Analysis of apex and transitional vertebra of the spine according to pelvic incidence using orientation and position parameters

Objective: To identify the different apex and transitional vertebra according to the shape of the pelvis of individuals despite their difference in sagittal alignment using our measurement system. Methods: Full spine X-rays using EOS in standard stand-position of 99 volunteers were selected (47 women, 52 men, mean age 31years old). Validated 3D reconstruction technique allowing extraction of spinopelvic parameters, and position and rotation of each vertebra and lumbar discs. Subjects were divided in three groups: low PI (low PI, n=37), moderate PI (mid PI, n=52), high PI (high PI, n=10), with respectively a PI below 45 °, between 45 °-60 ° and above 60 °. Occurrence of specific position and rotation values of apex and transitional vertebra were assessed in each groups. Results: Frequency curves tend to move cranially when the incidence increases except in cervicothoracic where T1 is a constant for all shape of spine with occurrence approaching 90%. Angulation value of relevant vertebra and lumbar lordosis are significantly positively correlated for the whole population. Conclusions: Our study allowed the assessment of the distribution of spine curvatures according to the pelvic incidence. It describes the occurrence of localization of the apex and transitional vertebrae according to pelvic incidence. These results should be taken into account during the analysis of the sagittal balance, especially when planning deformity surgery in adults

Sagittal Balance Using Position and Orientation of Each Vertebra in an Asymptomatic Population

Study design: A monocentric, retrospective radiographic study with 99 asymptomatic volunteers. Objective: We performed the postural analysis commonly scheduled when evaluating sagittal balance in a vertebra-by-vertebra manner by enrolling an asymptomatic population. We measured the position and angulation of each vertebra to reveal those for which the spatial positioning could be relevant during spinal surgeries. Methods: We obtained full-spine EOS X-rays of 99 volunteers in the standard free-standing position. We used a validated three-dimensional (3D) reconstruction technique to extract current spinal parameters and the positions and angulations of all vertebrae and lumbar discs. Particular attention was paid to the positions and angulations of the apical and transitional vertebrae. Results: T1 was the most common transitional cervicothoracic vertebra (in 89.9% of subjects) and was oriented downwards by an average of 22.0° (standard deviation 7.3°, minimum 2.3°, maximum 40.1°). The thoracic apex trio of T5 (22.2%), T6 (28.3%) and T7 (36.4%) were equally found. The transitional thoracolumbar vertebrae were L1 (39.4%) and T12 (33.3%). The lumbar apex was usually the L3L4 disc (36.4%). T1 seemed to be the transitional vertebra (90%) irrespective of the pelvic incidence (PI). For the other relevant vertebrae, the greater the PI, the more cranial the vertebra. Conclusions: We performed a detailed 3D assessment of overall spinal balance using positional and rotational parameters. The positions and orientations of all vertebrae were specified, particularly the apical and transitional vertebrae

Mise au point d un modèle de compression médullaire chez la souris (étude comportementale et histopathologique)

Malgré des efforts considérables effectués au cours des deux dernières décennies, il n'existe jusqu'à présent aucune approche thérapeutique efficace dans les lésions de la moelle épinière (SCI). Ceci est attribuable, du moins en partie, aux difficultés rencontrées pour l'élaboration de modèles animaux prédictifs précis. Des études antérieures ont identifié deux conditions pertinentes à ces modèles. D'abord, on note l'intérêt de valider des modèles de SCI de souris à partir des données provenant de modèles chez le rat. Ceci permet d'avoir accès à un large répertoire de modèles transgéniques afin de valider les hypothèses physiopathologiques. L'autre élément est l'exploration des conséquences de chaque mécanisme de traumatisme de la moelle. Ceci requiert la modélisation des différents aspects étiologiques de la lésion (c'est-à-dire l'ischémie, la contusion et la compression). Ainsi, nous avons conçu un nouveau modèle de compression de la moelle épinière de souris en utilisant un dispositif olivaire que nous décrivons. Nous rapportons les premiers résultats fonctionnels moteurs et histologiques pour 3 différents calibres d'olive et différentes durées de compressions. Nous montrons que le modèle est calibré et reproductible, avec un retentissement fonctionnel et une extension lésionnelle, tous les deux corrélés à la gravité de la compression. Pour étayer la caractérisation de ce modèle, nous l'avons validé pharmacologiquement par un antagoniste du récepteur NMDA, la gacyclidine, et démontré l'implication de l'excitotoxicité dans mécanisme lésionnel. Nous avons donc la preuve que ce modèle de compression chez la souris est reproductible, bien caractérisé et prévisible. Son caractère non magnétique et contrôlable à distance permettra en outre l'analyse de la SCI en temps réel par IRM, donnant un aperçu de la caractérisation spatiale et temporelle de l'évolution de la lésion. En outre, il ouvre la voie à des études in vivo de SCI chez en animaux génétiquement modifiés.Despite considerable efforts over the last two decades there is so far no efficient therapeutic approach in spinal cord injuries (SCI). This may be attributable, at least in part, to difficulties encountered for elaborating predictive and accurate experimental animal models of this pathology. Previous studies have identified two relevant conditions of such model. First, the comparison of data arising from rat models by developing mice models that permits to have access to a large repertory of transgenic models, thus allowing to probe precise pathophysiological hypotheses. Second, the exploration of the consequences of each mechanism of the spinal trauma requires modeling the different etiologic aspects of the injury (i.e. ischemia, mechanic contusion and compression). In order to fulfill these two conditions we have devised a new model of compression injury of the mouse spinal cord using a thread-driven olive-shaped compressive device. We havecharacterized early motor, sensory and histological outcomes using three olive diameters anddifferent compression duration. We show a gradual and reproducible functional severity thatcorrelates with lesion extension. To further substantiate the characterization of this model, wedispensed a non-competitive NMDA antagonist and demonstrated the involvement ofexcitotoxicity in this model. We thus demonstrate that spinal olive-compression injury in the mouse is a reproducible, well-characterized and predictable model to analyse early event following SCI. The nonmagnetic and remote controlled design of this model will allow further real-time MRI studies that will give insights in the characterization of spatial and temporal evolution of SCI. Moreover it paves the way toward in vivo studies of functional and histological outcomes following SCI in genetically engineered animals.MONTPELLIER-BU Sciences (341722106) / SudocSudocFranceF

Évaluation par l' Imagerie de la dégénérescence du segment adjacent après chirurgie lombaire mono ou bi segmentaire par prothèse discale ou arthrodèse type Alif

Les prothèses discales représentent une nouvelle alternative aux arthrodèses lombaires par voie antérieure (ALIF). Elles diminuent le risque de syndrome adjacent qui est évalué sur des radiographies standards. Le but de cette étude est d'apporter par l'IRM une évaluation précoce de la dégénérescence des segments adjacents après prothèse et lou ALIF en confrontant ces données à la radiographie conventionnelle évaluant l'équilibre sagittal. 71 patients ont fait J'objet d'une chirurgie de la lombalgie chronique par voie antérieure entre 2008 et 2011 sur deux centres. 15 sujets (21.1%) étaient perdus de vue. 56 patients ont été inclus dans une étude rétrospective. 20 patients ont eu une ALIF, 24 une prothèse et 12 un montage hybride. L'âge était plus grand (p=O.0437) et il existait une prédominance de sujet féminins (p=O.0212) dans le groupe ALIF. L'évaluation fonctionnelle était effectuée par l'EVA, rODI et le SF-36. L'analyse radiographique portait en pré opératoire et au recul sur les paramètres pelviens et les paramètres de l'équilibre sagittal. Une IRM était réalisée avant l'intervention et au recul. Le recul moyen était de 37.6 mois. Le taux global de complications était de 9.9%. Il n'existait aucune différence significative concernant les résultats fonctionnels entre les groupes ALIF, prothèse et hybride. En cas d'arthroplastie L4L5, les groupes prothèse et hybride retrouvaient un meilleur équilibre sagittal avec une amélioration de l'angle spino-sacré (p=O.0056) et du C7 ratio (p=0.0136). L'arthroplastie L4L5 améliorait de manière significative la lordose segmentaire (p=O.0093). On constatait une dégradation significative du grade de Pfirrman à l'IRM en L3L4 (p=O.038) et L4L5 (p=O.0159) après ALIF. A moyen terme, arthrodèse et prothèse semblent donner des résultats fonctionnels similaires. Néanmoins l'arthroplastie en L4L5 améliore l'équilibre sagittal et préserve les segments adjacents. En cas de double discopathie, le montage hybride paraît être un choix thérapeutique judicieux.MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Intérêt des clichés dynamiques de contrôle à distance des entorses cervicales

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Short-term functional outcomes of robotic-assisted TKA are better with functional alignment compared to adjusted mechanical alignment

Introduction: Ligament balancing is essential to the functional outcome of total knee arthroplasty (TKA). The optimal method of alignment remains a controversial issue. The primary objective was to compare the clinical outcomes of TKA between functional and adjusted mechanical alignment techniques. The secondary objectives were to compare bone resection, robotic alignment, and radiological assessment. Materials and methods: This was a retrospective case-control series comparing TKA performed with functional alignment (FA) and adjusted mechanical alignment (aMA). Sixty-four FA subjects were matched with 64 aMA controls. These two groups were matched for age, gender, body mass index (BMI), surgeon, and type of frontal deformity. Both surgical procedures were performed using the MAKO® haptic robotic system. Functional scores (Forgotten Joint Score (FJS), Knee Society Score (KSS), and Oxford Knee Score (OKS)) were measured at the final postoperative follow-up. A radiographic evaluation was performed at the same time. Results: Mean FJS were respectively 63.4 ± 25.1 [0–100] and 51.2 ± 31.8 [0–100] in FA versus aMA group (p = 0.034). Mean OKS were respectively 40.8 ± 6.3 [21–48] and 34.9 ± 11.8 [3–48] in FA versus aMA group (p = 0.027). Mean KSS were respectively 184.9 ± 17.0 [126–200] and 175.6 ± 23.1 [102–200] in FA versus aMA group (p = 0.02). The main residual symptom was “none” for 73.0% versus 57.8%, “instability” for 6.4% versus 21.9%, “Pain” for 19.1% versus 12.5%, and “effusion” for 1.6% and 7.8% respectively for FA and aMA group (p = 0.016). There were 4 complications in the FA group versus 5 in the aMA group (p > 0.999). Mean postoperative hip-knee-ankle (HKA) robotic assessment were respectively 177.3° ± 2.0 [172–180] and 178.2° ± 2.0 [173–180] for FA and aMA group (p = 0.018). The median difference between HKA robotic and HKA radiological was −3.0° (IQR = 3.0; p < 0.001). Conclusion: With greater residual deformity and without release, functional alignment showed a statistically significantly better short-term clinical outcome than adjusted mechanical alignment. This difference may not be clinically significant

Femoral head mosaicplasty by direct anterior approach for an osteochondral impaction without performing surgical hip dislocation

Several surgical methods exist for the treatment of osteochondral lesions of the femoral head. They include osteochondral allograft transfer, femoral osteotomy, microfracture, autologous chondrocyte implantation, and hip arthroplasty. Mosaicplasty is a surgical method in which cylindrical plugs of bone and cartilage are transferred from a donor site to tunnels drilled into the bone and cartilage defects. This paper discusses the use of mosaicplasty by a direct anterior approach without dislocation in the treatment of an acute femoral head osteochondral impaction in a young patient

Arthroscopic Dorsal Capsuloplasty in Scapholunate Tears EWAS 3: Preliminary Results after a Minimum Follow-up of 1 Year

International audiencePurpose We retrospectively evaluated the results of all arthroscopic dorsal scapho-lunate (SL) capsuloplasty without pinning in patients presenting predynamic instability and dorsal capsuloscapholunate septum lesions on arthro-computed tomography scan after failed medical treatment. Materials and Methods Fifteen patients, mean age 34.3 years, underwent all arthroscopically assisted dorsal capsuloplasty. Patients were assessed preoperatively and postoperatively by a clinical (pain, Watson's test, range of motion, and strength), functional (quick disabilities of the arm, shoulder, and hand), patient-rated wrist evaluation, and Mayo wrist score scores), and radiological (SL gap and dorsal inter-calated segmental instability [DISI]) examination. SL tears were evaluated during surgery by European Wrist Arthroscopy Society (EWAS) classification. Results The mean follow-up period was 20.2 months (range, 12-41). Preoperatively, positive Watson's test was noted in all cases. DISI deformity was noted in three cases without any SL gap. The SL instability was graded EWAS IIIB (n ¼ 8) or EWAS IIIC (n ¼ 7). Postoperatively, positive Watson's test was noted in only one case. Activity pain decreased from 7.8 preoperatively to 2.4 postoperatively. Range of motion in flexion-extension increased from 92.9 degrees preoperatively to 126.2 degrees post-operatively. Grip strength increased from 24.2 preoperatively to 38.2 postoperatively. At final follow-up, range of motion in flexion-extension and grip strength were estimated at 87 and 91% compared with contralateral side, respectively. All functional scores were significantly improved at the last follow-up. No radiographic SL gapping in grip views or DISI deformity was noted. Discussion Cadaveric studies demonstrated that the dorsal portion of SL ligament is critical for the stability of the SL complex. The entire arthroscopic SL capsuloplasty technique provides reliable results for pain relief, avoiding postoperative stiffness associated with open procedures. It is an alternative technique for patients with predynamic SL instability after failure of medical management and shall not prelude the resort to any further open procedure. Level of Evidence This is a level IV, case series

Do Modular Dual Mobility Cups Offer a Reliable Benefit? Minimum 5-Year Follow-Up of 102 Cups

BackgroundAmong various options suggested to prevent hip instability after total hip replacement, the MDM-tritanium (modular dual mobility) cup features a cobalt-chrome liner (CoCr) positioned in a titanium acetabular shell and matched with a mobile insert in highly cross-linked annealed X3 polyethylene. The purpose of this study aimed to confirm whether there was no significant release of ions (Co and Cr) or higher occurrence of dislocation or even cases of aseptic loosening of the cementless shell with the use of MDM-tritanium cups at minimum of 5-year follow-up.MethodsThe clinical study was carried out on a homogeneous consecutive and nonselective series with 102 MDM cups (98 patients) implanted in 2 centers. This MDM-tritanium cup had been systematically used for surgical revisions (70% of cases) or for patients with major hip dysplasia or in elderly patients with poor bone quality. A biological assessment of ion releases has been performed in a specific cohort of 39 cases that had an internal ceramic head.ResultsNone of the following complications was observed: no case of immunoallergic event, no aseptic loosening, and the dislocation rate was 4.9% involving only the difficult primary and revision cases. The clinical results were encouraging, with 89.7 points for Harris Hip Score, 41.16 points/48 for the OHS-12. The Agora Roentgenographic Assessment (ARA) radiologic score was graded “excellent” in 94.4%. The MDM-tritanium survivorship with revision for any cause in 102 cups at 7.95 years was 92.7%.ConclusionBased on the results of our first 102 cases, there were no immunoallergic complications—contrary to what was initially feared with the CoCr bearing-titanium pair—and no postoperative instability, including for complex primary and revisions total hip replacements