Risk factors for Cutibacterium acnes spinal implant-associated infection: a case-case-control study.

OBJECTIVES: The aim was to determine the characteristics of patients who developed Cutibacterium acnes spinal implant-associated infection (SIAI) and the associated risk factors. METHODS: We conducted two parallel case-control studies comparing 59 patients with SIAI caused by C. acnes (cases 1) and 93 patients with SIAI caused by other microorganisms (cases 2) diagnosed during 2010-2015 with 302 controls who underwent spinal instrumentation without subsequent infection. RESULTS: Late-onset infections (median time to diagnosis, 843 days versus 23 days; p < 0.001) were more common in cases 1 than in cases 2. However, 20/59 (34%) of cases 1 occurred within the first 3 months after the index surgery. In addition, cases 1 were less likely to have fever (27%, 16/59 versus 58%, 54/93; p 0.001) or wound inflammation (39%, 23/59 versus 72%, 67/93; p < 0.001). Moreover, 24/59 (40%) of cases 1 presented with polymicrobial infections, and staphylococcal pathogens accounted for 22/24 (92%) of the co-infections. By comparing and contrasting the two multivariate risk models (cases 1 versus controls and cases 2 versus controls), the following factors associated with C. acnes SIAI development were identified: age <54 years (adjusted odds ratio (aOR) 2.43, 95% confidence interval (CI) 1.09-5.58, p 0.03), a body mass index <22 kg/m2 (aOR 2.47, 95% CI 1.17-5.29, p 0.02), and thoracic instrumentation (aOR 16.1, 95% CI 7.57-37.0, p < 0.001). CONCLUSIONS: Future therapeutic and prophylactic studies on C. acnes SIAI should focus on young, thin patients who undergo spinal instrumentation procedures involving the thoracic spine.

Giant cell tumor of tendon sheath: Open surgery or arthroscopic synovectomy? A systematic review of the literature.

PURPOSE: Giant cell tumor of tendon sheath (GCTTS), formerly known as pigmented villonodular synovitis (PVNS), is a benign, locally aggressive, proliferative disorder of the synovium involving a joint, bursa, or tendon sheath. Treatment of GCTTS involves early surgical resection to limit articular destruction and the risk of recurrence. Synovectomy remains the treatment of choice for GCTTS, but without clear consensus to make an open or arthroscopic synovectomy and no certainty on the responsibility of surgery in the evolution towards the degenerative osteoarthritis. The aim of this study was to evaluate the long-term clinical outcomes and the rate of recurrence of open or arthroscopic excision of GCTTS of the four most frequently involved joints: the shoulder, hip, knee and ankle. METHODS: We performed a systematic review of literature in September 2015. The keywords were "villonodular synovitis" AND "surgical treatment". The two authors analyzed 413 articles, according to title and abstract. Forty articles were selected, read entirely and references were analyzed. RESULTS: Thirty-three articles were selected. CONCLUSION: Our review of literature showed that arthroscopic excision is effective for localized type of GCTTS for all four joints. In diffuse type GCTTS, the efficacy of arthroscopic synovectomy has only been shown for the knee joint. In the other joints, early diagnosis can improve clinical outcomes, but we cannot certify that surgical treatment avoids osteoarthritis degradation. STUDY DESIGN: Review of literature, level of evidence IV.

Comparison between total disc replacement and hybrid construct at two lumbar levels with minimum follow-up of two years.

INTRODUCTION: Lower back pain due to degenerative disc disease is a therapeutic challenge in young patients. Although arthrodesis is currently the gold standard for surgical treatment, improvement in total disc replacement techniques makes it possible to preserve segmental mobility with good results in one-level surgery. Nevertheless, the French National Health Authority does not recommend total disc replacement for multilevel surgery. Thus, hybrid constructs that combine one-level disc replacement with arthrodesis have been developed for multilevel indications. HYPOTHESIS: The outcome of two-level lumbar disc arthroplasty does not differ from hybrid constructs. METHODS: The clinical and radiographic outcomes of disc arthroplasty were compared to hybrid constructs for two-level degenerative disc disease in 72 patients after a continuous follow-up of at least 2 years. The patients were divided into two groups that were similar for the indication and type of implants. RESULTS: There was no statistical difference in pain relief (-3.9 points versus -3.5 points for lumbar VAS) or reduction in ODI (-29.5% versus -27.0%) between TDR and hybrid constructs, respectively. There was no statistical difference in range of motion at the level of arthroplasty (8.4° versus 7.6°) and no kinematic dysfunction was identified. The re-operation rate at two years for persistent lumbar pain was respectively 6.7% for two-level disc arthroplasty and 4.3% for hybrid constructs. The complication rate was 4.8% and 8.7% respectively. DISCUSSION: No difference was found in this comparison of two homogeneous series between two-level disc arthroplasty and hybrid constructs for the treatment of degenerative disc disease after two years of follow-up. Two-level disc arthroplasty may be an alternative for young patients depending on an evaluation of long-term results. LEVEL OF EVIDENCE: Cohort observational study level III.

Correlation between radiographic parameters and functional scores in degenerative lumbar and thoracolumbar scoliosis.

INTRODUCTION: Adult scoliosis is a condition in which the spinal deformity occurs because of degeneration. Although various studies have agreed on the importance of restoring the sagittal balance, few have evaluated the relationship between functional scores and radiological parameters. The primary objective of this retrospective study was to demonstrate the correlation between radiographic parameters and functional outcomes in adult patients with lumbar or thoracolumbar degenerative scoliosis. The secondary objective was to assess the long-term effects of posterolateral fusion for treating this deformity. STUDY OUTLINE: This single-centre retrospective study included 47 patients over 50years of age who had degenerative lumbar scoliosis treated with an instrumented posterolateral fusion; the mean follow-up was 6.4years (range 2 to 20). METHODS: Radiographic analysis of A/P and lateral full spine standing radiographs was carried out with the KEOPS software. Three pelvic parameters (pelvic tilt, pelvic incidence, sacral slope), two spinal parameters (lumbar lordosis and thoracic kyphosis) and three sagittal balance parameters (C7 sagittal tilt, C7 Barrey's ratio and spinosacral angle) were calculated. The functional outcomes were evaluated through three self-assessment questionnaires: Oswestry Disability Index, SRS-30 and SF-36. The correlation between clinical and radiographic parameters was calculated with Spearman's correlation test. RESULTS: There was a significant correlation between the SF-36 (PCS) and the following three sagittal parameters: sacral slope (r=-0.31453; P=0.04), lumbar lordosis (r=-0.30198; P=0.0491) and spinosacral angle (r=-0.311967; P=0.0366). The mean ODI score was 33.61, which corresponds to minimal to moderate disability. The mean physical (PCS) and mental (MCS) component summary scores of the SF-36 were 37.70 and 38.40, respectively. The mean SRS-30 score was 3.07. CONCLUSION: It is essential that the sagittal balance be restored when treating degenerative lumbar scoliosis to generate better functional outcomes and better quality of life. To achieve this correction, instrumented posterolateral fusion appears to be a very reliable technique that leads to lasting improvement. LEVEL OF EVIDENCE: IV.

Does thoracoscopic anterior release of rigid idiopathic scolioses associated with correction by posterior instrumentation result in better long-term frontal and sagittal balance?

INTRODUCTION: The aim of treatment of scolioses is to reduce deformities and restore balance in the spine. HYPOTHESES: In rigid forms of scoliosis, associating anterior release could provide greater frontal and/or sagittal plane correction and improve balance in the spine. PATIENTS AND METHODS: This study compared correction and long-term balance on two planes between two homogeneous groups of idiopathic rigid scolioses treated with and without thoracoscopic release. The study included rigid scolioses with less than 35% reducibility and a Cobb angle of more than 60°, who all underwent posterior correction using a rod rotation technique. There were 29 patients, 14 who underwent a one-step procedure (group A) and 15 a two-step procedure (group B), with the subgroups of kyphoscolioses and lordoscolioses determined in each group. Frontal balance, Cobb angle, thoracic kyphosis and the Jackson plumbline were measured on pre- and postoperative X-rays and at the final follow-up. RESULTS: The mean long-term final follow-up was 144 months for group A and 54 months for group B. Frontal plane correction was identical in groups A and B. Frontal balance was preserved in all cases at the final follow-up. Sagittal balance was not modified with or without anterior release. The thoracoscopic release step resulted in an additional correction of 15.5° (23%) of thoracic hyperkyphosis in patients with kyphoscoliosis (P=0.003). DISCUSSION: Thoracoscopy did not improve short term results in the Cobb angle or frontal or saggital balance. Nevertheless, enhanced correction of thoracic hyperkyphosis was obtained with this procedure. In this study, the association of thoracoscopic anterior release with posterior correction by rod rotation to treat rigid scolioses did not appear to improve results, except for the correction of thoracic hyperkyphosis.