Total disc arthroplasty: consequences for sagittal balance and lumbar spine movement.

This in vivo biomechanical study was undertaken to analyze the consequences for sagittal balance and lumbar spine movement in three different lumbar disc prostheses. A total of 105 patients underwent total disc replacement in three different centers. The Maverick prosthesis was used in 46 patients, the SB Charité device was used in 49 patients and the Prodisc device was utilized in 10 patients. The analysis was computer assisted, using Spineview and Matlab softwares. The intra and inter-observer reliability and measurement uncertainty was performed. The analysis of lateral X-ray films in flexion-extension allowed to measure the prosthesis positioning, the range of motion (ROM), the localization of the mean center of rotation (MCR), the vertebral translation and the disc height, for each prosthesis device. The sagittal balance was analyzed on a full spine film. The parameters studied were described by Duval-Beaupère. The results were compared to the data found in literature, and compared to 18 asymptomatic volunteers, and 61 asymptomatic subjects, concerning the sagittal balance. The prostheses allowed an improvement of the ROM of less than 2 degrees. The ROM of L5-S1 prostheses ranged from 11.6 to 15.6% of the total lumbar motion during flexion-extension. At L4-L5 level, the ROM decreased when there was an arthrodesis associated at the L5-S1 level. There was no difference of ROM between the three prostheses devices. The MCR was linked to the ROM, but did not depend on the prosthesis offcentering. The disc height improved for any prosthesis, and decreased in flexion or in extension, when the prosthesis was offcentered. An increase of translation indicated a minor increase of the ROM at L4-L5 level after Maverick or SB Charité implantation. The L5-S1 arthrodesis was linked with an increase of the pelvic tilt. The lumbar lordosis curvature increased between L4 and S1, even more when a prosthesis was placed at the L3-L4 level. Total disc arthroplasty is useful in the surgical management of discogenic spinal pathology. The three prostheses studied allowed to retorate the disc height, the ROM, without disrupting the sagittal balance, but induced modification of the lumbar curvature.

[Pedicle closing-wedge osteotomy for the treatment of fixed sagittal imbalance]. / Ostéotomie de soustraction pédiculaire dans le traitement des déséquilibres antérieurs du rachis: à propos de 34 cas.

PURPOSE OF THE STUDY: The aim of this study was to analyze x-ray results in patients who underwent pedicle subtraction osteotomy for complex deformations (flat back, kyphosis) leading to fixed sagittal imbalance. MATERIAL AND METHODS: Thirty-four patients underwent surgery between 1996 and March 2003 in two centers, the orthopedic surgery unit devoted to spinal surgery and sports traumatology at the Strasbourg University Hospitals and the spinal surgery unit at the Chenove Clinic (Dijon). The series included 20 women and 14 men, mean age 46.5 years (range 14-74 years) treated for: postoperative flat back (n = 19), kyphoscoliosis (n = 6), ankylosing spondylarthritis (n = 5), and malunion (n = 4). After careful planning to achieve the necessary degree of correction, the patient was installed on a Cotrel table with a stable support enabling limited blood loss and facilitated reduction maneuvers via elevation of the lower limbs. The technique started by resection of the posterior arch, the transverse processes, and the pedicles, followed by partial resection of the body with a chisel under fluoroscopic control. The closure was achieved by in situ reduction with compressive rotation. Adjacent discs were then evaluated to search for any opening which could be filled by an anterior graft to complete the stabilization. The osteosynthesis used 2-, 4-, and 6-rod assemblies. The 6-rod assemblies enabled anchoring the fixation above and below before the osteotomy. Two prebent rods completed the assembly at reduction after osteotomy. Weight-bearing started on day 4. A protective corset was worn for three months by 19 patients. The patients resumed their occupational activities on average 6.73 months postoperatively without change in activity for 63%. Overall satisfaction was close to 90% excellent outcome. RESULTS: All clinical results were analyzed with the Profil software of Surgiview. X-ray data were analyzed with Spineview. A self-administered clinical questionnaire was used to evaluate pain, result of the operation, and the impact on the patient's body image. On average, the wedge osteotomy measured 28.9 degrees for correction of lumbar lordosis by 31.5 degrees with a maximum of 65 degrees. The misalignment at C7 was reduced from 51 mm to 2 mm. At the pelvic level, version improved 16 degrees, sacral slope 8 degrees. There were four dura mater breaches which had to be sutured, but with no clinical consequence (one progression to meningocele). Mean intraoperative blood loss was 1400 cc (300-4500cc) for a mean operative time of 260 minutes (165-450 min). There were two early infections at day 15 postop which resolved with antibiotics. Four patients developed resolutive sciatica (n = 2) or cruralgia (n = 2) during the following months. The short-term follow-up revealed eight non-unions (25%) with rupture of osteosynthesis material and loss of correction. The opening in the adjacent discs and the insufficient posterior closure explained this mechanical complication. CONCLUSION: Pedicle subtraction osteotomy is an original operative technique reserved for specialized centers. A well-experienced team is needed to control the risks involved. Sagittal balance should be one of the important goals for modern spinal surgery.

[Treatment of exacerbation of asthma: what are today's issues?]. / Traitement de la crise d'asthme: où sont aujourd'hui les enjeux?

During past decades, major progress has been accomplished in the management of acute asthma. Most recent recommendations include evidence-based rationale. The improved quality of clinical guidelines makes them efficient models for medical education. The pediatric pharmacopoeia provides a great variety of choices of drugs as well as for asthma medical devices. These innovations dramatically facilitated the medical management of asthmatic children, but they did not solve all problems. Physicians now use higher doses of salbutamol, but the early prescription of systemic glucocorticoids for moderate exacerbation of asthma is still underused, given the most recent clinical guidelines and meta-analysis. Furthermore, repeated emergency department visits to the wards and lack of primary care physician should systematically be appraised when evaluating severity, as they are both major risk factors for severe exacerbations, even though they are not considered in acute asthma severity scores. Finally, initiating (or reinforcing) patient education at the time of exacerbation also presents important challenges, as emergency visits are a favorable moment to commence the therapeutic education of the child and his family. Indeed, framing the controller medications and educating families about how to manage the disease and to improve their domestic environment are the genuine tools available for the prevention of asthma exacerbations, and particularly those most severe.

[How are personal child health records completed? A multicentric evaluation study]. / Le carnet de santé de l'enfant est-il informatif? Evaluation dans différentes structures de prévention et de soins.

OBJECTIVE: To evaluate the completeness of personal child health record in France. PATIENTS AND METHODS: Cross-sectional multicentric study, based on child health records analysed and parents' interviews; 1685 children were included: 863 infants aged from 12 to 18 month and 822 children aged from three and a half to four and a half years. RESULTS: One Apgar score was recorded in 96% of cases; the sitting position's acquisition was registered in 91%; the age of walk in 81%. Growth curves were plotted in 64% of cases for weight and in 62% for height in infant's records and 22% of cases for both in older children's records. Ten per cent of the last visit to a physician were not recorded in infants health records, 19% in those of children; as well an hospitalisation for respectively 1,5% and 3,3% and a performed operation for 1,8% and 5,1% respectively. Immunization batches were exhaustively indicated in 68% and 50% of the records. CONCLUSION: Many important data for medical follow-up are missing in the child health records, especially for the oldest children. Physicians and parents should be incited to a better use of the personal record.

[Risk factors for early bronchiolitis at asthma during childhood: case-control study of asthmatics aged 4 to 12 years]. / Antécédent de bronchiolite précoce et asthme du grand enfant: étude cas-témoins chez des asthmatiques de 4 à 12 ans.

UNLABELLED: The group of general paediatrics of the French Paediatrics Society conducted a case-control study in order to verify the link between the occurrence of an acute bronchiolitis early during the first year of life, more specifically during the first trimester, and asthma during later childhood. METHODS: Parents of 4-to-12-year-old children answered a questionnaire during a general paediatrics visit. Exposition was attested by a diagnosis of bronchiolitis mentioned on the personal health record of the child. Environmental factors and medical history, obtained from the parents and by checking the health record of the child, were studied using multivariate analysis. RESULTS: Nineteen paediatricians included 80 children with asthma and 160 controls. Fifty-four per cent of asthmatic children had a medical history of bronchiolitis during the first year of life versus 17% of control children (P < 0.001). Mean age of bronchiolitis occurrence was 6.6 months in both groups (P = 0.98). Multivariate analysis showed that occurrence of bronchiolitis during the first year of life was significantly more frequent in asthmatic children (P < 0.001, OR = 5.6, IC95 = [2.6-11.6]) but this effect was not observed during the first trimester of life. CONCLUSION: Bronchiolitis during the first year of life was significantly related to later asthma in 4-to-12-year-old children treated by general paediatricians. On the other hand, a very early bronchiolitis during the first trimester of life did not appear, in our set of data, as a contributive factor to explain asthma in later childhood.

Intervertebral disc prosthesis. Results and prospects for the year 2000.

Presently, the kinematic disc prosthesis model (SB Charité) is the best disc replacement compromise, and is the basis of the evolution of the prosthetic concept at the dawning of the year 2000. Clinical results of a homogeneous series of 105 cases with a mean followup of 51 months show 79% of the patients had an excellent result and 87% returned to work, radiologically, these results correlated with restoration of a well balanced lordosis and with segmental mobility. Factors leading to failure are posterior facet arthritis, osteoporosis, structural deformities, and secondary facet pain. Two- and 3-dimensional numeric modeling enables one to study the total facet joint loading and the maximal local loading on the facet. Dissociation of the stiffness in pure rotation and stiffness in translation of the disc are the bases of the technologic improvement.

A multicenter retrospective study of the clinical results of the LINK SB Charité intervertebral prosthesis. The initial European experience.

OBJECTIVE: This study is a multicenter, retrospective review of the initial clinical results of an artificial disc replacement, the LINK SB Charité intervertebral prosthesis. METHODS: Independent analysis by chart review included patient demographics, surgical data, and a comparison of presurgical to follow-up data. Data were analyzed from 93 patients (average age = 43.0 +/- 7.3) in whom a total of 139 Model III prostheses (Waldemar Link GmbH & Co, Hamburg, Germany) were implanted. RESULTS: The predominant diagnostic indication for the disc was degenerative disc disease (52.4%). The L4-L5 and L5-S1 levels comprised 87.1% of all levels implanted. The average follow-up was 11.5 +/- 8.4 months. After disc implantation, a significant proportion of the patient sample experienced pain relief (P < 0.05). Improvements were also noted in pain intensity, walking distance, lumbar mobility, and the percentage of patients showing a positive SLR or neurological weakness. No difference in work status after disc implantation could be detected. Device failure, migration, or dislocation occurred in 6 of 93 (6.5%) patients. CONCLUSIONS: This study represents the largest multicenter case series of any functional artificial disc implantation. Carefully controlled, prospective studies that compare disc implantation and fusion are warranted.

[Urine retention following herpes zoster meningoencephalitis]. / Rétention d'urine après méningo-encéphalite zostérienne.

A case of retention of urine after ophthalmic zoster is reported. The sphincter vesicae disorder was of central origin, being caused by a meningoencephalitis. The patient progressively recovered. The respective responsibilities of brain suffering and meningeal involvement in these urinary tract disturbances are discussed.

[Rotatory anomaly of the lumbar spine from asymmetry of posterior articular facets (author's transl)]. / Anomalie rotatoire de la colonne lombaire par asymétrie des articulaires postérieures.

Radiographs of the lumbar spine frequently demonstrate asymmetry of posterior articular facets, but this is asymptomatic in patients with good abdominal and lumbar muscles when the anomaly is only of a moderate degree. It can, however, cause rotatory instability of the subjacent vertebra leading to lumbago. It is then frequently associated with osteo-articular complications affecting the posterior arch, this being a logical consequence of a sequence of changes which can be explained by simple mechanical factors.

[Bipartite atlas]. / Atlas bipartites.

A case is described of a child aged twelve with rib abnormalities, a Klippel-Feil syndrome and a complete fusion between C2 and C7. The atlas showed abnormal ossification of the anterior and posterior arches. No similar description has been found in the literature. A posterior spine fusion between C1 and C2 was performed.