Biomedical subjects

I Bogorin

Publications and source records attributed to I Bogorin.

3 recordsLinked to original sources

PubMed2006

[Pedicle closing-wedge osteotomy for the treatment of fixed sagittal imbalance].

PURPOSE OF THE STUDY: The aim of this study was to analyze x-ray results in patients who underwent pedicle subtraction osteotomy for complex deformations (flat back, kyphosis) leading to fixed sagittal imbalance. MATERIAL AND METHODS: Thirty-four patients underwent surgery between 1996 and March 2003 in two centers, the orthopedic surgery unit devoted to spinal surgery and sports traumatology at the Strasbourg University Hospitals and the spinal surgery unit at the Chenove Clinic (Dijon). The series included 20 women and 14 men, mean age 46.5 years (range 14-74 years) treated for: postoperative flat back (n = 19), kyphoscoliosis (n = 6), ankylosing spondylarthritis (n = 5), and malunion (n = 4). After careful planning to achieve the necessary degree of correction, the patient was installed on a Cotrel table with a stable support enabling limited blood loss and facilitated reduction maneuvers via elevation of the lower limbs. The technique started by resection of the posterior arch, the transverse processes, and the pedicles, followed by partial resection of the body with a chisel under fluoroscopic control. The closure was achieved by in situ reduction with compressive rotation. Adjacent discs were then evaluated to search for any opening which could be filled by an anterior graft to complete the stabilization. The osteosynthesis used 2-, 4-, and 6-rod assemblies. The 6-rod assemblies enabled anchoring the fixation above and below before the osteotomy. Two prebent rods completed the assembly at reduction after osteotomy. Weight-bearing started on day 4. A protective corset was worn for three months by 19 patients. The patients resumed their occupational activities on average 6.73 months postoperatively without change in activity for 63%. Overall satisfaction was close to 90% excellent outcome. RESULTS: All clinical results were analyzed with the Profil software of Surgiview. X-ray data were analyzed with Spineview. A self-administered clinical questionnaire was used to evaluate pain, result of the operation, and the impact on the patient's body image. On average, the wedge osteotomy measured 28.9 degrees for correction of lumbar lordosis by 31.5 degrees with a maximum of 65 degrees. The misalignment at C7 was reduced from 51 mm to 2 mm. At the pelvic level, version improved 16 degrees, sacral slope 8 degrees. There were four dura mater breaches which had to be sutured, but with no clinical consequence (one progression to meningocele). Mean intraoperative blood loss was 1400 cc (300-4500cc) for a mean operative time of 260 minutes (165-450 min). There were two early infections at day 15 postop which resolved with antibiotics. Four patients developed resolutive sciatica (n = 2) or cruralgia (n = 2) during the following months. The short-term follow-up revealed eight non-unions (25%) with rupture of osteosynthesis material and loss of correction. The opening in the adjacent discs and the insufficient posterior closure explained this mechanical complication. CONCLUSION: Pedicle subtraction osteotomy is an original operative technique reserved for specialized centers. A well-experienced team is needed to control the risks involved. Sagittal balance should be one of the important goals for modern spinal surgery.

Adolescent↗

PubMed2000

[Results of lumbar and lumbosacral fusion: clinical and radiological correlations in 113 cases reviewed at 3.8 years].

PURPOSE OF THE STUDY: Spinal fusion requires the use of hardware for reduction and stabilization. We present the clinical and radiological behavior of a population of patients with lumbar and lumbosacral spinal fusion. MATERIALS AND METHODS: Between 1990 and 1992, 113 patients were operated for lumbar and lumbosacral fusion. Mean age of the population was 43 years and mean follow-up was 3.8 years. Most of the fusions were L4-S1 fusions. 56% of the patients had a previous surgery. Thirteen patients in the series were reoperated and analyzed separately. In the majority of the cases, the indication for surgery was back pain with or without leg pain. Diagnoses were: spondylolisthesis, discopathy, scoliosis, and pseudoarthrosis. The spine was fused and reduced using two lordotic rods. Peroperative and postoperative lordosis were calculated on X-rays. Clinical results were analyzed with the Beaujon-Lassale score. RESULTS: Mean improvement was significantly better for spondylolisthesis than for other pathologies (85.6% versus 77.1%). Returning to work was possible for 85.5% of those with improvement and was not possible for 69.8%. The gain achieved in lordosis at surgery was lost at last follow-up. The lordosis of the construct appeared to protect against the development of discopathies above and below the construct. Discopathis led to a poor score. The rate of non-union was 7.9%, the rate of repeated surgery 6.1% and the rate of hardware removal 23.8%. At last follow-up, improvement was achieved in 45.6% of the 13 patients of the series who had repeat surgery. DISCUSSION: The results in our series are similar to those reported by others. Lumbar lordosis is an important factor: if lost, more interbody fusions may be subsequently required. Diagnosis of non-union is difficult and reoperation is the only sure manner to prove it by applying distraction-compression manoeuvres on the screws. All non-unions presented were symptomatic; incidence in the series was thus probably higher. Non-union and reoperation with a longer fusion are perhaps correlated with insufficient elasticity in the osteosynthesis. Optimal rod elasticity is a factor which remains to be defined. CONCLUSION: Clinical results of lumbar and lumbosacral fusions are not unsatisfactory, but in our series almost one patient out of three had to be reoperated. One of the reasons for so many reoperations is certainly hardware rigidity. Hardware was not removed without testing the fusion as this is the only means of sure diagnosis of non-union. Reoperation should not be considered a failure in this difficult surgery of back pain which requires long-term surgical follow-up.

Adolescent↗

PubMedDate not supplied

[Single compartment Oxford knee prosthesis].

From 1988 to 1992, we implanted 30 Oxford single compartment prostheses. Follow-up was sufficient for study in 27 cases. The Oxford single compartment prosthesis is original because the height of the meniscal component varies with mobility during flexion-extension. This single compartment prosthesis requires a rigorous technique on the basis of well respected fundamental principles. The opposite femorotibial compartment must be untouched, otherwise a slight deviation of the axis may occur. Mobility must be satisfactory and the anterior cruciate ligament must not be injured. In our series, we obtained the same results as published in the literature, particularly those reported by Goodfellow who advocates its use. Results were satisfactory in 89% of the patients. There was an extraordinary improvement in pain symptomatology. There was little improvement in mobility. Overcorrection must be absolutely avoided because of the risk of destroying the opposite compartment. Besides the classical complications which include thrombophlebitis and retarded scar formation, we noted 3 luxations of the meniscus, 2 involving the medial meniscus and 1 the lateral meniscus. In 2 cases we had to change the meniscus (once under general anaesthesia) and in 1 cases had to reoperate to install a total prosthesis. The Oxford single compartment knee prosthesis is an important implant which has its place between osteotomy and a total prosthesis, when used according to rigorous technique. There is nevertheless the risk of meniscal luxation with this type of prosthesis.

Aged↗