59 research outputs found
Intra and inter-observer reliability of determining degree of pelvic obliquity in neuromuscular scoliosis using the EOS-CHAIRÂź protocol
Purpose Scoliosis with pelvic obliquity (PO) could be investigated with the EOS-CHAIR protocol as the most common deformity especially in patients with trunk hypotonia and quadriplegia. However, the intra-observer and inter-observer reliability of various angles assessing PO was not investigated with this new imaging protocol. Methods A retrospective cohort of 36 EOS frontal fullspine acquisitions made in sitting position was used. The sacroiliac pelvic obliquity angle, iliac crest pelvic obliquity angle, and ischiatic pelvic obliquity angle were assessed in an intra-observer and inter-observer study. Results The use of the EOS-CHAIR protocol was implemented satisfactory with a high acceptance rate by all caregivers and patients and their families. Intra-observer and inter-observer reliability was excellent for the three tested angular measurements. Discussion As for idiopathic scoliosis, we postulate the EOS system as being superior to standard radiographs to assess 3D spinal deformities in neuromuscular conditions. The EOS-CHAIR protocol improves preoperative comprehension of the lumbosacral junction anatomy in patients with poor standing or sitting postures. Our results show a very high reliability of three different angular measurements of the frontal pelvic obliquity in sitting position. Then it is possible to use one of these three angles as well as the others to assess frontal pelvic obliquity in neuromuscular patients. This frontal pelvic obliquity protocol in sitting position with the EOS-CHAIR is a validated measurement technique that needs to be used now to measure PO as a critical parameter of the global trunk balance in neuromuscular patients
Titanium implant-bone Interface and Tissue Engineering
Introduction : Le titane, Ă la fois utilisĂ© comme moyen de fixation dâun implant devant ses propriĂ©tĂ©s biomĂ©caniques proches de lâos et comme moyen dâostĂ©ointĂ©gration a pris une place prĂ©pondĂ©rante en orthopĂ©die. LâostĂ©ointĂ©gration dâun implant titane (IT) essentielle pour la pĂ©rennitĂ© de ce dernier, dĂ©pend de 2 phases : une phase primaire MECANIQUE correspondant Ă lâimpaction ou tenue primaire de lâIT et une phase secondaire BIOLOGIQUE correspondant Ă la colonisation de lâIT par le tissu osseux.Lâobjectif de ce travail fut dâĂ©valuer et dâamĂ©liorer lors de ces deux phases la stabilitĂ© et lâostĂ©ointĂ©gration de lâimplant titane :(1) Ăvaluer la tenue primaire des tiges fĂ©morales en titane non cimentĂ©es par lâanalyse de lâimpact correspondant Ă la mesure de lâimpact au cours du temps.(2) Ăvaluer si la quantitĂ© de CSM contenues dans lâaile iliaque est corrĂ©lĂ©e Ă la survie sans reprise de des implants acĂ©tabulaires impactĂ©s dans le cadre de lâostĂ©onĂ©crose aseptique de la tĂȘte fĂ©morale.(3) AmĂ©liorer lâostĂ©ointĂ©gration des IT par les mĂ©thodes de thĂ©rapie cellulaire en Ă©tudiant in vitro la survie et la division des cellules stromales mĂ©senchymateuses humaines (CSM) osseuses au contact de cages lombaires inter-somatiques recouvertes dâalliage titane rugueux.MatĂ©riels et MĂ©thodes: LâĂ©valuation de la tenue primaire des tiges fĂ©morales en titane sans ciment selon lâanalyse de lâimpact a Ă©tĂ© rĂ©alisĂ©e Ă lâaide dâun marteau muni dâun capteur de force piĂ©zo-Ă©lectrique sur 20 sujets anatomiques soit 40 hanches. On a comparĂ© le nombre de coups de marteau pour obtenir lâimpaction idĂ©ale de la prothĂšse selon 3 mĂ©thodes dâĂ©valuation diffĂ©rentes : le nombre de coups nĂ©cessaires pour le chirurgien (Nchir), le nombre de coups nĂ©cessaires par lâanalyse vidĂ©o de lâenfoncement de la tige dans le fĂ©mur (Nvid) et le nombre de coups nĂ©cessaires par lâanalyse de lâimpact (NI).Pour savoir si la quantitĂ© de CSMs dans la crĂȘte iliaque pouvait reflĂ©ter lâostĂ©ointĂ©gration des implants acĂ©tabulaires impactĂ©es et le risque de reprise chirurgicale, on a comparĂ© le taux de CSMs mesurĂ© lors de la rĂ©alisation dâune ponction concentration et rĂ©injection dans la zone dâostĂ©onĂ©crose et lâĂ©volution clinico-radiographique des implants acĂ©tabulaires mis en place par la suite pour ces mĂȘme patients (n=90) qui ont eu une arthroplastie totale de hanche in fine. Le recul moyen Ă©tait de 15 ans.La survie cellulaire des CSM osseuses humaines a Ă©tĂ© Ă©valuĂ©e sur des cages intersomatiques lombaires recouvertes de titane. Trois groupes (n=5) furent constituĂ©s : un groupe contrĂŽle, un groupe cages avec surface titane, un groupe cage sans titane. Sur chaque implant, 1 microlitre contenant 106 CSM osseuses humaines a Ă©tĂ© mis en culture. Lâanalyse de la survie cellulaire, de la prolifĂ©ration cellulaire et de lâexpression de gĂšnes de diffĂ©renciation ostĂ©oblastique ont Ă©tĂ© rĂ©alisĂ©s et comparĂ©s.RĂ©sultats : Concernant la premiĂšre Ă©tude sur lâintĂ©rĂȘt de lâanalyse de lâimpact pour la tenue de la tige fĂ©morale, la diffĂ©rence entre NI, Nchir et Nvid Ă©tait infĂ©rieure ou Ă©gale Ă 3 pour plus de 85% des configurations rĂ©alisĂ©es. Concernant la deuxiĂšme Ă©tude, il a Ă©tĂ© mis en Ă©vidence quâun faible nombre de CSM dans la crĂȘte iliaque Ă©tait un facteur de risque de rĂ©vision chirurgicale chez les patients traitĂ©s par un implant acĂ©tabulaire sans ciment. La troisiĂšme Ă©tude a montrĂ© que les CSMs pouvaient survivre, se dĂ©velopper pendant 96 heures et exprimer des gĂšnes de diffĂ©renciation ostĂ©oblastique de maniĂšre identique sur les cages avec ou sans titane.Conclusion : Lâanalyse de lâimpact permet de donner une information objective sur la tenue primaire de la tige fĂ©morale en titane et impactĂ©e. Le titane est aussi un milieu favorisĂ© de survie et de prolifĂ©ration des CSM osseuses prĂ©destinĂ©es Ă devenir des cellules ostĂ©oformatrices surtout quâun faible nombre de CSM semble ĂȘtre un risque dâĂ©chec dâostĂ©ointĂ©gration des implants acĂ©tabulaires sans ciment.Introduction: Titanium, both used as a mean of fixing an implant to its biomechanical properties close to the bone and as a mean of osseointegration has taken a prominent place. The implant stability is essential for the durability of a titanium implant (TI); it depends on 2 phases: a primary phase, MECHANICAL, corresponding to the impaction or primary holding of the TI and a secondary phase, BIOLOGICAL, corresponding to the colonization of TI by bone tissue.The objective of this work was to evaluate and improve during these two phases the osseointegration of the titanium implant:(1) To evaluate the primary stability of uncemented titanium femoral stems by impact analysis corresponding to the measurement of impact over time.(2) To evaluate whether the amount of mesenchymal stromal cells (MSCs) contained in the iliac crest is correlated with the non-recovery survival of acetabular implants impacted in a context of aseptic osteonecrosis of the femoral head.(3) To improve the osseointegration of TI by cell therapy methods in vitro by studying the survival and division of human MSCs in contact with interbody lumbar cages coated with rough titanium alloy.Methods: The evaluation of the primary stability of cementless titanium femoral stems according to the impact analysis was carried out using a hammer equipped with a piezoelectric force sensor on 20 anatomical subjects, i.e. 40 hips. The number of hammer strokes was compared to obtain the ideal impaction of the prosthesis according to 3 different evaluation methods: number of impacts required by the surgeon (Nsurg), number of impacts required by the video analysis of the depression of the stem in the femur (Nvid), numbers of impacts needed by the impact analysis (Ni).To determine whether the amount of MSCs in the iliac crest could reflect the osseointegration of impacted acetabular implants and the risk of surgical revision. The rate of MSCs measured when performing a surgical cell therapy for aseptic osteonecrosis of the femoral head and the clinical and radiographic outcome of acetabular implants subsequently established for these same patients (n = 90), who had total hip arthroplasty in fine were compared. The mean follow-up was 15 years.The cell survival of bone marrow-derived MSCs was evaluated on lumbar interbody cages coated with titanium. Three groups (n = 5) were formed: a control group, a cage group with titanium surface, a cage group without titanium. On each implant, 1 microliter containing 106 human bone MSCs was cultured. The analysis of cell survival, cell proliferation and expression of osteoblastic genes were performed and compared.Results: Regarding the impact analysis of the cementless femoral stem impaction, the difference between NI, Nchir and Nvid was lower than 3 for more than 85% of the configurations performed.For the second study, a small number of MSCs in the iliac crest was a risk factor for surgical revision in patients treated with a cementless acetabular implant.The third study showed that MSCs could grow until 96 hours and could express osteoblastics genes 21 days after cell seed. No difference between PEEK cage and Titanium-coated PEEK has been found.Conclusion: The impact analysis provides objective data on the primary holding of the titanium impacted femoral stem. Titanium is also a favored biomaterial for the survival and proliferation of bone marrow-derived MSC predestined to become osteforming cells, especially since a small number of MSCs seems to be a risk of failure of osseointegration of cementless acetabular implants
Interface os-implant titane et ingénierie tissulaire
Introduction: Titanium, both used as a mean of fixing an implant to its biomechanical properties close to the bone and as a mean of osseointegration has taken a prominent place. The implant stability is essential for the durability of a titanium implant (TI); it depends on 2 phases: a primary phase, MECHANICAL, corresponding to the impaction or primary holding of the TI and a secondary phase, BIOLOGICAL, corresponding to the colonization of TI by bone tissue.The objective of this work was to evaluate and improve during these two phases the osseointegration of the titanium implant:(1) To evaluate the primary stability of uncemented titanium femoral stems by impact analysis corresponding to the measurement of impact over time.(2) To evaluate whether the amount of mesenchymal stromal cells (MSCs) contained in the iliac crest is correlated with the non-recovery survival of acetabular implants impacted in a context of aseptic osteonecrosis of the femoral head.(3) To improve the osseointegration of TI by cell therapy methods in vitro by studying the survival and division of human MSCs in contact with interbody lumbar cages coated with rough titanium alloy.Methods: The evaluation of the primary stability of cementless titanium femoral stems according to the impact analysis was carried out using a hammer equipped with a piezoelectric force sensor on 20 anatomical subjects, i.e. 40 hips. The number of hammer strokes was compared to obtain the ideal impaction of the prosthesis according to 3 different evaluation methods: number of impacts required by the surgeon (Nsurg), number of impacts required by the video analysis of the depression of the stem in the femur (Nvid), numbers of impacts needed by the impact analysis (Ni).To determine whether the amount of MSCs in the iliac crest could reflect the osseointegration of impacted acetabular implants and the risk of surgical revision. The rate of MSCs measured when performing a surgical cell therapy for aseptic osteonecrosis of the femoral head and the clinical and radiographic outcome of acetabular implants subsequently established for these same patients (n = 90), who had total hip arthroplasty in fine were compared. The mean follow-up was 15 years.The cell survival of bone marrow-derived MSCs was evaluated on lumbar interbody cages coated with titanium. Three groups (n = 5) were formed: a control group, a cage group with titanium surface, a cage group without titanium. On each implant, 1 microliter containing 106 human bone MSCs was cultured. The analysis of cell survival, cell proliferation and expression of osteoblastic genes were performed and compared.Results: Regarding the impact analysis of the cementless femoral stem impaction, the difference between NI, Nchir and Nvid was lower than 3 for more than 85% of the configurations performed.For the second study, a small number of MSCs in the iliac crest was a risk factor for surgical revision in patients treated with a cementless acetabular implant.The third study showed that MSCs could grow until 96 hours and could express osteoblastics genes 21 days after cell seed. No difference between PEEK cage and Titanium-coated PEEK has been found.Conclusion: The impact analysis provides objective data on the primary holding of the titanium impacted femoral stem. Titanium is also a favored biomaterial for the survival and proliferation of bone marrow-derived MSC predestined to become osteforming cells, especially since a small number of MSCs seems to be a risk of failure of osseointegration of cementless acetabular implants.Introduction : Le titane, Ă la fois utilisĂ© comme moyen de fixation dâun implant devant ses propriĂ©tĂ©s biomĂ©caniques proches de lâos et comme moyen dâostĂ©ointĂ©gration a pris une place prĂ©pondĂ©rante en orthopĂ©die. LâostĂ©ointĂ©gration dâun implant titane (IT) essentielle pour la pĂ©rennitĂ© de ce dernier, dĂ©pend de 2 phases : une phase primaire MECANIQUE correspondant Ă lâimpaction ou tenue primaire de lâIT et une phase secondaire BIOLOGIQUE correspondant Ă la colonisation de lâIT par le tissu osseux.Lâobjectif de ce travail fut dâĂ©valuer et dâamĂ©liorer lors de ces deux phases la stabilitĂ© et lâostĂ©ointĂ©gration de lâimplant titane :(1)Ăvaluer la tenue primaire des tiges fĂ©morales en titane non cimentĂ©es par lâanalyse de lâimpact correspondant Ă la mesure de lâimpact au cours du temps.(2)Ăvaluer si la quantitĂ© de CSM contenues dans lâaile iliaque est corrĂ©lĂ©e Ă la survie sans reprise de des implants acĂ©tabulaires impactĂ©s dans le cadre de lâostĂ©onĂ©crose aseptique de la tĂȘte fĂ©morale.(3)AmĂ©liorer lâostĂ©ointĂ©gration des IT par les mĂ©thodes de thĂ©rapie cellulaire en Ă©tudiant in vitro la survie et la division des cellules stromales mĂ©senchymateuses humaines (CSM) osseuses au contact de cages lombaires inter-somatiques recouvertes dâalliage titane rugueux.MatĂ©riels et MĂ©thodes: LâĂ©valuation de la tenue primaire des tiges fĂ©morales en titane sans ciment selon lâanalyse de lâimpact a Ă©tĂ© rĂ©alisĂ©e Ă lâaide dâun marteau muni dâun capteur de force piĂ©zo-Ă©lectrique sur 20 sujets anatomiques soit 40 hanches. On a comparĂ© le nombre de coups de marteau pour obtenir lâimpaction idĂ©ale de la prothĂšse selon 3 mĂ©thodes dâĂ©valuation diffĂ©rentes : le nombre de coups nĂ©cessaires pour le chirurgien (Nchir), le nombre de coups nĂ©cessaires par lâanalyse vidĂ©o de lâenfoncement de la tige dans le fĂ©mur (Nvid) et le nombre de coups nĂ©cessaires par lâanalyse de lâimpact (NI).Pour savoir si la quantitĂ© de CSMs dans la crĂȘte iliaque pouvait reflĂ©ter lâostĂ©ointĂ©gration des implants acĂ©tabulaires impactĂ©es et le risque de reprise chirurgicale, on a comparĂ© le taux de CSMs mesurĂ© lors de la rĂ©alisation dâune ponction concentration et rĂ©injection dans la zone dâostĂ©onĂ©crose et lâĂ©volution clinico-radiographique des implants acĂ©tabulaires mis en place par la suite pour ces mĂȘme patients (n=90) qui ont eu une arthroplastie totale de hanche in fine. Le recul moyen Ă©tait de 15 ans.La survie cellulaire des CSM osseuses humaines a Ă©tĂ© Ă©valuĂ©e sur des cages intersomatiques lombaires recouvertes de titane. Trois groupes (n=5) furent constituĂ©s : un groupe contrĂŽle, un groupe cages avec surface titane, un groupe cage sans titane. Sur chaque implant, 1 microlitre contenant 106 CSM osseuses humaines a Ă©tĂ© mis en culture. Lâanalyse de la survie cellulaire, de la prolifĂ©ration cellulaire et de lâexpression de gĂšnes de diffĂ©renciation ostĂ©oblastique ont Ă©tĂ© rĂ©alisĂ©s et comparĂ©s.RĂ©sultats : Concernant la premiĂšre Ă©tude sur lâintĂ©rĂȘt de lâanalyse de lâimpact pour la tenue de la tige fĂ©morale, la diffĂ©rence entre NI, Nchir et Nvid Ă©tait infĂ©rieure ou Ă©gale Ă 3 pour plus de 85% des configurations rĂ©alisĂ©es. Concernant la deuxiĂšme Ă©tude, il a Ă©tĂ© mis en Ă©vidence quâun faible nombre de CSM dans la crĂȘte iliaque Ă©tait un facteur de risque de rĂ©vision chirurgicale chez les patients traitĂ©s par un implant acĂ©tabulaire sans ciment. La troisiĂšme Ă©tude a montrĂ© que les CSMs pouvaient survivre, se dĂ©velopper pendant 96 heures et exprimer des gĂšnes de diffĂ©renciation ostĂ©oblastique de maniĂšre identique sur les cages avec ou sans titane.Conclusion : Lâanalyse de lâimpact permet de donner une information objective sur la tenue primaire de la tige fĂ©morale en titane et impactĂ©e. Le titane est aussi un milieu favorisĂ© de survie et de prolifĂ©ration des CSM osseuses prĂ©destinĂ©es Ă devenir des cellules ostĂ©oformatrices surtout quâun faible nombre de CSM semble ĂȘtre un risque dâĂ©chec dâostĂ©ointĂ©gration des implants acĂ©tabulaires sans ciment
Screw augmentation for spinopelvic fixation in neuromuscular spine deformities: technical note
International audienceThe primary goal of curve correction in neuromuscular patients is to restore coronal and sagittal trunk balance, including the pelvis, to maximize sitting balance. For several years, it has been a common practice to inject polymeric cement into osteoporotic bone through specially designed, perforated pedicle screws in an effort to enhance screw stability. Therefore, we started using the association of a spinopelvic fixation with S1 pedicle screw augmentation, using bisphenol-a-glycidyl dimethacrylate composite resin in neuromuscular patients with pelvic obliquity, technique in neuromuscular patients to improve pedicle screw stability of our pelvic construct
Rat model of spinal cord injury preserving dura mater integrity and allowing measurements of cerebrospinal fluid pressure and spinal cord blood flow.
International audiencePURPOSES: Cerebrospinal fluid (CSF) pressure elevation may worsen spinal cord ischaemia after spinal cord injury (SCI). We developed a rat model to investigate relationships between CSF pressure and spinal cord blood flow (SCBF). METHODS: Male Wistar rats had SCI induced at Th10 (n = 7) or a sham operation (n = 10). SCBF was measured using laser-Doppler and CSF pressure via a sacral catheter. Dural integrity was assessed using subdural methylene-blue injection (n = 5) and myelography (n = 5). RESULTS: The SCI group had significantly lower SCBF (p < 0.0001) and higher CSF pressure (p < 0.0001) values compared to the sham-operated group. Sixty minutes after SCI or sham operation, CSF pressure was 8.6 ± 0.4 mmHg in the SCI group versus 5.5 ± 0.5 mmHg in the sham-operated group. No dural tears were found after SCI. CONCLUSION: Our rat model allows SCBF and CSF pressure measurements after induced SCI. After SCI, CSF pressure significantly increases
Effect of norepinephrine on spinal cord blood flow and parenchymal hemorrhage size in acute-phase experimental spinal cord injury.
International audiencePURPOSE: In the acute phase of spinal cord injury (SCI), ischemia and parenchymal hemorrhage are believed to worsen the primary lesions induced by mechanical trauma. To minimize ischemia, keeping the mean arterial blood pressure above 85Â mmHg for at least 1Â week is recommended, and norepinephrine is frequently administered to achieve this goal. However, no experimental study has assessed the effect of norepinephrine on spinal cord blood flow (SCBF) and parenchymal hemorrhage size. We have assessed the effect of norepinephrine on SCBF and parenchymal hemorrhage size within the first hour after experimental SCI. METHODS: A total of 38 animals were included in four groups according to whether SCI was induced and norepinephrine injected. SCI was induced at level Th10 by dropping a 10-g weight from a height of 10Â cm. Each experiment lasted 60Â min. Norepinephrine was started 15Â min after the trauma. SCBF was measured in the ischemic penumbra zone surrounding the trauma epicenter using contrast-enhanced ultrasonography. Hemorrhage size was measured repeatedly on parasagittal B-mode ultrasonography slices. RESULTS: SCI was associated with significant decreases in SCBF (PÂ =Â 0.0002). Norepinephrine infusion did not significantly modify SCBF. Parenchymal hemorrhage size was significantly greater in the animals given norepinephrine (PÂ =Â 0.0002). CONCLUSION: In the rat, after a severe SCI at the Th10 level, injection of norepinephrine 15Â min after SCI does not modify SCBF and increases the size of the parenchymal hemorrhage
Progressive restoration of spinal sagittal balance after surgical correction of lumbosacral spondylolisthesis before skeletal maturity
International audienceSpinopelvic alignment is crucial in assessing an energy-efficient posture in both normal and disease states, such as high-displacement developmental spondylolisthesis (HDDS). The overall effect in patients with HDDS who have undergone local surgical correction of lumbosacral imbalance for the global correction of spinal balance remains unclear. This paper reports the progressive spontaneous improvement of global sagittal balance following surgical correction of lumbosacral imbalance in patients with HDDS
Late local recurrence, at 19 and 17years, of sacral chordoma treated by en bloc resection
A cadaveric validation of a method based on impact analysis to monitor the femoral stem insertion
International audienc
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