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Biomedical subjects

J Senegas

Publications and source records attributed to J Senegas.

At least 19 recordsLinked to original sources
PubMed1998

[Thoracolumbar fractures. Pathomorphology and indications for treatment].

The indications for conservative and surgical management of fractures of the thoracolumbar spine are reviewed, based upon the morphology of the lesions, which is assessed by meticulous analysis of radiographs, CT scan and in some cases MRI. The author advocates using the AO classification, which considers several subtypes of fractures: compression fractures, distraction fractures and fractures with multidirectional displacement. The indication for treatment is based upon morphological analysis of the lesions, while other factors such as the general condition of the patient or the locally available surgical environment must also be taken into consideration. Up to 50% of thoracolumbar fractures can benefit from surgical management, with posterior or anterior stabilisation, the latter performed through thorascoscopy in selected cases.

Humans↗
PubMed1997

Study of the course of the incidence angle during growth.

Standing posture is made possible by hip extension and lumbar lordosis. Lumbar lordosis is correlated with pelvic parameters, such as the declivity angle of the upper surface of the sacrum and the incidence angle, which determine the sagittal morphotype. Incidence angle, which is different for each individual, is known to be very important for up-right posture, but its course during life has not yet been established. Incidence angle was measured on radiographs of 30 fetuses, 30 children and 30 adults, and results were analysed using the correlation coefficient r and Student's t test. A statistically significant correlation between age and incidence angle was observed. Incidence angle considerably increases during the first months, continues to increase during early years, and stabilizes around the age of 10 years. Incidence is a mark of bipedism, and its role in sagittal balance is essential.

Adult↗
PubMed1997

A novel paraspinal surgical approach for lumbar lateral extraforaminal root entrapment.

We describe a new surgical route that we call the "crest approach" for treating extraforaminal disc herniation in the lumbar spine. This approach is useful only for the levels above L5-S1. It permits perfect root decompression without any bony resection that would contribute to instability. Muscle retraction and devascularization are reduced. Risk of nerve root lesions is minimal since the herniation is removed before root mobilization. Fifteen patients have been treated using this procedure. In all 15, pain and/or neurologic deficits remitted rapidly with no postoperative complications. In conclusion, the crest approach provides highly satisfactory operating conditions by simplifying exposure and greatly limiting the risk of complications. In our relatively limited experience using this procedure, only satisfactory results have been observed.

Adult↗
PubMed1996

Asymptomatic cervical haemangioma treated by percutaneous vertebroplasty.

We report a 17-year-old asymptomatic patient with a partially collapsed seventh cervical vertebra due to a haemangioma revealed by conventional radiographs performed for army enrollment. Given radiological evidence of aggressiveness, percutaneous vertebroplasty by injection of methyl methacrylate cement was performed to prevent complications. CT a year later showed no progression of the lesion. The patient remains asymptomatic.

Adolescent↗
PubMed1995

Anterior discectomy without interbody fusion for cervical disc herniation.

Between 1985 and 1990, 68 patients with cervical radiculopathy due to soft disc herniation were treated by anterior cervical discectomy without interbody fusion. Eleven patients were unavailable for follow-up examination. The mean follow-up was 23 months (range 12-54 months). Both clinical and radiographic follow-ups were done, and 92% of the patients was found to have excellent or good clinical results. Radiographic follow-up revealed that 34% had fused spontaneously and 66% developed fibrous healing of the disc space with an average range of mobility of 2.07 deg. All patients were shown to be stable on flexion-extension films. Complications included two transient CSF leaks. No neurologic deficits arose. One patient was reoperated and fused for intractable residual neck pain. We conclude that anterior cervical discectomy without interbody fusion is a simple, safe and effective procedure for patients with soft disc herniation.

Adult↗
PubMed1995

[Chronic cervico-brachial neuralgia treated by cervical epidural injection of corticosteroids. Long-term results].

OBJECTIVE: To assess long-term results of a single cervical epidural corticosteroid injection (CECI) in patients suffering from chronic cervicobrachial neuralgia (CCBN). STUDY DESIGN: Open prospective study. PATIENTS: A CECI was performed in 29 patients suffering for more than 12 months from a non-compressive and non-surgical CCBN with permanent pain for at least three months non relieved by an adequately conducted medical treatment. METHODS: The cervical epidural space was injected (C7-T1, 18 G needle) with an increasing volume (maximum 10 mL) of isotonic saline solution to exacerbate patient's cervicobrachial pain. The patients then received an equivalent volume of 0.5% lidocaine plus triamcinolone acetonide (10 mg.mL-1). The pain decrease was estimated on a visual analogic scale (VAS), in comparison to intensity of pain rated at 100 mm before CECI. RESULTS: The mean volume injected into the epidural space was 6 +/- 2 mL. It increased pain in 26 out of 29 patients. After 3 months, a success rate of 83% was obtained, with a pain rate of 12 mm on VAS. Concerning mid- and long-term results, pain relief remained stable for at least 24 months (mean follow-up: 48 +/- 18 months). Simultaneously, the need for analgesics decreased significantly. CONCLUSION: A single CECI in patients suffering from non-compressive and non-surgical CCBN results in long-lasting pain relief.

Administration, Topical↗
PubMed1995

Thoracic spinal trauma and associated injuries: should early spinal decompression be considered?

The relative benefits of conservative or surgical treatment in thoracic spinal trauma are still controversial. Owing to its anatomic relations, thoracic spinal trauma is specific regarding neurologic prognosis, the high incidence of associated injuries, and surgical management. Over a 30-month period, 49 patients sustained thoracic spinal trauma with neurologic impairment. The authors review population characteristics, associated injuries, and surgical management, and underline the high incidence of associated injuries, in particular, blunt chest trauma. In their opinion, early spinal decompression has no indication in complete paraplegia. Concerning partial paraplegia, early surgery may enhance neurologic recovery. Nevertheless, they suggest three main criteria in deciding whether or not to perform surgery early: the existence of residual spinal compression, the degree of neurologic impairment, and the presence of potential hemorrhagic lesions or blunt chest trauma, especially pulmonary contusion.

Adolescent↗
PubMed1994

Odontoid fractures. Review of 150 cases and practical application for treatment.

A total of 150 odontoid fractures was treated over a 12-year period, 43 by anterior screw fixation. The rate of pseudarthrosis dropped from 20% to 5% in type II unstable fractures. Thus, anterior screw fixation seems to be safe and efficient, and may be more widely used to treat all type II and some type III fractures. Odontoid pseudarthrosis is usually tolerated quite well and therefore requires no correction. If necessary, anterior grafting with fixation can be proposed as an alternative for posterior fusion.

Bone Screws↗
PubMed1994

[Bases for drug therapy of spinal cord injuries].

The initial lesion after spinal cord injury is due to two types of lesions: "primary" and "secondary". Aim of drug treatment is the limitation of the secondary lesion to facilitate recovery at the injury site. Mechanisms involved in the secondary lesion are of two types: a "macroscopic" one due to the compression of the cord and the ischemia due to hypoxia and fall of arterial blood pressure, a "microscopic" one due to biochemical and enzymatic phenomena. In those, glutamate liberation, intracellular calcium modifications, free radical synthesis and lipid peroxidation are the more fashionable. Numerous drug treatments are proposed which will never take the place of immediate resuscitation care and cord decompression.

Female↗
PubMed1992

Anatomical basis of the anterior cervical spine approach: topographic study of the nerve structure.

The results of the surgical anterior approach to the cervical spine are marked in a number of cases by dysphagia and dysphonia, especially when the approach is extensive or performed at the upper cervical spine. 35 cadaver dissections were performed to define the topography of the nerve structures during operative exposure at various vertebral levels: superior and recurrent laryngeal nerves, hypoglossal nerve and its superior root of the ansa cervicalis. The authors suggest some technical improvements, for each stage of surgical dissection.

Aged↗
PubMed1991

Study of correlation between intradiscal pressure and magnetic resonance imaging data in evaluation of disc degeneration. Therapeutic issue with percutaneous nucleotomy.

Intradiscal pressure and volume measurements using discomanometry were correlated to features of degeneration noted with magnetic resonance (MR) imaging in 36 discs in patients scheduled for percutaneous nucleotomy. Discomanometric data (intradiscal pressure and degree of pressure loss at 0 and 60 seconds after intradiscal infusion, area under the pressure curve, and discal volume) were not correlated with the MR data (degree of disc height loss and degree of signal intensity loss on T2-weighted images). Results of nucleotomy were strongly correlated with discomanometric data but not with the studied MR factors. Discomanometry by evaluating the physical status of discs, may predict results of percutaneous nucleotomy and consequently play a major role in patients selection.

Female↗
PubMed1989

Normal and disrupted lumbar longitudinal ligaments: correlative MR and anatomic study.

The posterior and anterior longitudinal ligaments of the lumbar spine appear on magnetic resonance (MR) images as thin lines of very low signal intensity in all spin-echo sequences. They cover the periphery of the outer fibers of the anulus fibrosus on sagittal images. The lumbar spine of 17 patients with 19 disk herniations was prospectively evaluated with MR imaging, and these findings were correlated with surgical findings. At surgery the posterior ligament was found to be disrupted in eight cases and intact in 11. Absence of a low-signal peripheral line around the herniated nucleus pulposus (HNP) was the most reliable sign of ligament rupture (no false-negative or false-positive findings). The peripheral line appeared to be interrupted in four cases, two of which were falsely positive. The two false-positive cases were related to a chemical shift artifact between epidural fat and the HNP. Presence of a normal and continuous peripheral line outlining the HNP excluded ligament disruption. The overall sensitivity for detecting disruption was 100%, and the specificity was 78%.

Adult↗
PubMed1989

[Evolutive atlanto-axial luxation revealing chronic inflammatory rheumatism in children].

Atlanto-axial luxation in uncommon in chronic arthritis in childhood, especially early in the course of the disease. One case is described in which atlanto-axial luxation occurred early. Computed tomographic myelography showed the cervico-medullary compression which was treated by transoral anterior decompression and posterior occipito-cervical fusion.

Adolescent↗
PubMed1989

[Extensive resection of primary malignant tumors of the sacrum].

The most common primary tumors of the sacrum are chondrosarcoma, and giant cell tumors. These tumors can display a great development at the time of first examination on account of their slow growth, delayed expression of pelvic organs compression and metastases. The spontaneous long lasting evolution of sacral primary tumors is disastrous with neurological involvement, painful visceral complications and a high incidence of lethal evolution. Local control and cure of these tumors is possible only if radical resection is done regardless to neurological sequelae. The author proposes a surgical procedure for a carcinologic resection using two different anterior and posterior approaches in one stage with two teams. Six patients were treated in this way and the follow-up ranges from 5 to 11 years. One patient died two years post-operatively (malignant teratoma); the others survive: 2 chordomas (11 and 5 years post-op.), 2 chondrosarcomas (8 and 6 years pos-op.) and 1 giant cell tumor (6 years post-op.). These results with prolonged survival without recurrence justify our proposal of an aggressive surgical approach to treat these malignant tumors.

Adult↗