Treatment challenges associated with bone echinococcosis

Objectives In this literature review, we concentrate on epidemiology and therapy of osseous echinococcosis, with an emphasis on the recurrence risk. Methods Literature review 1930-2012. Results We retrieved 200 publications based upon single case reports or case series, mostly from resource-poor settings. Among the 721 rural patients (22% females; median age 37 years), 60% of all reported cases were from the Mediterranean region and almost all patients were immune competent. Echinococcus granulosus was identified as the most frequent species. Most infections involved a single bone (602/721; 83%) and often the spine (321 cases; 45%). In eight cases (8/702; 1%), a secondary bacterial surgical site infection was reported. Surgical intervention was performed in 702 cases (97%), with single intervention in 687 episodes (95%). Complete excision of the lesion was possible in only 117 episodes (16%). Albendazole was by far the most frequently used agent in monotherapy with various dosages, while mebendazole in monotherapy was less frequent (32 cases). The median duration of antihelminthic therapy was 6 months (range 0.7-144 months). There were 124 recurrences (17%) after a median delay of 2 years (range 0.4-17 years). In multivariate analysis, the presence of visceral organ involvement increased the odds of recurrence by 5.4 (95% CI 3.1-9.4), whereas the number of surgical interventions, the duration of antihelminthic therapy or the use of hypertonic saline did not influence recurrence. Conclusions Bone echinococcosis is a rare parasitic disease. While treatment modalities vary considerably, combined surgical and medical approaches are the standard of care with a 17% risk of recurrenc

Impact de l'ostéotomie de soustraction pédiculaire sur les douleurs rachidiennes en évaluant les paramètres de la balance sagittale

Neuf personnes sur 10 vivront l'expérience d'une lombalgie durant leur vie. Derrière ce symptôme se cache plusieurs pathologies, notamment une instabilité sagittale. Pour pouvoir émettre ce diagnostic, le chirurgien analysera les paramètres spino-pelviens sur un cliché debout de profile de tout le rachis. L'origine du déséquilibre est souvent dégénérative ou iatrogénique. Lorsque le malade présente un déséquilibre majeur global antérieur, une ostéotomie de soustraction pédiculaire peut être réalisée pour corriger cette biomécanique perturbée et traiter des symptômes. Lors d'une revue rétrospective de 33 de nos patients ayant bénéficié d'une ostéotomie, plusieurs complications notoires ont pu être mises en évidence : l'anémie majeure, l'infection, la perte de la correction avec insuffisance du matériel ou la pseudarthrose. 42% des patients ont d'ailleur dû être repris chirurgicalement. L'évaluation finale des patients montre une satisfaction de 73%, une amélioration de leur qualité de vie, une diminution des lombalgies et du handicap fonctionnel journalier

Tumeurs musculo-squelettiques diagnostiquées à tort comme lésions sportives

During our medical activity, we would necessarily be confronted with sport related complaints. Most of the diagnosed pathologies belong to the inflammation category and other traumas. However, as we will see in this review, we sometimes discover musculoskeletal tumours from different origins. One should never underestimate non-developing or slowly developing conditions among athletes, and to keep in mind a possible oncologic diagnosis. A critical assistance for diagnosis is given by the medical imagery with MRI being the leading technique. The aim is to avoid any delay in making the correct diagnosis, and therefore to avoid a more severe prognosis that would lead to a more radical surgery for either benign or malign tumours

Radial Nerve Neuropraxis due to Compression by C-Arm Fluoroscopy in Spine Surgery: A Case Report

Introduction. Peripheral nerve injury is a well-known surgical complication related to the position of the patient. Moreover, in spine surgery, prone position for prolonged period places the patient at increased risk. The aim of this study was to report a case of a radial nerve neuropraxis due to compression by C-arm fluoroscopy during spine surgery. Case Presentation. An 81-year-old-female underwent a posterior spinal fixation L2-S1 due to lumbar spinal stenosis. In the recovery room, she presented an hematoma at the posterolateral part of her arm associated with a wrist drop due to radial nerve neuropraxis. The patient was referred to an occupational therapist and fully recovered four months later. After analysis of the patient positioning during the intervention, we came to the conclusion that this radial nerve injury was very possibly due to a compression by the C-arm fluoroscopy during the surgery. Conclusion. Our case describes a rare case of compression of the radial nerve during lumbar spine surgery, which is an unexpected complication as the site of the nerve injury is not at all related to the surgery itself, but to the position of the patient. Although C-arm fluoroscopy is essential, spine surgeons should be aware of this possible complication related to its use in order to avoid it

Evaluation of the modern luque trolley construct for treatment of early onset scoliosis using a gliding implant in an immature animal model

STUDY DESIGN: Experimental animal study. OBJECTIVE: To determine biological compatibility, stability, and growth potential of the Trolley Gliding Vehicle (TGV) used in a novel surgical technique for guided spinal growth. SUMMARY OF BACKGROUND DATA: Current treatments for Early Onset Scoliosis (EOS) maintaining spinal growth consist of posteriorly based spinal constructs requiring repetitive lengthening. Such interventions have a high rate of complications. Using a muscle sparing technique, a modified dual growing rods construct and new sliding spinal anchors, we set out to test a Modern Luque Trolley construct in an immature animal model. METHODS: Six matched pairs of 3 month old lambs were randomized to an observation or surgical group and were followed for 9 months. The surgical group underwent implantation of a Modern Luque Trolley construct with the new TGV inserted in a minimally invasive transmuscular technique capturing the spine and the 2 overlapping rods on either side. Physical exams and imaging were conducted at routine intervals, with a subsequent necropsy. RESULTS: The spines of the study group grew 96% between the instrumented segments compared to the control group without evidence of implant failure. Forty-two % of the fixed anchors (pedicle screws) and 13.90% of the TGV were loose. All 6 animals had some heterotrophic bone formation tracking along the rods (<20%) mainly originating from the distal anchor point. We identified 19 unplanned spontaneous facet arthrodesis out of the 132 mobile facets found between the fixed proximal and distal anchors. An additional 10 facets spontaneously fused proximal to the most proximal instrumented implants. CONCLUSIONS: Implantation of a Modern Luque construct with Trolley gliding vehicle allows for spinal growth in a non-scoliotic animal model. Implant loosening was likely mechanical as no sign of reactive inflammatory reaction were found. Reducing heterotrophic ossification and spontaneous facet arthrodesis remains a challenge in managing immature spine

Scoliose de l’adulte: prise en charge chirurgicale

La scoliose de l’adulte est une pathologie fréquente qui peut être très handicapante. La prise en charge chirurgicale, après échec des traitements conservateurs, nécessite une évaluation objective de l’impact fonctionnel de la scoliose pour le patient et une analyse systématique des investigations radiologiques (radiographie de colonne totale, clichés dynamiques et IRM). Les techniques chirurgicales (double abord, chirurgie mini-invasive, ostéotomies, longs montages) doivent être adaptées à chaque patient. Les buts principaux de la chirurgie sont de traiter les symptômes, corriger la déformation dans les plans coronal et sagittal, et obtenir une fusion solide. Malgré les complications potentielles, le traitement chirurgical de la scoliose permet d’offrir aux patients une meilleure qualité de vie

Four versus six weeks of antibiotic therapy for osteoarticular infections after implant removal: a randomized trial

The optimal duration of antibiotic therapy for treating orthopaedic implant infections after surgical drainage and complete implant removal is unknown. This was a single-centre, unblinded, prospective trial randomizing (1:1) eligible patients to either 4 or 6 weeks of systemic, pathogen-targeted antibiotic therapy. We analysed 123 eligible patients (62 in the 4 week antibiotic arm and 61 in the 6 week arm) in the ITT analysis. The patients’ median age was 64 years, 75 (61%) were men and 38 (31%) were immunocompromised. The most common types of infection treated included: two-stage exchange procedure for prosthetic joint infection (n"38); orthopaedic plate infection (44) and infected nail implants (11). The median duration of post-explant intravenous antibiotic therapy was 4 days. Overall, 120 episodes (98%) were cured microbiologically and 116 (94%) clinically after a median follow-up period of 2.2 years. During follow-up, four patients had a clinical recurrence with a pathogen other than the initial causative agent. We noted recurrence of clinical infection in four patients in the 4 week arm and three patients in the 6 week arm (4/62 versus 3/61; v2 test; P"0.74); in all cases, this occurred at around 2months following the end of antibiotic treatment. Conclusions: We found no statistically significant difference in the rates of clinical or microbiological remission between patients randomized to only 4 compared with 6 weeks of systemic antibiotic therapy after removal of an infected osteoarticular implant

Epidemiology of adverse events and Clostridium difficile-associated diarrhea during long-term antibiotic therapy for osteoarticular infections

Osteoarticular infections require several weeks of antibiotic therapy, but little is known about the epidemiology of adverse events (AE) including symptomatic Clostridium difficile-associated diarrhea during treatment in these patients

Treatment challenges associated with bone echinococcosis

In this literature review, we concentrate on epidemiology and therapy of osseous echinococcosis, with an emphasis on the recurrence risk