Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · Nov 2008
[Dynamic stabilisation and compression without fusion using Dynesys for the treatment of degenerative lumbar spondylolisthesis: a prospective series of 25 cases].
We used the Dynesys stabilization to treat degenerative lumber spondylolysis by decompression without fusion with the objective of decreasing the morbidity related to instrumented arthrodesis in older patients yet preventing progression of the displacement. ⋯ The most logical indication for this instrumentation is the older subject aged at least 65 years with degenerative lumber spondylolysis and a predominantly self-reducible angular displacement and satisfactory disc height. This context (group 3 in our series) occurs in patients with a weak sacral slope and incidence, as well as minimal lordosis adapted to the pelvic parameters. The Dynesys instrumentation can be a palliative alternative to fusion for more advanced degenerative lumber spondylolysis occurring on spines with anterior imbalance where fusion would be technically difficult in terms of correction of the kyphosis or because of the general risk factors.
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Rev Chir Orthop Reparatrice Appar Mot · Nov 2008
[Recurrent anterior instability of the shoulder associated with full thickness rotator cuff tear: results of surgical treatment].
Recurrent anterior dislocations associated with full thickness rotator cuff tear (RCT) carry a difficult therapeutic problem: should we treat instability and rotator cuff tear at the same time or only one of both pathologies? The goal of this study was to analyse a retrospective series of patients operated on to try to answer this question. ⋯ In case of recurrent dislocations associated with rotator cuff tear, treatment of instability should be proposed whereas the concomitant repair of the cuff depends upon the possibility to perform it: size of the rupture, fatty infiltration, age and motivation of the patients.
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Rev Chir Orthop Reparatrice Appar Mot · Nov 2008
Case Reports[Paraplegia after interlaminar epidural steroid injection: a case report].
We report the first case of paraplegia observed after epidural steroid injection in the upper spine. The patient was a 42-year-old male who underwent surgery two years earlier for stenosis of the lumbar spine from L2 to the sacrum leading to early manifestations of an equina cauda syndrome. This first operation provided satisfactory function with complete resolution of the objective neurological symptoms. ⋯ The patient's neurological status remained unchanged and four days later the T2 MRI sequence revealed a high-intensity intramedullar signal in the cone. The diagnosis of ischemia of the medullary cone was retained, hypothetically by injury to the dominant radiculomedullary artery via an undetermined mechanism. This complication has been previously described after upper foraminal steroid injections but not after intralaminar epidural steroid injection.
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Rev Chir Orthop Reparatrice Appar Mot · Nov 2008
[Surgical treatment of anterior shoulder instability in rugby players: clinical and radiographic results with minimum five-year follow-up].
In rugby players, 9 to 11% of injuries involve shoulder trauma. Anterior dislocation is one of the most severe accidents affecting the upper limb; recurrent dislocation, observed in more than 60%, appears to be related to the characteristic mechanism of injury in this sport (tackling). Surgical treatment for this instability is a bone block or capsulolabral repair. The purpose of this work was to evaluate outcome with minimum five-years follow-up after treatment by selective capsule repair in a homogeneous series of rugby players. ⋯ Young age appears to be a major factor, predictive of recurrence after a first instability accident; the type of sport would only be indirectly involved. Nevertheless, for patients playing this type of contact sports, the appropriateness of surgical stabilization can be debated; arthroscopic anatomic methods have not yet yielded results equivalent to open surgery. The results in this series are similar to those found elsewhere in the literature, but with a follow-up longer than generally reported. Anatomic reconstruction of anterior stability elements enables these patients to resume their contact sport at an equivalent level with restored joint motion.