Correction of hypokyphosis in thoracic adolescent idiopathic scoliosis using sublaminar bands: a 3D multicenter study

INTRODUCTION: The comparison of implants and correction methods remain controversial in AIS. Excellent frontal and axial correction rates have been reported with all-screw constructs, but at the expense of sagittal alignment, which has a tendency to flatten postoperatively. Posteromedial translation using hybrid constructs seems to preserve and improve thoracic kyphosis (TK), but no series exist to date with a significant number of hypokyphotic patients. In addition, the measures of TK in 2D are often wrong in severe AIS due to axial rotation. The goals of this study were therefore to analyze the 3D radiological outcomes of a group of hypokyphotic AIS patients operated with sublaminar bands. METHODS: 35 consecutive AIS hypokyphotic patients (T4T12 <15°) operated in three centers were included, with a minimum 2-year follow-up. The surgical technique was similar in all centers, associating lumbar pedicle screws and thoracic sublaminar bands. Posteromedial translation was the main correction technique, and no patient underwent prior anterior release. 3D spinal reconstructions were performed preoperatively, postoperatively and at the latest follow-up by an independent observer using SterEOS (EOS imaging, Paris, France), and 2D and 3D measurements were compared. In addition, a new 3D parameter [sagittal shift of the apical vertebra (SSAV)], reflecting the translation of the apical vertebra of the main curve in the patient sagittal plane, was described and reported. RESULTS: The age of the cohort was 16 years and the number of sublaminar bands used for correction averaged 6 (±1.5). T1T12 and T4T12 sagittal Cobb angles appeared to be overestimated on 2D postoperatively (3°, p = 0.002 and 4°, p < 0.001, respectively). Hence, only 3D measurements were kept for the quantitative analysis of the postoperative correction. T4T12 TK significantly increased after surgery (average 8° ± 7°, p < 0.001), but 11 patients (31.4%) remained hypokyphotic. Seven out of the eight patients (87.5%) who presented a thoracic lordosis (i.e., T4T12 <0°) preoperatively were corrected after surgery (mean gain 16° ± 4°). A posterior shift (positive SSAV) of the apical vertebra was reported in 24 patients (68.6%). In this subgroup, the mean SSAV was +2 cm (±1). Good correlation was found between the SSAV and the postoperative change in 3D T4T12 kyphosis (r = 0.62). CONCLUSION: Measures in 2D tend to overestimate sagittal alignment and are not sufficient to evaluate postoperative correction. SSAV is a new 3D parameter reflecting the TK change that needs to be further investigated and used in the future. This series confirms that sublaminar bands should be considered in hypokyphotic patients, since thoracic sagittal alignment was restored in 68.6% of the cases

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Unicompartmental Knee Arthroplasty in Patients Older Than 75 Results in Better Clinical Outcomes and Similar Survivorship Compared to Total Knee Arthroplasty. A Matched Controlled Study.

Place: United StatesBACKGROUND: Due to the potential reduction of morbidity and mortality, unicompartmental knee arthroplasty (UKA) may represent an interesting solution for older patients with unicompartmental arthritis. It was our hypothesis that UKA can represent an alternative to total knee arthroplasty (TKA) for patients older than 75. We, thus, aimed to compare in those patients (1) functional results, (2) rates of forgotten joint, and (3) survivorships of UKA vs TKA. METHODS: In this retrospective matched-pair study, 101 patients who underwent UKA in our institution were included and then matched one-to-one with TKA group based on age, gender, body mass index, preoperative Knee Society Score (KSS). Inclusion criteria were age between 75 and 90 years on the day of surgery, knee arthroplasty performed for primary osteoarthritis or osteonecrosis of the knee. All patients were evaluated clinically (using KSS, Knee Injury Osteoarthritis Outcome Score [KOOS], and Forgotten Joint Score) at 1, 2, and every 5 years, thereafter. Survivorships of UKA and TKA implants were also compared. RESULTS: At last follow-up, patients from UKA group had better KSS than in TKA group, (respectively, KSS function 82.8 ± 12.2 vs 79.2 ± 13.1 [P = .0448] and KSS knee 88.2 ± 8.9 vs 82.3 ± 12.5 [P = .0005]). Knee Injury Osteoarthritis Outcome Scores were also higher in UKA group (all P \textless .001) as well as the rate of forgotten knees (42% vs 25% P = .01). Sixteen-year survivorships free from revision for any reason were similar in the 2 groups (91.8% vs 94.6% P = .66). CONCLUSION: The results of our study showed that UKA provide higher function and better forgotten joint scores with similar survivorship, compared to TKA, for patients older than 75

The lateral wedge augmentation trochleoplasty in a pediatric population: a 5-year follow-up study.

Place: United StatesPatellofemoral instability in children requires surgery when recurrent dislocation occurs. The aim of this study is to report the 5-year clinical and radiographic outcomes following lateral wedge augmentation trochleoplasty of the femoral trochlea. This is a review of 23 (mean age: 12.5 years) patients who underwent surgery for recurrent patellar dislocations related to a flat trochlea. In every case, a lateral wedge augmentation trochleoplasty was performed with preservation of the growth plate. This surgery was consistently associated with a soft tissue procedure. All patients were reviewed for a clinical and radiographic evaluation [computed tomography (CT)-scan]. No case of recurrent patellar dislocation was reported and all patients were satisfied with the procedure; three patients reported anterior knee pain after physical activities. CT scan analysis revealed improvement of the trochlear shape measurements in all cases, but osteoarthritis lesions (narrowing of the lateral patellofemoral compartment) were visible on four CT scans. This trochleoplasty technique augmented by a soft tissue procedure on the extensor apparatus led to acceptable clinical mid-term results in terms of stability for patients with a flat trochlea (grade B according to Dejour classification). However, at the 5-year follow-up, four patients showed signs of osteoarthritis on CT scan evaluation. This warrants serious concern in this young population, and alternative methods should be considered whenever possible

“Patient-specific” rods in the management of adult spinal deformity. One-year radiographic results of a prospective study about 86 patients

International audienceIntroduction.-Based on global knowledge regarding sagittal alignment, preoperative planning is a crucial point in the management of adult spinal deformity (ASD). Patient-specific rods (PSR) have been recently developed in order to change preoperative planning into a postoperative reality. The aim of this study was therefore to analyze the 1-year radiographic results of prospective ASD cohorts managed using PSR.Methods.-In this prospective study, all patients managed for an ASD using PSR since 2014 and with a minimal follow-up of 1-year were included. Radiographic parameters were evaluated pre and postoperatively and patients were stratified according to their final sagittal alignment status (A: aligned vs. MA: malaligned) according to the age-related Schwab classification. Statistical analyses were performed using the Student's-t-test in order to compare groups.Results.-Eighty-six patients were included in the study, with a mean age of 57.2 years. At one-year follow-up, mean sagittal vertical axis and pelvic incidence-lumbar lordosis mismatch were significantly improved. Twenty-two patients were aligned on both sagittal and coronal planes, 52 patients were still considered as malaligned in the sagittal plane, 3 were still malaligned in the coronal plane and 9 patients were malaligned in both planes (vs. 42 patients preoperatively). At final follow-up, the rate of mechanical complications was 18%.Conclusion.-Based on our results, patient-specific rods can represent a useful supplementary tool in the management of ASD and transform preoperative planning into a postoperative reality. Corrections rates are comparable to other series in the literature with conventional rods, and fewer complications have been reported. However, further studies will be required in order to confirm these results

Percutaneous Cement-Augmented Screws Fixation in the Fractures of the Aging Spine: Is It the Solution?

Introduction. Management of elderly patients with thoracolumbar fractures is still challenging due to frequent osteoporosis and risk of screws pull-out. The aim of this study was to evaluate results of a percutaneous-only procedure to treat these fragile patients using cement-augmented screws. Methods. 12 patients diagnosed with a thoracolumbar fracture associated with an important loss of bone stock were included in this prospective study. Surgical procedure included systematically a percutaneous osteosynthesis using cemented fenestrated screws. When necessary, additional anterior support was performed using a kyphoplasty procedure. Clinical and radiographic evaluations were performed using CT scan. Results. On the whole series, 15 fractures were diagnosed and 96 cemented screws were inserted. The difference between the pre- and postoperative vertebral kyphosis was statistically significant (12.9° versus 4.4°, P=0.0006). No extrapedicular screw was reported and one patient was diagnosed with a cement-related pulmonary embolism. During follow-up period, no infectious complications, implant failures, or pull-out screws were noticed. Discussion. Aging spine is becoming an increasing public health issue. Management of these patients requires specific attention due to the augmented risk of complications. Using percutaneous-only screws fixation with cemented screw provides satisfactory results. A rigorous technique is mandatory in order to achieve best outcomes

Sagittal reduction of spinal deformity: Superior versus lateral screw-rod connection

International audienc

mars-avril 2016

Vous avez dit "médiateur scientifique" ? Médiateur scientifique est aujourd'hui un métier en mal de reconnaissance. D'ailleurs, il n'a pas la même appellation selon les structures dans lesquelles il s'exerce : animateur, guide, interprète scientifique, chargé ou assistant de médiation scientifique... Et pourtant, bien souvent la mission remplie est sensiblement identique d'un établissement à l'autre : le médiateur scientifique transmet aux publics des connaissances relatives aux sciences et facilite l'accès des visiteurs aux contenus exposés en présentant les informations scientifiques de manière attractive. Parallèlement à ces activités en présence du public, les médiateurs, selon les organismes, remplissent également des missions d'aide à la conception d'exposition, de gestion de projets, de communication... Deux des articles de la Lettre de l'OCIM sont consacrés à cette problématique avec un premier texte qui revient sur la création de l'Ecole de la médiation destinée à répondre aux besoins de formation des professionnels de ce secteur et un second qui présente les résultats d'une enquête menée auprès des médiateurs. Une réflexion concernant la diffusion des données libres sur les collections et la présentation d'un web-documentaire complètent un sommaire qui s'enrichit d'une nouvelle rubrique "Quoi de neuf ?" apparue en 2015 à l'occasion des 30 ans de l'OCIM et qui s'installe désormais durablement dans la revue. Serge Lochot, rédacteur en chef de la Lettre de l'OCIM

Experience in Perioperative Management of Patients Undergoing Posterior Spine Fusion for Neuromuscular Scoliosis

The objective of this investigation was to determine the outcome of spine fusion for neuromuscular (NM) scoliosis, using Unit Rod technique, with emphasis on complications related to preoperative general health. Between 1997 and 2007, 96 consecutive patients with neuromuscular scoliosis operated on with Unit Rod instrumentation were retrospectively reviewed. The inclusion criteria were diagnosis of NM scoliosis due to cerebral palsy (CP) and muscular dystrophy (DMD). Patient’s preoperative general health, weight, and nutrition were collected. Different radiographic and clinical parameters were evaluated. There were 66 CP patients (59 nonwalking) and 30 DMD patients (24 nonwalking). Mean age at surgery was 16.5 years and 13.9 years, respectively. All radiographic measurements improved significantly. Wound infection rate was 16.7% (11% of reoperation rate in CP; 10% in DMD; 3 hardware removal cases). No pelvic fracture due to rod irritation was observed. Unit Rod technique provides good radiographic and clinical outcomes even if this surgery is associated with a high complication rate. It is a quick, simple, and reliable technique. Perioperative management strategy should decrease postoperative complications and increases outcome. A standardized preoperative patient evaluation and preparation including respiratory capacity and nutritional, digestive, and musculoskeletal status are mandatory prior to surgery

Sacral hiatus corticosteroid injection in the management of radicular pain in adults

International audienceRadicular pain is a common reason for patients to consult at back pain clinics. While epidural steroid injections are widely done, some aspects are still controversial. The epidural space can be accessed via a transforaminal approach, an interlaminar route or by passing through the sacral hiatus. The aim of this article is to describe the epidural injection technique through the sacral hiatus that our team uses and to report our experience with it. Beyond the treatment effect, sacral hiatus corticosteroid injection can be useful as a diagnostic test or as an interim solution. Image-guided injection is recommended to ensure optimal positioning of the needle below S3. Sacral hiatus corticosteroid injection is a relevant alternative for treating lumbar radiculopathy in adults