http://hdl.handle.net/10993/118 Search this channel search https://orbilu.uni.lu/simple-search http://hdl.handle.net/10993/45782 Title: Does lobar or size-reduced lung transplantation offer satisfactory early and late outcomes? <br/> <br/>Author, co-author: Silva, João Santos; Olland, Anne; Massard, Gilbert; Falcoz, Pierre-Emmanuel <br/> <br/>Abstract: A best evidence topic was constructed according to a structured protocol. The question addressed was whether size-reduced or lobar lung transplantation (LLTx) offers the same benefit as classic lung transplantation (LTx). Of the 147 papers found using the reported search, 9 were selected to provide the best evidence. Details of the studies regarding authors, date, journal, country of publication, study type, group studied, relevant outcomes and results are given. All studies reported survival rates of LLTx and most compared it with classical LTx. No statistical differences were reported in medium term and long term. Two of the studies reported a higher incidence of postoperative complications, such as the need for cardiopulmonary bypass, reperfusion oedema or primary graft dysfunction, and longer intubation or intensive care unit stay times. Although the largest study showed a significantly worse 1-year survival in LLTx, a sub-analysis considering patients successfully discharged showed similar outcomes at 1, 3 and 5 years when compared with classic LTx patients. We conclude that LLTx is a valid therapeutic option for recipients with significant donor size mismatch, offering similar outcomes as classical LTx in the medium term and long term. Fri, 22 Jan 2021 10:48:25 GMT http://hdl.handle.net/10993/45781 Title: Adverse events reporting in stage III NSCLC trials investigating surgery and radiotherapy <br/> <br/>Author, co-author: Iseli, Thomas; Berghmans, Thierry; Glatzer, Markus; Rittmeyer, Achim; Massard, Gilbert; Durieux, Valérie; Buchsbaum, Thomas; Putora, Paul Martin <br/> <br/>Abstract: Background: Current treatment options for stage III non-small cell lung cancer (NSCLC) consist of different combinations of chemotherapy, surgery, radiotherapy and immunotherapy. Treatment choices are highly individual decisions, in which adverse events (AEs) are relevant for decision-making. This study aims to analyse reporting of AEs in prospective stage III NSCLC trials, focussing on trials including radiotherapy and/or surgery. Methods: PubMed was searched for prospective studies dealing with stage III NSCLC from January 1987 to April 2019. Meta-analyses were screened as a positive control. Pearson’s Chi-squared test and smooth kernel distribution were used to estimate distributions. Data was resampled using bootstrapping. Results: Out of 1193 initially identified studies, 119 met the inclusion criteria. Of these, 31 had a surgical procedure in any study arm. Grade 3 and 4 AEs were reported in 94.12% and 92.44% of the included studies, respectively. Reporting of grade 5 AEs was provided in 87.39% of cases. Grade 1 and 2 AEs were less commonly reported at 53.78% and 63.03%, respectively. One study did not mention any AEs. Of the 31 treatment arms including any form of surgery, AEs were not reported in 10. Overall, 231 different AE items were reported, only 18 of them were included in at least 20% of the analysed studies. Conclusion: Overall, AE reporting in stage III NSCLC was inconsistent and inhomogeneous. Studies including surgical study arms often reported only treatment-related deaths in regards of surgical AEs. Underreporting of AEs prohibits the extraction of patient-relevant information for decision-making and represents a suboptimal use of invested resources. Fri, 22 Jan 2021 10:48:17 GMT http://hdl.handle.net/10993/45780 Title: Conversion from video-assisted thoracic surgery (VATS) to thoracotomy during major lung resection: how does it affect perioperative outcomes? <br/> <br/>Author, co-author: Seitlinger, Joseph; Olland, Anne; Guinard, Sophie; Massard, Gilbert; Falcoz, Pierre-Emmanuel <br/> <br/>Abstract: Objectives: Since video-assisted thoracic surgery (VATS) was first performed in the early 1990s, there have been many developments, and the conversion rate has decreased over the years. This article highlights the specific outcomes of patients undergoing conversion to thoracotomy despite initially scheduled VATS lung resection. Methods: We retrospectively reviewed 501 patients who underwent thoracoscopic anatomic lung resection (i.e. lobectomy, segmentectomy or bilobectomy) between 1 January 2012 and 1 August 2017 at our institution. We explored the risk factors for surgical conversion and adverse events occurring in patients who underwent conversion to thoracotomy. Results: A total of 44/501 patients underwent conversion during the procedure (global rate: 8.8%). The main reasons for conversion were (i) anatomical variation, adhesions or unexpected tumour extension (37%), followed by (ii) vascular causes (30%) and (iii) unexpected lymph node invasion (20%). The least common reason for conversion was technical failure (13%). We could not identify any specific risk factors for conversion. The global complication rate was significantly higher in converted patients (40.9%) than in complete VATS patients (16.8%) (P = 0.001). Postoperative atrial fibrillation was a major complication in converted patients (18.2%) [odds ratio (OR) 5.09, 95% confidence interval (CI) 1.80-13.27; P = 0.001]. Perioperative mortality was higher in the conversion group (6.8%) than in the VATS group (0.2%) (OR 33.3, 95% CI 3.4-328; P = 0.003). Conclusions: Through the years, the global conversion rate has dramatically decreased to <10%. Nevertheless, patients who undergo conversion represent a high-risk population in terms of complications (40.9% vs 16.8%) and perioperative mortality (6.8% vs 0.2%). Fri, 22 Jan 2021 10:48:04 GMT http://hdl.handle.net/10993/45779 Title: European Respiratory Society Statement on Thoracic Ultrasound <br/> <br/>Author, co-author: Laursen, Christian B.; Clive, Amelia; Hallifax, Rob; Pietersen, Pia Iben; Asciak, Rachelle; Davidsen, Jesper Rømhild; Bhatnagar, Rahul; Bedawi, Eihab O.; Jacobsen, Niels; Coleman, Courtney; Edey, Anthony; Via, Gabriele; Volpicelli, Giovanni; Massard, Gilbert; Raimondi, Francesco; Evison, Matthew; Konge, Lars; Annema, Jouke; Rahman, Najib M; Maskell, Nick <br/> <br/>Abstract: Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It is used in diverse clinical scenarios, including as an adjunct to clinical decision making for diagnosis, a real-time guide to procedures, and a predictor or measurement of treatment response. The aim of this European Respiratory Society task force was to produce a statement on thoracic ultrasound for pulmonologists using thoracic ultrasound within the field of respiratory medicine. The multidisciplinary panel performed a review of the literature, addressing major areas of thoracic ultrasound practice and application. The selected major areas include equipment and technique, assessment of the chest wall, parietal pleura, pleural effusion, pneumothorax, interstitial syndrome, lung consolidation, diaphragm assessment, intervention guidance, training, and the patient perspective. Despite the growing evidence supporting the use of thoracic ultrasound, the published literature still contains a paucity of data in some important fields. Key research questions for each of the major areas were identified, which serve to facilitate future multi-centre collaborations and research to further consolidate an evidence-based use of thoracic ultrasound, for the benefit of the many patients being exposed to clinicians using thoracic ultrasound. Fri, 22 Jan 2021 10:47:47 GMT http://hdl.handle.net/10993/44904 Title: Impressive weight gain after deep brain stimulation of nucleus accumbens in treatment- ­ resistant bulimic anorexia nervosa <br/> <br/>Author, co-author: Arroteia, Isabel Fernandes; Husch, Andreas; Baniasadi, Mehri; Hertel, Frank <br/> <br/>Abstract: Anorexia nervosa (AN) severely impacts individual’s mental and physical health as well as quality of life. In 21% of cases no durable response to conservative treatment can be obtained. The serious course of the disease in the most severely affected patients justifies invasive treatment options. One of the treatment methods increasingly used in recent years is deep brain stimulation (DBS). A 42-year- old woman suffering from chronic AN of the bulimic subtype shows a 46.9% weight gain and a subjective increase in quality of life, 12 months after bilateral nucleus accumbens (NAcc) DBS implantation. No improvement in comorbid depression could be achieved. DBS of the NAcc is a treatment option to be considered in severe AN when conventional treatment modalities recommended by evidence-based guidelines have not been able to bring lasting relief to the patient’s suffering. Tue, 01 Dec 2020 13:08:18 GMT http://hdl.handle.net/10993/42783 Title: Impact of Donor, Recipient and Matching on Survival After High Emergency Lung Transplantation in France <br/> <br/>Author, co-author: Roussel, Arnaud; Sage, Edouard; Massard, Gilbert; Thomas, Pascal-Alexandre; Castier, Yves; Fadel, Elie; Le Pimpec-Barthes, Françoise; Maury, Jean-Michel; Jougon, Jacques; Lacoste, Philippe; Claustre, Johanna; Dahan, Marcel; Pirvu, Augustin; Tissot, Adrien; Thumerel, Matthieu; Drevet, Gabrielle; Pricopi, Ciprian; Le Pavec, Jérôme; Mal, Hervé; D'Journo, Xavier-Benoit; Kessler, Romain; Roux, Antoine; Dorent, Richard; Thabut, Gabriel; Mordant, Pierre <br/> <br/>Abstract: Introduction: Since July 2007, the French high emergency lung transplantation (HELT) allocation procedure prioritises available lung grafts to waiting patients with imminent risk of death. The relative impacts of donor, recipient and matching on the outcome following HELT remain unknown. We aimed at deciphering the relative impacts of donor, recipient and matching on the outcome following HELT in an exhaustive administrative database. Methods: All lung transplantations performed in France were prospectively registered in an administrative database. We retrospectively reviewed the procedures performed between July 2007 and December 2015, and analysed the impact of donor, recipient and matching on overall survival after the HELT procedure by fitting marginal Cox models. Results: During the study period, 2335 patients underwent lung transplantation in 11 French centres. After exclusion of patients with chronic obstructive pulmonary disease/emphysema, 1544 patients were included: 503 HELT and 1041 standard lung transplantation allocations. HELT was associated with a hazard ratio for death of 1.41 (95% CI 1.22-1.64; p<0.0001) in univariate analysis, decreasing to 1.32 (95% CI 1.10-1.60) after inclusion of recipient characteristics in a multivariate model. A donor score computed to predict long-term survival was significantly different between the HELT and standard lung transplantation groups (p=0.014). However, the addition of donor characteristics to recipient characteristics in the multivariate model did not change the hazard ratio associated with HELT. Conclusions: This exhaustive French national study suggests that HELT is associated with an adverse outcome compared with regular allocation. This adverse outcome is mainly related to the severity status of the recipients rather than donor or matching characteristics. Tue, 10 Mar 2020 12:16:16 GMT http://hdl.handle.net/10993/42782 Title: Organized Management of Diabetes Mellitus in Lung Transplantation: Study of Glycemic Control and Patient Survival in a Single Center <br/> <br/>Author, co-author: Riou, Marianne; Renaud-Picard, Benjamin; Munch, Marion; Lefebvre, François; Baltzinger, Philippe; Porzio, Michele; Hirschi, Sandrine; Dégot, Tristan; Schuller, Armelle; Santelmo, Nicola; Reeb, Jeremie; Olland, Anne; Falcoz, Pierre-Emmanuel; Massard, Gilbert; Kessler, Laurence; Kessler, Romain <br/> <br/>Abstract: Objective: To study patient survival and glycemic control before and after lung transplantation (LTx) according to the diabetes status in patients submitted to an organized management of diabetes mellitus (DM) at the Strasbourg University Hospital, France. Material and methods: Two hundred and sixty-seven LTx recipients were included retrospectively and analyzed according to diabetes status: pretransplant diabetes, new-onset diabetes mellitus after transplant (NODAT) or no diabetes. Organized DM management was coordinated by a diabetologist trained in DM management before and after transplantation and included pretransplant screening, a close monitoring of glycemia after transplant and optimized treatment before and after LTx. Results: DM was well-controlled after transplantation: mean glycosylated hemoglobin and fasting blood glucose levels after LTx were 5.8 ± 0.2% and 5.4 ± 0.1 mmol/L respectively, in pretransplant DM patients and 5.7 ± 0.1% and 5.6 ± 0.2 mmol/L respectively, in NODAT patients. The overall median survival time was 8.3 ± 1.9 years. Pretransplant DM increased the risk of mortality (1.82-fold increase; 95% confidence interval, 1.08-3.06; P = .02) in LTx recipients. Conclusions: Organized management of diabetes achieved very satisfactory glycemic control in both pretransplant DM and NODAT patients. However, no specific protocols have been created for managing DM following LTx. As DM continues to become an increasing comorbidity in LTx, there exist a significant need of studies in this area. Tue, 10 Mar 2020 12:16:01 GMT http://hdl.handle.net/10993/42781 Title: Training Curriculum for European Thoracic Surgeons: A Joint Initiative of the European Society of Thoracic Surgeons and the European Respiratory Society <br/> <br/>Author, co-author: Massard, Gilbert; Tabin, Nathalie; Konge, Lars; Frick, Anna Elisabeth; Batirel, Hasan; Brunelli, Alessandro; Elia, Stefano; Huertgen, Martin; Molins, Laureano; Papagiannopoulos, Kostas; Subotic, Dragan; van Schil, Paul; Varela, Gonzalo; van Raemdonck, Dirk Tue, 10 Mar 2020 12:15:53 GMT http://hdl.handle.net/10993/42779 Title: Patients Treated for Central Airway Stenosis After Lung Transplantation Have Persistent Airflow Limitation <br/> <br/>Author, co-author: Mazzetta, Andrea; Porzio, Michele; Riou, Marianne; Coiffard, Benjamin; Olland, Anne; Dégot, Tristan; Seitlinger, Joseph; Massard, Gilbert; Renaud-Picard, Benjamin; Kessler, Romain <br/> <br/>Abstract: BACKGROUND: Although central airway stenosis (CAS) is a common complication after lung transplantation, its consequences have been poorly evaluated. The objective of our study was to evaluate the impact of CAS on lung function after lung transplantation. MATERIAL AND METHODS: All lung transplant recipients from June 2009 to August 2014 in a single center (Strasbourg, France) were retrospectively reviewed. RESULTS: A total of 191 lung transplantations were performed: 175 bilateral, 15 single, and 1 heart-lung transplantation. Of the 161 bilateral lung-transplanted patients who survived >3 months, 22 (13.6%) developed CAS requiring endobronchial treatment. All these patients were treated by endoscopic balloon dilatation, and 9 additionally needed endobronchial stents. Respiratory function tests demonstrated persistent obstructive ventilatory pattern despite endoscopic treatment in recipients with CAS compared to those without CAS at 6, 12, and 18 months post-transplant. At 18 months, CAS patients had significantly lower post-transplant FEV1 (1.96±0.60 L versus 2.57±0.76 L, p=0.001) and FEV1/FVC (61±14% versus 81±13%, p<0.001). The percentage of patients hospitalized for respiratory infections and number of hospital days were significantly increased in recipients with CAS (20 [91%] versus 92 [66%] p=0.036, and 144±110 days versus 103±83 days p=0.042, respectively). Survival in transplant recipients did not significantly differ between those with CAS and those without. CONCLUSIONS: CAS after lung transplantation was not associated with worse survival, but it did have a significant and persistent effect on lung function, and was associated with increased rate of respiratory infection. Tue, 10 Mar 2020 12:15:02 GMT http://hdl.handle.net/10993/42778 Title: Training Curriculum for European Thoracic Surgeons: A Joint Initiative of the European Society of Thoracic Surgeons and the European Respiratory Society <br/> <br/>Author, co-author: Massard, Gilbert; Tabin, Nathalie; Konge, Lars; Frick, Anna Elisabeth; Batirel, Hasan; Brunelli, Alessandro; Elia, Stefano; Huertgen, Martin; Molins, Laureano; Papagiannopoulos, Kostas; Subotic, Dragan; van Schil, Paul; Varela, Gonzalo; van Raemdonck, Dirk <br/> <br/>Abstract: Because of the differing definitions of the margins of thoracic surgery as a specialty and the variability in the training curricula among European countries, the European Society of Thoracic Surgeons formed a task force to elaborate a consensual proposal. The first step comprised creating a harmonized syllabus that was completed and published in 2018. This publication presents a proposal for a curriculum upon which the task force and the external expert reviewers have agreed. The curriculum was developed by the task force: each module and item describe the expected level of knowledge, skills and attitudes to be attained by the participants; learning opportunities, assessment tools and minimal clinical exposures have been defined as well. Competence in terms of non-technical skills has been defined for each module according to the CanMEDS (http://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e) glossary. The different modules were subsequently submitted to an internal and an external review process and re-edited accordingly before final validation. The authors hope that this document will serve as a roadmap for both thoracic surgical trainees and mentors. It should further guide continuous professional development. However, evolving scientific and technological advances are expected to modify the diagnosis and treatment of diseases and disorders in the future and hence will mandate periodical revisions of the document. Tue, 10 Mar 2020 12:14:40 GMT http://hdl.handle.net/10993/42717 Title: Surgical Stabilization for Multiple Rib Fractures: Whom the Benefit? -A Prospective Observational Study <br/> <br/>Author, co-author: Olland, Anne; Puyraveau, Marc; Guinard, Sophie; Seitlinger, Joseph; Kadoche, Déborah; Perrier, Stéphanie; Renaud, Stéphane; Falcoz, Pierre-Emmanuel; Massard, Gilbert <br/> <br/>Abstract: Background: Surgical repair has demonstrated a beneficial effect on outcome for patients presenting with flail chest or with multiple rib fractures. We hypothesized that benefit on outcome parameters concerns predominantly patients being extubated within 24 hours post-operatively. Methods: We prospectively recorded all patients presenting with chest traumatism eligible for surgical repair with anticipated early extubation according to our institutional consensus (flail chest, major deformity, poor pain control, associated lesions requiring thoracotomy). We compared outcomes of patients extubated within 24 hours post-operatively to those who required prolonged ventilator support. We tested predictive factors for prolonged intubation with univariate and multivariate analysis. Results: From 2010 to 2014, 132 patients required surgical repair. Two thirds were extubated within 24 hours following surgical repair. Pneumonia was the main complication and occurred in 30.3% of all patients. Patients extubated within 24 hours following surgical repair had significantly shorter ICU stay and shorter in-hospital stay (P<0.0001 both). Pneumonia occurred significantly more often in patients with longer mechanical ventilation (over 24 hours) (P<0.0001) and the overall post-operative complications rate was higher (P=0.0001). Main independent risk factors for delayed extubation were bilateral chest rib fractures and initially associated pneumothorax. Conclusions: We conclude that patients extubated within 24 hours after repair have an improved outcome with reduced complication rate and shorter hospital stay. The initial extent of the trauma is an important risk factor for delayed extubation and high complication rate despite surgical stabilization. Tue, 03 Mar 2020 15:14:19 GMT http://hdl.handle.net/10993/42716 Title: In Lung Transplantation, Are Pulmonary Grafts From Donors Deceased From Hanging as Suitable as Grafts From Donors Deceased From Other Causes? <br/> <br/>Author, co-author: Santos Silva, João; Olland, Anne; Massard, Gilbert; Falcoz, Pierre-Emmanuel <br/> <br/>Abstract: A best evidence topic was constructed according to a structured protocol. The question addressed was whether pulmonary grafts from donors deceased from hanging offer the same benefit as grafts from donors deceased from other causes in lung transplantation. Of the 17papers found, 4 provided the best evidence to answer the question. The authors, date, journal, country of publication, study type, group studied, relevant outcomes and results of these papers are tabulated. One study reported a large cohort of donors and analysed the out-comes by cause of death, reporting no differences in survival. The remaining 3 papers analysed observational studies on the outcomes of lung transplantation using pulmonary grafts from donors deceased from hanging, compared with donors deceased from other causes. No differences in the rates of post-transplantation pulmonary graft dysfunction and long-term overall survival were reported. Although the cohort of donors deceased from hanging is small, we conclude that these donors are an important contribution to the donor pool. Ex vivo lung perfusion may have a role in assessing graft viability in this scenario Tue, 03 Mar 2020 15:14:08 GMT http://hdl.handle.net/10993/42715 Title: Multiple Lung Transplant in a Patient Within 25 Years: A Case Report <br/> <br/>Author, co-author: Zhang, Min; SecoAntunes, Ana Rita; Kessler, Romain; Massard, Gilbert <br/> <br/>Abstract: With survival after retransplant improving over the years, issues regarding multiple retransplant have emerged. Here, we report the 25-year follow-up of a 16-year-old male patient who received 4 successful lung transplant procedures in 1990, 1991, 1995, and 2005. Tue, 03 Mar 2020 15:13:32 GMT http://hdl.handle.net/10993/39602 Title: Conscious Experience and Psychological Consequences of Awake Craniotomy <br/> <br/>Author, co-author: Hejrati, N.; Spieler, D.; Samuel, Robin; Regli, L.; Weyerbrock, A.; Surbeck, W. <br/> <br/>Abstract: Background Experiencing cranial surgery under awake conditions may expose patients to considerable psychological strain. Methods This study aimed to investigate the occurrence and course of psychological sequelae following awake craniotomy (AC) for brain tumors in a series of 20 patients using a broad, validated psychological assessment pre-, intra-, postoperatively and a standardized follow-up of 3 months. In addition, the association of the preoperative psychological condition (including, but not limited to, anxiety and fear) with perioperative pain perception and interference was assessed. Results AC did not induce any shift in the median levels of anxiety, depression, and stress symptoms already present prior to the procedure. Furthermore, anxiety and depression were all moderately to strongly associated over time (all p<0.05). Stress symptoms also correlated positively over all times of measurement. Stress three days after surgery was strongly associated with stress three months after surgery (p<0.001), while the correlation between pre- and immediate postoperative stress showed a statistical trend (p=0.07). Preoperative fear was not related to intraoperative pain, but to pain and its interference with daily activity on the third postoperative day (p<0.001 and p<0.01, respectively). Conclusion Postoperative psychological symptoms clearly correlated with their corresponding preoperative symptoms. Thus, mental health was not negatively affected by the awake craniotomy experience in our series. Intraoperative fear and pain were not related to the preoperative psychological condition. However, preoperative fear and anxiety were positively related with pain and its interference with daily activity in the immediate postoperative period Mon, 03 Jun 2019 08:58:09 GMT http://hdl.handle.net/10993/39523 Title: Habenula deep brain stimulation for refractory bipolar disorder. <br/> <br/>Author, co-author: Zhang, Chencheng; Kim, Seung-Goo; Li, Dianyou; Zhang, Yingying; Li, Yan; Husch, Andreas; Hertel, Frank; Yan, Fuhua; Voon, Valerie; Sun, Bomin <br/> <br/>Abstract: Bipolar disorder (BD) is a mood disorder associated with significant morbidity and mortality. In many cases, BD can be managed with pharmacotherapy, psychological therapy, or electroconvulsive therapy [1]. For some afflicted patients, however, BD is a chronic and severely disabling condition that is resistant to the aforementioned treatments. Deep brain stimulation (DBS) offers a safe and effective neurosurgical treatment for otherwise refractory movement disorders and obsessive-compulsive disorder [2,3]. Tue, 21 May 2019 12:53:26 GMT http://hdl.handle.net/10993/35432 Title: Dystone Bewegungsstörungen bei Kindern <br/> <br/>Author, co-author: Hertel, Frank <br/> <br/>Abstract: Bei den Dystonien handelt es sich um eine heterogene Gruppe verschiedenartiger Erkrankungen mit ähnlichen Symptomen. Klassifikation, Differenzialdiagnosen und Therapien sind komplex und sollten von spezialisierten Zentren durchgeführt werden. Die Erkrankungen können vom Säuglings- bis ins späte Erwachsenenalter auftreten. Das Spektrum reicht von oligosymptomatischen Formen bis hin zu solchen, die schwerste Beeinträchtigungen in der Lebensqualität und Behinderungen bedingen können. Zur konservativen Therapie werden Krankengymnastik, orale Medikamente sowie lokale Injektionsbehandlungen eingesetzt. Von neurochirurgisch operativer Seite existieren die Neuromodulationstherapien (implantierbare Pumpen, Tiefe Hirnstimulation) sowie ablative Verfahren. Die neuere Literatur zeigt, dass insbesondere die kognitive Entwicklung bei Kindern umso günstiger beeinflusst werden kann, je früher eine effektive Therapie erfolgt. Mon, 09 Apr 2018 07:37:49 GMT http://hdl.handle.net/10993/34180 Title: Method for identification of anatomical landmarks <br/> <br/>Author, co-author: Gielen, F. L. H.; Hertel, Frank; Gemmar, P.; Appenrodt, P. <br/> <br/>Commentary: US Patent 8,160,677 Wed, 24 Jan 2018 12:16:26 GMT http://hdl.handle.net/10993/34179 Title: System for navigating a planned procedure within a body <br/> <br/>Author, co-author: Gielen, F. L. H.; Hertel, Frank; Gemmar, P.; Appenrodt, P. <br/> <br/>Commentary: US Patent 8,150,497 Wed, 24 Jan 2018 12:15:56 GMT http://hdl.handle.net/10993/34178 Title: Method for planning a surgical procedure <br/> <br/>Author, co-author: Gielen, Frans L. H.; Hertel, Frank; Gemmar, Peter; Appenrodt, Peter Wed, 24 Jan 2018 12:15:21 GMT http://hdl.handle.net/10993/34059 Title: Stabilization with the Dynamic Cervical Implant: a novel treatment approach following cervical discectomy and decompression. <br/> <br/>Author, co-author: Matge, Guy; Berthold, Christophe; Gunness, Vimal Raj Nitish; Hana, Ardian; Hertel, Frank <br/> <br/>Abstract: OBJECT: Although cervical total disc replacement (TDR) has shown equivalence or superiority to anterior cervical discectomy and fusion (ACDF), potential problems include nonphysiological motion (hypermobility), accelerated degeneration of the facet joints, particulate wear, and compromise of the mechanical integrity of the endplate during device fixation. Dynamic cervical stabilization is a novel motion-preserving concept that facilitates controlled, limited flexion and extension, but prevents axial rotation and lateral bending, thereby reducing motion across the facet joints. Shock absorption of the Dynamic Cervical Implant (DCI) device is intended to protect adjacent levels from accelerated degeneration. METHODS: The authors conducted a prospective evaluation of 53 consecutive patients who underwent DCI stabilization for the treatment of 1-level (n = 42), 2-level (n = 9), and 3-level (n = 2) cervical disc disease with radiculopathy or myelopathy. Forty-seven patients (89%) completed all clinical and radiographic outcomes at a minimum of 24 months. Clinical outcomes consisted of Neck Disability Index (NDI) and visual analog scale (VAS) scores, neurological function at baseline and at latest follow-up, as well as patient satisfaction. Flexion-extension radiography was evaluated for device motion, implant migration, subsidence, and heterotopic ossification. Cervical sagittal alignment (Cobb angle), functional spinal unit (FSU) angle, and range of motion (ROM) at index and adjacent levels were evaluated with WEB 1000 software. RESULTS: The NDI score, VAS neck and arm pain scores, and neurological deficits were significantly reduced at each postoperative time point compared with baseline (p < 0.0001). At 24 months postoperatively, 91% of patients were very satisfied and 9% somewhat satisfied, while 89% would definitely and 11% would probably elect to have the same surgery again. In 47 patients with 58 operated levels, the radiographic assessment showed good motion (5 degrees -12 degrees ) of the device in 57%, reduced motion (2 degrees -5 degrees ) in 34.5%, and little motion (0-2 degrees ) in 8.5%. The Cobb and FSU angles improved, showing a clear tendency for lordosis with the DCI. Motion greater than 2 degrees of the treated segment could be preserved in 91.5%, while 8.5% had a near segmental fusion. Mean ROM at index levels demonstrated satisfying motion preservation with DCI. Mean ROM at upper and lower adjacent levels showed maintenance of adjacent-level kinematics. Heterotopic ossification, including 20% minor and 15% major, had no direct impact on clinical results. There were 2 endplate subsidences detected with an increased segmental lordosis. One asymptomatic anterior device migration required reoperation. Three patients underwent a secondary surgery in another segment during follow-up, twice for a new disc herniation and once for an adjacent degeneration. There was no posterior migration and no device breakage. CONCLUSIONS: Preliminary results indicate that the DCI implanted using a proper surgical technique is safe and facilitates excellent clinical outcomes, maintains index-and adjacent-level ROM in the majority of cases, improves sagittal alignment, and may be suitable for patients with facet arthrosis who would otherwise not be candidates for cervical TDR. Shock absorption together with maintained motion in the DCI may protect adjacent levels from early degeneration in longer follow-up. Wed, 17 Jan 2018 10:42:43 GMT