Gaby Kreichati

Vertebral Augmentation: State of the Art

Osteoporotic vertebral compression fractures (OVF) are an increasing public health problem. Cement augmentation (vertebroplasty of kyphoplasty) helps stabilize painful OVF refractory to medical treatment. This stabilization is thought to improve pain and functional outcome. Vertebroplasty consists of injecting cement into a fractured vertebra using a percutaneous transpedicular approach. Balloon kyphoplasty uses an inflatable balloon prior to injecting the cement. Although kyphoplasty is associated with significant improvement of local kyphosis and less cement leakage, this does not result in long-term clinical and functional improvement. Moreover, vertebroplasty is favored by some due to the high cost of kyphoplasty. The injection of cement increases the stiffness of the fracture vertebrae. This can lead, in theory, to adjacent OVF. However, many studies found no increase of subsequent fracture when comparing medical treatment to cement augmentation. Kyphoplasty can have a protective effect due to restoration of sagittal balance.

Aneurysmal Bone Cyst of the Cervical Spine in Children: A Review and a Focus on Available Treatment Options.

Objective: To present a series of pediatric cervical spine (CS) aneurysmal bone cysts (ABC), to review the literature, and to propose a treatment algorithm. Material: We present a series of 4 cases of ABC and review the literature using PubMed, EMBASE, and Google scholar. Results: Only 51 cases are documented. The mean age at diagnosis is 11.5 years, and there is a small female predominance (F:M ratio=1.6). Most of ABC occurs in the upper CS (41%), are located in the posterior component (75%), and extends in 40% of the vertebral body. A single treatment modality was used in 56.9%, whereas combination of surgery with other treatment modalities was used in the rest. Of the total number of cases, 56.8% were managed with marginal resection, and instrumentation was used in 80%. Mean follow-up was 72.5 months, with the majority of patients disease free. Pain is the most common symptom present at the latest follow-up. Conclusions: ABC of the spine is a pediatric tumor occurring rarely in the CS. Treatment options vary from simple curettage to total resection with or without instrumentation. Recurrence after surgery is highest after curettage alone. The main indications for surgery are rapid progression, despite intracystic injection, and/or the presence of neurological signs or symptoms. Level of Evidence: Level IV.

Herniated intervertebral disc associated with a lumbar spine dislocation as a cause of Cauda Equina syndrome: a case report

To report a case of Cauda Equina syndrome with the completion of the paralysis after the reduction of a L4L5 dislocation due to a herniated disc. Although several articles have described a post-traumatic disc herniation in the cervical spinal canal, this is not well known in the lumbar region. A 30-year-old man was admitted to the emergency room with blunt trauma to the chest and abdomen with multiple contusions plus a dislocation of L4-L5 with an incomplete neurological injury. After an emergency open reduction and instrumentation of the dislocation, the patient developed a complete cauda equina syndrome that has resulted from an additional compression of the dural sac by a herniated disc. In a dislocation of the lumbar spine, MRI study is mandatory to check the state of the spinal canal prior to surgical reduction. A posterior approach is sufficient for reduction of the vertebral displacement, however an intra-canal exploration for bony or disc material should be systematically done.

Etiology, Evaluation, and Treatment of Failed Back Surgery Syndrome

The study aimed to review the etiology of failed back surgery syndrome (FBSS) and to propose a treatment algorithm based on a systematic review of the current literature and individual experience. FBSS is a term that groups the conditions with recurring low back pain after spine surgery with or without a radicular component. Since the information on FBSS incidence is limited, data needs to be retrieved from old studies. It is generally accepted that its incidence ranges between 10% and 40% after lumbar laminectomy with or without fusion. Although the etiology of FBSS is not completely understood, it is possibly multifactorial, and the causative factors may be categorized into preoperative, operative, and postoperative factors. The evaluation of patients with FBSS symptoms should ideally initiate with reviewing the patients’ clinical history (observing “red flags”), followed by a detailed clinical examination and imaging (whole-body X-ray, magnetic resonance imaging, and computed tomography). FBSS is a complex and difficult pathology, and its accurate diagnosis is of utmost importance. Its management should be multidisciplinary, and special attention should be provided to cases of recurrent disc herniation and postoperative spinal imbalance.

Influence of the Level of Pedicle Subtraction Osteotomy on Pelvic Tilt Change in Adult Spinal Deformity

Background Spine osteotomy is used for patients with rigid severe spinal deformity. Pedicle Subtraction Osteotomy (PSO) is performed by removing the posterior elements and both pedicles, removing a wedge from the vertebral body, and closure of the osteotomy by hinging on the anterior cortex. This technique is demanding and have very steep learning curve. We analyze the effect of the level of PSO on the change of pelvic tilt Methods this is a retrospective study of 35 patients (mean age, 60.7 years; range, 45–81 years) undergoing thoracolumbar PSO at a single institution in the past 4 years. One patient underwent PSO at T11, two patient underwent PSO at L2, and 16 patients underwent PSO at L3 and 16 at the L4 level. Seventy percent of the patients had undergone at least one previous spine surgery in the region of the PSO. Results the mean pelvic incidence in the cohort was 54.5. There was no change in the pelvic tilt between the preoperative and postoperative state (24.8 vs 22; p > 0.05). On the other hand, lumbar lordosis (26 vs 44), thoracic kyphosis (27 vs 38.8) and T1 pelvic angle (26.6 vs 14.7) had all significant improvement. Mean PSO resection was 35°. With subgroup analysis, mean pelvic tilt change -3.3° at the L3 level and -8.6 ° at the L4 level. Conclusions The degree of PSO resection correlates greatly with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, and T1PA). More importantly, PSO level impacts postoperative PT correction; L4 level PSO have shown a better correction of the pelvic tilt than L3 PSO.