A 18-year-old woman patient suffering from JCA was operated on non-dominant left shoulder joint destruction. The dysplasia of the affected side was clearly recognisable on the X-ray befor the operation as compared to the other side. The smallest of the prothesis typs (De Puy Global, Biomet Modular) couldn’t be implanted. So we have used an other method. We have achived good results for years by using Tuto-plast‚
Aims:. The interposition arthroplasty using
Purpose of the study: Diastematomyelia is a rare spinal cord malformation defined as the presence of two separate spinal cords separated or not by an osseous, cartilaginous, or fibrous septum. Spinal malformations are almost always associated, raising difficult therapeutic challenges. Material and method: We report three cases of congenital kyphoscoliosis associated with diastematomyelia in three girls aged 12, 14 and 15 years. The diastematomyelia was dorsal in one case, thoracolumbar in one and lumbar in the third. For all three patients, the indication for surgery was progression of the scoliosis with development of neurological signs of recent progressive aggravation. Preoperative distraction with a plaster cast was pursued for several months prior to posterior instrumentation. No attempt was made to correct the cord malformation nor achieve major correction of the spinal malformation. The instrumentation bridged the thoracolumbar scoliosis in one case and stopped above the malformation in the two others. Results: The postoperative period was uneventful. There were no neurological complications. Preoperative neurological signs improved after surgery. Control radiographs showed an improvement in the deformity. At mean 6 years follow-up, these patients were not bothered in their everyday life. They had stable deformities which a globally balanced trunk. There were no signs of neurological evolution. Discussion: The therapeutic strategy for diastematomyelia remains a subject of debate. For some authors, the spinal cord should be released systematically which for the majority, this is not necessary except if spinal distraction is planned or if there is a neurological problem. If there is an indication for spinal cord release, any spurs must be removed followed by the necessary
Purpose of the study: Surgery for lumbar canal stenosis is classically an intracanalar procedure with the risk of injury of the
Introduction: Spinal cord injury (SCI) continues to challenge the healthcare and the adjunct social welfare systems. Significant advances have been made in our understanding of the pathological cascade following the initial insult. However, this has yet to be translated into clinically significant treatments and one possible reason for this is that little is known about the actual interaction between the cord and the spinal column at the moment of impact; a factor that is becoming increasingly recognised as important. Burst fractures are a common cause of SCI and are sufficiently well defined to allow significant advances to be made in developing laboratory models of the fracture process. Following on from these advances an in-vitro model of the interaction between the cord and burst fracture fragment was developed and used to perform preliminary experiments to establish those factors that are important in determining the extent of probable cord damage. Methods: A rig was developed that reliably reproduced a range of fragment-cord impact scenarios previously observed in the development of a model of the burst fracture process. In summary, a simulated bone fragment of mass 7.2 g was fired, transversely, at explanted bovine cord (within 3 hours of slaughter) with a velocity of 2.5, 5.0 or 7.5 ms-1. The cords were mounted in a tensile testing machine using a novel clamping system and held at 8 % strain. A surrogate posterior longitudinal ligament (PLL) was included and simulated in three biomechanically relevant conditions: absent, 0 % strain and 14 % strain. The posterior elements were represented by an anatomically correct surrogate. The impacts were recorded by using either a high speed video camera (4500 frames/s) or a series of fine pressure transducers. Results: The fragments were recorded to undergo the same occlusion profile as previously reported in the burst fracture model, except that the cord itself reduced the level of maximum occlusion possible. All tests displayed the fragment recoiling following maximum occlusion. The maximum occlusion and the time to this position were found to be significantly dependent on both the fragment velocity and the condition of the PLL. Similar results were observed for peak pressure. One surprising result was that maximum occlusion or time to this event did not change with or without the cord being encased in the