Professeur BRONSARD Nicolas, Chef de Pôle de l'Institut Universitaire Locomoteur et du Sport du CHU de Nice, Spécialisé en chirurgie du Rachis

Pr BRONSARD Nicolas

Chirurgie du rachis

Professeur des Universités Anatomie & Chirurgie Orthopédique
Chef de Pôle IULS
Praticien Hospitalier en  Chirurgie du Rachis
Responsable de l’Unité de Chirurgie Ambulatoire
Responsable de  l’Unité de Chirurgie Rachidienne

Secrétariat:
Tel. : 04.92.03.61.27 / 06.49.22.44.41
Mail : dupre.c2@chu-nice.fr

Cécile Dupré

Cécile DUPRÉ, secrétariat chirurgie du Rachis à l'Institut Universitaire Locomoteur et du Sport du CHU de Nice

Titres

  • Ancien interne Médaille d’Or des Hôpitaux de Nice
  • Ancien Assistant Hospitalo-Universitaire en Orthopédie-Traumatologie à la Faculté de Médecine de Nice-Sophia-Antipolis
  • Chirurgie Orthopédiste et Traumatologue
  • Patricien Hospitalier (2009)

Diplômes

  • DESC de Chirurgie Orthopédique et Traumatologique 2010
  • Maitrise de Sciences biologiques et médicales 2001
  • Master2 d’anthropologie biologique (M2) 2005/2006
  • Thèse de Science en anthropologie biologique (M3) 2007/2012
  • DU de Microchirurgie 1ère année 2001/2002 (Marseille)
  • DU de Microchirurgie 2ème année 2002/2003 (Marseille)
  • DU anglais médical 2003 /2004 (Nice)
  • DU de chirurgie endoscopique et mini invasive du rachis 2003/2004 (Bordeaux)
  • DU d’expertise médicale (réparation du dommages corporels) 2005/2006 (Nice) 1ère année
  • DU de Pathologie Rachidienne 2006/2007 (Bordeaux) DES de chirurgie générale validé en 2007 (Nice)
  • DIU de Chirurgie Vertébrale 2007/2009 (Nice) 2 années
  • DIU d’ expertise médicale 2008/2009 (Nice) 2ème année

Publications 2020 du Pr BRONSARD Nicolas

Early mortality and morbidity of odontoid fractures after 70 years of age
O-arm-guided sacroiliac joint injection: New techniques with reflux test
Sacroiliac joint syndrome after lumbosacral fusion
Spino-femoral muscles affect sagittal alignment and compensatory recruitment: a new look into soft tissues in adult spinal deformity

Publications 2018 du Pr BRONSARD Nicolas

Is it possible to give a single definition of the rectosigmoid junction?

Publications 2017 du Pr BRONSARD Nicolas

Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal angular parameter, the CTPA
Estimation of spinopelvic muscles' volumes in young asymptomatic subjects: a quantitative analysis

Publications 2016 du Pr BRONSARD Nicolas

Inferior Cubital Artery Perforator Flap for Soft-Tissue Coverage of the Elbow: Anatomical Study and Clinical Application

Publications 2015 du Pr BRONSARD Nicolas

Facial artery perforator flap for reconstruction of perinasal defects: An anatomical study and clinical application
Volume and fat infiltration of spino-pelvic musculature in adults with spinal deformity

Publications 2011 du Pr BRONSARD Nicolas

Can fluoroscopy radiation exposure be measured in minimally invasive trauma surgery?
Discoscanner: indications, technique, tips and tricks, interpretation
Imaging of intervertebral disc prostheses
Medicoeconomic evaluation of total disc replacement based on French National Health Care System data
Minimally invasive posterior surgery for thoracolumbar fractures. New trends to decrease muscle damage

Publications 2010 du Pr BRONSARD Nicolas

One-stage percutaneous treatment in a patient with pelvic and vertebral compression fractures

Publications 2009 du Pr BRONSARD Nicolas

Centering of cervical disc replacements: usefulness of intraoperative anteroposterior fluoroscopic guidance to center cervical disc replacements: study on 20 discocerv (scient'x prosthesis)
Surgical management of elbow dislocation associated with non-reparable fractures of the radial head

Publications 2008 du Pr BRONSARD Nicolas

Extension reserve of the hip in relation to the spine: Comparative study of two radiographic methods
Percutaneous osteosynthesis of lumbar and thoracolumbar spine fractures without neurological deficit: surgical technique and preliminary results

Early mortality and morbidity of odontoid fractures after 70 years of age

Early mortality and morbidity of odontoid fractures after 70 years of age

Jeremy Allia, Hugo Darmanté, Laurent Barresi, Fernand De Peretti, Christophe Trojani, Nicolas Bronsard

https://pubmed.ncbi.nlm.nih.gov/32094064/

Abstract

Introduction: Odontoid fractures are very common in older adults and are associated with a high mortality rate. The aim of this study was to evaluate the outcomes after conservative treatment of non-displaced odontoid fractures and surgical treatment of displaced fractures in patients older than 70 years. It was hypothesized that early mortality of displaced fractures is higher than in non-displaced fractures.

Material and methods: This was a single-center retrospective observational study of odontoid fractures (type II in the Anderson and Alonzo classification) in patients older than 70 years that occurred between 2014 and 2017. Conservative treatment with immobilization for 3 months was proposed when the fracture was displaced less than 2 mm (non-displaced fracture group). Surgical treatment in the form of anterior screw fixation was proposed when the fracture displacement was more than 2 mm (displaced fracture group). The primary endpoint was the mortality rate at 3 months.

Results: The study included 79 patients (46 women) who had a mean age of 85 years (70-105). The 3-month mortality in the entire cohort was 27% and the 1-year mortality was 30%. Conservative treatment was provided to the 36 patients with non-displaced fractures. The 3-month mortality rate in this group was 11%. A displaced fracture occurred in 43 patients: 17 were treated surgically by anterior screw fixation; 20 could not be operated on because of anesthesia contraindications and 6 died within 24hours of the fracture event. The 3-month mortality rate in this group was 40%; 3 of the 17 operated patients died from postoperative respiratory complications; 8 of the 20 patients with contraindications died, in addition to the 6 that died soon after the fracture occurred.

Discussion: This study confirms that mortality and morbidity are high following odontoid fractures. The mortality rate was significantly higher in patients with displaced fractures, confirming our hypothesis. The mortality rate was especially high when patients with displaced fractures could not undergo surgery because of anesthesia contraindications. Also, there was a high rate of respiratory complications after anterior screw fixation of displaced fractures.

Conclusion: Given our findings, conservative treatment should be compared to surgical treatment for displaced fractures and the anterior approach should be compared to the posterior one for surgical cases.

Level of evidence: IV.

Keywords: Anterior Screw Fixation; Conservative treatment; Elderly; Mortality; Odontoid Fracture.

Copyright © 2020 Elsevier Masson SAS. All rights reserved.

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

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.

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Sacroiliac joint syndrome after lumbosacral fusion

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.

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Spino-femoral muscles affect sagittal alignment and compensatory recruitment: a new look into soft tissues in adult spinal deformity

Spino-femoral muscles affect sagittal alignment and compensatory recruitment: a new look into soft tissues in adult spinal deformity

Hongda Bao, Bertrand Moal, Shaleen Vira, Nicolas Bronsard, Celia Amabile, Thomas Errico, Frank Schwab, Wafa Skalli, Jean Dubousset, Virginie Lafage

https://pubmed.ncbi.nlm.nih.gov/32529524/

Abstract

Objective: To quantify muscle characteristics (volumes and fat infiltration) and identify their relationship to sagittal malalignment and compensatory mechanism recruitment.

Methods: Female adult spinal deformity patients underwent T1-weighted MRI with a 2-point Dixon protocol from the proximal tibia up to the T12 vertebra. 3D reconstructions of 17 muscles, including extensors and flexors of spine, hip and knee, were obtained. Muscle volume standardized by bone volume and percentage of fat infiltration (Pfat) were calculated. Correlations and regressions were performed.

Results: A total of 22 patients were included. Significant correlations were observed between sagittal alignment and muscle parameters. Fat infiltration of the hip and knee flexors and extensors correlated with larger C7-S1 SVA. Smaller spinal flexor/extensor volumes correlated with greater PI-LL mismatch (r = – 0.45 and – 0.51). Linear regression identified volume of biceps femoris as only predictor for PT (R2 = 0.34, p = 0.005) and Pfat of gluteus minimus as only predictor for SVA (R2 = 0.45, p = 0.001). Sagittally malaligned patients with larger PT (26.8° vs. 17.2°) had significantly smaller volume and larger Pfat of gluteus medius, gluteus minimus and biceps femoris, but similar values for gluteus maximus, the hip extensor.

Conclusion: This study is the first to quantify the relationship between degeneration of spino-femoral muscles and sagittal malalignment. This pathoanatomical study identifies the close relationship between gluteal, hamstring muscles and PT, SVA, which deepens our understanding of the underlying etiology that contributes to adult spinal deformity.

Keywords: Adult spinal deformity; Compensatory recruitment; Sagittal malalignment; Spino-femoral muscles.

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Is it possible to give a single definition of the rectosigmoid junction?

Is it possible to give a single definition of the rectosigmoid junction?

Damien Massalou, David Moszkowicz, Daniela Mariage, Patrick Baqué, Olivier Camuzard, Nicolas Bronsard

https://pubmed.ncbi.nlm.nih.gov/29218384/

Abstract

Aim: The rectosigmoid junction is the limit separating the sigmoid colon and rectum. This transition zone has different definitions. We want to highlight different landmarks of the rectosigmoid junction (RSJ), to help the clinicians to adopt a consensual definition.

Method: We reviewed anatomical, endoscopic, physiological and surgical points of view concerning the rectosigmoid junction (RSJ).

Results: The rectosigmoid junction has a different definition depending on who is studying it. Nevertheless, it is a high pressure location, a place connecting different muscles organizations, neurological systems or vascular anastomosis. The clear pathophysiology of the RSJ is not yet determined with certainty, but its resection is essential for the therapeutic care of patients and also for the improvement of surgical skills. From a surgical point of view, anatomical landmarks has to be chosen: easily reproducible and identifiable. The disappearance of taenia coli (belonging to the colon) and the peritoneal reflection (recto-genital pouch), located below the upper rectum, seem the most reliable. The level of rectal section must, in any case, be below the promontory.

Conclusion: There is not a single definition, but rather several definitions of the RSJ. Each one of them reflects one appearance of this region: embryological and anatomical evolution or clinical entity. From a surgical point of view, the criterion which seems to be the most reliable is the disappearance of taenia coli and the peritoneal reflection (recto-genital pouch).

Keywords: Anatomy; Lymph node; Rectosigmoid junction; Rectum.

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Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal angular parameter, the CTPA

Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal angular parameter, the CTPA

Themistocles Protopsaltis, Nicolas Bronsard, Alex Soroceanu, Jensen K Henry, Renaud Lafage, Justin Smith, Eric Klineberg, Gregory Mundis, Han Jo Kim, Richard Hostin, Robert Hart, Christopher Shaffrey, Shay Bess, Christopher Ames; International Spine Study Group

https://pubmed.ncbi.nlm.nih.gov/27437690/

Abstract

Purpose: To describe reciprocal changes in cervical alignment after adult spinal deformity (ASD) correction and subsequent development of proximal junctional kyphosis (PJK). This study also investigated these changes using two novel global sagittal angular parameters, cervical-thoracic pelvic angle (CTPA) and the T1 pelvic angle (TPA).

Methods: Multicenter, retrospective consecutive case series of ASD patients undergoing thoracolumbar three-column osteotomy (3CO) with fusion to the pelvis. Radiographs were analyzed at baseline and 1 year post-operatively. Patients were substratified into upper thoracic (UT; UIV T6 and above) and lower thoracic (LT; UIV below T6). PJK was defined by >10° angle between UIV and UIV + 2 and >10° change in the angle from baseline to post-op.

Results: PJK developed in 29 % (78 of 267) of patients. CTPA was linearly correlated with cervical plumbline (CPL) as a measure of cervical sagittal alignment (R = 0.826, p < 0.001). PJK patients had significantly greater post-operative CTPA and SVA than patients without PJK (NPJK) (p = 0.042; p = 0.021). For UT (n = 141) but not LT (n = 136), PJK patients at 1 year had larger CTPA (4.9° vs. 3.7°, p = 0.015) and CPL (5.1 vs. 3.8 cm, p = 0.022) than NPJK patients, despite similar corrections in PT and PI-LL.

Conclusions: The prevalence of PJK was 29 % at 1 year follow-up. CTPA, which correlates with CPL as a global analog of cervical sagittal balance, and TPA describe relative proportions of cervical and thoracolumbar deformities. Patients who develop PJK in the upper thoracic spine after thoracolumbar 3CO also develop concomitant cervical sagittal deformity, with increases in CPL and CTPA.

Keywords: Adult spinal deformity; Cervical alignment; Proximal junctional kyphosis; Sagittal alignment; Three-column osteotomy.

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Estimation of spinopelvic muscles' volumes in young asymptomatic subjects: a quantitative analysis

Estimation of spinopelvic muscles’ volumes in young asymptomatic subjects: a quantitative analysis

Celia Amabile, Bertrand Moal, Oussama Arous Chtara, Helene Pillet, Jose G Raya, Antoine Iannessi, Wafa Skalli, Virginie Lafage, Nicolas Bronsard

https://pubmed.ncbi.nlm.nih.gov/27637762/

Abstract

Purpose: Muscles have been proved to be a major component in postural regulation during pathological evolution or aging. Particularly, spinopelvic muscles are recruited for compensatory mechanisms such as pelvic retroversion, or knee flexion. Change in muscles’ volume could, therefore, be a marker of greater postural degradation. Yet, it is difficult to interpret spinopelvic muscular degradation as there are few reported values for young asymptomatic adults to compare to. The objective was to provide such reference values on spinopelvic muscles. A model predicting the muscular volume from reduced set of MRI segmented images was investigated.

Methods: A total of 23 asymptomatic subjects younger than 24 years old underwent an MRI acquisition from T12 to the knee. Spinopelvic muscles were segmented to obtain an accurate 3D reconstruction, allowing precise computation of muscle’s volume. A model computing the volume of muscular groups from less than six MRI segmented slices was investigated.

Results: Baseline values have been reported in tables. For all muscles, invariance was found for the shape factor [ratio of volume over (area times length): SD < 0.04] and volume ratio over total volume (SD < 1.2 %). A model computing the muscular volume from a combination of two to five slices has been evaluated. The five-slices model prediction error (in % of the real volume from 3D reconstruction) ranged from 6 % (knee flexors and extensors and spine flexors) to 11 % (spine extensors).

Conclusion: Spinopelvic muscles’ values for a reference population have been reported. A new model predicting the muscles’ volumes from a reduced set of MRI slices is proposed. While this model still needs to be validated on other populations, the current study appears promising for clinical use to determine, quantitatively, the muscular degradation.

Keywords: Asymptomatic subjects; MRI; Muscles; Volume; Young.

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Inferior Cubital Artery Perforator Flap for Soft-Tissue Coverage of the Elbow: Anatomical Study and Clinical Application

Inferior Cubital Artery Perforator Flap for Soft-Tissue Coverage of the Elbow: Anatomical Study and Clinical Application

Olivier Camuzard, Rémi Foissac, Cyril Clerico, Jonathan Fernandez, Thierry Balaguer, Tarik Ihrai, Fernand de Peretti, Patrick Baqué, Pascal Boileau, Charalambos Georgiou, Nicolas Bronsard

https://pubmed.ncbi.nlm.nih.gov/26984913/

Abstract

Background: Soft-tissue defects surrounding the elbow can be a challenging problem for the orthopaedic surgeon. Reliable reconstruction with use of muscular flaps or even perforator flaps derived from the surrounding vessels has been described. The inferior cubital artery (ICA) is an indirect septocutaneous perforator branch that most frequently arises from the lateral side of the radial artery. The purposes of the present study were to characterize the capillary cutaneous perforators of the ICA and to evaluate the potential of a local perforator flap procedure for soft-tissue coverage of the elbow.

Methods: Twenty fresh cadaveric forearms were dissected in order to describe the ICA anatomy, and in ten additional forearms the ICA was selectively injected with a red ink solution to detail the ICA vascular territory. For each artery, we recorded the site of origin, the diameter of the artery at its source, the course of the artery, and the number, type, and diameter of capillary cutaneous perforators.

Results: A total of seventy-eight ICA capillary perforators were analyzed from the twenty dissected forearms: forty-six were in-transit capillary perforators, nineteen were terminal capillary perforators, and thirteen were musculocutaneous capillary perforators. Of these seventy-eight perforators, sixteen (21%) had a caliber of <0.5 mm and sixty-two capillary perforators (79%) had a caliber of ≥0.5 mm. Ten ICAs were selectively injected, and the mean size of all stained skin areas was 30.9 ± 11.9 cm(2). A perforator pedicled flap was readily feasible for all dissections. We also describe the case of a patient with a medial soft-tissue defect of the elbow that was covered with a pedicled perforator flap based on an ICA. The patient had satisfactory healing at two months.

Conclusions: The ICA flap is a reliable and useful flap for elbow soft-tissue reconstruction.

Clinical relevance: The perforator flap procedure is a major advancement in reconstructive surgery. One potential application of the perforator flaps is the use of tissue adjacent to a defect as a perforator-based island flap. The use of this tissue allows for thinner flaps to be tailored for more accurate reconstruction. A flap that depends on a perforator branch of the radial artery called the inferior cubital artery seems to be an excellent solution for soft-tissue coverage of the elbow.

Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

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Facial artery perforator flap for reconstruction of perinasal defects: An anatomical study and clinical application

Facial artery perforator flap for reconstruction of perinasal defects: An anatomical study and clinical application

Olivier Camuzard, Rémi Foissac, Charalambos Georgiou, Lucas Andot, Florent Alcaraz, Patrick Baqué, Nicolas Bronsard, Gilles Poissonnet

https://pubmed.ncbi.nlm.nih.gov/26590853/

Abstract

Background: The concept of the facial artery perforator flap was developed for improved freedom during the reconstruction of perioral and perinasal defects. This flap enables tailor-made reconstruction and a shift from the traditional two-stage procedure to a one-stage technique. In this cadaveric study, the authors quantify the number, length, and diameter of facial artery perforators (FAPs) and present their clinical experience with the FAP flap.

Methods: The authors performed 20 dissections of facial arteries (FAs). All FAPs greater than 0.5 mm were dissected to study the number, length, and diameter of FAPs. In addition, the authors report a case series of 15 perinasal defect reconstruction procedures performed using facial artery-based perforator flap.

Results: A total of 125 FAPs were dissected. We identified a mean of six FAPs per hemiface (range five to eight). The average length of all FAPs was 17.6 ± 1.9 mm, and the mean diameter of the FAPs was 0.91 ± 0.2. Fifteen patients underwent a perinasal defect reconstruction using a FAP flap with good aesthetic and functional results.

Conclusions: The following study thus improves our understanding of FAP anatomy and clinical application and will enable the nasolabial fold to become the area where perinasal defect reconstruction using perforator flaps is performed.

Keywords: Cadaveric study; Facial artery; Facial artery perforator; Facial artery perforator flap; Facial reconstruction; Latex injection.

Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

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Volume and fat infiltration of spino-pelvic musculature in adults with spinal deformity

Volume and fat infiltration of spino-pelvic musculature in adults with spinal deformity

Bertrand Moal, Nicolas Bronsard, José G Raya, Jean Marc Vital, Frank Schwab, Wafa Skalli, Virginie Lafage

https://pubmed.ncbi.nlm.nih.gov/26495250/

Abstract

Aim: To investigate fat infiltration and volume of spino-pelvic muscles in adults spinal deformity (ASD) with magnetic resonance imaging (MRI) and 3D reconstructions.

Methods: Nineteen female ASD patients (mean age 60 ± 13) were included prospectively and consecutively and had T1-weighted Turbo Spin Echo sequence MRIs with Dixon method from the proximal tibia up to T12 vertebra. The Dixon method permitted to evaluate the proportion of fat inside each muscle (fat-water ratio). In order to investigate the accuracy of the Dixon method for estimating fat vs water, the same MRI acquisition was performed on phantoms of four vials composed of different proportion of fat vs water. With Muscl’X software, 3D reconstructions of 17 muscles or group of muscles were obtained identifying the muscle’s contour on a limited number of axial images [Deformation of parametric specific objects (DPSO) Method]. Musclar volume (Vmuscle), infiltrated fat volume (Vfat) and percentage of fat infiltration [Pfat, calculated as follow: Pfat = 100 × (Vfat/Vmuscle)] were characterized by extensor or flexor function respectively for the spine, hip and knee and theirs relationship with demographic data were investigated.

Results: Phantom acquisition demonstrated a non linear relation between Dixon fat-water ratio and the real fat-water ratio. In order to correct the Dixon fat-water ratio, the non linear relation was approximated with a polynomial function of degree three using the phantom acquisition. On average, Pfat was 13.3% ± 5.3%. Muscles from the spinal extensor group had a Pfat significantly greater than the other muscles groups, and the largest variability (Pfat = 31.9% ± 13.8%, P < 0.001). Muscles from the hip extensor group ranked 2(nd) in terms of Pfat (14% ± 8%), and were significantly greater than those of the knee extensor (P = 0.030). Muscles from the knee extensor group demonstrated the least Pfat (12% ± 8%). They were also the only group with a significant correlation between Vmuscle and Pfat (r = -0.741, P < 0.001), however this correlation was lacking in the other groups. No correlation was found between the Vmuscle total and age or body mass index. Except for the spine flexors, Pfat was correlated with age. Vmuscle and Vfat distributions demonstrated that muscular degeneration impacted the spinal extensors most.

Conclusion: Mechanisms of fat infiltration are not similar among the muscle groups. Degeneration impacted the spinal and hip extensors most, key muscles of the sagittal alignment.

Keywords: Adults with spinal deformity; Dixon method; Fat infiltration; Muscular degeneration; Muscular volume; Spino-pelvic musculature.

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Can fluoroscopy radiation exposure be measured in minimally invasive trauma surgery?

Can fluoroscopy radiation exposure be measured in minimally invasive trauma surgery?

A Roux, N Bronsard, N Blanchet, F de Peretti

https://pubmed.ncbi.nlm.nih.gov/21943776/

Abstract

Repeated use of X-rays in orthopedic surgery poses the problem of irradiation of patient and caregivers. Seven common minimally invasive bone trauma surgical procedures requiring image intensifier use were investigated: percutaneous K-wire fixation of the wrist, minimally invasive fixation plating of the wrist, percutaneous intramedullary nailing of the tibia and of the femur, short and long trochanteric nail fixation of trochanteric and sub-trochanteric fracture, and percutaneous fixation of thoracolumbar fracture. The study analyzed three parameters: dose area product (DAP), radiation duration, and skin entrance dose (SED). Data were collected from 15 successive implementations of each procedure. The aim of the study was to establish a database for this kind of bone trauma surgery and a hierarchy of the X-ray doses delivered. Percutaneous spinal osteosynthesis involved the highest dose, followed in decreasing order by long trochanteric nailing, femoral nailing, short trochanteric nailing, tibial nailing, wrist K-wire fixation and frontal wrist plate osteosynthesis. One short trochanteric nail procedure delivered the same DAP as 13 wrist K-wire fixation procedures, and one spinal osteosynthesis was equivalent to 13 short trochanteric nail or 174 wrist K-wire procedures. The anatomic area X-rayed appeared to be the main radiation dose factor. A database was established, but actual patient and staff radiation levels remained unknown.

Copyright © 2011 Elsevier Masson SAS. All rights reserved.

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Discoscanner: indications, technique, tips and tricks, interpretation

Discoscanner: indications, technique, tips and tricks, interpretation

N Amoretti, O Hauger, N Poussange, P Browaeys, L Huwart, P-Y Marcy, M-E Amoretti, I Hovorka, L Coco, T Benzaken, Y Nouri, N Bronsard, C Ibba, P Boileau

https://pubmed.ncbi.nlm.nih.gov/21821290/

Abstract

Discography test associated with the scanner (discoscanner) is an exam that has been a renewed interest in recent few years. Thanks to the emergence of new interventions such as disc prosthesis, the procedures require confirmation of the disc level to deal with and the origin of discogenic symptoms. The aim of this paper is to describe the techniques, challenges and tips as well as the interpretation of functional and morphological examination.

Copyright © 2011. Published by Elsevier Masson SAS.

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Imaging of intervertebral disc prostheses

Imaging of intervertebral disc prostheses

N Amoretti, A Iannessi, V Lesbats, P-Y Marcy, E Hovorka, N Bronsard, M-E Fonquerne, O Hauger

https://pubmed.ncbi.nlm.nih.gov/22277706/

Abstract

Disc arthroplasty is the replacement of a painful pathological intervertebral disc by a prosthesis, which, unlike spinal fixation, has the advantage of retaining vertebral mobility in the segment concerned. The success of the procedure is dictated by the indication. The radiologist must look for radiographic arguments indicating or contraindicating fitting an implant, and particularly for the presence of facet arthritis which will prompt the surgeon to choose an arthrodesis. Moreover, radiological information plays a major part in preparing for a surgical procedure, as far as access to the disc via the anterior approach is concerned and assessment by CT angiography of the risk of vascular complications. After insertion, radiological monitoring using dynamic X-ray images checks that the implant is correctly positioned and that mobility is restored. In the long term, it can detect complications related to the prosthesis and premature wear to other points of support such as adjacent discs and the facet joints.

Copyright © 2011 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

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Medicoeconomic evaluation of total disc replacement based on French National Health Care System data

Medicoeconomic evaluation of total disc replacement based on French National Health Care System data

N Bronsard, S Litrico, I Hovorka, P Paquis, B Gastaud, G Daideri, J-J Greffeuille, P Boileau

https://pubmed.ncbi.nlm.nih.gov/21741890/

Abstract

Introduction: Total disc replacement (TDR) has existed since 1984 but is not covered by the French national healthcare system (Sécurité Sociale). The present study assessed clinical outcomes, and also pre-, peri- and postoperative treatment costs.

Hypothesis: Surgical management of low back pain (LBP) provides medical and economic benefit.

Materials and methods: A prospective study recruited 19 patients in the Nice University Hospital Center (France); mean age, 41 years; 15 female. Inclusion criteria were: age less than 60 years; chronic low back pain (LBP) with single-segment discopathy; work related injuries and patients not covered under the General provision of the Sécurité Sociale were excluded. VAS, Oswestry and SF36 scores and return to work capability were analyzed. The local national health insurance branch office (Caisse Primaire d’Assurance Maladie [CPAM]) provided detailed coverage data for a 39-month period around the operation.

Results: Revision surgery was required for one instance of vertebral fracture. Preoperative follow-up was 14 months, postoperative FU 21 months and the perioperative period 4 months. LBP and quality of life showed improvement. Seventy-nine percent of patients reported satisfaction, 59% returned to work, and 84% had leisure activity. Total CPAM payout (reimbursement) was €399,082. Daily sickness benefit and disability compensation were the main cost items. Mean TDR cost per patient was €6833. Mean reimbursements were 19% lower post- than preoperatively. Pre- and postoperative clinical results did not correlate, while pre- and postoperative reimbursement costs did, as did cost and postoperative clinical status (r=-0.72). Preoperative cost was a predictive factor for postoperative clinical result.

Discussion: TDR achieves favorable medicoeconomic results.

Level of evidence: III: case-control study.

Copyright © 2011 Elsevier Masson SAS. All rights reserved.

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Minimally invasive posterior surgery for thoracolumbar fractures. New trends to decrease muscle damage

Minimally invasive posterior surgery for thoracolumbar fractures. New trends to decrease muscle damage

Yann Philippe Charles, Fahed Zairi, César Vincent, Stéphane Fuentes, Nicolas Bronsard, Charles Court & Jean-Charles Le Huec

https://link.springer.com/article/10.1007/s00590-011-0781-2

Abstract

High-energy spine fractures mainly affect the thoracolumbar junction. Surgery helps restore spine stability and sagittal realignment and improves long-term outcomes of patients. Posterior instrumentation ensures stability in most cases, some patients with unstable fractures benefitting from an additional anterior approach. This article discusses the indications for surgery with a view to conservative treatment and presents the advantages of posterior and anterior approaches. It also describes posterior, minimally invasive surgical techniques that have been developed in the past decade. In the light of scientific arguments, posterior minimally invasive surgery, combined with balloon-assisted vertebroplasty (or kyphoplasty) when necessary, appears to be at least as efficient as other posterior techniques, including open surgery. It has the advantage of being less aggressive towards soft tissues and of generating fewer complications than open surgery. Minimally invasive surgery may have better long-term outcomes for patients and may be cost-effective for health budgets, but these points need to be confirmed by further investigations.

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One-stage percutaneous treatment in a patient with pelvic and vertebral compression fractures

One-stage percutaneous treatment in a patient with pelvic and vertebral compression fractures

Jacques Sedat, Yves Chau, Cesar Razafidratsiva, Nicolas Bronsard, Fernand de Peretti

https://pubmed.ncbi.nlm.nih.gov/19774411/

Abstract

An active 38-year-old patient presenting a vertebral compression fracture associated with a pelvic fracture was treated in one stage with CT-guided fixation of the sacrum and kyphoplasty. This treatment decreased the pain, restored the vertebral height, and enabled the patient to be ambulatory. The main advantage of this double approach was to shorten the hospital stay and the nonworking period.

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Centering of cervical disc replacements: usefulness of intraoperative anteroposterior fluoroscopic guidance to center cervical disc replacements: study on 20 discocerv (scient'x prosthesis)

Centering of cervical disc replacements: usefulness of intraoperative anteroposterior fluoroscopic guidance to center cervical disc replacements: study on 20 discocerv (scient’x prosthesis)

Pascal Kouyoumdjian, Nicolas Bronsard, Jean Marc Vital, Olivier Gille

https://pubmed.ncbi.nlm.nih.gov/19564767/

Abstract

Study design: This is a prospective randomized computed tomographic scan study on the centering of cervical disc prosthesis (Discocerv; Scient’X) with and without anteroposterior (AP) fluoroscopic guidance.

Objective: Analyze interest of AP fluoroscopic guidance for coronal positioning in cervical disc replacements.

Summary of background data: This series consisted of 20 patients. One group of 10 patients was operated using only lateral fluoroscopic guidance (L guidance) and the other group of 10 patients was operated using both lateral and AP fluoroscopic guidance (AP + L guidance). Total disc replacements positioning is analyzed in the 2 groups.

Methods: All patients had a computed tomographic scan 24 hours after surgery. Specific reconstructions were obtained from the native slices. Three planes P1, P2, and P3 are defined to quantify centering of the prosthesis in axial sagittal and coronal planes. RESULTS.: In the coronal plane P1, there is no difference in lateralization between the L guidance (absolute value of average M = 0.93 mm; SD = 0.59 mm) and AP + L guidance groups (M = 1.28 mm; SD = 0.75 mm). In the axial plane, there is no difference in lateralization between the L guidance and AP + L guidance groups. In the L guidance group, average was 1.96 degrees (SD = 1.43 degrees ) and 3.18 degrees (SD = 2.94 degrees ) in AP + L guidance. There is no significative difference between 2 groups in coronal (P = 0.26) and axial plane (P = 0.19).

Conclusion: Unci are reliable landmarks for coronal centering of total disc replacements. AP fluoroscopic guidance does not improve this positioning.

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Surgical management of elbow dislocation associated with non-reparable fractures of the radial head

Surgical management of elbow dislocation associated with non-reparable fractures of the radial head

M Winter, C Chuinard, A Cikes, C Pelegri, N Bronsard, F de Peretti

https://pubmed.ncbi.nlm.nih.gov/19356963/

Abstract

Background: The « terrible triad » of the elbow is the combination of an elbow dislocation, radial head and a coronoid process fracture. Because of a combined sagittal, frontal and transverse instability, these injuries are notoriously difficult to treat. We report our results with a technique for reconstruction of « terrible triad » injuries with either no facture or a type I fracture of the coronoid process in addition to a non-reparable radial head fracture. The hypothesis of this study was that standard surgical treatment of this lesion using a « deep to superficial » stabilisation by a single lateral approach and radial head replacement enables early and reliable functional results.

Patients: From June 2004 to January 2007, 13 patients with an average age of 40 years at the date of trauma (range 18-77) underwent reconstruction of a « terrible triad » injury of the elbow with the same technique. The mean follow-up was 25 months (range 15-48).

Results: Eighty-four percent of the patients were very satisfied and satisfied. Average flexion was 131 degrees (110-140). Average extension was -11 degrees (-30-0). Average pronation was 72 degrees (40-80). Average supination was 70 degrees (50-80). The grip strength averaged 75% of that of the non-injured side (50-105). All elbows were stable at review. Eight complications occurred.

Conclusion: Our results suggest that some terrible triad injuries can be successfully managed with deep to superficial stabilisation by lateral approach, consisting in three-dimensional stabilisation done by anterior capsular reinsertion with absorbable anchors, radial head replacement and lateral collateral ligament repair. This standard management provides enough stability to allow early active rehabilitation, preventing post-operative instability and stiffness. This procedure appears to be reliable and reproducible.

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Extension reserve of the hip in relation to the spine: Comparative study of two radiographic methods

Extension reserve of the hip in relation to the spine: Comparative study of two radiographic methods

I Hovorka, P Rousseau, N Bronsard, M Chalali, M Julia, M Carles, N Amoretti, P Boileau

https://pubmed.ncbi.nlm.nih.gov/19070721/

Abstract

Free-hip movement is necessary for good spinal function. Limitation generally affects extension. The range of hip extension from the standing position can be considered as the hip’s « extension reserve ». The amplitude of this reserve must be known because any deficit requires a pathological solicitation of the vertebral column. Measurement of the extension reserve of the hip is useful for analyzing spinal disease and for preoperative planning. Physical examination can measure extension, but cannot differentiate movement produced by the hip from that originating in the spine. We have been unable to locate any radiographic method in the literature. The purpose of this study was to evaluate radiographic measurements and to propose a novel method. The study was conducted with 37 patients with spinal disease. Two radiographic methods were compared. Four lateral views, including the lumbar spine, the pelvis and the femur were obtained in each patient: neutral position, retroversion of the pelvis and extension of each hip in lunge position. The X-rays were digitalized for computer processing. The extension reserve of the hip was calculated for each radiographic method. Extension reserve was defined as the difference in the pelvis-femoral angle between the neutral position and extension. There was a positive correlation between the two methods (p<0.0006; p<0.0009). Mean extension using the pelvis retroversion method was 1.8 degrees +/-6.77; with the hip-extension method, it was hip I (side with the superior value): 15.9 degrees +/-6.57; hip II 10.0 degrees +/-7.89. The pelvis-retroversion method gave a lower measurement compared with the lunge position method (p<0.0001). For 13 of 37 subjects (35%), this method gave negative values, that is, failure of the measurement method. The method of hip extension in lunge position was superior to the pelvis-retroversion method, which gave lower measurements that were often incoherent and unable to provide specific information for each hip. The method using the lunge position for hip extension appears to be preferable. We are currently conducting a clinical trial to include extension reserve in the analysis of sagittal balance and for determining curvature corrections. We propose a mathematical formula using extension reserve for determining sagittal correction. Radiographic determination of extension reserve of the hip joint is of major importance for assessing spinal disease in addition to its contribution to the analysis of hip and pelvic disease. The methods presented here enable radiographic measurement of the extension reserve of the hip.

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Percutaneous osteosynthesis of lumbar and thoracolumbar spine fractures without neurological deficit: surgical technique and preliminary results

Percutaneous osteosynthesis of lumbar and thoracolumbar spine fractures without neurological deficit: surgical technique and preliminary results

C Pelegri, A Benchikh El Fegoun, M Winter, N Brassart, N Bronsard, I Hovorka, F de Peretti

https://pubmed.ncbi.nlm.nih.gov/18774020/

Abstract

Purpose of the study: The aim of this work was to study the technique of percutaneous osteosynthesis of lumbar and thoracolumbar spine fractures without neurological deficit and to report preliminary results.

Material and methods: This retrospective study included 15 patients with lumbar or thoracolumbar spine fractures who were treated between January 2004 and January 2006 by percutaneous osteosynthesis. There were seven men and eight women, mean age 36 years (range 16-58 years). The Magerl classification (AO) was A1 (n=4), A2 (n=1), A3 (n=9), B2 (n=1). Levels were T12 (n=1), L1 (n=10), L2 (n=2), L3 (n=1), L4 (n=1). A specific instrument set was used to insert a short fixation using two pedicular screws on either side of the fractured vertebra and two prebent 5.5mm rods introduced with an aiming device. The operation was performed under fluoroscopy. Ten patients wore a removable corset. The upright position was allowed if there were no other injuries. Computed-tomography scans were obtained preoperatively, postoperatively and at two years follow-up. Function was assessed with the Oswestry score.

Results: Mean operative time was 108 minutes (range 40-180 minutes). None of the patients with an isolated spinal injury required blood transfusion. Mean hospital stay was 12 days (range 4-28). Results were expressed for 13 patients whose operations were exclusively percutaneous. Mean follow-up was 17 months (range 6-30). The visual analog scale (VAS) was 1.6/10. The mean Oswestry score was 16. Three quarters of the patients resumed their occupational activities. None of the patients was dissatisfied. Mean vertebral kyphosis (VK) improved from 16 to 8.1 degrees , corrected regional angle (CRA) from 12 to 2.5 degrees at last follow-up. Loss of correction at last follow-up was 1.1 degrees for VK and 2.5 degrees for CRA. The rate of pedicle screw malposition was 3.8%. There were no cases of disassembly nor material failure. There were no infections. None of the implants had to be removed.

Discussion: Percutaneous osteosynthesis of the spine is technically feasible, but requires considerable experience. Functional and subjective results have been good. The loss of correction at last follow-up has been comparable to that observed with conventional open surgery. This technique is an intermediary method between orthopaedic treatment and conventional surgery. Exact indications must be established.

Conclusion: Percutaneous osteosynthesis of lumbar and thoracolumbar spine fractures is an attractive therapeutic option. Our results are encouraging. Indications and limitations of this technique must be carefully identified.

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Early mortality and morbidity of odontoid fractures after 70 years of age

Early mortality and morbidity of odontoid fractures after 70 years of age

Jeremy Allia, Hugo Darmanté, Laurent Barresi, Fernand De Peretti, Christophe Trojani, Nicolas Bronsard

https://pubmed.ncbi.nlm.nih.gov/32094064/

Abstract

Introduction: Odontoid fractures are very common in older adults and are associated with a high mortality rate. The aim of this study was to evaluate the outcomes after conservative treatment of non-displaced odontoid fractures and surgical treatment of displaced fractures in patients older than 70 years. It was hypothesized that early mortality of displaced fractures is higher than in non-displaced fractures.

Material and methods: This was a single-center retrospective observational study of odontoid fractures (type II in the Anderson and Alonzo classification) in patients older than 70 years that occurred between 2014 and 2017. Conservative treatment with immobilization for 3 months was proposed when the fracture was displaced less than 2 mm (non-displaced fracture group). Surgical treatment in the form of anterior screw fixation was proposed when the fracture displacement was more than 2 mm (displaced fracture group). The primary endpoint was the mortality rate at 3 months.

Results: The study included 79 patients (46 women) who had a mean age of 85 years (70-105). The 3-month mortality in the entire cohort was 27% and the 1-year mortality was 30%. Conservative treatment was provided to the 36 patients with non-displaced fractures. The 3-month mortality rate in this group was 11%. A displaced fracture occurred in 43 patients: 17 were treated surgically by anterior screw fixation; 20 could not be operated on because of anesthesia contraindications and 6 died within 24hours of the fracture event. The 3-month mortality rate in this group was 40%; 3 of the 17 operated patients died from postoperative respiratory complications; 8 of the 20 patients with contraindications died, in addition to the 6 that died soon after the fracture occurred.

Discussion: This study confirms that mortality and morbidity are high following odontoid fractures. The mortality rate was significantly higher in patients with displaced fractures, confirming our hypothesis. The mortality rate was especially high when patients with displaced fractures could not undergo surgery because of anesthesia contraindications. Also, there was a high rate of respiratory complications after anterior screw fixation of displaced fractures.

Conclusion: Given our findings, conservative treatment should be compared to surgical treatment for displaced fractures and the anterior approach should be compared to the posterior one for surgical cases.

Level of evidence: IV.

Keywords: Anterior Screw Fixation; Conservative treatment; Elderly; Mortality; Odontoid Fracture.

Copyright © 2020 Elsevier Masson SAS. All rights reserved.

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

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.

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Sacroiliac joint syndrome after lumbosacral fusion

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.

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Spino-femoral muscles affect sagittal alignment and compensatory recruitment: a new look into soft tissues in adult spinal deformity

Spino-femoral muscles affect sagittal alignment and compensatory recruitment: a new look into soft tissues in adult spinal deformity

Hongda Bao, Bertrand Moal, Shaleen Vira, Nicolas Bronsard, Celia Amabile, Thomas Errico, Frank Schwab, Wafa Skalli, Jean Dubousset, Virginie Lafage

https://pubmed.ncbi.nlm.nih.gov/32529524/

Abstract

Objective: To quantify muscle characteristics (volumes and fat infiltration) and identify their relationship to sagittal malalignment and compensatory mechanism recruitment.

Methods: Female adult spinal deformity patients underwent T1-weighted MRI with a 2-point Dixon protocol from the proximal tibia up to the T12 vertebra. 3D reconstructions of 17 muscles, including extensors and flexors of spine, hip and knee, were obtained. Muscle volume standardized by bone volume and percentage of fat infiltration (Pfat) were calculated. Correlations and regressions were performed.

Results: A total of 22 patients were included. Significant correlations were observed between sagittal alignment and muscle parameters. Fat infiltration of the hip and knee flexors and extensors correlated with larger C7-S1 SVA. Smaller spinal flexor/extensor volumes correlated with greater PI-LL mismatch (r = – 0.45 and – 0.51). Linear regression identified volume of biceps femoris as only predictor for PT (R2 = 0.34, p = 0.005) and Pfat of gluteus minimus as only predictor for SVA (R2 = 0.45, p = 0.001). Sagittally malaligned patients with larger PT (26.8° vs. 17.2°) had significantly smaller volume and larger Pfat of gluteus medius, gluteus minimus and biceps femoris, but similar values for gluteus maximus, the hip extensor.

Conclusion: This study is the first to quantify the relationship between degeneration of spino-femoral muscles and sagittal malalignment. This pathoanatomical study identifies the close relationship between gluteal, hamstring muscles and PT, SVA, which deepens our understanding of the underlying etiology that contributes to adult spinal deformity.

Keywords: Adult spinal deformity; Compensatory recruitment; Sagittal malalignment; Spino-femoral muscles.

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Is it possible to give a single definition of the rectosigmoid junction?

Is it possible to give a single definition of the rectosigmoid junction?

Damien Massalou, David Moszkowicz, Daniela Mariage, Patrick Baqué, Olivier Camuzard, Nicolas Bronsard

https://pubmed.ncbi.nlm.nih.gov/29218384/

Abstract

Aim: The rectosigmoid junction is the limit separating the sigmoid colon and rectum. This transition zone has different definitions. We want to highlight different landmarks of the rectosigmoid junction (RSJ), to help the clinicians to adopt a consensual definition.

Method: We reviewed anatomical, endoscopic, physiological and surgical points of view concerning the rectosigmoid junction (RSJ).

Results: The rectosigmoid junction has a different definition depending on who is studying it. Nevertheless, it is a high pressure location, a place connecting different muscles organizations, neurological systems or vascular anastomosis. The clear pathophysiology of the RSJ is not yet determined with certainty, but its resection is essential for the therapeutic care of patients and also for the improvement of surgical skills. From a surgical point of view, anatomical landmarks has to be chosen: easily reproducible and identifiable. The disappearance of taenia coli (belonging to the colon) and the peritoneal reflection (recto-genital pouch), located below the upper rectum, seem the most reliable. The level of rectal section must, in any case, be below the promontory.

Conclusion: There is not a single definition, but rather several definitions of the RSJ. Each one of them reflects one appearance of this region: embryological and anatomical evolution or clinical entity. From a surgical point of view, the criterion which seems to be the most reliable is the disappearance of taenia coli and the peritoneal reflection (recto-genital pouch).

Keywords: Anatomy; Lymph node; Rectosigmoid junction; Rectum.

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Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal angular parameter, the CTPA

Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal angular parameter, the CTPA

Themistocles Protopsaltis, Nicolas Bronsard, Alex Soroceanu, Jensen K Henry, Renaud Lafage, Justin Smith, Eric Klineberg, Gregory Mundis, Han Jo Kim, Richard Hostin, Robert Hart, Christopher Shaffrey, Shay Bess, Christopher Ames; International Spine Study Group

https://pubmed.ncbi.nlm.nih.gov/27437690/

Abstract

Purpose: To describe reciprocal changes in cervical alignment after adult spinal deformity (ASD) correction and subsequent development of proximal junctional kyphosis (PJK). This study also investigated these changes using two novel global sagittal angular parameters, cervical-thoracic pelvic angle (CTPA) and the T1 pelvic angle (TPA).

Methods: Multicenter, retrospective consecutive case series of ASD patients undergoing thoracolumbar three-column osteotomy (3CO) with fusion to the pelvis. Radiographs were analyzed at baseline and 1 year post-operatively. Patients were substratified into upper thoracic (UT; UIV T6 and above) and lower thoracic (LT; UIV below T6). PJK was defined by >10° angle between UIV and UIV + 2 and >10° change in the angle from baseline to post-op.

Results: PJK developed in 29 % (78 of 267) of patients. CTPA was linearly correlated with cervical plumbline (CPL) as a measure of cervical sagittal alignment (R = 0.826, p < 0.001). PJK patients had significantly greater post-operative CTPA and SVA than patients without PJK (NPJK) (p = 0.042; p = 0.021). For UT (n = 141) but not LT (n = 136), PJK patients at 1 year had larger CTPA (4.9° vs. 3.7°, p = 0.015) and CPL (5.1 vs. 3.8 cm, p = 0.022) than NPJK patients, despite similar corrections in PT and PI-LL.

Conclusions: The prevalence of PJK was 29 % at 1 year follow-up. CTPA, which correlates with CPL as a global analog of cervical sagittal balance, and TPA describe relative proportions of cervical and thoracolumbar deformities. Patients who develop PJK in the upper thoracic spine after thoracolumbar 3CO also develop concomitant cervical sagittal deformity, with increases in CPL and CTPA.

Keywords: Adult spinal deformity; Cervical alignment; Proximal junctional kyphosis; Sagittal alignment; Three-column osteotomy.

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Estimation of spinopelvic muscles' volumes in young asymptomatic subjects: a quantitative analysis

Estimation of spinopelvic muscles’ volumes in young asymptomatic subjects: a quantitative analysis

Celia Amabile, Bertrand Moal, Oussama Arous Chtara, Helene Pillet, Jose G Raya, Antoine Iannessi, Wafa Skalli, Virginie Lafage, Nicolas Bronsard

https://pubmed.ncbi.nlm.nih.gov/27637762/

Abstract

Purpose: Muscles have been proved to be a major component in postural regulation during pathological evolution or aging. Particularly, spinopelvic muscles are recruited for compensatory mechanisms such as pelvic retroversion, or knee flexion. Change in muscles’ volume could, therefore, be a marker of greater postural degradation. Yet, it is difficult to interpret spinopelvic muscular degradation as there are few reported values for young asymptomatic adults to compare to. The objective was to provide such reference values on spinopelvic muscles. A model predicting the muscular volume from reduced set of MRI segmented images was investigated.

Methods: A total of 23 asymptomatic subjects younger than 24 years old underwent an MRI acquisition from T12 to the knee. Spinopelvic muscles were segmented to obtain an accurate 3D reconstruction, allowing precise computation of muscle’s volume. A model computing the volume of muscular groups from less than six MRI segmented slices was investigated.

Results: Baseline values have been reported in tables. For all muscles, invariance was found for the shape factor [ratio of volume over (area times length): SD < 0.04] and volume ratio over total volume (SD < 1.2 %). A model computing the muscular volume from a combination of two to five slices has been evaluated. The five-slices model prediction error (in % of the real volume from 3D reconstruction) ranged from 6 % (knee flexors and extensors and spine flexors) to 11 % (spine extensors).

Conclusion: Spinopelvic muscles’ values for a reference population have been reported. A new model predicting the muscles’ volumes from a reduced set of MRI slices is proposed. While this model still needs to be validated on other populations, the current study appears promising for clinical use to determine, quantitatively, the muscular degradation.

Keywords: Asymptomatic subjects; MRI; Muscles; Volume; Young.

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Inferior Cubital Artery Perforator Flap for Soft-Tissue Coverage of the Elbow: Anatomical Study and Clinical Application

Inferior Cubital Artery Perforator Flap for Soft-Tissue Coverage of the Elbow: Anatomical Study and Clinical Application

Olivier Camuzard, Rémi Foissac, Cyril Clerico, Jonathan Fernandez, Thierry Balaguer, Tarik Ihrai, Fernand de Peretti, Patrick Baqué, Pascal Boileau, Charalambos Georgiou, Nicolas Bronsard

https://pubmed.ncbi.nlm.nih.gov/26984913/

Abstract

Background: Soft-tissue defects surrounding the elbow can be a challenging problem for the orthopaedic surgeon. Reliable reconstruction with use of muscular flaps or even perforator flaps derived from the surrounding vessels has been described. The inferior cubital artery (ICA) is an indirect septocutaneous perforator branch that most frequently arises from the lateral side of the radial artery. The purposes of the present study were to characterize the capillary cutaneous perforators of the ICA and to evaluate the potential of a local perforator flap procedure for soft-tissue coverage of the elbow.

Methods: Twenty fresh cadaveric forearms were dissected in order to describe the ICA anatomy, and in ten additional forearms the ICA was selectively injected with a red ink solution to detail the ICA vascular territory. For each artery, we recorded the site of origin, the diameter of the artery at its source, the course of the artery, and the number, type, and diameter of capillary cutaneous perforators.

Results: A total of seventy-eight ICA capillary perforators were analyzed from the twenty dissected forearms: forty-six were in-transit capillary perforators, nineteen were terminal capillary perforators, and thirteen were musculocutaneous capillary perforators. Of these seventy-eight perforators, sixteen (21%) had a caliber of <0.5 mm and sixty-two capillary perforators (79%) had a caliber of ≥0.5 mm. Ten ICAs were selectively injected, and the mean size of all stained skin areas was 30.9 ± 11.9 cm(2). A perforator pedicled flap was readily feasible for all dissections. We also describe the case of a patient with a medial soft-tissue defect of the elbow that was covered with a pedicled perforator flap based on an ICA. The patient had satisfactory healing at two months.

Conclusions: The ICA flap is a reliable and useful flap for elbow soft-tissue reconstruction.

Clinical relevance: The perforator flap procedure is a major advancement in reconstructive surgery. One potential application of the perforator flaps is the use of tissue adjacent to a defect as a perforator-based island flap. The use of this tissue allows for thinner flaps to be tailored for more accurate reconstruction. A flap that depends on a perforator branch of the radial artery called the inferior cubital artery seems to be an excellent solution for soft-tissue coverage of the elbow.

Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

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Facial artery perforator flap for reconstruction of perinasal defects: An anatomical study and clinical application

Facial artery perforator flap for reconstruction of perinasal defects: An anatomical study and clinical application

Olivier Camuzard, Rémi Foissac, Charalambos Georgiou, Lucas Andot, Florent Alcaraz, Patrick Baqué, Nicolas Bronsard, Gilles Poissonnet

https://pubmed.ncbi.nlm.nih.gov/26590853/

Abstract

Background: The concept of the facial artery perforator flap was developed for improved freedom during the reconstruction of perioral and perinasal defects. This flap enables tailor-made reconstruction and a shift from the traditional two-stage procedure to a one-stage technique. In this cadaveric study, the authors quantify the number, length, and diameter of facial artery perforators (FAPs) and present their clinical experience with the FAP flap.

Methods: The authors performed 20 dissections of facial arteries (FAs). All FAPs greater than 0.5 mm were dissected to study the number, length, and diameter of FAPs. In addition, the authors report a case series of 15 perinasal defect reconstruction procedures performed using facial artery-based perforator flap.

Results: A total of 125 FAPs were dissected. We identified a mean of six FAPs per hemiface (range five to eight). The average length of all FAPs was 17.6 ± 1.9 mm, and the mean diameter of the FAPs was 0.91 ± 0.2. Fifteen patients underwent a perinasal defect reconstruction using a FAP flap with good aesthetic and functional results.

Conclusions: The following study thus improves our understanding of FAP anatomy and clinical application and will enable the nasolabial fold to become the area where perinasal defect reconstruction using perforator flaps is performed.

Keywords: Cadaveric study; Facial artery; Facial artery perforator; Facial artery perforator flap; Facial reconstruction; Latex injection.

Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

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Volume and fat infiltration of spino-pelvic musculature in adults with spinal deformity

Volume and fat infiltration of spino-pelvic musculature in adults with spinal deformity

Bertrand Moal, Nicolas Bronsard, José G Raya, Jean Marc Vital, Frank Schwab, Wafa Skalli, Virginie Lafage

https://pubmed.ncbi.nlm.nih.gov/26495250/

Abstract

Aim: To investigate fat infiltration and volume of spino-pelvic muscles in adults spinal deformity (ASD) with magnetic resonance imaging (MRI) and 3D reconstructions.

Methods: Nineteen female ASD patients (mean age 60 ± 13) were included prospectively and consecutively and had T1-weighted Turbo Spin Echo sequence MRIs with Dixon method from the proximal tibia up to T12 vertebra. The Dixon method permitted to evaluate the proportion of fat inside each muscle (fat-water ratio). In order to investigate the accuracy of the Dixon method for estimating fat vs water, the same MRI acquisition was performed on phantoms of four vials composed of different proportion of fat vs water. With Muscl’X software, 3D reconstructions of 17 muscles or group of muscles were obtained identifying the muscle’s contour on a limited number of axial images [Deformation of parametric specific objects (DPSO) Method]. Musclar volume (Vmuscle), infiltrated fat volume (Vfat) and percentage of fat infiltration [Pfat, calculated as follow: Pfat = 100 × (Vfat/Vmuscle)] were characterized by extensor or flexor function respectively for the spine, hip and knee and theirs relationship with demographic data were investigated.

Results: Phantom acquisition demonstrated a non linear relation between Dixon fat-water ratio and the real fat-water ratio. In order to correct the Dixon fat-water ratio, the non linear relation was approximated with a polynomial function of degree three using the phantom acquisition. On average, Pfat was 13.3% ± 5.3%. Muscles from the spinal extensor group had a Pfat significantly greater than the other muscles groups, and the largest variability (Pfat = 31.9% ± 13.8%, P < 0.001). Muscles from the hip extensor group ranked 2(nd) in terms of Pfat (14% ± 8%), and were significantly greater than those of the knee extensor (P = 0.030). Muscles from the knee extensor group demonstrated the least Pfat (12% ± 8%). They were also the only group with a significant correlation between Vmuscle and Pfat (r = -0.741, P < 0.001), however this correlation was lacking in the other groups. No correlation was found between the Vmuscle total and age or body mass index. Except for the spine flexors, Pfat was correlated with age. Vmuscle and Vfat distributions demonstrated that muscular degeneration impacted the spinal extensors most.

Conclusion: Mechanisms of fat infiltration are not similar among the muscle groups. Degeneration impacted the spinal and hip extensors most, key muscles of the sagittal alignment.

Keywords: Adults with spinal deformity; Dixon method; Fat infiltration; Muscular degeneration; Muscular volume; Spino-pelvic musculature.

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Can fluoroscopy radiation exposure be measured in minimally invasive trauma surgery?

Can fluoroscopy radiation exposure be measured in minimally invasive trauma surgery?

A Roux, N Bronsard, N Blanchet, F de Peretti

https://pubmed.ncbi.nlm.nih.gov/21943776/

Abstract

Repeated use of X-rays in orthopedic surgery poses the problem of irradiation of patient and caregivers. Seven common minimally invasive bone trauma surgical procedures requiring image intensifier use were investigated: percutaneous K-wire fixation of the wrist, minimally invasive fixation plating of the wrist, percutaneous intramedullary nailing of the tibia and of the femur, short and long trochanteric nail fixation of trochanteric and sub-trochanteric fracture, and percutaneous fixation of thoracolumbar fracture. The study analyzed three parameters: dose area product (DAP), radiation duration, and skin entrance dose (SED). Data were collected from 15 successive implementations of each procedure. The aim of the study was to establish a database for this kind of bone trauma surgery and a hierarchy of the X-ray doses delivered. Percutaneous spinal osteosynthesis involved the highest dose, followed in decreasing order by long trochanteric nailing, femoral nailing, short trochanteric nailing, tibial nailing, wrist K-wire fixation and frontal wrist plate osteosynthesis. One short trochanteric nail procedure delivered the same DAP as 13 wrist K-wire fixation procedures, and one spinal osteosynthesis was equivalent to 13 short trochanteric nail or 174 wrist K-wire procedures. The anatomic area X-rayed appeared to be the main radiation dose factor. A database was established, but actual patient and staff radiation levels remained unknown.

Copyright © 2011 Elsevier Masson SAS. All rights reserved.

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Discoscanner: indications, technique, tips and tricks, interpretation

Discoscanner: indications, technique, tips and tricks, interpretation

N Amoretti, O Hauger, N Poussange, P Browaeys, L Huwart, P-Y Marcy, M-E Amoretti, I Hovorka, L Coco, T Benzaken, Y Nouri, N Bronsard, C Ibba, P Boileau

https://pubmed.ncbi.nlm.nih.gov/21821290/

Abstract

Discography test associated with the scanner (discoscanner) is an exam that has been a renewed interest in recent few years. Thanks to the emergence of new interventions such as disc prosthesis, the procedures require confirmation of the disc level to deal with and the origin of discogenic symptoms. The aim of this paper is to describe the techniques, challenges and tips as well as the interpretation of functional and morphological examination.

Copyright © 2011. Published by Elsevier Masson SAS.

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Imaging of intervertebral disc prostheses

Imaging of intervertebral disc prostheses

N Amoretti, A Iannessi, V Lesbats, P-Y Marcy, E Hovorka, N Bronsard, M-E Fonquerne, O Hauger

https://pubmed.ncbi.nlm.nih.gov/22277706/

Abstract

Disc arthroplasty is the replacement of a painful pathological intervertebral disc by a prosthesis, which, unlike spinal fixation, has the advantage of retaining vertebral mobility in the segment concerned. The success of the procedure is dictated by the indication. The radiologist must look for radiographic arguments indicating or contraindicating fitting an implant, and particularly for the presence of facet arthritis which will prompt the surgeon to choose an arthrodesis. Moreover, radiological information plays a major part in preparing for a surgical procedure, as far as access to the disc via the anterior approach is concerned and assessment by CT angiography of the risk of vascular complications. After insertion, radiological monitoring using dynamic X-ray images checks that the implant is correctly positioned and that mobility is restored. In the long term, it can detect complications related to the prosthesis and premature wear to other points of support such as adjacent discs and the facet joints.

Copyright © 2011 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

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Medicoeconomic evaluation of total disc replacement based on French National Health Care System data

Medicoeconomic evaluation of total disc replacement based on French National Health Care System data

N Bronsard, S Litrico, I Hovorka, P Paquis, B Gastaud, G Daideri, J-J Greffeuille, P Boileau

https://pubmed.ncbi.nlm.nih.gov/21741890/

Abstract

Introduction: Total disc replacement (TDR) has existed since 1984 but is not covered by the French national healthcare system (Sécurité Sociale). The present study assessed clinical outcomes, and also pre-, peri- and postoperative treatment costs.

Hypothesis: Surgical management of low back pain (LBP) provides medical and economic benefit.

Materials and methods: A prospective study recruited 19 patients in the Nice University Hospital Center (France); mean age, 41 years; 15 female. Inclusion criteria were: age less than 60 years; chronic low back pain (LBP) with single-segment discopathy; work related injuries and patients not covered under the General provision of the Sécurité Sociale were excluded. VAS, Oswestry and SF36 scores and return to work capability were analyzed. The local national health insurance branch office (Caisse Primaire d’Assurance Maladie [CPAM]) provided detailed coverage data for a 39-month period around the operation.

Results: Revision surgery was required for one instance of vertebral fracture. Preoperative follow-up was 14 months, postoperative FU 21 months and the perioperative period 4 months. LBP and quality of life showed improvement. Seventy-nine percent of patients reported satisfaction, 59% returned to work, and 84% had leisure activity. Total CPAM payout (reimbursement) was €399,082. Daily sickness benefit and disability compensation were the main cost items. Mean TDR cost per patient was €6833. Mean reimbursements were 19% lower post- than preoperatively. Pre- and postoperative clinical results did not correlate, while pre- and postoperative reimbursement costs did, as did cost and postoperative clinical status (r=-0.72). Preoperative cost was a predictive factor for postoperative clinical result.

Discussion: TDR achieves favorable medicoeconomic results.

Level of evidence: III: case-control study.

Copyright © 2011 Elsevier Masson SAS. All rights reserved.

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Minimally invasive posterior surgery for thoracolumbar fractures. New trends to decrease muscle damage

Minimally invasive posterior surgery for thoracolumbar fractures. New trends to decrease muscle damage

Yann Philippe Charles, Fahed Zairi, César Vincent, Stéphane Fuentes, Nicolas Bronsard, Charles Court & Jean-Charles Le Huec

https://link.springer.com/article/10.1007/s00590-011-0781-2

Abstract

High-energy spine fractures mainly affect the thoracolumbar junction. Surgery helps restore spine stability and sagittal realignment and improves long-term outcomes of patients. Posterior instrumentation ensures stability in most cases, some patients with unstable fractures benefitting from an additional anterior approach. This article discusses the indications for surgery with a view to conservative treatment and presents the advantages of posterior and anterior approaches. It also describes posterior, minimally invasive surgical techniques that have been developed in the past decade. In the light of scientific arguments, posterior minimally invasive surgery, combined with balloon-assisted vertebroplasty (or kyphoplasty) when necessary, appears to be at least as efficient as other posterior techniques, including open surgery. It has the advantage of being less aggressive towards soft tissues and of generating fewer complications than open surgery. Minimally invasive surgery may have better long-term outcomes for patients and may be cost-effective for health budgets, but these points need to be confirmed by further investigations.

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One-stage percutaneous treatment in a patient with pelvic and vertebral compression fractures

One-stage percutaneous treatment in a patient with pelvic and vertebral compression fractures

Jacques Sedat, Yves Chau, Cesar Razafidratsiva, Nicolas Bronsard, Fernand de Peretti

https://pubmed.ncbi.nlm.nih.gov/19774411/

Abstract

An active 38-year-old patient presenting a vertebral compression fracture associated with a pelvic fracture was treated in one stage with CT-guided fixation of the sacrum and kyphoplasty. This treatment decreased the pain, restored the vertebral height, and enabled the patient to be ambulatory. The main advantage of this double approach was to shorten the hospital stay and the nonworking period.

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Centering of cervical disc replacements: usefulness of intraoperative anteroposterior fluoroscopic guidance to center cervical disc replacements: study on 20 discocerv (scient'x prosthesis)

Centering of cervical disc replacements: usefulness of intraoperative anteroposterior fluoroscopic guidance to center cervical disc replacements: study on 20 discocerv (scient’x prosthesis)

Pascal Kouyoumdjian, Nicolas Bronsard, Jean Marc Vital, Olivier Gille

https://pubmed.ncbi.nlm.nih.gov/19564767/

Abstract

Study design: This is a prospective randomized computed tomographic scan study on the centering of cervical disc prosthesis (Discocerv; Scient’X) with and without anteroposterior (AP) fluoroscopic guidance.

Objective: Analyze interest of AP fluoroscopic guidance for coronal positioning in cervical disc replacements.

Summary of background data: This series consisted of 20 patients. One group of 10 patients was operated using only lateral fluoroscopic guidance (L guidance) and the other group of 10 patients was operated using both lateral and AP fluoroscopic guidance (AP + L guidance). Total disc replacements positioning is analyzed in the 2 groups.

Methods: All patients had a computed tomographic scan 24 hours after surgery. Specific reconstructions were obtained from the native slices. Three planes P1, P2, and P3 are defined to quantify centering of the prosthesis in axial sagittal and coronal planes. RESULTS.: In the coronal plane P1, there is no difference in lateralization between the L guidance (absolute value of average M = 0.93 mm; SD = 0.59 mm) and AP + L guidance groups (M = 1.28 mm; SD = 0.75 mm). In the axial plane, there is no difference in lateralization between the L guidance and AP + L guidance groups. In the L guidance group, average was 1.96 degrees (SD = 1.43 degrees ) and 3.18 degrees (SD = 2.94 degrees ) in AP + L guidance. There is no significative difference between 2 groups in coronal (P = 0.26) and axial plane (P = 0.19).

Conclusion: Unci are reliable landmarks for coronal centering of total disc replacements. AP fluoroscopic guidance does not improve this positioning.

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Surgical management of elbow dislocation associated with non-reparable fractures of the radial head

Surgical management of elbow dislocation associated with non-reparable fractures of the radial head

M Winter, C Chuinard, A Cikes, C Pelegri, N Bronsard, F de Peretti

https://pubmed.ncbi.nlm.nih.gov/19356963/

Abstract

Background: The « terrible triad » of the elbow is the combination of an elbow dislocation, radial head and a coronoid process fracture. Because of a combined sagittal, frontal and transverse instability, these injuries are notoriously difficult to treat. We report our results with a technique for reconstruction of « terrible triad » injuries with either no facture or a type I fracture of the coronoid process in addition to a non-reparable radial head fracture. The hypothesis of this study was that standard surgical treatment of this lesion using a « deep to superficial » stabilisation by a single lateral approach and radial head replacement enables early and reliable functional results.

Patients: From June 2004 to January 2007, 13 patients with an average age of 40 years at the date of trauma (range 18-77) underwent reconstruction of a « terrible triad » injury of the elbow with the same technique. The mean follow-up was 25 months (range 15-48).

Results: Eighty-four percent of the patients were very satisfied and satisfied. Average flexion was 131 degrees (110-140). Average extension was -11 degrees (-30-0). Average pronation was 72 degrees (40-80). Average supination was 70 degrees (50-80). The grip strength averaged 75% of that of the non-injured side (50-105). All elbows were stable at review. Eight complications occurred.

Conclusion: Our results suggest that some terrible triad injuries can be successfully managed with deep to superficial stabilisation by lateral approach, consisting in three-dimensional stabilisation done by anterior capsular reinsertion with absorbable anchors, radial head replacement and lateral collateral ligament repair. This standard management provides enough stability to allow early active rehabilitation, preventing post-operative instability and stiffness. This procedure appears to be reliable and reproducible.

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Extension reserve of the hip in relation to the spine: Comparative study of two radiographic methods

Extension reserve of the hip in relation to the spine: Comparative study of two radiographic methods

I Hovorka, P Rousseau, N Bronsard, M Chalali, M Julia, M Carles, N Amoretti, P Boileau

https://pubmed.ncbi.nlm.nih.gov/19070721/

Abstract

Free-hip movement is necessary for good spinal function. Limitation generally affects extension. The range of hip extension from the standing position can be considered as the hip’s « extension reserve ». The amplitude of this reserve must be known because any deficit requires a pathological solicitation of the vertebral column. Measurement of the extension reserve of the hip is useful for analyzing spinal disease and for preoperative planning. Physical examination can measure extension, but cannot differentiate movement produced by the hip from that originating in the spine. We have been unable to locate any radiographic method in the literature. The purpose of this study was to evaluate radiographic measurements and to propose a novel method. The study was conducted with 37 patients with spinal disease. Two radiographic methods were compared. Four lateral views, including the lumbar spine, the pelvis and the femur were obtained in each patient: neutral position, retroversion of the pelvis and extension of each hip in lunge position. The X-rays were digitalized for computer processing. The extension reserve of the hip was calculated for each radiographic method. Extension reserve was defined as the difference in the pelvis-femoral angle between the neutral position and extension. There was a positive correlation between the two methods (p<0.0006; p<0.0009). Mean extension using the pelvis retroversion method was 1.8 degrees +/-6.77; with the hip-extension method, it was hip I (side with the superior value): 15.9 degrees +/-6.57; hip II 10.0 degrees +/-7.89. The pelvis-retroversion method gave a lower measurement compared with the lunge position method (p<0.0001). For 13 of 37 subjects (35%), this method gave negative values, that is, failure of the measurement method. The method of hip extension in lunge position was superior to the pelvis-retroversion method, which gave lower measurements that were often incoherent and unable to provide specific information for each hip. The method using the lunge position for hip extension appears to be preferable. We are currently conducting a clinical trial to include extension reserve in the analysis of sagittal balance and for determining curvature corrections. We propose a mathematical formula using extension reserve for determining sagittal correction. Radiographic determination of extension reserve of the hip joint is of major importance for assessing spinal disease in addition to its contribution to the analysis of hip and pelvic disease. The methods presented here enable radiographic measurement of the extension reserve of the hip.

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Percutaneous osteosynthesis of lumbar and thoracolumbar spine fractures without neurological deficit: surgical technique and preliminary results

Percutaneous osteosynthesis of lumbar and thoracolumbar spine fractures without neurological deficit: surgical technique and preliminary results

C Pelegri, A Benchikh El Fegoun, M Winter, N Brassart, N Bronsard, I Hovorka, F de Peretti

https://pubmed.ncbi.nlm.nih.gov/18774020/

Abstract

Purpose of the study: The aim of this work was to study the technique of percutaneous osteosynthesis of lumbar and thoracolumbar spine fractures without neurological deficit and to report preliminary results.

Material and methods: This retrospective study included 15 patients with lumbar or thoracolumbar spine fractures who were treated between January 2004 and January 2006 by percutaneous osteosynthesis. There were seven men and eight women, mean age 36 years (range 16-58 years). The Magerl classification (AO) was A1 (n=4), A2 (n=1), A3 (n=9), B2 (n=1). Levels were T12 (n=1), L1 (n=10), L2 (n=2), L3 (n=1), L4 (n=1). A specific instrument set was used to insert a short fixation using two pedicular screws on either side of the fractured vertebra and two prebent 5.5mm rods introduced with an aiming device. The operation was performed under fluoroscopy. Ten patients wore a removable corset. The upright position was allowed if there were no other injuries. Computed-tomography scans were obtained preoperatively, postoperatively and at two years follow-up. Function was assessed with the Oswestry score.

Results: Mean operative time was 108 minutes (range 40-180 minutes). None of the patients with an isolated spinal injury required blood transfusion. Mean hospital stay was 12 days (range 4-28). Results were expressed for 13 patients whose operations were exclusively percutaneous. Mean follow-up was 17 months (range 6-30). The visual analog scale (VAS) was 1.6/10. The mean Oswestry score was 16. Three quarters of the patients resumed their occupational activities. None of the patients was dissatisfied. Mean vertebral kyphosis (VK) improved from 16 to 8.1 degrees , corrected regional angle (CRA) from 12 to 2.5 degrees at last follow-up. Loss of correction at last follow-up was 1.1 degrees for VK and 2.5 degrees for CRA. The rate of pedicle screw malposition was 3.8%. There were no cases of disassembly nor material failure. There were no infections. None of the implants had to be removed.

Discussion: Percutaneous osteosynthesis of the spine is technically feasible, but requires considerable experience. Functional and subjective results have been good. The loss of correction at last follow-up has been comparable to that observed with conventional open surgery. This technique is an intermediary method between orthopaedic treatment and conventional surgery. Exact indications must be established.

Conclusion: Percutaneous osteosynthesis of lumbar and thoracolumbar spine fractures is an attractive therapeutic option. Our results are encouraging. Indications and limitations of this technique must be carefully identified.

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