Synthesis of the 19th ArgoSpine Symposium.

After a short introduction of the meeting by the President 2015, Wilco Peul, the opening lecture was delivered by Bart Koes, who dealt with Health Technology Assessment and Guidelines. Then, it was the turn of Carmen Vleggert to show whether there was any Evidence for the Use of Implants in Spinal Stenosis. The final presentation of this session was delivered by Björn Strömqvist who dealt with Surgery for Lumbar Disc Herniation, patients' selection and outcomes. Developing the subject of "Do Not's", Jeremy Fairbank described the UK experience for Low Back Pain. Yves Coppens then took over and further elaborated on "Lucy's legacy". Prof. Coppens recalled that Lucy is a partial skeleton of a pre-human found in Ethiopia among other remains. Prof. Alan Crockard offered what he called "a whimsical view" of his practice of Craniocervical Surgery. Wafa Skalli was asked to speak about Finite Element Analysis of the Spine and Arts et Métiers Paris Tech where there is a long tradition of close collaboration between engineers and clinicians. Rune Hedlund, who will serve as 2016 Symposium President, further elaborated on Scoliosis with a focus on Unsolved Issues in Adolescent Idiopathic Scoliosis Treatment.

Synthesis of the 18th ArgoSpine Symposium.

The subject of this 18th Symposium of ArgoSpine Association was the space of the intervertebral discs. Space of the intervertebral discs must be initially defined anatomically and histologically. A geometrical rebuilding in 3D is possible and must allow a modeling of the intervertebral discs. The physiology of the disc, its nutrition, must be known, in particular that of the center of the disc. The disc constitutes the base of the balance of the rachis, balances which can be only dynamic. The degenerative cascade by the loss of the proteoglycans involves the loss of the biomechanical properties of the disc. The consequences of this degenerative cascade are the base of all the vertebral pathology of origin of the intervertebral discs and even of the posterior articular facets. The origin of the pains and the diagnosis, especially at the lumbar level, are studied by the speakers. Traumatology of the intervertebral discs is the object of a particular chapter. Finally, the average therapeutic ones, that is, decompression of the intervertebral discs, fusion of the intervertebral discs, the recovery of mobility of the intervertebral discs, and the capacity of restoration of space of the intervertebral discs, are studied in detail. The infection of the disc is studied in detail.

[Clear-cell sarcoma of tendons and aponeuroses: three case reports]. / Sarcome à cellules claires des tendons et des aponévroses: à propos de trois cas.

Clear-cell sarcoma (CCS) of tendons and aponeuroses is a rare malignant tumor representing about 1% of soft tissue tumors. Preferentially observed in young adults in the second or third decade, the tumor generally develops in the limbs. Only 2% of SCC of tendons and aponeuroses have been reported in children less than 10 years of age. This slowly progressive tumor usually forms a painless mass. The tumor increases in size followed by metastatic dissemination to lymph nodes and the lungs. The prognosis is related to tumor size. At the present time, the recognized limit is greater than 5 cm. Early diagnosis must be achieved to enable effective treatment by carcinological surgical resection. We report the three cases of CCS of tendons and aponeuroses observed at the Strasbourg University hospital over a 35-year period. Each case had a special clinical presentation. The first patient, treated in 1967, presented tumor bone lysis on the plain x-ray, an observation rarely reported in the literature. In the second patient, treated in 2002, the tumor was discovered after trauma. This patient developed skin ulceration associated with paraplegia secondary to metastatic thoracic cord compression. The third case occurred in a 12-year-old girl, treated in 2002.

Repair of distal biceps tendon ruptures using a suture anchor and an anterior approach.

In a prospective study, eight consecutive patients with nine ruptures of the distal biceps tendon underwent repair through a single incision. All patients were satisfied with their clinical results and had full ranges of elbow and forearm motion. There were no radial nerve injuries and no radio-ulnar synostoses. Isokinetic testing, after correction for dominance, demonstrated a 6% strength deficit, but 7% higher endurance in the repaired extremity for the flexion-concentric test, and no strength deficit and 13% higher endurance for supination. The improved endurance is probably explained by initial reduced effort due to apprehension which minimized subsequent fatigue.

[Proximal tibial meniscal slope: a comparison with the bone slope]. / La pente méniscale de l'extrémité proximale du tibia: comparaison avec la pente osseuse.

PURPOSE OF THE STUDY: X-ray measurements of the proximal tibial slope only study bony structures, without considering cartilage and meniscil thickness. It is well known that the posterior horn of the meniscil is thicker than the anterior one, and this could decrease the bony postero-distal slope. The aim of this study was to measure the meniscal slope, including cartilage and meniscil, and to compare it to the usual bony slope. MATERIAL AND METHODS: 19 knee cadaver specimens without meniscal or chondral lesions were studied. Four metallic clamps were inserted at the most anterior or posterior part of the medial or lateral meniscosynovial border. Lateral plain X-ray was taken for each knee. The bony proximal tibial slope and the medial and lateral meniscal slopes were measured and compared for each knee. Paired Wilcoxon T-test and correlations were calculated with a 5 per cent significant limit. RESULTS: The mean paired difference between bony slope and medial or lateral meniscal slope was -6 degrees: the actual meniscal slope was less oblique than the bony slope, and it was almost perpendicular to the proximal tibial axis. There was a very significant correlation between bony and medial meniscal slopes. There was no correlation between bony and lateral meniscal slopes, nor between medial and lateral meniscal slopes. DISCUSSION: These results suggest that the proximal tibial meniscal slope, which is the mechanically active one, is less oblique than the usually measured bony slope. Medial meniscal slope and bony slopes are very strongly correlated for one given knee. But medial and lateral meniscal slopes can be very different for one given knee. CONCLUSION: These results could have an influence on the design of total or unicondylar knee replacements: the polyethylene slope of the tibial surface, which should reconstruct the natural articular design, should reproduce the meniscal, and not the bony slope. The medial and lateral slopes, should perhaps be individually reconstructed.

[Radiation-induced sarcoma of the sixth cervical vertebra (author's transl)]. / Ostéosarcome post-radiothérapique de la 6e vertèbre cervicale. A propos d'un cas.

The authors report the case of a patient who suffered a sarcoma of the sixth cervical vertebra eleven years after a malpighian epithelioma of the pharynx had been treated and healed by local excision and radiotherapy. A radiation-induced sarcoma caused a tetraplegia. Laminectomy and plate fixation resulted in some recovery but the patient died three months later.

[Cylindrical osteotomy of the upper end of the tibia [author's transl)]. / L'ostéotomie semi-cylindrique de l'extrémité supérieure du tibia. Réalisation par une technique originale.

The authors describe a modification of the original technique of Blaimont and Maquet. Cylindrical osteotomy allows correction of deformity in the frontal plane (genu varum or valgum) with forward displacement of the tibial tuberosity. The technique and instruments are described. The osteotomy is fixed by screws and joint mobilisation is begun after two weeks. Thirty patients have been operated on. The results are described as satisfactory.

[Long-term survival rate of tibial osteotomies for valgus gonarthrosis]. / Taux de survie à long terme des ostéotomies tibiales de valgisation pour gonarthrose.

PURPOSE OF THE STUDY: High tibial osteotomy (HTO) is a routine procedure for medial gonarthrosis. Mid-term results are known to be satisfactory, but they deteriorate with longer follow-up. The authors present a long term survival analysis of 109 out of 111 consecutive HTO with a minimal potential follow-up of ten years. MATERIAL AND METHODS: 111 patients were consecutively operated on for isolated primary varus gonarthrosis between 1977 and 1985: 57 men and 54 women, with a mean age of 53 years (range, 27 to 79 years). X-ray measurements were done on stance, hip-ankle view. Global axial deformation was defined as the angle between mechanical axes of femur and tibia. The respective part of congenital and degenerative tibial deformation was assessed according to Dejour. The angle between femoral and tibial bicondylar lines, representing lateral instability, was added to the tibial degenerative deformation to represent the total degenerative deformation. The goal of correction was a 3 to 7 degree mechanical valgus angulation. At the time of bone healing, 82 patients (74 per cent) had an optimal correction. Two patients were excluded from the follow-up study because of a severe complication (1 bacterial arthritis and 1 tibia non union) which could interfere with the long term result. The 109 remaining patients were followed for a minimal period of 1 year (mean: 8.4 years). GUEPAR pain grading and the occurrence of a revision were prospectively analyzed. 57 non reoperated patients could be re-examined at a mean maximal follow-up of 13.5 years (range, 10 to 18 years). Failure was defined as either the occurrence of a grade 2 or 3. GUEPAR pain during the whole follow-up, or a clinical or functional Knee Society score < 80 points at final follow-up, or revision. Failure and revision rates were calculated according to Kaplan and Meier. RESULTS: 11 patients were reoperated on before final examination (10 per cent): 2 medial unicondylar and 9 total knee prostheses. At final follow-up, the mean clinical and functional scores were respectively 87.0 points (range, 24 to 100 points) and 86.3 (range, 45 to 100 points). The cumulative failure rate was 33 per cent after 10 years and 54 per cent after 15 years; the respective revision rates were 9 per cent and 19 per cent. A pre-operative total degenerative deformation superior to 3 degrees led to a 3.5 fold increased failure rate (p < 0.000,1). A pre-operative medial joint space narrowing over the half of the normal, lateral one led to a 2.2 fold increased failure rate (p = 0.014). An optimal post-operative correction led to a 3.2 fold decreased failure rate (p = 0.000,1). For a given total degenerative deformation, patients with a congenital deformation superior to 5 degrees had a significant lower failure rate (p < 0.000,1). No factor significantly influenced the revision rate. DISCUSSION: Ideal patients for HTO, with an expected survival rate of 100 per cent after 13 years, have moderate degenerative changes and a congenital deformation superior to 5 degrees. Patients with advanced degenerative changes and no congenital deformation experienced a 35 per cent failure rate after 10 years. In this population, unicondylar replacement should be considered as a valuable alternative.

[Study by radioactive microspheres of bone microcirculation in aseptic osteonecrosis of the femoral head]. / Etude par microsphères radioactives de la microcirculation osseuse dans l'ostéonécrose aseptique de la tête fémorale.

Thirty-two hips affected by aseptic necrosis, four of them post-traumatic and 12 contralateral hips thought to be healthy have been studied by combining superselective arteriography with the injection of radioactive microspheres. It has been possible to show that aseptic necrosis begins with a global ischaemia and is followed by an incomplete revascularisation leaving a necrotic area. On the border between the two areas hypervascularity produces a zone of fragility where microfractures develop with detachment of a sequestrum. The presumed opposite hip is almost always, even in traumatic lesions, the site of a hypovascularity which seems to suggest a predisposition to the lesion. There is a correlation between radiological and clinical worsening and the development of revascularisation in the femoral head.

[Bacteriophage therapy of septic complications of orthopaedic surgery (author's transl]. / Bactériophages et chirurgie orthopédique. A propos de sept cas.

Seven septic cases have been treated by bacteriophage; two infections after insertion of a hip prosthesis, two septic arthritis of the knee, one osteomyelitis of the tibia, one septic non-union of the femur and one septic complication following Harrington rodding. Only specific phages were used in association with several types of surgical procedure. The technique of treatment is described. All cases were long-term infections with resistant organisms. Results were good in five, fair in one and one case was a failure. It is concluded that phage therapy may be helpful in the treatment of long-term infections.

[Angiography of the cervico-cephalic vessels of the dog. The carotid system]. / Angiographie des vaisseaux cervico-céphaliques du chien. Le système carotidien

The authors report an experimental study of the pathology and cervico-cerebral hemodynamics in the dog and discuss the normal anatomy of the carotid arteries in the dog. These results include the interpretation of 30 selective angiographies and numerous anatomical dissections. Many points distinguish the carotid arteries in the dog from those in man. Firstly, in their distribution, where the internal carotid artery appears particularly narrow the internal maxillary artery particularly large. Then and above all, their function, it seems that external carotid artery is more important than the internal carotid artery in the dog, so that the blood supply of the central nervous system seems to be obtained almost entirely through the vertebro-basilar system. Finally, there exists between each network of internal carotid arteries, the external carotid artery and the vertebral arteries numerous anastomoses. Contrary to the distrubution of arteries in man, these anastomoses usually function permanently.

[Madelung's deformity - Why choose the Sauvé-Kapandji osteotomy?] / Maladie de Madelung ­ Pourquoi avoir choisi une ostéotomie selon Sauvé-Kapandji?

For bilateral Madelung's deformity in a 14-year-old girl we did the Sauvé and Kapandji operation without additional radius osteotomy. The operation was justified by the protrusion of the head of the ulna, the limitation of the rotation and diminution of the strength of the wrist, and inability to do sporting activity. The clinical findings were referred to the instability of the inferior radio ulnar joint There was no pain. The post operative review showed no pain, with recovery of grasp and of sporting activity (gymnastic and dance). The esthetic result satisfied the surgeon and the patient The operation permitted repositioning of the inferior radio ulnar joint. We have not seen synostosis of the osteotomy and the width of it increased progressively without radiological and physical instability of the inferior radio ulnar joint. The literature study allows us to discuss the different treatment possibilities and to explain our choice.The simplicity of this operation is interesting, because it was possible to stabilize the carpal joint, with abolition of the physical problems of this youg girl, without the needing osteotomy of the radius, which takes longer to recover, in those cases without pain before the operation.

[Thoracic outlet syndrome. A study of 45 cases treated between 1975 and 1993]. / Syndrome de la traversée thoraco-cervico-brachiale. Étude de 45 cas traités entre 1975 et 1993.

Since 1970 we have experience of more than 100 cases of the thoracic outlet syndrome. We have rewied 45 patients operated on between 1975 and 1993.The cause, in agreement with the literature, was in 30% a road accident (cervical spine and clavicular disease), in 54% malformations (cervical rib) with a similar frequency of involvement with neurological pathology of the upper limb.We always found a vascular symptomatology, wich increased in shoulder abduction. In 82% of the cases we found an associated neurological deficit. The diagnosis was confirmed with electromyography and arteriography.The treatment was in initially medical and in resistant case, surgery was performed. We have use a supra-clavicular approach with scalenotomy of the scalenus anterior muscle, resection of the distal part of the cervical rib or an anterior fibrous band. We did not do (first operation) a resection of the first rib throught a transaxillary approach, in order to avoid elongation of the brachialplexus roots.We found 80% good results from the opinion of the patients and after clinical examination.We have operated on 6 recurrent cases throught a supra-clavicular approach (fibrous sheath) or by trans axillary approach with resection of the first rib in case of lack of response to scalenotomy.