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INTRODUCTION: The biomechanical resistance and the surgical morbidity of spinal posterior pedicle screw fixation relies on the intraosseous position of the implants. Upper thoracic pedicle screws are particularly demanding given their convergence and thin character. We present our experience as military surgeons of free hand placement of upper thoracic pedicle screws supported by antero-posterior, i.e. frontal X-ray fluoroscopy solely. MATERIALS AND METHODS: Monocentric retrospective analysis at Sainte-Anne Military Teaching Hospital between 2017 and 2024 of patients operated on using upper thoracic pedicle screws (levels T1 to T5) using antero-posterior fluoroscopy solely. RESULTS: 23 patients were included (mean age 59, male/female 3.6), 16 traumas and 7 neoplastic lesions), with 15 cervicothoracic junction fixation and 8 upper thoracic spine surgeries. 124 screws were inserted (T1 to T5). 85% (106/124) were graded 0 (Gertzbein-Robbins scale) whereas 14.5% (18/124) displayed some degree of misplacement (grade 1 to 3): all the T1 screws (22/22) were accurately placed compared to 83% (20/24) of T2 screws, 88% (30/34) of T3 screws, 85% (17/20) of T4 screws, and finally 71% (17/24) of T5 screws, without any clinical consequences. There were 3 surgical revisions (1 asymptomatic misplaced screw, 2 mechanical failures in trauma). Last, 92.7% (n=51/55) of the screws inserted during working hours were accurately placed compared to 79.7% (n=55/69) during after-hours surgeries (p=0.039) CONCLUSION: Clinically speaking, placement of upper thoracic pedicle screws using antero-posterior fluoroscopy solely appears safe. The surgical technique is simple enough to be used in strained resources settings such as a mobile field surgical team.
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Combined deficit of the four lower cranial nerves (CN IX, X, XI, and XII) was originally described by French physicians Collet (1915) and Sicard (1917) during World War I. To date though, this rare neurological clinical picture lacks systematic evidence regarding its epidemiology, clinical presentation, treatment strategies, and outcome. We conducted a systematic review and meta-analysis concerning Collet-Sicard syndrome (CSS) on Medline database in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research yielded 84 articles among which 73 individual case reports were eventually retained. Mean age was 53.7 (± 16) years old and the male-to-female ratio was 1.8/1. CSS was firstly caused by tumors (38.4%), following by vascular etiologies (28.8%), trauma (16.4%), and infection (6.8%), among others. Temporary enteral nutrition was required for 17 patients (23.3%). The four CN presented significant chances of complete or partial recovery: 52.1% for CN IX ( p < 0.001), 46.6% for CN X and CN XII ( p < 0.001), and 39.7% for CN XI ( p = 0.002). Tumoral causes presented significantly lower chances of favorable CN recovery (7.1%) compared to infection (60%), vascular (52.4%), and trauma (41.7%) ( p < 0.001). Older age (> 53 years old) was not associated with a dismal CN prognostic ( p = 0.763). Most patients (71.2%) presented a favorable outcome (Glasgow Outcome Scale score ≥ 4). All the patients who died (6.8%) suffered from skull base tumors. CSS is a rare condition requiring prompt clinical and radiologic diagnostic and multidisciplinary management. Vascular or infectious-related CSS seem to present a rather good prognostic, closely followed by trauma, whereas tumoral-related CSS seem to suffer from a more dismal prognostic.
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Unstable trauma lesion of the spinopelvic junction, including U-shaped sacral fractures and Tile C pelvic ring disruptions, require surgical stabilization in order to realign the bone arches of the pelvis thus reducing the upcoming orthopaedic impairment during sitting, standing, and walking positions, decompress the nerves roots of the cauda equina in a view of reducing neurological impairment, and allow early weight bearing. Even though posterior open modified triangular spinopelvic fixation is particularly efficient for treating unstable trauma lesions of the spinopelvic junction, it may not be sufficient alone in order to prevent long-term counter-nutation, i.e. rotation and anteflexion deformity of the anterior pelvis under load bearing conditions. Such progressive deformation is caused by either the slight rotation of the iliac connectors within the head of iliac screws for spinopelvic constructs, or the slight rotation of sacral cancellous bone around transsacral screws in case of percutaneous procedure. Regardless of the posterior surgical technique that is used, complementary anterior pelvic fixation appears mandatory in order to prevent such deformation over time, which can lead to pelvic asymmetry and then gait imbalance.
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Fijación Interna de Fracturas , Huesos Pélvicos , Sacro , Fracturas de la Columna Vertebral , Humanos , Sacro/cirugía , Huesos Pélvicos/cirugía , Huesos Pélvicos/lesiones , Fijación Interna de Fracturas/métodos , Fracturas de la Columna Vertebral/cirugía , Soporte de Peso/fisiología , Tornillos Óseos , Pelvis/cirugíaRESUMEN
Unstable traumas of the spinopelvic junction, which include displaced U-shaped sacral fractures (Roy-Camille type 2 and type 3) and Tile C vertical shear pelvic ring disruptions, occur in severe traumas patients following high speed traffic accident or fall from a height. These unstable traumas of the spinopelvic junction jeopardize one's ability to stand and to walk by disrupting the biomechanical arches of the pelvis, and may also cause cauda equina syndrome. Historically, such patients were treated with bed rest and could suffer a life-long burden of orthopedic and neurological disability. Since Schildhauer pioneer work back in 2003, triangular spinopelvic fixation, whether it is performed in a percutaneous fashion or by open reduction and internal fixation, allows to realign bone fragments of the spinopelvic junction and to resume walking within three weeks. Nevertheless, such procedure remains highly technical and it not encountered very often, even for spine surgeons working in high-volume level 1 trauma centers. Hence, this visual technical note aims to provide a few tips to guide less experience surgeons to complete this procedure safely.
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Tornillos Óseos , Fijación Interna de Fracturas , Huesos Pélvicos , Sacro , Fracturas de la Columna Vertebral , Humanos , Sacro/cirugía , Sacro/lesiones , Fijación Interna de Fracturas/métodos , Fluoroscopía/métodos , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Fracturas de la Columna Vertebral/cirugía , Ilion/cirugía , Fracturas Óseas/cirugía , Pelvis/cirugíaAsunto(s)
Analgésicos Opioides , Dolor de Cuello , Humanos , Dolor de Cuello/tratamiento farmacológico , Dolor de Cuello/etiología , Analgésicos Opioides/uso terapéutico , Analgésicos Opioides/efectos adversos , Dolor de Espalda/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como AsuntoAsunto(s)
Fijación Interna de Fracturas , Vértebras Lumbares , Huesos Pélvicos , Sacro , Fracturas de la Columna Vertebral , Humanos , Sacro/lesiones , Sacro/cirugía , Sacro/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fracturas de la Columna Vertebral/cirugía , Fracturas de la Columna Vertebral/diagnóstico por imagen , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Huesos Pélvicos/diagnóstico por imagen , Vértebras Lumbares/cirugía , Vértebras Lumbares/lesiones , Tornillos Óseos , Resultado del TratamientoAsunto(s)
Laminectomía , Vértebras Lumbares , Tornillos Pediculares , Fracturas de la Columna Vertebral , Vértebras Torácicas , Humanos , Fracturas de la Columna Vertebral/cirugía , Fracturas de la Columna Vertebral/complicaciones , Laminectomía/métodos , Vértebras Torácicas/cirugía , Vértebras Lumbares/cirugía , Cifoplastia/métodos , Masculino , Estenosis Espinal/cirugía , Titanio , Fijación Interna de Fracturas/métodos , Procedimientos de Cirugía Plástica/métodos , AdultoRESUMEN
BACKGROUND: Symptomatic spinal epidural hematoma (SSEH) is one of the most feared complications and source of litigation in spine surgery. Its occurrence rises up to 2% in minimally invasive spine surgery. In parts of the world where the population is aging, more fragile patients are expected to undergo degenerative spine surgery. Management of the SSEH includes emergent spine MRI, though some experts advocate for direct second-look surgery without imaging. Then, an urgent revision surgery under general anesthesia for hematoma evacuation is warranted. We report the case of a threatening SSEH in an 88-year-old patient after lumbar spine stenosis surgery. In order to spare a second general anesthesia for this fragile patient, we opted for a percutaneous ultra-sound guided drainage of the hematoma under local anesthesia as a first line treatment. The procedure was successful, we report an instant relief of his neurological deficit while performing the procedure. CONCLUSION: Ultra-sound guided percutaneous drainage of hyperacute SSEH successfully avoided a revision surgery. It spared a second general anesthesia in a fragile patient. This procedure could be an alternative first-line treatment of SSEH for fragile patients.
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Descompresión Quirúrgica , Hematoma Espinal Epidural , Vértebras Lumbares , Complicaciones Posoperatorias , Estenosis Espinal , Humanos , Hematoma Espinal Epidural/etiología , Hematoma Espinal Epidural/cirugía , Estenosis Espinal/cirugía , Masculino , Anciano de 80 o más Años , Descompresión Quirúrgica/métodos , Vértebras Lumbares/cirugía , Drenaje/métodos , Ultrasonografía Intervencional/métodos , Imagen por Resonancia MagnéticaRESUMEN
Neurosurgical approach to lesions located in the occipital lobes or in the posterior fossa require very specific and time-consuming patient installations, such as the park bench position, the prone position, or the sitting position. Nevertheless, each of these position present major drawbacks regarding specific installation-related adverse events and potentially serious neurosurgical complications such as venous air embolism, iatrogenic intracranial hypertension, and supratentorial remote hematoma just to cite a few. In order to provide neurosurgeons with a simpler, physiologically-respective, easily tolerated, less time-consuming, and less provider or specific adverse events patient installation, Ochiai (1979) introduced the supine modified park-bench / lateral decubitus position. Given that this patient position has not gained wide visibility among the neurosurgical community despite its obvious numerous advantages over its classic counterparts, we provide our experience using this installation for neurosurgical approach to lesions located in the occipital lobes and in the posterior fossa.
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Fosa Craneal Posterior , Procedimientos Neuroquirúrgicos , Lóbulo Occipital , Posicionamiento del Paciente , Humanos , Lóbulo Occipital/cirugía , Procedimientos Neuroquirúrgicos/métodos , Posicionamiento del Paciente/métodos , Fosa Craneal Posterior/cirugía , Posición Supina , Masculino , PosturaAsunto(s)
Pérdida de Líquido Cefalorraquídeo , Complicaciones Posoperatorias , Humanos , Pérdida de Líquido Cefalorraquídeo/etiología , Complicaciones Posoperatorias/etiología , Neoplasias Hipofisarias/cirugía , Masculino , Femenino , Hueso Esfenoides/cirugía , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/efectos adversos , Imagen por Resonancia MagnéticaAsunto(s)
Síndrome de Cauda Equina , Hematoma Subdural Agudo , Imagen por Resonancia Magnética , Anciano , Humanos , Masculino , Síndrome de Cauda Equina/cirugía , Síndrome de Cauda Equina/diagnóstico , Hematoma Subdural Agudo/cirugía , Hematoma Subdural Agudo/diagnóstico , Hematoma Subdural Espinal/complicaciones , Hematoma Subdural Espinal/cirugía , Compresión de la Médula Espinal/cirugíaRESUMEN
In large-scale naval battles during World War II, sailors sometimes sustained serious lower limb injuries when explosion blast of sea mines was transmitted from underneath through the metal deck of the ships. Some of these sailors were thrown in the air due to the blast and sustained axial trauma of the spine when they landed on the hard deck, which was thus called a deck slap by Captain Joseph Barr in 1946, among others. Nowadays, this peculiar mechanism has shifted to the civilian setting. Tourists unaware of the danger may sustain spine compression fractures when they sit at the bow of speed boats while underway on a calm sea. When the craft unexpectedly crosses the wake of another ship, tourists are thrown a few feet in the air before suffering a hard landing on their buttocks. This historical vignette is presented as a preventive message to help to reduce this poorly known yet avoidable "summer wave of vertebral fractures."
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Traumatismos por Explosión , Fracturas de la Columna Vertebral , Segunda Guerra Mundial , Humanos , Traumatismos por Explosión/historia , Historia del Siglo XX , Historia del Siglo XXI , Personal Militar/historia , Navíos/historia , Fracturas de la Columna Vertebral/historia , ViajeRESUMEN
CONTEXT: Penetrating craniocerebral injury associated with depressed skull fracture is an infrequent yet timely neurosurgical emergency. Such injury frequently occurs in the frontal region during traffic accident or stone throw in the civilian setting. As military neurosurgeons, we present our experience in the surgical debridement and reconstruction of this peculiar type of traumatic brain injury. METHODS: The patient lies supine, the head in neutral position heal by a Mayfield head clamp. The first step is the debridement of the frontal wound. Then, the depressed skull fracture is operated on using a tailored coronal approach through Merkel dissection plane, in order to keep a free pericranial flap. The bone flap is cut around the depressed skull fracture. Neuronavigation allows to locate the frontal sinus depending on whether it has been breached and thus requires cranialization. Brain and dura mater debridement and plasty are performed. Cranioplasty is performed using either native bone fragments fixed with bone plates or tailored titanium plate if they are too damaged. CONCLUSION: Performing wounded skin closure first and then a tailored coronal approach with free pericranial flap and a craniotomy encompassing the depressed skull fracture allows to treat frontal penetrating craniocerebral injury in an easy-to-reproduce manner.