Biomedical subjects

R Trabelsi

Publications and source records attributed to R Trabelsi.

7 recordsLinked to original sources

PubMed2002

[Systematic circumferential (360 degree) decompression treatment of major arthrotic cervical stenosis].

PURPOSE OF THE STUDY: Worsening and irreducible evolution of neural involvement in cervical stenosis requires cord decompression. Different techniques have been proposed. We associated a dual posterior then anterior approach to achieve 360 degrees decompression. We evaluated results on the basis of neurological and mechanical outcome. MATERIAL AND METHODS: Twenty-eight patients, 16 men and 12 women, mean age 60.2 years (range 40-82) underwent surgery between 1989 and 1999 for severe cervical canal stenosis. Patients were referred for neurological symptoms: 20 for radicular symptoms (8 pain, 11 motor deficit, 12 sensitive deficit). Fifteen patients presented myelopathic symptoms. Pyramidal syndrome in 11 and tetraparesia in 3. Neurological involvement was scored according to Nurick (average 1.74) and JOA (average 12.6). Pain was scored on the Robinson scale. Levels to decompress were identified on static and dynamic plain x-rays, CT scans and MRI. Myelography was rarely used (first case only). MRI demonstrated preoperative myelomalacia in 5 patients and syringomyelia in 2. The surgical technique for 360 degrees fusion involved two steps, performed with a 1-week interval for 12 patients and during the same procedure for the others. The first approach was posterior enabling spine fixation with bilateral Roy-Camille plates and decompression by laminectomy using the lobster shell technique. The anterior approach consisted in corpectomy with the Simmons technique (22 cases or multilevel interbody fusion according to Robinson. Iliac bone grafting was used in all but one patient who had a fibular bone graft. Mean follow-up was 18.5 months (6-78). RESULTS: Neurological improvement was 1.74 to 0.92 on the Nurick sclae and from 12.6 to 15.2 on the JOA scale at last follow-up. Fusion was obtained in all cases. There were 2 cases of neurological worsening and one transient dysphagia. Operative bleeding for the two steps was 700 ml (150 ml for the posterior procedure and 400 ml for the anterior procedure). CONCLUSION: 360 degrees arthrodesis for severe cervical canal stenosis provides a satisfactory solution to mechanical problems and substantial neurological improvement. Fusion is regularly obtained without complementary anterior instrumentation. Neurological improvement is correlated with disease duration and the degree of deficit at onset. Anteroposterior decompression and 360 degrees fusion provide cure for all the components of stenotic disease. The dual approach is indicated in severe cases with cord involvement as recognized by myleopathic clinical manifestations and on the MRI.

Adult↗

PubMed2001

[Congenital hypoplasia of lumbosacral articular process: report of a case, review of the literature, and therapeutic proposition].

Congenital hypoplasia of the lumbosacral process is an uncommon cause of recurrent lumbalgia. The 37 cases reported in the literature illustrate the complexity of the pathological implications of these anomalies. We report another case and our diagnostic methodology. We propose lumbosacral arthrodesis which provided complete relief in our patient. This satisfactory outcome has been maintained at one year.

Abnormalities, Multiple↗

PubMed2000

Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain.

The objective of this study was to conduct a radiological analysis of posture before and after lumbosacral fusion to evaluate the influence of spinal alignment on the occurrence and pattern of post surgical pain. The study included 81 patients, of whom 51 had a history of previous low back surgery. We excluded patients with suspected or confirmed nonunion. In the fusion group, the 27 patients who were pain free after the procedure were compared to the 54 patients with residual pain. Thirty patients had pain only or primarily when they were standing immobile, 18 when they were sitting immobile, and six in both positions. Measurements were done on full-length lateral radiographs of the spine, with the patient standing according to Duval Beaupère criteria. The subgroup with postfusion pain was characterized at baseline by a more vertical sacrum with less sacral tilt (ST) (P < 0.0062) and more pelvic tilt (PT) (P < 0.0160). PT at last follow-up (PT fu) correlated with the presence of postfusion pain (NP: P = 0.0003). In the patients with postfusion pain, PT was almost twice the normal value. ST at last follow-up (ST fu) in the standing position was also correlated with the presence of postfusion pain (P < 0.0001) indicating that the sacrum remained abnormally vertical in the subjects with postfusion pain. Using logistic regression, the only prognostic factor for residual pain at last follow-up was ST fu. Both at pre-operative evaluation and at last follow-up, patients with pain in the standing position or in both the standing and sitting positions were characterized at pre-operative status by a more vertical sacrum with less sacral tilt. The results of this study indicate that, achieving a strong fusion should not be the only goal. Appropriate position of the fused vertebrae is also of paramount importance to minimize muscle work during posture maintenance. The main risk is failing to correct or to causing excessive pelvic retroversion with a vertical sacrum leading to a sagittal alignment that replicates the sitting position. This situation is often accompanied by loss of lumbar lordosis and adversely affects stiff or degenerative hips.

Adult↗

PubMed2000

[Comminuted fractures in multiple trauma patients: an analysis of 31 cases].

PURPOSE OF THE STUDY: We analyzed calcaneum burst fractures in multiple trauma patients and propose a management scheme. MATERIAL AND METHODS: In a retrospective study, we isolated 23 patients with 31 calcaneum burst fractures. All were stage V in the Duparc classification. We call them "pied de mine" fractures as they resembled those described in military reports. Half of them (16 cases; 54%) were open fractures. All patients suffered multiple injuries and 12 had a psychiatric history. These fractures were associated with spinal fracture in 17 cases (73%) and half had neurologic deficit, limb fracture in 16 (73%), and pelvic fracture in 12 (52%). The most frequent associated foot injuries were a talus fracture in 9 cases (29%) and Chopart displacement in 10 cases (32%). Clinical evaluation used the Maryland foot score, foot print and radiologic evaluation with lateral retrotibial view. RESULTS: Mean follow-up was 35 months. Mean Maryland foot score was 62.7 and 13 cases were pain free. Pain was due to conflict with the lateral malleolus, bony plantar thorns, medial malleolus and subtalar osteoarthritis. Orthopedic shoes were used 11 times. The other patients used sports shoes. Subtalar mobility was most frequently absent (23/29 cases, 2 amputations). Foot print showed 13/16 flat feet; 6 thorns were indirectly visible. Two patients had retraction toes and were initially treated by external fixation. Radiologic evaluation showed 23/29 complete subtalar arthrodeses, 23/29 migration of the great tuberosity, often(17/23 cases) associated with varus angulation. Eleven patients needed subsequent surgery: 5 for arthrodeses and 6 for resection of bony thorns. Rate of complication was high, especially for open fractures: 2 infections for 15 closed fractures, and 8 infections (50%) for 16 open fractures with 2 cases of chronic osteitis. Secondary amputation was required in 2/31 cases due to sepsis. TREATMENT PROPOSITIONS: For closed calcaneum burst fractures, it is better to wait one week before osteosynthesis. This delay is used to decrease edema with limb elevation and compressive bandaging. Skin tension due to trauma is increased by edema and osteosynthesis gives a high risk of wound disunion. We recommend reduction and Y-plate fixation even for burst fracture. Reduction must lower the tuberosity and correct the varus. After surgery, subtalar spontaneous arthrodesis is usually observed in a good position. Any bony plantar thorn must be resected. For open calcaneum burst fracture, the risk of sepsis is high. First treatment is debridement, stabilization and external fixation with antibiotic therapy. Stabilization should improve vascularization and facilitate internal fixation. The external fixation can be placed on the medial side to free the lateral approach to the calcaneum. Flap repair can be performed after one week when skin tension has subsided and areas of necrosis controlled.

Adult↗

PubMed1999

Anatomic basis of minimal anterior extraperitoneal approach to the lumbar spine.

Anterior lumbar spine approaches may be indicated for fusion in degenerative lumbar spine disorders or to fill discal and bone gaps after fracture reduction. We present an anterior extraperitoneal approach applicable to any discal and vertebral levels from T12 to S1. The anatomic study, based on 25 cadavers, highlights retroperitoneal dissection principles for easy kidney and duodenopancreatic mobilisation and direct left anterior access to the entire lumbar spine. We established a precise description of the lumbar veins and the anastomoses between the left renal vein and hemiazygos system, in order to define different topographic and anatomic factors related to safe and easily reproducible approaches for cage or graft implementation. Independent of the level and previous intraperitoneal surgery, lumbar spine access with this approach safeguards the kidney, ureter, spleen, hypogastric plexus and duodenopancreatic system. Regarding operating time, blood-loss and possibilities for freshening and grafting, this technique seems an effective counterbalance to the difficulties and complex technology of endoscopic approaches. The clinical study includes our first 42 cases in traumatic and degenerative lesions. Avoiding the neurologic or hemorrhagic risk inherent in classical posterior lumbar interbody fusion (PLIF) techniques, it can be considered as a reasonable and valid alternative. This technique could be used in the near future for mini invasive discal prosthesis insertion.

Cadaver↗

PubMed1999

Vertical atlantoaxial dislocation.

An unusual case of vertical atlantoaxial dislocation without medulla oblongata or spinal cord injury is reported. The pathogenic process suggested occipito-axial dislocation. The case was treated surgically with excellent results on mobility and pain.

Arthrodesis↗

PubMed1998

[Practical aspects of knee anatomy].

The anatomy of the knee provides a standardised description of articular surfaces, ligament and tendinous insertions in order to understand the combined action of the femoro-tibial and femoro-patellar compartments, as well as their stabilisation mechanisms. Nevertheless, the isolated vision of the articulation is insufficient; one also needs to study the global action of the limb by integrating the rotation of the whole skeletal body and its positions in the sagittal and frontal plans.

Biomechanical Phenomena↗