ABSTRACT
Trauma of the spine involving several thoracic and lumbar vertebrae is rare (4 case in 250 spine operated in our unit from 1985 to 1990) and require difficult therapeutic decisions. The patients has one or more unstable fractures which could require 4 screw-plates that would be mechanically unsatisfactory, or an unstable fracture combined with other stable lesions requiring a mixed orthopaedic and surgical treatment that would lead to long term decubitus with a corset. The Cotrel-Dubousset system makes it possible to approach each lesion separately with segmentary instrumentation. Using different combinations of the implants we were able to obtain a construction which was both technically and mechanically satisfactory and allowed recovery of the sagittal spinal curvatures without external contention. A single operation treating all the different lesions was sufficient in 3 Frankel E patients, allowing them to return to their former activities in 3 to 6 months. The material was removed at about 20 months allowing good spinal mobility.
Subject(s)
Internal Fixators , Lumbar Vertebrae/injuries , Spinal Fractures/surgery , Thoracic Vertebrae/injuries , Adolescent , Adult , Female , Humans , Male , Time FactorsABSTRACT
Sixteen patients suffering from degenerative lumbar stenosis with or without spondylolisthesis underwent surgery following medical treatment failure; symptoms consisted of intermittent claudication, radiculalgia, and lumbago. In all cases, treatment involved dural and nerve root release with extensive lamino-arthrectomy, followed by arthrodesis using the Cotrel and Dubousset Instrumentation with posterolateral arthrodesis in order to avoid postoperative spinal instability. One case met with failure, owing to peridural fibrosis caused by a previous operation, while fifteen good to excellent results were obtained as evaluated according to Stauffer and Coventry criteria.
Subject(s)
Orthopedic Fixation Devices , Spinal Stenosis/surgery , Adult , Aged , Female , Humans , Laminectomy , Male , Middle Aged , Nerve Compression Syndromes/etiology , Nerve Compression Syndromes/surgery , Spinal Fusion , Spinal Nerve Roots , Spinal Stenosis/complicationsABSTRACT
Twenty-five one-stage lengthenings of the femur have been made using a specific technique: an oblique osteotomy in the frontal plane with a mean length of 12 cm, with routine tenotomies and fascial divisions. The average lengthening was 37 mm, that is 9.4 per cent of the femoral length. Complications were uncommon: one infection, three non-unions and one fracture, none of which resulted in any loss of length or deleterious late effects. One-stage lengthening is ideally indicated in adolescents at the end of growth for inequalities of limb length of 40 to 50 mm mainly affecting the femur, whatever the cause.
Subject(s)
Bone Lengthening/methods , Femur , Leg Length Inequality/surgery , Adolescent , Child , Female , Humans , Male , Osteotomy/methods , Postoperative Complications/etiology , Postoperative Complications/surgery , Reoperation , Tendons/surgeryABSTRACT
Five patients were treated after a period varying between 6 weeks and 18 months following original injury. The five lesions were similar in that they could not be reduced by conventional orthopedic measures and that they were fixed during dynamic review examinations using a brilliance amplifier.
Subject(s)
Bony Callus/diagnostic imaging , Cervical Vertebrae/injuries , Joint Dislocations/diagnostic imaging , Thoracic Vertebrae/injuries , Adult , Cervical Vertebrae/surgery , Child , Female , Humans , Joint Dislocations/physiopathology , Joint Dislocations/surgery , Male , Middle Aged , Radiography , Spine/diagnostic imaging , Thoracic Vertebrae/surgeryABSTRACT
The legitimacy of osteosynthesis for the treatment of spinal injuries in children is analyzed as a function of results in 10 cases, 7 affecting the cervical, 2 the thoracic and one the lumbar region, six of the children being under 10 years of age. Five of these children had serious neurologic disorders, including 4 with high tetraplegia. Technical difficulties of osteosynthesis were not made easier by the poorly adapted nature of the material for infantile statures. Indications for this surgery were not only those cases not improved by orthopedic therapy: instability of lesions, the child's condition and deterioration in the neurologic state can also require initial treatment by osteosynthesis. The principal complication is postoperative cervical kyphosis, but this can be prevented by early active reeducation, the stability of the fixation dispensing with the need for external contention.
