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Purpose Nocardia farcinica is an opportunistic pathogen causing mainly pneumonia in immunocompromised patients, complicated in almost one-third of the cases by a thick-walled multiloculated cerebral abscess which induces significant morbidity and mortality. This review aims to assess the optimal treatment strategy for N. farcinica cerebral abscess. Methods Report of a case. Medline database was used to conduct a systematic review from inception to January 2020 looking for English-language articles focused on N. farcinica cerebral abscess, in accordance with the PRISMA guidelines. Results The research yielded 54 articles for a total of 58 patients. N. farcinica cerebral abscess displayed three different neuroimaging patterns: a single multiloculated abscess in half of the cases, multiple cerebral abscesses, or a small paraventricular abscess with meningitis. The patients who benefited from surgical excision of the abscess showed a trend towards a lower risk of surgical revision (8% versus 31%, P = 0.06) and a lower mortality rate (8% versus 23%, P = 0.18) than patients who benefited from needle aspiration. Twenty-two percent of the patients benefited from microbiological documentation from another site with a mortality rate of 23%. Conclusion Urgent multimodal MRI is necessary in face with clinical suspicion of cerebral nocardiosis. In case of single or multiple small cerebral abscesses, microbiological documentation can be obtained with puncture of pseudotumoral visceral lesions. In case of large or symptomatic cerebral abscess, an aggressive surgical excision seems a reliable option and can be preferred over needle aspiration. Long-term antibiotic therapy with cotrimoxazole is necessary thereafter.

BACKGROUND Post-operative complications do occur in all neurosurgical departments, but the way they are defined, and their true incidence vary a lot. The aim of the present study is to objectively assess the morbidity and mortality related to all neurosurgical procedures performed in our department and provide insight on their main causes and identify key factors to reduce their incidence. METHODS Data were retrieved from a prospectively-maintained database regarding all patients undergoing a cranial or spinal neurosurgical procedure between November 2016 and April 2016 in the neurosurgical department in Timone University Hospital (APHMMarseille). Patients undergoing a functional, pediatric or interventional neuroradiological procedures were not included. RESULTS The medical records of a total number of 963 patients were analyzed. A postoperative complication occurred in 208 patients (21.6%) including 115 (26.6%) in the cranial surgery group and 93 (17.5%) in the spinal surgery group. A complication occurred 1.5 more frequently in the cranial than in the spinal surgery group. Cranial surgery is 1.5 times more at risk of complications than spinal surgery (p=0.007). Preoperative comorbidities (ASA score > 3 to 4) were significantly associated with the occurrence of complications (p

Background Since the nineteenth century, a great variety of crossed brainstem syndromes (CBS) have been described in the medical literature. A CBS typically combines ipsilateral cranial nerves deficits to contralateral long tracts involvement such as hemiparesis or hemianesthesia. Classical CBS seem in fact not to be so clear-cut entities with up to 20% of patients showing different or unnamed combinations of crossed symptoms. In terms of etiologies, acute brainstem infarction predominates but CBS secondary to hemorrhage, neoplasm, abscess, and demyelination have been described. The aim of this study was to assess the proportion of CBS caused by a bleeding episode arising from a brainstem cavernous malformation (BCM) reported in the literature. Case presentation We present the case of a typical Foville syndrome in a 65-year-old man that was caused by a pontine BCM with extralesional bleeding. Following the first bleeding episode, a conservative management was decided but the patient had eventually to be operated on soon after the second bleeding event. Discussion A literature review was conducted focusing on the five most common CBS (Benedikt, Weber, Foville, Millard-Gubler, Wallenberg) on Medline database from inception to 2020. According to the literature, hemorrhagic BCM account for approximately 7 % of CBS. Microsurgical excision may be indicated after the second bleeding episode but needs to be carefully weighted up against the risks of the surgical procedure and openly discussed with the patient. Conclusions In the setting of a CBS, neuroimaging work-up may not infrequently reveal a BCM requiring complex multidisciplinary team management including neurosurgical advice.

Purpose. The aim of this study is to analyze results according to postoperative pelvic incidence-lumbar lordosis (PI-LL) mismatch in the management of adult spine deformity (ASD) patients. Recently, it has been reported that in addition to lumbar lordosis amount, lordosis repartition between its proximal and distal parts was crucial. Methods. We enrolled 77 consecutive ASD patients who underwent posterior spinal fusion and deformity correction between 2015 and 2018. On preoperative and 1-year follow-up radiographs, we analyzed different parameters such as L1-S1 lumbar lordosis, L1-L4 proximal lordosis (PLL), L4-S1 distal lordosis (DLL), pelvic tilt (PT), sagittal vertical axis (SVA), and PI-LL mismatch. Comparisons were performed according to postoperative PI-LL mismatch (defined as “aligned” when PI-LL was p < 0.001 , respectively). On the other hand, PT remained unchanged (30° vs. 28°, p > 0.05 ). 35 patients were classified as “aligned” and 42 as “not aligned.” Patients from the “aligned” group had a significantly lower PI than patients from the “not aligned” group (52° vs. 61°, p = 0.009 ). Postoperative PLL was not different between groups (18° vs. 16° p > 0.05 ), whereas DLL was significantly higher in the “aligned” group (31° vs. 22°, p = 0.003 ). PI-LL was significantly correlated to DLL (rho = 0.407, p < 0.001 ) but not with PLL (rho = 0.110, p = 0.342 ). Conclusions. Our results revealed that in ASD patients, postoperative malalignment was associated with a lack of DLL restoration. “Not aligned” patients had also a significantly higher pelvic incidence. Specific attention must be paid to restore optimal distal lumbar lordosis in order to set the amount and the distribution of optimal postoperative lumbar lordosis.

Surgical management of adult spinal deformities remains challenging, and one of the major goals is to restore sagittal alignment. Spinal rods used for posterior fixation are usually delivered straight and bended manually during surgery. This manual bending can be responsible for undercorrection of the deformity. In the last years, prebended patient-specific rods have been developed and might be a valuable tool in order to optimize surgical results. The objective is therefore to use the time between surgical decision and operative room in order to realize a precise surgical planning and obtain patient-specific rods. We describe here the planning process and our preliminary experience with patient-specific rods in the management of adult deformity about 77 cases. On the 77 cases, PSR were used without further modifications of the shape. Based on 3-month postoperative evaluation, a significant decrease of sagittal vertical axis (−41%, p<0.0001) and pelvic incidence-lumbar lordosis (−62%, p<0.0001) was reported. Pelvic tilt was not significantly corrected, except in patients with Parkinson’s disease. In this subgroup of patients, measurements revealed a significant correction of SVA and PI-LL (−53%, p=0.005, and −81%, p<0.0001, respectively) but also of PT (−23%, p<0.001). The use of PSR, in our experience, was feasible and provided satisfactory short-term results. It can be a valuable tool in the management of adult spinal deformities. Further studies will be needed in order to confirm these preliminary results.

Study Design: Observational study.Purpose: The actual sanitary crisis led to a massive mobilization of the sanitary system toward intensive care units and management of coronavirus disease 2019 (COVID-19) patients. However, some patients still require spinal interventions. The present study aimed to assess the impact of the COVID-19 pandemic on spine surgical in a moderate COVID-19 cluster region.Overview of Literature: Previous studies have reported screening and management of patients with spinal conditions during the COVID-19 pandemic. However, to date, knowledge, no observational study on spine surgeries during the pandemic has not been reported.Methods: Between March 17, 2020 and April 17, 2020, information on spine surgical activity was prospectively collected at our institution. This surgical activity related to the first month of confinement in France was compared to the activity during the same period in 2019 to evaluate the impact of the COVID-19 pandemic on surgical activities.Results: In order to reduce the contamination rate of patients and medical staff during hospitalization, the spine department was completely reorganized. Non-urgent elective spine surgeries were cancelled. When considering the global amount of surgeries procedures during the first month of confinement, a decrease of almost 50% was observed in the number of surgical procedures. During the study period, 62 patients were eligible for spine surgery. The numbers of patients managed for tumor and infectious cases were stable, while a considerable reduction was observed in the number of trauma and degenerative cases. During the follow-up period, two patients were tested as COVID+ during the postoperative course, and no cases of medical or paramedical staff contamination were reported using polymerase chain reaction-testing.Conclusions: During the COVID-19 pandemic, it is possible to maintain spine surgical activity. Each surgical procedure must be discussed and organized with all the caregivers involved. Indications for surgery must be in line with the scientific guidelines and adapted to each healthcare facility.

International audience

Background. Although lumbar isthmic spondylolisthesis is frequent in the Caucasian population, its association with spondylodiscitis is extremely rare. Case Description. The authors reported the case of a 44-year-old patient affected by pyogenic spondylodiscitis on previously documented isthmic spondylolisthesis at the L5-S1 level. The patient was surgically treated by circumferential arthrodesis combining anterior lumbar interbody fusion (ALIF), followed by L4-S1 percutaneous osteosynthesis using the same anesthesia. Appropriate antibiotherapy to methicillin-susceptible Staphylococcus aureus, found on the intraoperative samplings, was then delivered for 3 months, allowing satisfactory evolution on the clinical, biological, and radiological levels. Discussion. This is the first case report of spondylodiscitis affecting an isthmic spondylolisthesis surgically treated by circumferential arthrodesis. In addition to providing large samplings for analysis, it confirms the observed evolution over the past 30 years in modern care history of spondylodiscitis, increasingly including surgical treatment with spinal instrumentation, thus avoiding the need of an external immobilization. Care must nonetheless be exercised in performing the ALIF because of the inflammatory tissue increasing the risk of vascular injury. Conclusion. Spondylodiscitis occurring on an L5-S1 isthmic spondylolisthesis can be safely managed by circumferential arthrodesis combining ALIF then percutaneous osteosynthesis in the same anesthesia, obviously followed by appropriate antibiotherapy.

Minimally invasive approaches for lumbar fusion are aimed at reducing soft tissue injury in order to minimize surgical morbidity and facilitate recovery. Applied to lumbar fusion, such an approach is described as a mini-open transforaminal lumbar interbody fusion (TLIF). Important anatomical landmarks are reviewed. Indications, advantages, and limitations are discussed, and a step-by-step description of the procedure is presented. Decompression, fixation, and bone grafting can be achieved efficiently through this approach with lesser blood loss, shorter hospital stay, reduced rate of general complications, and infections as well as a lower readmission rate. The mini-open TLIF technique, as presented here, is a safe and efficient procedure to achieve lumbar fusion with a reduced rate of complications related to surgery.

International audience; Introduction.-Based on global knowledge regarding sagittal alignment, preoperative planning is a crucial point in the management of adult spinal deformity (ASD). Patient-specific rods (PSR) have been recently developed in order to change preoperative planning into a postoperative reality. The aim of this study was therefore to analyze the 1-year radiographic results of prospective ASD cohorts managed using PSR.Methods.-In this prospective study, all patients managed for an ASD using PSR since 2014 and with a minimal follow-up of 1-year were included. Radiographic parameters were evaluated pre and postoperatively and patients were stratified according to their final sagittal alignment status (A: aligned vs. MA: malaligned) according to the age-related Schwab classification. Statistical analyses were performed using the Student's-t-test in order to compare groups.Results.-Eighty-six patients were included in the study, with a mean age of 57.2 years. At one-year follow-up, mean sagittal vertical axis and pelvic incidence-lumbar lordosis mismatch were significantly improved. Twenty-two patients were aligned on both sagittal and coronal planes, 52 patients were still considered as malaligned in the sagittal plane, 3 were still malaligned in the coronal plane and 9 patients were malaligned in both planes (vs. 42 patients preoperatively). At final follow-up, the rate of mechanical complications was 18%.Conclusion.-Based on our results, patient-specific rods can represent a useful supplementary tool in the management of ASD and transform preoperative planning into a postoperative reality. Corrections rates are comparable to other series in the literature with conventional rods, and fewer complications have been reported. However, further studies will be required in order to confirm these results.

Background. The development of postural analysis thanks to force and pressure platforms, in order to determine the center of pressure, can be valuable in the setting of spinal malalignment. The purpose of this study was to compare “pressure” and “force” platforms for the evaluation of the center of pressure. In other words, can we neglect the horizontal ground reaction force in the evaluation of intersegmental moments during standing posture? Methods. Postural data from two healthy adult volunteers were analyzed. Analysis of the posture was done according to a protocol providing sagittal intersegmental moments. A set of 36 markers was used to divide the body in 10 segments. Postacquisition calculations were done in order to obtain the sagittal net intersegmental moments. To evaluate the differences in intersegmental moments between force and pressure platforms, the postacquisition calculations were done with a simulated pressure platform. Mean intersegmental moments between each body segment for each volunteer were compared. Findings. There were significant differences between the 2 platforms in intersegmental moments for the lumbo-sacral junction, hips, knees, and ankles (p<0.005). All differences were inferior to intrasubject variability measured with the force platform (p<0.001). Results from intra- and interobserver comparisons showed that differences measured with the pressure platform were all inferior to the standard error obtained with the force platform for every intersegmental moment (p<0.001). Interpretation. The use of a simulated pressure platform to determine intersegmental moments has the same clinical efficiency as force platforms. Moreover, the possibility to set the platform into the radiograph room will allow in a second time a correlation between radiographic parameters and biomechanical constraints applied to the spine.

International audience; IntroductionTrois types de fractures de C1 ont été décrits en fonction de la localisation : type 1 (arc antérieur ou postérieur), type 2 (Jefferson : arc antérieur et postérieur), type 3 (masse latérale). Leur stabilité dépend de l’intégrité du ligament transverse. L’objectif principal était d’analyser le taux de complications et de consolidation en fonction du type de fracture, de l’âge et du traitement.Matériel et méthodesLa Société française de chirurgie du rachis (SFCR) a réalisé une étude prospective multicentrique sur les traumatismes C1–C2. Tout patient avec une fracture récente diagnostiquée sur tomodensitométrie était inclus. La consolidation tomodensitométrique était étudiée à 3 mois et 1 an. Les complications médicales, neurologiques, infectieuses ou mécaniques étaient documentées sur base de données KEOPS.RésultatsSur 417 patients, 63 (15,1 %) avaient une fracture de C1. Les fractures étaient classifiées en type 1 (33,3 %), type 2 (38,1 %), type 3 (28,6 %). Le ligament transverse était intact dans 53,9 % des cas. Le traitement était orthopédique chez 63,5 %, chirurgical chez 27,0 %, chirurgical après échec du traitement orthopédique chez 9,5 % des patients. Neuf complications médicales étaient enregistrées. Elles étaient plus fréquentes chez les patients > 70 ans après chirurgie (p < 0,0001). Le taux de consolidation était de 84,2 % après traitement orthopédique, 100 % après chirurgie initiale, 33,3 % après chirurgie secondaire (p = 0,002). Dix pseudarthroses concernaient 4,8 % des fractures de type 1, 13,6 % des types 2, 33,3 % des types 3 (p = 0,001).ConclusionLes complications médicales dépendaient de l’âge et du traitement. La consolidation dépendait du type de fracture et du traitement. Le traitement orthopédique était adapté aux types 1, 2 et 3 à faible déplacement avec ligament transverse intact. L’arthrodèse C1–C2 était adaptée aux fractures de type 2 déplacés et instables. Les fractures de type 3 déplacées prédisposaient à la pseudarthrose. Une chirurgie précoce pourrait être préconisée.Niveau de preuveIII.

International audience; Hypothèse.-Les fixations percutanées par vis pédiculaire (FPVP) (FPVP) sont de plus en plus pratiquées en chirurgie du rachis, minimisant la morbidité via un moindre délabrement musculaire mais au prix d'un guidage fluoroscopique peropératoire générant une forte exposition aux rayonnements. Peu d'études ont été conduites pour les mesurer précisément. L'objectif de notre étude est de quantifier, lors d'une PPSF réa-lisé dans différents centres expérimentés respectant les recommandations actuelles de radioprotection, cette irradiation reç ue au niveau du chirurgien et du patient. Matériel et méthodes.-Nous avons inclus prospectivement 100 procédures de FPVP pour lesquelles nous avons relevé les doses d'irradiation de l'opérateur principal. Pour chaque intervention, les doses du rayonnement absorbées sur le corps entier, les cristallins et les extrémités ont été mesurées. Résultats.-Nos résultats montrent une dose d'exposition moyenne par procédure sur le corps entier, les extrémités et les cristallins qui atteint respectivement, 1,7 ± 2,8 Sv, 204,7 ± 260,9 Sv et 30,5 ± 25,9 Sv. Discussion.-Selon ses valeurs, l'exposition des extrémités et des cristallins du chirurgien dépassera la limite annuelle admise par la Commission internationale de protection radiologique (CIPR) après respectivement 2440 et 4840 procédures. Conclusion.-Les directives récentes européennes vont réduire la dose d'exposition oculaire annuelle maximale de 150 à 20 mSv. Le nombre d'interventions chirurgicales pour ne pas atteindre le seuil oculaire, selon nos résultats, ne devra pas dépasser 645 procédures par an. Dans l'attente de la démocratisation des systèmes de neuronavigations, l'utilisation de la fluoroscopie conventionnelle expose les yeux en premier lieu et doivent donc être protégé par des verres plombés.

OBJECTIVEMeningiomas express somatostatin receptor subtype 2 (SST2), which is targeted by the somatostatin analog octreotide. However, to date, using somatostatin analog therapy for the treatment of these tumors in clinical practice has been debated. This study aims to clarify the in vitro effects of octreotide on meningiomas for precise clinical applications.METHODSThe effects of octreotide were analyzed in a large series of 80 meningiomas, including 31 World Health Organization (WHO) Grade II and 4 WHO Grade III tumors, using fresh primary cell cultures to study the impact on cell viability, apoptosis, and signal transduction pathways.RESULTSSST2 mRNA was detected in 100% of the tested meningiomas at levels similar to those observed in other SST2-expressing tumors, neuroendocrine tumors, or pituitary adenomas. Octreotide significantly decreased cell proliferation in 88% of meningiomas but did not induce cell death. On average, cell proliferation was more inhibited in the meningioma group expressing a high level of SST2 than in the low-SST2 group. Moreover, octreotide response was positively correlated to the level of merlin protein and inversely correlated to the level of phosphorylated p70-S6 kinase, a downstream effector of the PI3K/Akt/mammalian target of rapamycin (mTOR) pathway. Octreotide inhibited Akt phosphorylation and activated tyrosine phosphatase without impacting the extracellular regulated kinase (ERK) pathway.CONCLUSIONSOctreotide acts exclusively as an antiproliferative agent and does not promote apoptosis in meningioma in vitro. Therefore, in vivo, octreotide is likely to limit tumor growth rather than induce tumor shrinkage. A meta-analysis of the literature reveals an interest in octreotide for the treatment of WHO Grade I tumors, particularly those in the skull base for which the 6-month progression-free survival level reached 92%. Moreover, somatostatin analogs, which are well-tolerated drugs, could be of interest for use as co-targeting therapies for aggressive meningiomas.

International audience; Pasireotide is a somatostatin analog (SSA) that targets somatostatin receptor subtype 1 (SST1), SST2, SST3, and SST5 with a high affinity. Pasireotide has a better antisecretory effect in acromegaly, Cushing's disease, and neuroendocrine tumors than octreotide. In this study, we compared the effects of pasireotide to those of octreotide in vitro on meningioma primary cell cultures, both alone and in combination with the mTOR inhibitor everolimus. Significant mRNA expression levels of SST1, SST2, and SST5 were observed in 40.5%, 100%, and 35% of meningioma samples, respectively. Pasireotide had a significantly stronger inhibitory effect on cell proliferation than octreotide. The effect of pasireotide, but not of octreotide, was significantly stronger in the group expressing the highest level of SST1 mRNA. Combined treatment with pasireotide and everolimus induced a higher reduction in cell viability than that with octreotide plus everolimus. Moreover, pasireotide decreased Akt phosphorylation and reversed everolimus-induced Akt hyperphosphorylation to a higher degree than octreotide. Using 4E-BP1 siRNA (si4E-BP), we demonstrated that 4E-BP1 protein silencing significantly reversed the response to everolimus, both alone and in combination with SSAs. Moreover, si4E-BP completely reversed the inhibition of cyclin D1 expression level and the increase in p27kip1 induced by SSAs, both alone and in combination with everolimus. Our results strongly support the need for further studies on the combination of pasireotide and everolimus in medical therapy for meningiomas.

Despite being one of the most frequent soft-tissue sarcomas, well-differentiated liposarcoma has never been reported near the spine. The authors present the case of a 67-year-old man with progressive history of back pain. Physical examination revealed a mass located within the right paravertebral muscles. MR and CT imaging showed a heavily ossified central mass surrounded by a peripheral fatty component. No connection with the underlying bone was detected on imagery and during surgery. After surgical resection, histopathological examination revealed a tumor harboring combined features of well-differentiated liposarcoma and low-grade osteosarcoma. Tumor cells displayed overexpression of MDM2, CDK4, and P16 by immunohistochemistry and CGH revealed amplification of 12q13-15 as the only genetic imbalance. MDM2 FISH analysis was performed but was inconclusive. The pathological, immunohistochemical, and genetic features, the differential diagnoses, and the therapeutic management of this unusual tumor are discussed. No complementary treatment was performed initially. Following first treatment, two recurrences occurred 6 and 9 years later, both displaying histological features similar to the first occurrence. Radiotherapy was started after the second recurrence. Follow-up shows no evidence of disease 11 years after initial diagnosis. This case was unusual due to the paravertebral location of the tumor and its divergent differentiation.

Objective: This study is to estimate the diagnostic accuracy of Tokuhashi and Tomita scores that assures 6-month predicting survival regarded as a standard of surgical treatment. Method: We searched PubMed, EMBASE, European PubMed central, and the Cochrane library for papers about the sensitivities[for full text, please go to the a.m. URL], 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

International audience; OBJECTIVE: To analyze complications of endoscopic transsphenoidal surgery (ETS) for nonfunctioning pituitary macroadenomas (NFPAs).ăMETHODS: A retrospective study of 300 NFPAs was performed. Complications and factors that could influence these complications were analyzed.ăRESULTS: Visual and pituitary functions worsened in 2.4% and 13.7% of cases, respectively. Postoperative diabetes insipidus was permanent in 6.2% of cases. Postoperative meningitis occurred in 3.3% of patients. Meningitis was strongly associated with intraoperative cerebrospinal fluid (CSF) leaks (P = 0.01), postoperative CSF leaks (P = 0.0001), and operation times longer than 1 hour (P = 0.023). Detection of Staphylococcus aureus and preoperative treatment with mupirocin in the nostrils did not impact the occurrence of meningitis. Two patients with meningitis died (unique causes of death). Postoperative CSF leaks occurred in 2.7% of cases and were associated with intraoperative CSF leaks (P = 0.007) and permanent diabetes insipidus (P = 0.028). The rate of CSF leak decreased from 4% to 0.8% (P = 0.048) after we moved from a soft to hard reconstruction of the sella. The rate of postoperative epistaxis decreased from 6.7% to 1.25% after we stopped using monopolar coagulation (P = 0.013).ăCONCLUSIONS: ETS permits a wide view, allowing good conditions for a satisfactory resection in the majority of NFPAs. Some pitfalls of endoscopy can lead to complications that improve with modification of the operative technique (i.e., CSF leak and postoperative epistaxis). This study confirms an acceptable rate of complications associated with ETS.

Introduction Anterior approach indications in unstable thoracolumbar fractures (UTLF) are debated. The aim of this study was to evaluate the results of anterior fixation and expandable prosthetic vertebral body cage (EPVBC) implantation alone or combined with a posterior approach in the management of UTLF. Materials and methods Ninety-three patients underwent anterior fixation with implantation of an EPVBC for UTLF from T7 to L5. Long-term kyphosis and vertebral height loss reduction, functional outcomes including visual analogical scale and Oswestry disability index were evaluated. Results Anterior fixation led to a significant increase of vertebral body height with a gain of 13% after a previous posterior approach, 38% after a single anterior approach and 65% after combined posterior and anterior approaches ( P = 0.0001). However, anterior fixation did not significantly enhance the vertebral regional kyphosis angle ( P = 0.08), except in cases of single anterior approach for thoracic fractures ( P = 0.03). No significant difference was found between early, 3 months and 1 year postoperative vertebral regional kyphosis angle and vertebral body height ( P = 0.6). Complete fusion was routinely observed at 1 year postoperatively. rhBMP2 implantation in selected cases appears to be a safe and reliable strategy. No infections or surgical revisions were observed after the anterior approach. Conclusion Anterior approach and EPVBC implantation, in UTLF, is a safe and effective procedure, providing long-term vertebral body height and kyphosis correction. Adverse effects of anterior approach remain acceptable. Single anterior fixation is a reliable surgical alternative in thoracic fractures without posterior spine segment injury or spinal cord compression. These results prompted us to extend anterior approach indications in oncology and infectious diseases.

Introduction. While thoracolumbar fractures are common lesions, no strong consensus is available at the moment.Objectives. The aim of this study was to evaluate the results of a minimal invasive strategy using percutaneous instrumentation and anterior approach in the management of thoracolumbar unstable fractures.Methods. 39 patients were included in this retrospective study. Radiologic evaluation was based on vertebral and regional kyphosis, vertebral body height restoration, and fusion rate. Clinical evaluation was based on Visual Analogic Score (VAS). All evaluations were done preoperatively and at 1-year follow-up.Results. Both vertebral and regional kyphoses were significantly improved on postoperative evaluation (13° and 7° versus −1° and −9° P<0.05, resp.) as well as vertebral body height (0.92 versus 1.16,P<0.05). At 1-year follow-up, mean loss of correction was 1°. A solid fusion was visible in all the cases, and mean VAS was significantly reduced form 8/10 preoperatively to 1/10 at the last follow-up.Conclusion. Management of thoracolumbar fractures using percutaneous osteosynthesis and minimal invasive anterior approach (telescopic vertebral body prosthesis) is a valuable strategy. Results of this strategy offer satisfactory and stable results in time.

Introduction. Management of elderly patients with thoracolumbar fractures is still challenging due to frequent osteoporosis and risk of screws pull-out. The aim of this study was to evaluate results of a percutaneous-only procedure to treat these fragile patients using cement-augmented screws.Methods. 12 patients diagnosed with a thoracolumbar fracture associated with an important loss of bone stock were included in this prospective study. Surgical procedure included systematically a percutaneous osteosynthesis using cemented fenestrated screws. When necessary, additional anterior support was performed using a kyphoplasty procedure. Clinical and radiographic evaluations were performed using CT scan.Results. On the whole series, 15 fractures were diagnosed and 96 cemented screws were inserted. The difference between the pre- and postoperative vertebral kyphosis was statistically significant (12.9° versus 4.4°,P=0.0006). No extrapedicular screw was reported and one patient was diagnosed with a cement-related pulmonary embolism. During follow-up period, no infectious complications, implant failures, or pull-out screws were noticed.Discussion. Aging spine is becoming an increasing public health issue. Management of these patients requires specific attention due to the augmented risk of complications. Using percutaneous-only screws fixation with cemented screw provides satisfactory results. A rigorous technique is mandatory in order to achieve best outcomes.

Mutations in the gene encoding isocitrate dehydrogenase enzyme isoforms 1 (IDH1) and 2 (IDH2) have recently been identified in a large proportion of glial tumors of the CNS, but their mechanistic role in tumor development remains unclear. Here, we assessed the actual impact of IDH1 and IDH2 mutations in patients harboring WHO grade II and III gliomas. We sequenced IDH1 at codon 132 and IDH2 at codon 172 in 33 patients with WHO grade II and III gliomas who benefited from a preoperative (18)F-FDG positron emission tomography (PET). Immunohistochemical expression of Hypoxia Inducible Factor-1alpha (HIF-1α), Carbonic Anhydrase IX (CAIX), Glucose Transporter 1 (GLUT1) and Caspase 3 active form (CASP3) along with the R132HIDH1 mutation was assessed in all cases as well as 1p/19q deletion status and p53 expression. HIF-1α expression was found in 15% of IDH-mutated compared to 7.7% of IDH-nonmutated tumors (P = 0.954). Also, GLUT-1 positive staining was found in 5% of IDH-mutated and in 7.1% of IDH-nonmutated tumors (P = 0.794). Finally, CA-IX expression was found in 15% of IDH-mutated and in 7.7% of IDH-nonmutated tumors (P = 0.484). The combined expression of these three hypoxic markers was found in two WHO grade III tumors, one of which was IDH-mutated whereas the other was IDH-nonmutated (P = 0.794). In IDH-mutated tumors, the median SUVmax ratio was 2.24 versus 2.15 in IDH-nonmutated tumors (P = 0.775). Together, these data question the actual relationship between IDH mutation status and in vivo hypoxic biomarkers expression in WHO grade II and III gliomas.

The recurrence and progression of treated intracranial meningiomas highlights the problem of the type of follow-up that should be used and whether early complementary treatment is indicated. The aim of this study was to evaluate different biochemical markers involved in cell proliferation and transformation to identify new prognostic factors in intracranial meningiomas. Between 1989 and 2003, 120 intracranial meningiomas were studied biochemically. The levels of estrogen receptors (RE), progesterone receptors (RP), cathepsin B (CB), cathepsin L (CL), stefin A (ATA), stefin B (STB), cystatin C (CYSC), urokinase (u-PA), type 1 plasminogen activator inhibitors (PAI-1), cathepsin D (CD) and thymidine kinase activity (TK) were measured in tumor extracts using biochemical assays. Results Out of 120 meningiomas, 73 were grade I, 39 grade II and eight grade III according to the WHO classification. Of these patients, 17 showed recurrence. The mean follow-up was 47 months. Monofactorial analysis showed that expression of progesterone receptors (RP) had an inverse correlation with recurrence (p = 0.0025 %) and that thymidine kinase activity (TK), cathepsin L (CL), the WHO grade and the degree of tumor resection correlated with recurrence (p

>Les tumeurs cerebrales primitives malignes font partie des 10 premieres causes de deces par cancer et leur incidence, en augmentation, est estimee a 6-7/100000. Les tumeurs du systeme nerveux central (SNC) posent un probleme de sante publique du fait de la morbidite associee, de la gravite des formes les plus malignes qui demeurent incurables et enfin des populations affectees. En effet, les tumeurs cerebrales touchent particulierement les jeunes et elles constituent le deuxieme cancer chez les 15-34 ans. Le pronostic des gliomes malins est influence par l'âge, l'indice de performance Karnofsky (IK), le Mini-Mental Status (MMS), le type de chirurgie, l'histologie, la dose de radiotherapie delivree, facteurs dont la combinaison definit 6 groupes pronostiques distincts, ou la survie mediane varie de 4,6 a 58,6 mois.

To determine the potential value of multimodal MRI for the presurgical management of patients with brain tumors, we performed combined magnetic resonance imaging (MRI) and proton MR spectroscopy (MRS) in 164 patients who presented with tumors of various histological subtypes confirmed by surgical biopsy. Univariate statistical analysis of metabolic ratios carried out on the first 121 patients demonstrated significant differences in between-group comparisons, but failed to provide sufficiently robust classification of individual cases. However, a multivariate statistical approach correctly classified the tumors using linear discriminant analysis (LDA) of combined MRI and MRS data. After initial separation of contrast-enhancing and non-contrast-enhancing lesions, 91% of the former and 87% of the latter were correctly classified. The results were stable when this diagnostic strategy was tested on the additional 43 patients included for validation after the initial statistical analysis, with over 90% of correct classification. Combined MRI and MRS had superior diagnostic value compared to MRS alone, especially in the contrast-enhancing group. This study shows the clinical value of a multivariate statistical analysis based on multimodal MRI and MRS for the noninvasive evaluation of intracranial tumors.

IntroductionInterbody fusion is the gold standard treatment for the management of numerous diseases of the spine. Minimally invasive techniques may be more beneficial than conventional techniques. The main goal of this study was to report the one-year postoperative results of a series of posterior lumbar interbody fusions by a minimally invasive technique in relation to improvement in functional outcome, interbody fusion and morbidity.Materials and methodsBetween January 2012 and May 2013, 182 patients treated by minimally invasive posterior transforaminal lumbar interbody fusion (TLIF) were included in this prospective multicenter study. Clinical assessment was based on a comparison of the preoperative and one-year postoperative Oswestry (ODI), SF-12 and Quebec Scores and the Visual Analog Scale (VAS). Surgical and postoperative follow-up data were evaluated. Radiological assessment was based preoperative and one-year postoperative full spine teleradiographs. Interbody fusion at one-year was systematically evaluated by CT scan.ResultsOne hundred and eighty-two patients were included, mean age 58.9 years old. Surgery lasted a mean 101minutes, mean preoperative bleeding was 143mL, and mean radiation exposure was 247.4 cGy/cm2. The rate of postoperative complications was 7.7%. The ODI, the Quebec Score, the SF-12 and the VAS were all significantly improved at one-year (P

SummaryIntroductionThe majority of osteoporotic, spinal cord compressive, vertebral fractures occurs at the thoracolumbar junction level. When responsible for neurological impairment, these rare lesions require a decompression procedure. We present the results of a new option to treat these lesions: an open balloon kyphoplasty associated with a short-segment posterior internal fixation.Materials and methodsTwelve patients, aged a mean 72.3 years, were included in this prospective series; all of them presented osteoporotic burst fractures located between T11 and L2 associated with neurological impairment. The surgical procedure first consisted of a laminectomy, for decompression, followed by an open balloon kyphoplasty. A short-segment posterior internal fixation was subsequently put into place when the local kyphosis was considered severe. A CAT scan study evaluated local vertebral body's height restoration using two pre- and postoperative radiological indices.ResultsAll of the patients in the series were followed up for a mean 14 months. Local kyphosis improved a mean 10.8 (p

Our objective was to describe the management and prevention of thoracic aortic injuries caused by a malposition of pedicle screws in corrective surgery of major spine deformities. Positioning pedicle screws in thoracic vertebras by posterior approach exposes to the risk of injury of the elements placed ahead of the thoracic spine, as the descending thoracic aorta. This complication can result in a cataclysmic bleeding, needing urgent vascular care, but it can also be totally asymptomatic, resulting in the long run in a pseudoaneurysm, justifying the systematic removal of the hardware. We report the case of a 76-year-old woman who underwent spinal correction surgery for thoraco-lumbar degenerative kypho-scoliosis. Immediately after the surgery, a thoracic aortic injury caused by the left T7 pedicle screw was diagnosed. The patient underwent a two-step surgery. The first step was realized by vascular surgeons and aimed to secure the aortic wall by short endovascular aortic grafting. During the second step, spine surgeons removed the responsible screw by posterior approach. The patient was discharged in a rehabilitation center 7 days after the second surgery. When such a complication occurs, a co-management by vascular and spine surgeons is necessary to avoid major complications. Endovascular management of this kind of vascular injuries permits to avoid an open surgery that have a great rate of morbi-mortality in frail patients. Nowadays, technologies exist to prevent this kind of event and may improve the security when positioning pedicle screws.