Biomedical subjects

S Ramaré

Publications and source records attributed to S Ramaré.

4 recordsLinked to original sources

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↗

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

[Orthopedic treatment of fractures of the lower extremity of the radius by the Judet technique. Anatomic results in function of the type of lesion: apropos of 280 cases].

PURPOSE OF THE STUDY: The authors evaluated the anatomical results and limits of the conservative treatment for displaced Colle's fracture. MATERIAL AND METHODS: The anatomical results of 280 consecutive fractures were retrospectively analysed. Conservative treatment was performed according to Judet. Stability of the reduction was assessed for grade 0, 1, 2 of Kapandji's classification. Radiographical mean follow-up for all patient was three months (2 months to 8 years). RESULTS: In 122 cases (64 per cent) mal-union was observed. Mal-union was due in 93.5 per cent of cases (114) to secondary displacement of the distal fragment and in 6.5 per cent (8 cases) to poor reduction. Secondary displacement was essentially posterior in the sagittal plane. The principal factors of instability were radial shortening superior to 3 mm (p = 0.005), patient age of 55 years of more (p = 0.004), metaphyseal comminution (p = 0.004) and degree of primary displacement in the frontal plane (p = 0.01). Stability after reduction was determined by crossing the distal fragment in relation to the anterior cortex of the proximal fragment. There were 10.5 per cent algodystrophies and 9 per cent median nerve paresthesiae which were avoided by 45 degrees of wrist flexion. DISCUSSION: Judet's conservative treatment is indicated in extra-articular Colle's fractures (grade 0, 1, 2 of Kapandji's classification), after evaluation of factors of instability, secondary displacement and mal-union. Minor mal-unions may be well tolerated, and do not seem to affect wrist function with 3 mm of radial shortening and 10 degrees of radial glenoid posterior angulation on the sagittal plane.

Adolescent↗

PubMed1997

Surgery of the deformities in ankylosing spondylitis: our experience of lumbar osteotomies in 31 patients.

Corrective surgery for kyphotic deformities of the spine in ankylosing spondylitis is a major surgery for rare indications. The authors report 31 lumbar osteotomies. The goal is to correct the deformity through a posterior limited approach and to minimise the neurological risks. The modifications developed by the authors for monosegmental closing wedge osteotomies are explained. The posterior resection is rhomboid shaped with a bilateral lamina removal. An osteotomy is performed in a forwards direction on the lateral aspects of the vertebral body without bone resection. This osteoclasty allows progressive vertebral body compression. Pediclectomy is associated if the corresponding foramen at the osteotomy level becomes too narrow in the process of redressing the spine. The resection level is adjusted so that superior and inferior posterior arches come into contact with a good compression. The authors point out the risk of lateral translation. Before the osteotomy, the two adjacent vertebrae are implanted with 5-mm cylindrical pedicular screws, so that posterior fixation can be carried out at any time. Posterior monobloc fixation allows for very great compression of the osteoclasty. The authors compare the results of their experiences in opening and closing osteotomy. They progressively changed their technique for closing osteotomies, because of published vascular complications and mechanical risks (instability and pseudarthrosis in opening osteotomies). Closing osteotomy also minimises the risk of stenosis with radicular compression or traction if an important correction is performed. The level of the osteotomy varied in this series, which had a correction rate of up to 75 degrees. The choice of level depends on secondary effects on pelvic position and projection of the centre of gravity. The preferred procedure remains a monosegmental correction because it is faster and easier, with minimum bleeding. Short monobloc posterior fixation is sufficient to maintain reduction and to obtain stability from posterior compression.

Adult↗