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O Gille

Publications and source records attributed to O Gille.

5 recordsLinked to original sources
PubMed2006

[T1-T2 disc herniation: two cases].

We report two cases of exceptional first thoracic disc herniation in a 60-year-old man and a 55-year-old woman. The man was treated surgically and the woman medically. Osteoarthritis appeared to be the predominant cause of the disc herniation in both patients. Unlike the usual calcification in the medioposterior position for middle or lower thoracic spine herniations, a soft posterolateral herniation was observed here. The symptoms are limited, as observed in both patients, to a T1 radiculopathy, to be distinguished from C8 radicopathy. Myelopathy is rare. Claude-Bernard-Horner syndrome is not constant but highly suggestive. Both of these signs were absent in our patients. T1-T2 disc herniation should be suspected in patients presenting cervico-brachial medial neuralgia. MRI provides the diagnosis. Anterior surgery can be achieved without sternotomy. Careful radiographic analysis is needed preoperatively to identify the upper limit of the sternum.

Female↗
PubMed2004

[Delayed diagnosis of inferior cervical spine injury].

PURPOSE OF THE STUDY: According to data in the literature, traumatic injury of the inferior cervical spine is not recognized in 4.5 to 33% of victims. The purpose of our study was to evaluate the rate of delayed diagnosis, search for causes, and propose a diagnostic approach. MATERIAL AND METHODS: This prospective study included 284 patients recruited by eleven referral centers between November 1999 and March 2001. Each participating center completed a data chart and classified lesions. Exclusion criteria were whiplash without neurological disorder and without imaging anomaly, spinal ankylosis, and trauma more than three weeks before the first examination. RESULTS: Among the 284 patients included, 240 had a unique lesion of the inferior cervical spine, 44 had multiple injuries. In all, 338 spinal lesions were recorded. There were 35 patients with multiple trauma injuries and 95 patients with spinal cord injuries. Time to diagnosis was less than 24 hours for 211 patients (74%), one day to one week for 38 patients (14%), and more than one week for 35 patients (12%). Defective management was noted in 13% of the cases. Late diagnosis was considered to have had a prejudicial effect in nine patients (3%). There was no correlation between time to diagnosis and type of lesion, level of lesion, or presence of multiple injuries. DISCUSSION: Late diagnosis of inferior cervical spine injury can be an inevitable result of the context. This is particularly true for patients with multiple injuries or patients with purely discal or ligament injuries whose first manifestations occur late after the trauma. Beyond these specific situations, there is no logical explanation for late diagnosis other than insufficient diagnostic management. Spinal injury should always be suspected in trauma victims and the initial neurological status must be noted. If the subject is conscious, plain x-rays should be obtained in the event of pain in the cervical spine. A computed tomography is the exploration of choice. Dynamic views should be performed in all cases to search for pure ligament injury. The correct time for such explorations can only be determined on an individual basis. If the patient is unconscious, standard procedure includes x-ray of the cervical spine, and computed tomography of the skull-spine junction and the cervico-thoracic spine. Widespread systematic use of spiral and multiple array computed tomography should limit the number of late diagnoses. CONCLUSION: Late diagnosis of inferior cervical spine injury is probably not uncommon. Improved management can be achieved through better medical awareness, better knowledge of cervical spine injuries, and routine imaging in application of the rule of prudence.

Cervical Vertebrae↗
PubMed2003

Course of Modic 1 six months after lumbar posterior osteosynthesis.

STUDY DESIGN: A prospective study was conducted to investigate the outcome of the Modic Type 1 inflammatory signal in magnetic resonance imaging (MRI) in 17 patients with chronic low back pain 6 months after instrumented posterior lumbar arthrodesis. OBJECTIVE: To assess the course of the inflammatory signal after stabilization of a painful intervertebral segment by posterior instrumentation alone visualized on MRI systematically performed 6 months after the operation. SUMMARY OF BACKGROUND DATA: In 1988, Modic and colleagues described three degenerative stages of vertebral endplates and subchondral bone. The inflammatory stage, or Stage 1, is correlated with substantial functional disability. According to these authors, Stage 1 lesions naturally transform into Stage 2, the fatty stage. In the literature, patients with Modic 1 signal tend to have good results after arthrodesis, better than those with Modic 2 lesions. METHODS: This study included 17 patients (average age, 46 years) who had experienced chronic low back pain more than 1 year and showed Modic 1 changes in MRI and disc narrowing on plain radiographs. Every patient underwent posterior screw-rod osteosynthesis and posterolateral arthrodesis. Disc disease had occurred subsequently to discectomy (n = 7), rapidly destructive disc disease (n = 5), or spondylolisthesis resulting from spondylolysis (n = 5). Clinical results were assessed according to a visual analog scale for pain, a functional disability score for the evaluation of patients with low back pain (Eiffel), and the validated French version of the self-administered Dallas quality-of-life test (DRAD). RESULTS: Systematic MRI at 6 months showed transformation from Modic 1 to Modic 0 (normal endplate signal) in 4 patients and transformation from Modic 1 to Modic 2 in the remaining 13 patients. Clinical evaluation was performed at 6 months (at the same time as the MRI) and at 1 year. In every patient, there was improvement in the visual analog score and the functional score, which remained stable at 1 year. CONCLUSIONS: According to the literature, most Modic 1 lesions change to become Stage 2 lesions in 18 to 24 months. In this study, 17 patients with Modic Type 1 signal had changes after 6 months. It appears that posterior osteosynthesis combined with posterolateral arthrodesis accelerates the course of Modic 1 lesions, probably by correcting mechanical instability.

Adult↗
PubMed1998

Reduction technique for uni- and biarticular dislocations of the lower cervical spine.

STUDY DESIGN: A technical report concerning the methods of reduction of dislocations of the lower cervical spine used in 168 consecutive cases (77 unilateral and 91 bilateral dislocations). OBJECTIVES: To evaluate the efficacy of a reduction protocol comprising three successive phases: reduction by traction, reduction by closed maneuvers with the patient under general anesthesia, and open reduction. SUMMARY OF BACKGROUND DATA: Management of cervical dislocations varies greatly among spine treatment centers, especially concerning the upper limit of traction, the safety of closed manipulations in anesthetized patients, and the approach preferred when surgical reduction is necessary. METHODS: Reduction by gradual traction without anesthesia was attempted first. In case of failure, specific closed manipulations were used with the patient under general anesthesia just before anterior arthrodesis was performed. If this failed, anterior surgical reduction was attempted. Anterior fusion was performed in every patient, even when closed reduction was successful, because of the lasting instability produced by attending ligamentous lesions. RESULTS: Of the patients in 168 cases of dislocation, the protocol failed in 5, all of whom had longstanding unilateral dislocation. Of the 91 with bilateral dislocation, reduction was achieved by simple traction in 39 (43%), by maneuvers with the patient under general anesthesia in 27 (30%), and by anterior surgery in 25 (27%). Among the patients in 77 cases of unilateral dislocation, reduction was achieved by traction in 18 (23%), by external maneuvers in 28 (36%), and by anterior surgery in 26 (34%). In 7 patients, discal herniation engendering neurologic signs was resected during anterior surgery. No neurologic deterioration during or immediately after reduction by this protocol was observed. CONCLUSIONS: This protocol consists of application of rapidly progressive traction, followed if necessary by one or two reduction maneuvers with the patient under general anesthesia. If both methods fail, specific surgical procedures using an anterior exposure seem to be reliable, in that anatomic reduction was obtained in 163 of 168 patients without neurologic deterioration.

Adolescent↗