ABSTRACT
Intraoperative spinal cord monitoring consists in a subcontinuous evaluation of spinal cord sensory-motor functions and allows the reduction the incidence of neurological complications resulting from spinal surgery. A combination of techniques is used: somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), neurogenic motor evoked potentials (NMEP), D waves, and pedicular screw testing. In absence of intraoperative neurophysiological testing, the intraoperative wake-up test is a true form of monitoring even if its latency long and its precision variable. A 2011 survey of 117 French spinal surgeons showed that only 36% had neurophysiological monitoring available (public healthcare facilities, 42%; private facilities, 27%). Monitoring can be performed by a neurophysiologist in the operating room, remotely using a network, or directly by the surgeon. Intraoperative alerts allow real-time diagnosis of impending neurological injury. Use of spinal electrodes, moved along the medullary canal, can determine the lesion level (NMEP, D waves). The response to a monitoring alert should take into account the phase of the surgical intervention and does not systematically lead to interruption of the intervention. Multimodal intraoperative monitoring, in presence of a neurophysiologist, in collaboration with the anesthesiologist, is the most reliable technique available. However, no monitoring technique can predict a delayed-onset paraplegia that appears after the end of surgery. In cases of preexisting neurological deficit, monitoring contributes little. Monitoring of the L1-L4 spinal roots also shows low reliability. Therefore, monitoring has no indication in discal and degenerative surgery of the spinal surgery. However, testing pedicular screws can be useful. All in all, thoracic and thoracolumbar vertebral deviations, with normal preoperative neurological examination are currently the essential indication for spinal cord monitoring. Its absence in this indication is a lost opportunity for the patient. If neurophysiological means are not available, intraoperative wake-up test is a minimal obligation.
Subject(s)
Intraoperative Neurophysiological Monitoring/methods , Spinal Cord Diseases/surgery , Spinal Cord/physiopathology , France , Humans , Reproducibility of Results , Spinal Cord/surgery , Spinal Cord Diseases/physiopathologySubject(s)
Bone Lengthening/methods , Enchondromatosis/therapy , Exostoses, Multiple Hereditary/therapy , Osteochondrodysplasias/therapy , Ulna , Adolescent , Bone Lengthening/adverse effects , Child , Female , Follow-Up Studies , Humans , Male , Orthopedic Fixation Devices , Radiography , Ulna/diagnostic imagingABSTRACT
Sixty Salter innominate osteotomies were analysed retrospectively with a mean post-operative follow-up of five years. The 53 children, suffering from congenital dislocation of the hip discovered at walking age, had initially been treated by Somerville-Petit conservative management. The results were assessed using the Severin classification and showed 80 per cent of good results (Severin groups Ia, Ib and IIa). The bad results were all due to errors of operative indications (failure to respect the Salter pre-requisites) or technical faults. Complications were uncommon. There were 11 pin extrusions, which led to the use of threaded pins to so as to gain sounder fixation of the osteotomy. An analysis of the characteristics of each hip allowed an assessment to be made of the effects of Salter osteotomy using several angular parameters, including Hilgenreiner's and Wiberg's angles. The description of a new parameter, the angle between the acetabulum and the epiphyseal line (acetabulo-epiphyseal line) and its normal values provides a new approach to the lower limit for the indications for operation on dysplastic hips. This parameter seems to be more discriminatory than Wiberg's angle in relation to dysplasia and makes it possible to determine a threshold of uncovering of the head that justifies surgical correction.
Subject(s)
Hip Dislocation, Congenital/surgery , Osteotomy/methods , Pelvic Bones/surgery , Adolescent , Child , Child, Preschool , Follow-Up Studies , Hip Dislocation, Congenital/diagnostic imaging , Humans , Radiography , Retrospective StudiesABSTRACT
The authors present 3 cases of brachymetapody (or "hereditary type E brachydactyly"). These conditions are defined by an abnormal shortness of some metacarpals and metatarsals, sometimes associated with other malformations and short stature. The feet may require a surgical correction with different alternatives, adapted to the type of malformations: lengthening of the short rays if they are the least numerous, shortening of one single "long" ray. Surgical indications depend upon pain, more than upon aesthetic considerations. In one of the reported cases, bilateral shortening osteotomy of the first metatarsal and proximal phalanx was performed.
Subject(s)
Metacarpus/abnormalities , Metatarsal Bones/abnormalities , Adolescent , Bone Lengthening/methods , Child , Female , Humans , Metacarpus/surgery , Metatarsal Bones/surgery , Osteotomy/methodsSubject(s)
Osteochondrodysplasias/diagnostic imaging , Child, Preschool , Female , Humans , RadiographyABSTRACT
After reviewing the anatomy of the frontal geometry of femur and values for femoral anteversion during growth, an ultrasound method is described for measurement of femoral anteversion. The principle underlying the technique is the use of a spirit level fixed to a bar probe and an effective contention in rotation of lower limbs, this ensuring validity of results even in infants. Analysis of findings in a preliminary series of 10 infants (20 hips), age range 2 to 16 years, with torsion anomalies of lower limbs, showed values obtained to be totally superimposable on those provided by a CT scan.
Subject(s)
Femur , Hip Joint , Joint Diseases/diagnosis , Ultrasonography , Adolescent , Adult , Child , Child, Preschool , Humans , Torsion AbnormalityABSTRACT
The measurements of femoral torsion by ultrasounds have been performed in both hips of 10 patients according to the technique proposed by Zarate et al. The measurements with CT were done in the same patients according to a technique similar to that used by Hernandez et al. The correlation between US and CT is excellent as far as the minutest particulars of the technique are followed for US examination. The authors recommend ultrasounds, as a non irradiating, non aggressive procedure for the measurement of femoral torsion. US must replace both conventional X-ray and CT for femoral torsion assessment.
Subject(s)
Femur , Tomography, X-Ray Computed , Ultrasonography , Adolescent , Child , Child, Preschool , Evaluation Studies as Topic , Female , Femur/diagnostic imaging , Femur/pathology , Humans , Male , Torsion Abnormality/diagnosisABSTRACT
The authors report 9 cases of major radiological abnormality of the navicular bone, of which only 5 were cases of Köhler's disease. The diagnosis of this disease requires a combination of clinical and radiological signs, the isolated presence of radiological signs only represents abnormalities of ossification which are very common in this bone. The treatment is generally accepted to be plaster immobilisation, but its duration is a topic of debate, varying between 4 and 8 weeks, according to different authors.
