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Lainé G, Coudert P, Damade C, Boissiere L, Pointillart V, Vital JM, Bouyer B, Gille O. Effects of indirect foraminal decompression during anterior cervical disc fusion procedure: preliminary results of a prospective study with clinical and radiological outcomes. Neurochirurgie 2024; 70:101523. [PMID: 38096985 DOI: 10.1016/j.neuchi.2023.101523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The respective effects of direct and indirect decompression in the clinical outcome after anterior cervical disc fusion (ACDF) is still debated. The main purpose of this study was to analyze the effects of indirect decompression on foraminal volumes during ACDF performed in patients suffering from cervico-brachial neuralgias due to degenerative foraminal stenosis, i.e. to determine whether implant height was associated with increased postoperative foraminal height and volume. METHODS A prospective follow-up of patients who underwent ACDF for cervicobrachial neuralgias due to degenerative foraminal stenosis was conducted. Patient had performed a CT-scan pre and post-operatively. Disc height, foraminal heights and foraminal volumes were measured pre and post operatively. RESULTS 37 cervical disc fusions were successfully performed in 20 patients, with a total of 148 foramina studied. Foraminal height and volume were measured bilaterally on the pre- and post-operative CT scans (148 foramina studied). After univariate analysis, it was found a significant improvement for every radiological parameter, with a significant increase in disc height, foraminal height and foraminal volume being respectively +3,22 mm (p < 0,001), +2,12 mm (p < 0,001) and +54 mm3 (p < 0,001). Increase in disc height was significantly associated with increase in foraminal height (p < 0,001) and foraminal volume (p < 0,001). At the same time, increase in foraminal height was significantly correlated with foraminal volume (p < 0,001), and seems to be the major component affecting increasing in foraminal volume. CONCLUSION Indirect decompression plays an important part in the postoperative foraminal volume increase after ACDF performed for cervicobrachial neuralgias.
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Affiliation(s)
- G Lainé
- Department of Neurosurgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France.
| | - P Coudert
- Department of Spine Surgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
| | - C Damade
- Department of Spine Surgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
| | - L Boissiere
- Department of Spine Surgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
| | - V Pointillart
- Department of Spine Surgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
| | - J M Vital
- Department of Spine Surgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
| | - B Bouyer
- Department of Spine Surgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
| | - O Gille
- Department of Neurosurgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France
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Lacasse M, Derolez S, Bonnet E, Amelot A, Bouyer B, Carlier R, Coiffier G, Cottier JP, Dinh A, Maldonado I, Paycha F, Ziza JM, Bemer P, Bernard L. 2022 SPILF - Clinical Practice guidelines for the diagnosis and treatment of disco-vertebral infection in adults. Infect Dis Now 2023; 53:104647. [PMID: 36690329 DOI: 10.1016/j.idnow.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/12/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
These guidelines are an update of those made in 2007 at the request of the French Society of Infectious Diseases (SPILF, Société de Pathologie Infectieuse de Langue Française). They are intended for use by all healthcare professionals caring for patients with disco-vertebral infection (DVI) on spine, whether native or instrumented. They include evidence and opinion-based recommendations for the diagnosis and management of patients with DVI. ESR, PCT and scintigraphy, antibiotic therapy without microorganism identification (except for emergency situations), therapy longer than 6 weeks if the DVI is not complicated, contraindication for spinal osteosynthesis in a septic context, and prolonged dorsal decubitus are no longer to be done in DVI management. MRI study must include exploration of the entire spine with at least 2 orthogonal planes for the affected level(s). Several disco-vertebral samples must be performed if blood cultures are negative. Short, adapted treatment and directly oral antibiotherapy or early switch from intravenous to oral antibiotherapy are recommended. Consultation of a spine specialist should be requested to evaluate spinal stability. Early lifting of patients is recommended.
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Affiliation(s)
- M Lacasse
- Medecine Interne et Maladies Infectieuses, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - S Derolez
- Rhumatologie, 125 rue de Stalingrad, CHU Avicenne, 93000 Bobigny, France
| | - E Bonnet
- Maladies Infectieuses, Pl. Dr Baylac, CHU Purpan, 31000 Toulouse, France.
| | - A Amelot
- Neurochirurgie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - B Bouyer
- Chirurgie orthopédique et traumatologique, CHU de Bordeaux, Place Amélie Raba-léon, 33076 Bordeaux, France
| | - R Carlier
- Imagerie, Hôpital Raymond Poincaré, 104 Bd R Poincaré, 92380 Garches, France
| | - G Coiffier
- Rhumatologie, GH Rance-Emeraude, Hôpital de Dinan, 22100 Dinan, France
| | - J P Cottier
- Radiologie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - A Dinh
- Maladies Infecteiuses, CHU Raymond Poicaré, 92380 Garches, France
| | - I Maldonado
- Radiologie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - F Paycha
- Médecine Nucléaire, Hôpital Lariboisière, 2 rue Ambroise Paré 75010 Paris, France
| | - J M Ziza
- Rhumatologie et Médecine Interne. GH Diaconesses Croix Saint Simon, 75020 Paris, France
| | - P Bemer
- Microbiologie, CHU de Nantes, 1 Place A. Ricordeau, Nantes 44000 Cedex 1, France
| | - L Bernard
- Medecine Interne et Maladies Infectieuses, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
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Tixier R, Duchateau J, Derval N, Pambrun T, Bouyer B, Chauvel R, Buliard S, André C, Strik M, Ploux S, Bordachar P, Hocini M, Jaïs P, Haissaguerre M, Sacher F. Retrospective single center experience use of propofol for general anesthesia in Brugada patients. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Cochet H, Legghe B, Bouyer B, Blanc G, Elbaz M, Thambo JB, Iriart X. Prevalence and outcomes of hypoattenuation defects and appendage patency on computed tomography after left atrial appendage closure. Europace 2022. [DOI: 10.1093/europace/euac053.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Council
Background
Hypoattenuation (HAT) on the atrial aspect of the device and persisting LAA patency are not uncommon on CT images after left atrial appendage closure (LAAC), but their prognostic and therapeutic implications remain unclear.
Purpose
To analyze the prevalence, aspects and outcomes of HAT and LAA patency on CT after LAAC.
Methods
Consecutive patients from 2 French centers underwent cardiac CT 3 months post-LAAC. All CTs were reviewed by 2 readers in consensus to detect LAA patency and HAT. Linear defects of less than 1mm thickness in continuity with the adjacent LA wall were not considered as HAT but rather suggestive of device endothelialization. Defects >1mm thickness were categorized as low grade HAT (if 1-3mm thick and linear/regular), or high grade HAT (if >3mm and/or nodular/irregular). Patients with HAT underwent trans-esophageal echocardiography and received anticoagulation at the discretion of the cardiologist. We analyzed the relationship between CT findings and patient outcomes at follow-up.
Results
From 2012 to 2020, 412 patients were included (age 76±8 years, 68% males, prior stroke or embolism in 39%, HASBLED 3.1±0.8, CHA2DS2-VASc 4.4±1.3). The devices were Watchman in 175 (42.5%) and Amplatzer in 237 (57.5%). On 3-month follow-up CT, LAA patency was detected in 185 (45%). It related to none of the clinical characteristics, but was more common in Amplatzer devices (52% vs. 35%, P=0.001), particularly when using large Amplatzer devices (P<0.001). HAT were detected in 117 (28%), including low grade HAT in 98 (23.8%) and high grade HAT in 19 (4.6%). Patients with high grade HAT were older (P<0.001), and showed higher CHA2DS2-VASc scores (P=0.03). No relationship was found between high grade HAT and device type (P=0.89). Over a median follow-up of 17 [Q1-Q3: 11-41] months, stroke occurred in 24 (5.8%), and death in 54 (13.1%). On survival analyses, stroke and death did not relate to LAA patency (P=0.69 and P=0.80), low grade HAT (P=0.81 and P=0.38), high grade HAT (P=0.22 and P=0.36), or device type (P=0.36 and P=0.27).
Conclusion: although relatively high rates of LAA patency and HAT are observed on post-LAAC CT studies, these do not significantly relate to adverse outcomes.
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Affiliation(s)
- H Cochet
- IHU Liryc, CHU Bordeaux, Univ. Bordeaux, Bordeaux, France
| | - B Legghe
- IHU Liryc, CHU Bordeaux, Univ. Bordeaux, Bordeaux, France
| | - B Bouyer
- IHU Liryc, CHU Bordeaux, Univ. Bordeaux, Bordeaux, France
| | - G Blanc
- University Hospital of Toulouse, Toulouse, France
| | - M Elbaz
- University Hospital of Toulouse, Toulouse, France
| | - JB Thambo
- University Hospital of Toulouse, Toulouse, France
| | - X Iriart
- University Hospital of Toulouse, Toulouse, France
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Coudert P, Lainé G, Pointillart V, Damade C, Boissiere L, Vital JM, Bouyer B, Gille O. Tomodensitometric bone anatomy of the intervertebral foramen of the lower cervical spine: measurements and comparison of foraminal volume in healthy individuals and patients suffering from cervicobrachial neuralgia due to foraminal stenosis. Surg Radiol Anat 2022; 44:883-890. [PMID: 35477797 DOI: 10.1007/s00276-022-02941-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Degenerative foraminal stenosis of the cervical spine can lead to cervicobrachial neuralgias. Computed tomography (CT)-scan assists in the diagnosis and evaluation of foraminal stenosis. The main objective of this study is to determine the bony dimensions of the cervical intervertebral foramen and to identify which foraminal measurements are most affected by degenerative disorders of the cervical spine. These data could be applied to the surgical treatment of this pathology, helping surgeons to focus on specific areas during decompression procedures. METHODS A descriptive study was conducted between two groups: an asymptomatic one (young people with no evidence of degenerative cervical spine disorders) and a symptomatic one (experiencing cervicobrachial neuralgia due to degenerative foraminal stenosis). Using CT scans, we determined a method allowing measurements of the following foraminal dimensions: foraminal height (FH), foraminal length (FL), foraminal width in its lateral part ((UWPP, MWPP and IWPP (respectively Upper, Medial and Inferior Width of Pedicle Part)) and medial part (UWMP, MWMP and IWMP (respectively Upper, Medial and Inferior Width of Medial Part)), and disk height (DH). Foraminal volume (FV) was calculated considering the above data. Mean volumes were measured in the asymptomatic group and compared to the values obtained in the symptomatic group. RESULTS Both groups were made up of 10 patients, and a total of 50 intervertebral discs (100 intervertebral foramina) were analyzed in each group. Comparison of C4C5, C5C6 and C6C7 levels between both groups showed several significant decreases in foraminal dimensions (p < 0.05) as well as in foraminal volume (p < 0.001) in the symptomatic group. The most affected dimensions were UWPP, MWPP, UWMP, MWMP and FV. The most stenotic foraminal areas were the top of the uncus and the posterior edge of the lower plate of the overlying vertebra. CONCLUSION Using a new protocol for measuring foraminal volume, the present study refines the current knowledge of the normal and pathological anatomy of the lower cervical spine and allows us to understand the foraminal sites most affected by degenerative stenosis. Those findings can be applied to foraminal stenosis surgeries. According to our results, decompression of the foramen in regard of both uncus osteophytic spurs and inferior plate of the overlying vertebra might be an important step for spinal nerves release.
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Affiliation(s)
- P Coudert
- Department of Spine Surgery, Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33000, Bordeaux, France
| | - G Lainé
- Department of Neurosurgery, University Hospital of Bordeaux, Place Amélie Raba-Léon, Bordeaux, France.
| | - V Pointillart
- Department of Spine Surgery, Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33000, Bordeaux, France
| | - C Damade
- Department of Spine Surgery, Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33000, Bordeaux, France
| | - L Boissiere
- Department of Spine Surgery, Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33000, Bordeaux, France
| | - J M Vital
- Department of Spine Surgery, Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33000, Bordeaux, France
| | - B Bouyer
- Department of Spine Surgery, Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33000, Bordeaux, France
| | - O Gille
- Department of Spine Surgery, Hôpital Pellegrin, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33000, Bordeaux, France
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Djenontin E, Lebeaux D, Acikgoz H, Rammaert B, Bougnoux ME, Rouzaud C, Bouyer B, Champigneulle B, Dannaoui E. Post-traumatic Curvularia sp. arthritis in an immunocompetent adult. J Mycol Med 2020; 30:100967. [PMID: 32321676 DOI: 10.1016/j.mycmed.2020.100967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/08/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
A 44-year-old woman, victim of a road accident in Mali was diagnosed with left knee arthritis. Joint effusion aspiration and subcutaneous surgical biopsies were positive for a melanized asexual ascomycete. Using microscopy and molecular biology, the fungus was identified as Curvularia sp. In vitro antifungal susceptibility was determined by the EUCAST broth microdilution reference technique and by E-test. The patient was treated with liposomal amphotericin B before posaconazole relay. Mycological samples obtained 10 days after starting the antifungal therapy by liposomal amphotericin B were negative in culture. Curvularia spp. are environmental fungi which can under certain conditions be pathogenic for humans.
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Affiliation(s)
- E Djenontin
- Unité de parasitologie-mycologie, service de microbiologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - D Lebeaux
- Unité mobile de microbiologie clinique, service de microbiologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France; Faculté de médecine, université Paris Descartes, Paris, France
| | - H Acikgoz
- Service d'anesthésie-réanimation, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - B Rammaert
- Inserm U1070, service de maladies infectieuses et tropicales, faculté de médecine et pharmacie, université Poitiers, CHU de Poitiers, Poitiers, France
| | - M-E Bougnoux
- Unité de parasitologie-mycologie, service de microbiologie, hôpital Necker-Enfants-Malades, AP-HP, Paris, France; Faculté de médecine, université Paris Descartes, Paris, France
| | - C Rouzaud
- Centre d'infectiologie Necker-Pasteur and Institut Imagine, hôpital Necker-Enfants-Malades, Paris, France; Faculté de médecine, université Paris Descartes, Paris, France
| | - B Bouyer
- Service d'orthopédie et de traumatologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France; Faculté de médecine, université Paris Descartes, Paris, France
| | - B Champigneulle
- Service d'anesthésie-réanimation, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - E Dannaoui
- Unité de parasitologie-mycologie, service de microbiologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France; Faculté de médecine, université Paris Descartes, Paris, France.
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Bouyer B, Rudnichi A, Dray-Spira R, Zureik M, Coste J. Thromboembolic risk after lumbar spine surgery: a cohort study on 325 000 French patients. J Thromb Haemost 2018; 16:1537-1545. [PMID: 29893460 DOI: 10.1111/jth.14205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 01/24/2023]
Abstract
Essentials The risk of venous thromboembolism (VTE) after lumbar spine surgery (LBS) is not precisely known. More than 320 000 patients who underwent LBS in France between 2009 and 2014 were followed-up. The overall risk of VTE after LBS is less than 1% but modulated by patient and procedural factors. Surgical device implantation, anterior approach and complex surgery increase the risk of VTE. SUMMARY: Background Postoperative venous thromboembolism (VTE) is a severe complication, the risk of which after lumbar spine surgery (LBS) is not precisely known. Objective To estimate the incidence of VTE after LBS, and to identify individual and surgical risk factors. Methods All patients aged >18 years who underwent LBS in France between 2009 and 2014 were identified. Among 477 024 patients screened, exclusions concerned recent VTE or surgery, and multiple surgeries during the same hospital stay. Results In 323 737 patients (mean age 52.9 years, 51.4% male), we observed 2911 events (0.91%) after a median time of 12 days (Q1-Q3: 5-72 days). The multivariate adjusted Cox model showed increased risks associated with age (4% per year of age; 95% confidence interval [CI] 3.8-4.3), obesity (hazard ratio [HR] 1.32, 95% CI 1.18-1.46), active cancer (HR 1.65, 95% CI 1.5-1.82), previous thromboembolism (HR 5.41, 95% CI 4.74-6.17), severe paralysis (HR 1.47, 95% CI 1.17-1.84), renal disease (HR 1.28, 95% CI 1.04-1.6), psychiatric disease (HR 1.21, 95% CI 1.1-1.32), use of antidepressants (HR 1.13, 95% CI 1.03-1.24), use of contraceptives (HR 1.56, 95% CI 1.19-2.03), extended surgery for scoliosis (HR 3.61, 95% CI 2.96-4.4), implantation of pedicular screws with a 'dose-effect' association, and an anterior approach (HR 1.97, 95% CI 1.6-2.43) or a combined approach (HR 2.03, 95% CI 1.44-2.84). Conclusions The overall VTE risk after LBS is moderate (< 1%) but is widely modulated by several easily identifiable risk factors. The surgical community should be aware of this heterogeneity, adapt prevention according to patients and to the procedure, and use drug prophylaxis in the event of a high risk being present.
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Affiliation(s)
- B Bouyer
- French National Agency for Medicines and Health Products Safety, Saint Denis, France
- AP-HP and Paris-Descartes University, Paris, France
- Paris-Sud University, Paris, France
| | - A Rudnichi
- French National Agency for Medicines and Health Products Safety, Saint Denis, France
| | - R Dray-Spira
- French National Agency for Medicines and Health Products Safety, Saint Denis, France
| | - M Zureik
- French National Agency for Medicines and Health Products Safety, Saint Denis, France
- Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - J Coste
- AP-HP and Paris-Descartes University, Paris, France
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Khalifé M, Lebeaux D, Mainardi JL, Guigui P, Bouyer B. Neurological deficit secondary to a pre-sacral abscess with epidural extension up to L3: A case report and literature review. Orthop Traumatol Surg Res 2017; 103:133-135. [PMID: 27979742 DOI: 10.1016/j.otsr.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/17/2016] [Accepted: 10/05/2016] [Indexed: 02/02/2023]
Abstract
Isolated epidural abscesses are uncommon lesions. Surgical treatment may be difficult due to the extension of these lesions. We present a case of a pelvic abscess spreading along the path of the sciatic nerve to the gluteus muscles and the lumbar canal, causing neurological compression; requiring surgical treatment with three simultaneous approaches.
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Affiliation(s)
- M Khalifé
- Orthopedics Department, Georges Pompidou European Hospital, 75015 Paris, France; Paris-Descartes University, 75006 Paris, France.
| | - D Lebeaux
- Clinical Microbiology Unit, Microbiology Department, Georges Pompidou European Hospital, 75015 Paris, France; Paris-Descartes University, 75006 Paris, France
| | - J-L Mainardi
- Clinical Microbiology Unit, Microbiology Department, Georges Pompidou European Hospital, 75015 Paris, France; Paris-Descartes University, 75006 Paris, France
| | - P Guigui
- Orthopedics Department, Georges Pompidou European Hospital, 75015 Paris, France; Paris-Descartes University, 75006 Paris, France
| | - B Bouyer
- Orthopedics Department, Georges Pompidou European Hospital, 75015 Paris, France; Paris-Descartes University, 75006 Paris, France
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Kajetanek C, Bouyer B, Ollivier M, Boisrenoult P, Pujol N, Beaufils P. Mid-term survivorship of Mini-keel™ versus Standard keel in total knee replacements: Differences in the rate of revision for aseptic loosening. Orthop Traumatol Surg Res 2016; 102:611-7. [PMID: 27364965 DOI: 10.1016/j.otsr.2016.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION To reduce the size of the surgical incision, modular mini-keel tibial components have been developed with or without extensions for the Nexgen™ MIS Tibial Component. Although a smaller component could theoretically result in defective fixation, this has never been evaluated in a large comparative series. Thus, we performed the following case control study to: (1) evaluate intermediate-term survival of a modular "mini-keel" tibial component compared to a reference standard keel component from the same line of products (Nexgen LPS-Flex Tibial Component, Zimmer); (2) to identify any eventual associated factors if the frequency of loosening was increased. HYPOTHESIS The rate of revision for aseptic tibial loosening is comparable for both components. MATERIALS AND METHODS This comparative, retrospective, single center series of 459 consecutive total knee arthroplasties (TKA) was performed between 2007 and 2010: with 212 modular "mini-keel" (MK) tibial components and 247 "standard" (S) components. Survival, rate of revision for aseptic tibial loosening and identification of a radiolucent line were analyzed at the final follow-up. RESULTS After a median follow-up of 5years, the rate of revision for tibial aseptic loosing was significantly higher in the MK group with 12 cases (5.7%) and 4 cases in the S group (1.6%) (P=0.036). The use of the MK component appears to be a prognostic factor for surgical revision (hazard ratio=3.86 (1.23-11.88), P=0.02) but not for the development of a radiolucent line (HR=1.75 (0.9-3.4), P=0.097). The mean delay before revision was 38months (8-64) in the MK group and 15.2months (8-22) in the S group (P=0.006). Individual factors, such as gender, body mass index (BMI) and pre- or postoperative alignment were not prognostic factors for revision or radiolucent lines. CONCLUSION The modular "mini-keel" tibial component was associated with a greater risk of revision for tibial component loosening. LEVEL OF EVIDENCE Case control study, III.
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Affiliation(s)
- C Kajetanek
- Service de chirurgie orthopédique, hôpital André-Mignot, centre hospitalier Versailles, 177, rue de Versailles, 78157 Le Chesnay, France.
| | - B Bouyer
- Service de chirurgie orthopédique, hôpital André-Mignot, centre hospitalier Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
| | - M Ollivier
- Service de chirurgie orthopédique, hôpital André-Mignot, centre hospitalier Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
| | - P Boisrenoult
- Service de chirurgie orthopédique, hôpital André-Mignot, centre hospitalier Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
| | - N Pujol
- Service de chirurgie orthopédique, hôpital André-Mignot, centre hospitalier Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
| | - P Beaufils
- Service de chirurgie orthopédique, hôpital André-Mignot, centre hospitalier Versailles, 177, rue de Versailles, 78157 Le Chesnay, France
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Knafo S, Lonjon G, Vassal M, Bouyer B, Lonjon N. Spinal cord compression due to undiagnosed thoracic meningioma following lumbar surgery in an elderly patient: a case report. Orthop Traumatol Surg Res 2013; 99:983-6. [PMID: 24210294 DOI: 10.1016/j.otsr.2013.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 07/03/2013] [Accepted: 08/23/2013] [Indexed: 02/02/2023]
Abstract
As spinal surgery in elderly patients is becoming increasingly frequent, comorbidities likely to be decompensated after such procedures must be kept in mind. We report here the case of an 82-year-old woman who presented rapidly progressive spinal cord compression following lumbar surgery for radiculopathy. Investigations showed a thoracic intradural extramedullary compressive lesion, which after removal turned out to be a meningioma. We suggest that radiculopathy and non-specific degenerative modifications partially masked this lesion, and that lumbar surgery caused this acute neurological deterioration. Therefore, we advice caution in older patients among whom such ambiguous clinical presentation is frequent.
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Affiliation(s)
- S Knafo
- Service de neurochirurgie, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Association des Jeunes Chirurgiens du Rachis (AJCR), 237, rue de Bercy, 75012 Paris, France.
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Bouyer B, Guedj N, Lonjon G, Guigui P. Recurrent solitary fibrous tumour of the thoracic spine. A case-report and literature review. Orthop Traumatol Surg Res 2012; 98:850-3. [PMID: 23092617 DOI: 10.1016/j.otsr.2012.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 04/05/2012] [Accepted: 05/21/2012] [Indexed: 02/02/2023]
Abstract
Solitary fibrous tumours (SFTs) are rare tumours originating in the soft tissues. SFT development in the spine is an exceedingly rare event about which little is known. We describe a case of SFT of the thoracic spine in a 56-year-old woman. She presented with neurological deficits that required emergency resection, which was incomplete. Two subsequent local recurrences prompted further surgical procedures. At last follow-up, 12 months after the last procedure, function was satisfactory and there was no evidence of tumour recurrence. The management of SFTs is not well standardised, and no proven adjuvant treatments are available to date. Complete excision is effective in controlling disease progression. Prolonged follow-up is mandatory.
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Affiliation(s)
- B Bouyer
- Paris Diderot Paris 7 University, Department of Orthopaedic and Trauma Surgery, Beaujon Hospital, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
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Tapprest J, Bouyer B, Pannequin M, Sévin C, Cauchard J, Le Net J, Duquesne F, Petry S, Lefleche-Mateos A, Hans A, Laugier C, Moutou F. Major outbreak of rhodococcosis in adult equidae. J Equine Vet Sci 2012. [DOI: 10.1016/j.jevs.2012.08.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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