Mortality, complication, and fusion rates of patients with odontoid fracture: the impact of age and comorbidities in 204 cases.

PURPOSE: The French Society of Spine Surgery (SFCR) conducted a prospective epidemiologic multicenter study. The purpose was to investigate mortality, complication, and fusion rates in patients with odontoid fracture, depending on age, comorbidities, fracture type, and treatment. METHODS: Out of 204 patients, 60 were ≤ 70 years and 144 were > 70 years. Demographic data, comorbidities, treatment types and complications (general medical, infectious, neurologic, and mechanical), and death were registered within the first year. Fractures were classified according to Anderson-D'Alonzo and Roy-Camille on the initial CT. A 1-year follow-up CT was available in 144 patients to evaluate fracture consolidation. RESULTS: Type II and oblique-posterior fractures were the most frequent patterns. The treatment was conservative in 52.5% and surgical in 47.5%. The mortality rate in patients ≤ 70 was 3.3% and 16.7% in patients > 70 years (p = 0.0002). Fracture pattern and treatment type did not influence mortality. General medical complications were significantly more frequent > 70 years (p = 0.021) and after surgical treatment (p = 0.028). Neurologic complications occurred in 0.5%, postoperative infections in 2.0%, and implant-related mechanical complications in 10.3% (associated with pseudarthrosis). Fracture fusion was observed in 93.5% of patients ≤ 70 years and in 62.5% >70 years (p < 0.0001). Pseudarthrosis was present in 31.5% of oblique-posterior fractures and in 24.3% after conservative treatment. CONCLUSIONS: Age and comorbidities influenced mortality and medical complication rates most regardless of fracture type and treatment choice. Pseudarthrosis represented the main complication, which increased with age. Pseudarthrosis was most frequent in type II and oblique-posterior fractures after conservative treatment.

Greater occipital nerve cryoneurolysis in the management of intractable occipital neuralgia.

OBJECTIVE: To assess technical feasibility of cryoneurolysis of the greater occipital nerve in the management of occipital neuralgia. METHODS: Six patients suffering from unilateral refractory greater occipital neuralgia and who underwent 7 GON cryoneurolysis were assessed between October 2015 and January 2017. All procedures were performed under CT guidance and local anesthesia. A planning CT was performed with contrast enhancement to plan needle target and identify surrounding major vascular structures. A 12G coaxial needle (Inomed) was then inserted and targeted the first bend of the GON under and lateral to the obliquus capitis inferior muscle. A 2.0mm cryoprobe was then inserted in the coaxial and sensitive stimulation at 100Hz was performed. One to three freezing cycles were performed in one session. RESULTS: Technical feasibility was 100% as cryoneurolysis could be performed in all 7 cases with accurate sensitive nerve stimulation prior to freezing cycle. One patient benefited from a second session after failure of the first session. More than 50% pain reduction was achieved at day 7 in all cases, and 5 of 6 cases at one and three months follow-up. CONCLUSION: Cryoneurolysis of the GON in the management of refractory GON neuralgia is feasible. Initial results are promising as 5/7 cases benefited from a 3-month pain alleviation period.

Effect of surgery on periventricular white matter in normal pressure hydrocephalus patients: comparison of two methods of DTI analysis.

BACKGROUND: Diffusion tensor imaging (DTI) is a useful tool for assessing changes that occur in microstructures. We have developed a novel method for region of interest (ROI) delineation in the assessment of DTI parameters in patients with normal pressure hydrocephalus (NPH). PURPOSE: To compare the standard method and our novel method in an evaluation of the impact of surgery on periventricular white matter in patients with NPH. MATERIAL AND METHODS: Ten patients with NPH underwent 3T magnetic resonance imaging (MRI; including 12-direction DTI sequences) before and after surgery. We recorded diffusion parameters (λi, the fractional anisotropy [FA], the apparent diffusion coefficient, and Dr) in the internal capsule (IC) and the body of the corpus callosum (BCC). Using the standard delineation technique, regions of interest (ROIs) were positioned according to anatomical and functional considerations and then filled with several sub-ROIs. The ROIs delineated with our novel technique (extracted as the six sub-ROIs with the lowest standard deviation for the FA) were arranged in two rows (medial and lateral), from the ventricle to the brain surface. RESULTS: The within-ROI homogeneity was higher with the novel method than with the conventional method (P<10(-4)). When the conventional delineation method was applied to the IC data, only λ2 was found to be significantly greater after surgery; in contrast, application of our novel method evidenced a significant decrease in FA and λ1 and a significant increase in λ2 (P<0.05). Both before and after surgery, the FA in the medial row of ROIs was greater than the FA in the lateral row (P<0.01). In the BCC, only λ2 and Dr varied significantly (when evaluated with the novel method). CONCLUSION: Our results show that use of a novel method of DTI data analysis may be more sensitive to local changes induced by surgical procedures. Furthermore, this novel method was able to detect the transmantle pressure gradient related to the regional stress distribution.

Bilateral abducens paralysis revealing bipartite spheno-occipital synchondrosis fracture in a child: case based update.

BACKGROUND: After reviewing the literature about sella turcica and spheno-occipital synchondrosis fracture, we present the case of a 6-year-old girl who suffered complex sphenoid bone fracture produced by an indirect mechanism. METHODS: The girl fell from her height after a blunt head injury due to a falling lamppost. RESULTS: Computer tomography (CT) scan showed occipital, sellar and clival fractures with pneumatocephalus. The probable fracture mechanism is contre-coup injury linked to osseous and brain oscillations after head trauma. CONCLUSION: Two complications, abducens nerve palsy and cerebrospinal fluid fistula, are observed and discussed.

Magnetic expression in kerogen reveals impact on fluid transport.

How can the transport of fluids in a confined and complex mixed organic/inorganic matrix be far below the expected value from a topological aspect? A good example of this situation is oil shales. Oil and gas shales are source rocks in which organic matter has matured to form hydrocarbons. They exhibit a dual porous network formed by the intertwining of mineral and organic pores that leads to very low permeability. Still, the exact origin of this extremely low permeability remains somehow unclear. The present communication addresses this important question and provides novel insights on the mechanisms that strongly hinder fluid diffusion in such materials. By combining nuclear and electronic magnetic resonance techniques with SEM imaging, we show evidence that magnetic interaction occurs in kerogen. This results from a magnetic coupling between vanadyl present in porphyrins and the organic matrix. We demonstrate that such coupling retards fluid diffusion and is reversible. This key dynamical feature explains the extremely low mobility of oil in shale rocks. This phenomenon may be a more general feature occurring in several systems where fluids are confined in a complex hierarchical matrix that embeds both organic and inorganic radicals resulting from the aging process.

Hangman's fracture: Management strategy and healing rate in a prospective multi-centre observational study of 34 patients.

BACKGROUND: Hangman's fractures account for 15% to 20% of all cervical spine fractures. The grading system developed by Effendi and modified by Levine and Edwards is generally used as the basis for management decisions. Nonetheless, the optimal management remains controversial. The objective of this study was to describe the treatments used in France in patients with hangman's fractures. The complications and healing rates were analysed according to the fracture type and treatment used. HYPOTHESIS: Among patients with hangman's fracture, those with disc damage must be treated surgically. MATERIAL AND METHODS: A prospective, multi-centre, observational study was conducted under the aegis of the French Society for Spine Surgery (SociétéFrançaisedeChirurgieRachidienne, SFCR). Patients were included if they had computed tomography (CT) evidence of hangman's fracture. Follow-up data were collected prospectively. Fracture healing was assessed on CT scans obtained 3 and 12 months after the injury. The type of treatment and complications were recorded routinely. RESULTS: We included 34 patients. The fracture type according to Effendi modified by Levine and Edwards was I in 68% of patients, II in 29% of patients, and III in a single patient (3%). The treatment was non-operative in 21 (62%) patients and surgical in 11 (32%). All 28 patients re-evaluated after 1 year had evidence of fracture healing. The remaining 6 patients were lost to follow-up. CONCLUSION: Hangman's fracture is associated with low rates of mortality and neurological complications. Non-operative treatment is appropriate in Type I hangman's fracture, with a 100% healing rate in our study. Types II and III are characterised by damage to the ligaments and discs requiring either anterior C2-C3 fusion or posterior C1-C3 screw fixation. LEVEL OF EVIDENCE: III.

Facet joint syndrome: from diagnosis to interventional management.

Low back pain (LBP) is the most common pain syndrome, and is an enormous burden and cost generator for society. Lumbar facet joints (FJ) constitute a common source of pain, accounting for 15-45% of LBP. Facet joint degenerative osteoarthritis is the most frequent form of facet joint pain. History and physical examination may suggest but not confirm facet joint syndrome. Although imaging (radiographs, MRI, CT, SPECT) for back pain syndrome is very commonly performed, there are no effective correlations between clinical symptoms and degenerative spinal changes. Diagnostic positive facet joint block can indicate facet joints as the source of chronic spinal pain. These patients may benefit from specific interventions to eliminate facet joint pain such as neurolysis, by radiofrequency or cryoablation. The purpose of this review is to describe the anatomy, epidemiology, clinical presentation, and radiologic findings of facet joint syndrome. Specific interventional facet joint management will also be described in detail. TEACHING POINTS: • Lumbar facet joints constitute a common source of pain accounting of 15-45%. • Facet arthrosis is the most frequent form of facet pathology. • There are no effective correlations between clinical symptoms, physical examination and degenerative spinal changes. • Diagnostic positive facet joint block can indicate facet joints as the source of pain. • After selection processing, patients may benefit from facet joint neurolysis, notably by radiofrequency or cryoablation.

C1 fracture: Analysis of consolidation and complications rates in a prospective multicenter series.

INTRODUCTION: Three types of C1 fracture have been described, according to location: type 1 (anterior or posterior arc), type 2 (Jefferson: anterior and posterior arc), and type 3 (lateral mass). Stability depends on transverse ligament integrity. The main aim of the present study was to analyze complications and consolidation rates according to fracture type, age and treatment. MATERIAL AND METHODS: The French Society of Spinal Surgery (SFCR) performed a multicenter prospective study on C1-C2 trauma. All patients with recent fracture diagnosed on CT were included. Consolidation on CT was studied at 3 months and 1 year. Medical, neurologic, infectious and mechanical complications were inventoried using the KEOPS data-base. RESULTS: Sixty-three of the 417 patients (15.1%) had C1 fracture: type 1 (33.3%), type 2 (38.1%), or type 3 (28.6%). The transverse ligament was intact in 53.9% of cases. Treatment was non-operative in 63.5% of cases, surgical in 27.0%, and surgical after failure of non-operative treatment in 9.5%. There were 8 medical complications, more frequently in patients aged >70 years, following surgery (p<0.0001). The consolidation rate was 84.2% with non-operative treatment, 100% for primary surgery, and 33.3% for secondary surgery (p=0.002). There were 10 cases of non-union, in 4.8% of type 1, 13.6% of type 2 and 33.3% of type 3 fractures (p=0.001). CONCLUSION: Medical complications showed association with age and with type of treatment. Non-operative treatment was suited to types 1, 2 and 3 with minimal displacement and intact transverse ligament. C1-C2 fusion was suited to displaced unstable type 2 fracture. Displaced type 3 fracture incurred risk of non-union. Early surgery may be recommended. LEVEL OF EVIDENCE: III.