwent instrumented spine fusion for degenerative lumbosacral disease. Serum CK concentration was determined on the first postoperative day. All patients received intravenous paracetamol and metamizole, and in cases of intense pain, rescue analgesia with iv meperidine. Patients were categorized according to whether or not they required rescue analgesia. Data on the number of levels fused, the duration of surgery, and operative bleeding were recorded in each patient. Results : CK values were higher in men and in younger patients. Significant correlations were found between CK and the number of fused levels and duration of surgery. Only 17.7% of patients required rescue analgesia. CK levels did not significantly differ between patients who did not need rescue analgesia (1135 IU/L) and those who did (1421.5 IU/L). Conclusion : Serum CK concentration is a valid marker of surgical muscle injury and is affected by the age and sex. Factors such as the magnitude and duration of surgery show a relationship with postoperative CK values. The incidence of severe postoperative pain is not significantly related to CK level. Permalink : ./index.php?lvl=notice_display&id=34676 [article] Validity Of Creatine Kinase As An Indicator Of Muscle Injury In Spine Surgery And Its Relation With Postoperative Pain [texte imprimé] / Domingo LOMBAO, Auteur . - 2014 . - p.545-550. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.545-550 Mots-clés : creatine kinase  muscle  pain  spine fusion  analgesia Résumé : Purpose : to confirm the validity of postoperative creatine kinase (CK) values as an indicator of muscle lesion, assess the relationship of CK with variables indicating surgical invasiveness and investigate an association between CK values and excessive postoperative pain. Material and Method : The study included 96 patients (mean age 62.8 years) who underwent instrumented spine fusion for degenerative lumbosacral disease. Serum CK concentration was determined on the first postoperative day. All patients received intravenous paracetamol and metamizole, and in cases of intense pain, rescue analgesia with iv meperidine. Patients were categorized according to whether or not they required rescue analgesia. Data on the number of levels fused, the duration of surgery, and operative bleeding were recorded in each patient. Results : CK values were higher in men and in younger patients. Significant correlations were found between CK and the number of fused levels and duration of surgery. Only 17.7% of patients required rescue analgesia. CK levels did not significantly differ between patients who did not need rescue analgesia (1135 IU/L) and those who did (1421.5 IU/L). Conclusion : Serum CK concentration is a valid marker of surgical muscle injury and is affected by the age and sex. Factors such as the magnitude and duration of surgery show a relationship with postoperative CK values. The incidence of severe postoperative pain is not significantly related to CK level. Permalink : ./index.php?lvl=notice_display&id=34676

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Cement Augmentation For Vertebral Fractures In Patients With Multiple Myeloma / Haroon MAJEED in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.551-557 Titre : Cement Augmentation For Vertebral Fractures In Patients With Multiple Myeloma Type de document : texte imprimé Auteurs : Haroon MAJEED, Auteur Année de publication : 2014 Article en page(s) : p.551-557 Langues : Anglais (eng) Mots-clés : kyphoplasty  vertebroplasty  vertebral stents  metastatic spine disease  plasmacytoma Résumé : Objective of our study was to assess the outcome of cement augmentation in patients with multiple myeloma. We reviewed 12 patients with 48 vertebral fractures. Mean age was 62.5 years. Average length of follow-up was 27.5 months. Expected survival was less than 12 months in 2 patients and more than 12 months in the remaining patients. After surgery mean survival was 32.5 months. Mean correction in vertebral angle was 3.6°. Karnofsky score was more than 70 in 5 patients, 50-70 in 6 and less than 50 in 1 patient preoperatively, while it was more than 70 in all patients postoperatively. Preoperative mean ODI was 72%. After surgery it was 46% at 6 weeks and 14% at 12 months. All patients reported improvement in their pain status after surgery. Cement augmentation is a safe and effective way of treating symptoms of multiple myeloma, which occur due to vertebral metastases. It results in excellent pain control and improvement in quality of life. Permalink : ./index.php?lvl=notice_display&id=34677 [article] Cement Augmentation For Vertebral Fractures In Patients With Multiple Myeloma [texte imprimé] / Haroon MAJEED, Auteur . - 2014 . - p.551-557. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.551-557 Mots-clés : kyphoplasty  vertebroplasty  vertebral stents  metastatic spine disease  plasmacytoma Résumé : Objective of our study was to assess the outcome of cement augmentation in patients with multiple myeloma. We reviewed 12 patients with 48 vertebral fractures. Mean age was 62.5 years. Average length of follow-up was 27.5 months. Expected survival was less than 12 months in 2 patients and more than 12 months in the remaining patients. After surgery mean survival was 32.5 months. Mean correction in vertebral angle was 3.6°. Karnofsky score was more than 70 in 5 patients, 50-70 in 6 and less than 50 in 1 patient preoperatively, while it was more than 70 in all patients postoperatively. Preoperative mean ODI was 72%. After surgery it was 46% at 6 weeks and 14% at 12 months. All patients reported improvement in their pain status after surgery. Cement augmentation is a safe and effective way of treating symptoms of multiple myeloma, which occur due to vertebral metastases. It results in excellent pain control and improvement in quality of life. Permalink : ./index.php?lvl=notice_display&id=34677

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A Cervical “Zero-Profile” Cage With Integrated Angle-Stable Fixation : 24-Months Results / Matti SCHOLZ in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.558-566 Titre : A Cervical “Zero-Profile” Cage With Integrated Angle-Stable Fixation : 24-Months Results Type de document : texte imprimé Auteurs : Matti SCHOLZ, Auteur Année de publication : 2014 Article en page(s) : p.558-566 Langues : Anglais (eng) Mots-clés : anterior cervical fusion  stand alone cage  ACDF  Zero-P Résumé : The purpose of this prospective mono-centric case series study is to investigate the mid-term (minimum follow-up 24 months) safety and efficacy using a new “zero-profile” stand-alone cage with integrated anglestable fixation in single- and multilevel anterior cervical fusions. 53 consecutive patients with radiculopathy/myelopathy at one to three levels underwent an anterior cervical discectomy and fusion procedure using the “zero-profile” implant (97 levels operated). A CTscan at 12-months was taken to assess fusion status, implant failure, subsidence and migration. The overall fusion rate was 97%. 3 out of 45 patients (6.6%) complained about mild dysphagia related symptoms at 24 months follow-up . There was no recorded incidence of hardware failure. The new cervical stand-alone anterior fusion device allows a safe anterior cervical decompression and stabilisation, a low rate of chronic dysphagia and achieves a high fusion rate. Prospective randomised trials are necessary to confirm these results. Permalink : ./index.php?lvl=notice_display&id=34678 [article] A Cervical “Zero-Profile” Cage With Integrated Angle-Stable Fixation : 24-Months Results [texte imprimé] / Matti SCHOLZ, Auteur . - 2014 . - p.558-566. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.558-566 Mots-clés : anterior cervical fusion  stand alone cage  ACDF  Zero-P Résumé : The purpose of this prospective mono-centric case series study is to investigate the mid-term (minimum follow-up 24 months) safety and efficacy using a new “zero-profile” stand-alone cage with integrated anglestable fixation in single- and multilevel anterior cervical fusions. 53 consecutive patients with radiculopathy/myelopathy at one to three levels underwent an anterior cervical discectomy and fusion procedure using the “zero-profile” implant (97 levels operated). A CTscan at 12-months was taken to assess fusion status, implant failure, subsidence and migration. The overall fusion rate was 97%. 3 out of 45 patients (6.6%) complained about mild dysphagia related symptoms at 24 months follow-up . There was no recorded incidence of hardware failure. The new cervical stand-alone anterior fusion device allows a safe anterior cervical decompression and stabilisation, a low rate of chronic dysphagia and achieves a high fusion rate. Prospective randomised trials are necessary to confirm these results. Permalink : ./index.php?lvl=notice_display&id=34678

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Is OPLL-Induced Canal Stenosis A Risk Factor Of Cord Injury In Cervical Trauma ? / Kyung-Jin SONG in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.567-574 Titre : Is OPLL-Induced Canal Stenosis A Risk Factor Of Cord Injury In Cervical Trauma ? Type de document : texte imprimé Auteurs : Kyung-Jin SONG, Auteur Année de publication : 2014 Article en page(s) : p.567-574 Langues : Anglais (eng) Mots-clés : ossifiation of posterior longitudinal ligament  spinal cord injury  incidence  injury severity score Résumé : The purpose of this study is to identify the relationship between trauma severity and the degree of cord injury in patients with ossification of posterior longitudinal ligament (OPLL). Four-hundred-one patients were classified into Group A (OPLL(+)), Group B (spinal stenosis (+) and OPLL(-)), and Group C (OPLL (-) and spinal stenosis(-)). Trauma severity and neurological injury severity were compared according to presence of OPLL and spinal stenosis. OPLL was associated with a higher incidence of neurological injury with statistical significance (p = 0.002), whereas spinal stenosis did not (p = 0.408). With Group B+C (no OPLL group) in M (minimal) trauma group as baseline, Group A in M trauma group showed about 5 times, and Group A in S (severe) trauma group showed about 16 times as many cord injury. Patients with OPLL more frequently sustained spinal cord injury from minimal trauma. Permalink : ./index.php?lvl=notice_display&id=34679 [article] Is OPLL-Induced Canal Stenosis A Risk Factor Of Cord Injury In Cervical Trauma ? [texte imprimé] / Kyung-Jin SONG, Auteur . - 2014 . - p.567-574. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.567-574 Mots-clés : ossifiation of posterior longitudinal ligament  spinal cord injury  incidence  injury severity score Résumé : The purpose of this study is to identify the relationship between trauma severity and the degree of cord injury in patients with ossification of posterior longitudinal ligament (OPLL). Four-hundred-one patients were classified into Group A (OPLL(+)), Group B (spinal stenosis (+) and OPLL(-)), and Group C (OPLL (-) and spinal stenosis(-)). Trauma severity and neurological injury severity were compared according to presence of OPLL and spinal stenosis. OPLL was associated with a higher incidence of neurological injury with statistical significance (p = 0.002), whereas spinal stenosis did not (p = 0.408). With Group B+C (no OPLL group) in M (minimal) trauma group as baseline, Group A in M trauma group showed about 5 times, and Group A in S (severe) trauma group showed about 16 times as many cord injury. Patients with OPLL more frequently sustained spinal cord injury from minimal trauma. Permalink : ./index.php?lvl=notice_display&id=34679

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Significance Of Spinal Canal And Dural Sac Dimensions In Predicting Treatment Of Lumbar Disc Herniation / Shuai YUAN in Acta Orthopaedica Belgica, Vol 80/4 (Décembre 2014)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.575-581 Titre : Significance Of Spinal Canal And Dural Sac Dimensions In Predicting Treatment Of Lumbar Disc Herniation Type de document : texte imprimé Auteurs : Shuai YUAN, Auteur Année de publication : 2014 Article en page(s) : p.575-581 Langues : Anglais (eng) Mots-clés : lumbar disc herniation  spinal canal  dural sac  MRI  parmeter  treatment Résumé : This retrospective study was performed to investigate the significance of quantitative MRI measurements of spinal canal and dural sac dimensions for treatment decisions and clinical outcome of lumbar disc herniation. 182 patients (111 nonsurgical patients and 71 surgical patients) were included, while 78 nonsurgical patients and 50 surgical patients were enrolled in the final follow-up. The initial JOA score in nonsurgical patients was significantly superior to surgical patients (t-test : p < 0.001), whereas the final JOA score and the rate of improvement were not significantly different between the two groups of patients (t-test : p > 0.05). 88.46% of nonsurgical patients and 90.00% of surgical patients had a good or excellent outcome (chi-square test : p > 0.05). However, if the 16 recurrent cases were included, the proportions dropped to 75.82% and 84.90% for nonsurgical and surgical patients, respectively. Compared with nonsurgical patients, quantitative parameters, such as midsagittal diameter and available diameter of spinal canal, lateral recess width and cross-sectional areas of spinal canal and dural sac, were significantly smaller in surgical patients (t-test : p < 0.001), and was reflected in the initial JOA score (128 cases ; Spearman rank correlation coefficient : r 0.01 = 0.486, 0.499, 0.493, 0.507, 0.484 ; p < 0.001). The spinal canal and dural sac dimensions were important predictive factors for treatment selection of lumbar disc herniation. Permalink : ./index.php?lvl=notice_display&id=34680 [article] Significance Of Spinal Canal And Dural Sac Dimensions In Predicting Treatment Of Lumbar Disc Herniation [texte imprimé] / Shuai YUAN, Auteur . - 2014 . - p.575-581. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol 80/4 (Décembre 2014) . - p.575-581 Mots-clés : lumbar disc herniation  spinal canal  dural sac  MRI  parmeter  treatment Résumé : This retrospective study was performed to investigate the significance of quantitative MRI measurements of spinal canal and dural sac dimensions for treatment decisions and clinical outcome of lumbar disc herniation. 182 patients (111 nonsurgical patients and 71 surgical patients) were included, while 78 nonsurgical patients and 50 surgical patients were enrolled in the final follow-up. The initial JOA score in nonsurgical patients was significantly superior to surgical patients (t-test : p < 0.001), whereas the final JOA score and the rate of improvement were not significantly different between the two groups of patients (t-test : p > 0.05). 88.46% of nonsurgical patients and 90.00% of surgical patients had a good or excellent outcome (chi-square test : p > 0.05). However, if the 16 recurrent cases were included, the proportions dropped to 75.82% and 84.90% for nonsurgical and surgical patients, respectively. Compared with nonsurgical patients, quantitative parameters, such as midsagittal diameter and available diameter of spinal canal, lateral recess width and cross-sectional areas of spinal canal and dural sac, were significantly smaller in surgical patients (t-test : p < 0.001), and was reflected in the initial JOA score (128 cases ; Spearman rank correlation coefficient : r 0.01 = 0.486, 0.499, 0.493, 0.507, 0.484 ; p < 0.001). The spinal canal and dural sac dimensions were important predictive factors for treatment selection of lumbar disc herniation. Permalink : ./index.php?lvl=notice_display&id=34680

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