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.

Transfacet screws using spinal navigation in addition to anterior or oblique lumbar interbody fusion: technical note and preliminary results

Antoine Gennari, Amandine Gavotto, Fabien Almairac, Yann Pelletier, Philippe Paquis, Stéphane Litrico

https://pubmed.ncbi.nlm.nih.gov/33523313/

Abstract

Transfacet screws (TFS) are an alternative to the classic bilateral pedicular screws (BPS) in addition to anterior (ALIF) or oblique (OLIF) lumbar interbody fusion. Spinal navigation could help the surgeon in technically demanding procedures in order to avoid screw malposition. Although spinal navigation is commonly used in BPS, its contribution in TFS remains unclear. Our aim here was to assess the feasibility of TFS using spinal navigation in addition to anterior lumbar fusion. Five patients suffering from lumbar degenerative disc disease were included. During the same general anaesthesia, we performed successively an ALIF or OLIF and then a TFS according to Boucher technique using spinal navigation (O-arm). No peri-operative complication occurred, and all the screws were successfully positioned (n = 10). All clinical scores (ODI, VAS L and VAS R) improved at 6-month follow-up. Segmental lordosis increased from 6° [2.4°-12°] to 13.6° [8°-17°]. Fusion was achieved for the five patients. TFS using O-arm in addition to ALIF/OLIF is feasible. To confirm our early favourable outcomes on clinical and radiological data, this technique must be evaluated on larger samples of patients.

Keywords: ALIF; Lumbar spine; OLIF; Spinal navigation; Transfacet screws.

© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS part of Springer Nature.

La formation de l’interne en chirurgie du rachis en France : état des lieux, démographie, auto-évaluation et perspectivesThe training of residents in spinal surgery in France: An inventory and self-assessment

Théo Broussolle, Renan Chapon, Yann Pelletier, Hugo Marty, Maxime Huneidi, Laurie Simon, Jean Meyblum

https://www.sciencedirect.com/science/article/abs/pii/S1877051721001076

Résumé

Introduction : La chirurgie du rachis, représentée à l’internat par la neurochirurgie et la chirurgie orthopédique, semble de moins en moins attrayante pour les futurs internes.

Hypothèses : Il existe des pistes afin d’améliorer la formation de l’interne en chirurgie du rachis, ainsi que des pistes pour homogénéiser ces formations entre interne en neurochirurgie et en chirurgie orthopédique.

Matériel et méthodes : Nous avons conduit une enquête nationale entre avril et juillet 2020, en diffusant un questionnaire numérisé par voie électronique. Des données démographiques, sur l’internat et son évaluation étaient recueillies chez des hommes et femmes effectuant leur internat de neurochirurgie ou d’orthopédie en France.

Résultats : Un total de 49 réponses d’internes en formation ont été obtenues. Les internes avaient effectué en moyenne 3,6 semestres en chirurgie du rachis en CHU, et 0,8 semestres hors-CHU, mais significativement plus pour les internes d’orthopédie que de neurochirurgie. 94 % des internes souhaitaient qu’un poste d’interne en clinique leur soit proposé aux choix de stage, mais 39 % n’y avaient pas accès. Les parts les plus importantes de la formation théorique, du point de vue des internes, étaient la formation autonome et la formation encadrée par les enseignants. Mais la majeure partie des internes ne bénéficiaient pas de la demi-journée de formation autonome réglementaire, ni de staffs scientifiques ou de cours de DES de façon régulière. Les internes en orthopédie évaluaient mieux leurs connaissances en rachis déformatif que les internes en neurochirurgie. Un total de 21 % des internes s’estimaient autonomes au bloc opératoire ; 58 % s’estimaient autonomes pour poser les indications opératoires et 65 % s’estimaient autonomes en consultation. Au bloc opératoire, les internes s’estimaient relativement autonomes en chirurgie de hernie discale lombaire en ouvert, de recalibrage et d’ostéosynthèse percutanée, mais peu autonomes en chirurgie de hernie discale mini-invasive ou de fusion inter-somatique.

Discussion : Afin d’améliorer la formation à la chirurgie du rachis, il faudrait permettre un meilleur accès à des stages hors-CHU, organiser plus de formations autonomes et encadrées, notamment les domaines du rachis tumoral, infectieux et déformatif, et développer la formation pratique, au bloc opératoire et en dehors du bloc opératoire, notamment dans les domaines de la fusion intersomatique et de la chirurgie mini-invasive.

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.

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.