Cage or Pelvic Graft-Study on Bony Fusion of the Ventral Thoracic and Lumbar Spine in Traumatic Vertebral Fractures.

Background and Objectives: Stabilization of the spine by cage implantation or autologous pelvic bone graft are surgical methods for the treatment of traumatic spine fractures. These methods serve to stably re-adjust the spine and to prevent late detrimental effects such as pain or increasing kyphosis. They both involve ventral interventions using interbody fusion to replace the intervertebral disc space between the vertebral bodies either by cages or autologous pelvic bone grafts. We examined which of these methods serves the patients better in terms of bone fusion and the long-term clinical outcome. Materials and Methods: Forty-six patients with traumatic fractures (12 cages; mean age: 54.08/34 pelvic bone grafts; mean age: 42.18) who received an anterior fusion in the thoracic or lumbar spine were included in the study. Postoperative X-ray images were evaluated, and fusion of the stabilized segment was inspected by two experienced spine surgeons. The time to discharge from hospital and gender differences were evaluated. Results: There was a significant difference of the bone fusion rate of patients with autologous pelvic bone grafts in favor of cage implantation (p = 0.0216). Also, the stationary phase of patients who received cage implantations was clearly shorter (17.50 days vs. 23.85 days; p = 0.0089). In addition, we observed a significant gender difference with respect to the bony fusion rate in favor of females treated with cage implantations (p < 0.0001). Conclusions: Cage implantations after spinal fractures result in better bony fusion rates as compared to autologous pelvic bone grafts and a shorter stay of the patients in the hospital. Thus, we conclude that cage implantations rather than autologous pelvic bone grafts should be the preferred surgical treatment for stabilizing the spine after fracture.

[Measles: from a simple rash - to a fatal outcome ?] / Rougeole: du « simple rash ¼ à l'issue fatale.

Measles is a disease that was considered as relegated to medical history, since an extremely efficient vaccine had been developed. However, in Switzerland and elsewhere there has been an increasing number of epidemics in the past years, and the highest number of new cases this year. Based on two clinical cases showing very different outcomes, we discuss the disease, its clinic, complications, management, and the challenges remaining in obtaining a sufficient vaccination coverage worldwide as well as in our country.

La rougeole est une maladie que l'on pensait pouvoir reléguer aux annales de la médecine, suite au développement d'un vaccin efficace. On assiste pourtant à une recrudescence d'épidémies en Suisse comme ailleurs, avec un nombre record de cas cette année. Sur la base de deux cas montrant des décours très différents, nous discutons la maladie, sa clinique, ses complications, sa prise en charge et les défis que pose encore la réalisation d'une couverture vaccinale efficace au niveau régional comme global.