Dr PELLETIER Yann

Management of Vascular Complications during Anterior Lumbar Spinal Surgery Using Mini-Open Retroperitoneal Approach

Yann Pelletier, Fabien Lareyre, Caroline Cointat, Juliette Raffort

https://pubmed.ncbi.nlm.nih.gov/33549783/

Abstract

Background: Anterior retroperitoneal spine exposure has become increasingly performed for the surgical treatment of various spinal disorders. Despite its advantages, the procedure is not riskless and can expose to potentially life-threatening vascular lesions. The aim of this review is to report the vascular lesions that can happen during anterior lumbar spinal surgery using mini-open retroperitoneal approach and to describe their management.

Methods: A systematic literature search was performed according to PRISMA to identify studies published in English between January 1980 and December 2019 reporting vascular complications during anterior lumbar spinal surgery with mini-open retroperitoneal approach. Three authors independently conducted the literature search on PubMed/Medline database using a combination of the following terms: « spinal surgery », « anterior lumbar surgery (ALS) », « anterior lumbar interbody fusion (ALIF) », « lumbar total disc replacement », « artificial disc replacement », « vascular complications », « vascular injuries ». Vascular complications were defined as any peri-operative or post-operative lesions related to an arterial or venous vessel. The management of the vascular injury was extracted.

Results: Fifteen studies fulfilled the inclusion criteria. Venous injuries were observed in 13 studies. Lacerations and deep venous thrombosis ranged from 0.8% to 4.3% of cases. Arterial lesions were observed in 4 studies and ranged from 0.4% to 4.3% of cases. It included arterial thrombosis, lacerations or vasospasms. The estimated blood loss was reported in 10 studies and ranged from 50 mL up to 3000 mL. Vascular complications were identified as a cause of abortion of the procedure in 2 studies, representing respectively 0.3% of patients who underwent ALS and 0.5% of patients who underwent ALIF.

Conclusion: Imaging pre-operative planning is of utmost importance to evaluate risk factors and the presence of anatomic variations in order to prevent and limit vascular complications. Cautions should be taken during the intervention when manipulating major vessels and routine monitoring of the limb oxygen saturation should be systematically performed for an early detection of arterial thrombosis. The training of the surgeon access remains a key-point to prevent and manage vascular complications during anterior lumbar spinal surgery with mini-open retroperitoneal.

Copyright © 2021 Elsevier Inc. All rights reserved.

O-arm-guided sacroiliac joint injection: New techniques with reflux test

Nicolas Bronsard, Yann Pelletier, Olivier Andréani, Fernand de Peretti, Christophe Trojani

https://pubmed.ncbi.nlm.nih.gov/31787556/

Abstract

Diagnosis of degenerative sacroiliac pain syndrome is difficult. Sacroiliac injection confirms diagnosis by relieving pain. The present study aimed to describe a sacroiliac injection technique under O-arm guidance. Fifty-four patients, with a mean age of 58 years, presenting resistant sacroiliac pain syndrome after two 2D CT-guided injections received O-arm guided sacroiliac injection. Anesthetic reflux on joint lavage validated the technique. Clinical efficacy was assessed as pain relief on a simple numeric scale (positive if>70%). Reflux was observed in 92% of cases. Pain was relieved in 81%, with mean score reduced to 3.1 from 8.5. O-arm guided sacroiliac injection was reproducible and relieved sacroiliac pain after failure of 2D-guided injection, thus confirming the clinical diagnosis.

Keywords: Navigation; O-arm; Sacroiliac joint infiltration.

Copyright © 2020 Elsevier Masson SAS. All rights reserved.

Sacroiliac joint syndrome after lumbosacral fusion

Nicolas Bronsard, Yann Pelletier, Hugo Darmante, Olivier Andréani, Fernand de Peretti, Christophe Trojani

https://pubmed.ncbi.nlm.nih.gov/32900669/

Abstract

Introduction: One-third of low back pain cases are due to the sacroiliac (SI) joint. The incidence increases after lumbosacral fusion. A positive Fortin Finger Test points to the SI joint being the origin of the pain; however, clinical examination and imaging are not specific and minimally contributory. The gold standard is a test injection of local anesthetic. More than 70% reduction in pain after this injection confirms the SI joint is the cause of the pain. The aim of this study was to evaluate the decrease in pain on a Numerical Rating Scale (NRS) after intra-articular injection into the SI joint. We hypothesised that intra-articular SI injection will significantly reduce SI pain after lumbosacral fusion.

Methods: All patients with pain (NRS>7/10) suspected of being caused by SI joint syndrome 1 year after lumbosacral fusion with positive Fortin test were included. Patients with lumbar or hip pathologies or inflammatory disease of the SI joint were excluded. Each patient underwent a 2D-guided injection of local anesthetic into the SI joint. If this failed, a second 2D-guided injection was done; if this also failed, a third 3D-guided injection was done. Reduction of pain on the NRS by>70% in the first 2 days after the injection confirmed the diagnosis. Whether the injection was intra-articular or not, it was recorded. Ninety-four patients with a mean age of 57 years were included, of which 70% were women.

Results: Of the 94 patients, 85 had less pain (90%) after one of the three injections. The mean NRS was 8.6/10 (7-10) before the injection and 1.7/10 after the injection (0-3) (p=0.0001). Of the 146 2D-guided injections, 41% were effective and 61% were intra-articular. Of the 34 3D-guided injections, 73% were effective and 100% were intra-articular.

Discussion: This study found a significant decrease in SI joint-related pain after intra-articular injection into the SI joint in patients who still had pain after lumbosacral fusion. If this injection is non-contributive when CT-guided under local anesthesia, it can be repeated under general anesthesia with 3D O-arm guidance. This diagnostic strategy allowed us to confirm that pain originates in the SI joint after lumbosacral fusion in 9 of 10 patients.

Conclusion: If the first two CT-guided SI joint injections fail, 3D surgical navigation is an alternative means of doing the injection that helps to significantly reduce SI joint-related pain after lumbosacral fusion.

Level of evidence: IV, retrospective study.

Keywords: Diagnosis; Lumbosacral fusion; Sacroiliac joint pain; Test injection.

Copyright © 2020 Elsevier Masson SAS. All rights reserved.

Platelet to lymphocyte ratio as a predictive factor of 30-day mortality in patients with acute mesenteric ischemia

Emmanuel Augène, Fabien Lareyre, Julien Chikande, Lucas Guidi, Ali Ballaith, Jean-Nicolas Bossert, Yann Pelletier, Caroline Caradu, Réda Hassen-Khodja, Juliette Raffort

https://pubmed.ncbi.nlm.nih.gov/31314768/

Abstract

Introduction: Acute mesenteric ischemia is associated with high rates of mortality. The aim of this study was to investigate the prognostic value of the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) on 30-day outcomes in patients with acute mesenteric ischemia.

Material and methods: Consecutive patients who were admitted for an acute mesenteric ischemia were retrospectively included. The full white blood count at the time of admission to the hospital was recorded. The population was divided into 4 subgroups according to the quartiles of the NLR and the PLR. The 30-day outcomes including the mortality and the complications were compared among the subgroups.

Results: In total, 106 patients were included. A surgical treatment including revascularization and/or digestive resection was performed for 56 patients (52.8%). The 30-day all-cause mortality was 72 patients (67.9%). Patients with higher PLR value (PLR >429.3) had significantly higher rate of mortality compared to the other groups (80.8% vs 46.2%, 66.7% and 77.8%, p = 0.03). No significant difference on 30-day outcome was observed among the subgroups divided according to the NLR.

Conclusion: The PLR, but not the NLR, is a predictive factor of 30-day mortality in patients with acute mesenteric ischemia.

High Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio are Associated with Symptomatic Internal Carotid Artery Stenosis

Nicolas Massiot, Fabien Lareyre, Audrey Voury-Pons, Yann Pelletier, Julien Chikande, Joseph Carboni, Emilien Umbdenstock, Elixène Jean-Baptiste, Réda Hassen-Khodja, Juliette Raffort

https://pubmed.ncbi.nlm.nih.gov/30268367/

Abstract

Introduction: The neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) have been identified as predictive factors in several cardiovascular diseases but their significance in patients with internal carotid artery (ICA) stenosis is still poorly known. The aim of this study was to determine the clinical significance of the preoperative NLR and PLR in patients with ICA stenosis undergoing carotid endarterectomy.

Material and methods: Consecutive patients who underwent carotid endarterectomy for ICA stenosis were retrospectively included (n = 270). The population was divided into 2 series of 4 groups based on the quartile values of the preoperative NLR and PLR: group Ia (NLR < 1.5), IIa (1.50 < NLR < 2.07), IIIa (2.07 < NLR < 2.95), IVa (NLR>2.95), and group Ib (PLR < 86.6), IIb (86.6 < PLR < 111.7), IIIb (111.7 < PLR < 148.3), IVb (PLR > 148.3). Clinical characteristics and 30-day postoperative outcomes were compared among the groups.

Results: One death (.4%) was reported during the 30-day postoperative period and the overall stroke and death rate was 1.5%. The proportion of patients with symptomatic ICA stenosis were significantly higher in group IVa compared to groups Ia, IIa, IIIa (64.2% vs 33.8%, 44.8% and 45.6%, respectively, P = .005), and higher in group IVb compared to groups Ib, IIb, IIIb (59.7% vs 47.1%, 35.8%, 45.6%, P = .051). No significant difference on 30-day postoperative all-cause complications was observed among the groups.

Conclusions: A high preoperative NLR and PLR is significantly associated with symptomatic ICA stenosis. Further studies are required to determine their interest as predictors of postoperative outcomes in patients undergoing carotid endarterectomy.

Keywords: Internal carotid artery stenosis; neutrophil to lymphocyte ratio; platelet to lymphocyte ratio; white blood count.

Copyright © 2018. Published by Elsevier Inc.