Spinal Unit

Berck, France

Spinal Unit

Berck, France
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Sundell C.-G.,Umeå University | Jonsson H.,Spinal Unit | Adin L.,Rontgenavdelningen
International Journal of Sports Medicine | Year: 2013

Symptomatic spondylolysis is a stress reaction caused by microtrauma during physical exercise, an imaging diagnostic subgroup of Adolescent Low Back Pain (ALBP), found in adolescent athletes. Early diagnosis increases the possibility of healing. Thus, it is important to divide ALBP into subgroups. The aim of this study was to evaluate clinical tests that can distinguish symptomatic spondylolysis from other forms of ALBP in order to facilitate early referral for diagnostic imaging. The investigation subjects were a prospective case series with a control group, 25 subjects with ALBP and 13 subjects that had no history of LBP. The 2 groups were examined using the same clinical protocol. MRI of the whole lumbar spine was performed in both the case and control groups and CT investigations of the L4 and L5 vertebrae were performed in the case group. Significant differences between the 2 groups were found in 8 of our clinical tests. No clinical test, alone or in combination, could distinguish between spondylolysis and other forms of ALBP. As 88% of the subjects in the case group had MRI findings and almost 50% had spondylolysis, MRI should be performed at an early age in young athletes with ALBP. © Georg Thieme Verlag KG Stuttgart · New York.


Rognoni C.,University of Pavia | Rognoni C.,Bocconi University | Fizzotti G.,Spinal Unit | Pistarini C.,Spinal Unit | Quaglini S.,University of Pavia
Studies in Health Technology and Informatics | Year: 2014

Quality of life is a complex concept, entailing the person's physical health and level of independence, as well as psychological well-being, social participation and the relationship with specific and relevant aspects of the environment. The World Health Organization encourages the integration of a comprehensive definition of health when examining patient-related outcomes after injury or disease. This study aims at evaluating the quality of life of 130 Italian patients with spinal cord injury, focusing on the associations among functional status and health dimensions elicited by SF-36 questionnaire. The subscale scores that revealed a stronger impact of the lesion were those related to the physical domains, especially for the physical functioning and physical role functioning. Physical functioning scores were significantly different in the acute phase with respect to chronic phase, in inpatients with respect to outpatients and in patients with lower functional impairment versus patients with higher functional impairment. Moreover, the functional impairment influenced significantly physical role, bodily pain and vitality scales. Disease phases also showed significantly different scores for general health. No differences were highlighted between tetraplegic and paraplegic patients. © 2014 European Federation for Medical Informatics and IOS Press.


Chandrasenan J.,Royal Derby Hospital | Chandrasenan J.,Spinal Unit | Klezl Z.,Royal Derby Hospital | Klezl Z.,Charles University | And 4 more authors.
Journal of Bone and Joint Surgery - Series B | Year: 2011

We retrospectively reviewed the records of 16 children treated for spondylodiscitis at our hospital between 2000 and 2007. The mean follow-up was 24 months (12 to 38). There was a mean delay in diagnosis in hospital of 25 days in the ten children aged less than 24 months. At presentation only five of the 16 children presented with localising signs and symptoms. Common presenting symptoms were a refusal to walk or sit in nine children, unexplained fever in six, irritability in five, and limping in four. Plain radiography showed changes in only seven children. The ESR was the most useful investigation when following the clinical course of the disease. Positive blood cultures were obtained in seven children with Staphylococcus aureus being isolated in five. Antibiotics were used in 14 children and spinal bracing in six. Children with spondylodiscitis often present with a confusing clinical picture leading to late diagnosis. The early use of MRI in the investigation of children with an atypical picture may avoid unnecessary delay in starting treatment and possibly prevent long-term problems. All except one of our children had made a complete clinical recovery at final follow-up. However, all six children in the > 24-month age group showed radiological evidence of degenerative changes which might cause problems in the future. ©2011 British Editorial Society of Bone and Joint Surgery.


PubMed | Spinal Unit, Bordeaux University Hospital Center and Auckland City Hospital
Type: Journal Article | Journal: The bone & joint journal | Year: 2016

We undertook a prospective non-randomised radiological study to evaluate the preliminary results of using magnetically-controlled growing rods (MAGEC System, Ellipse technology) to treat children with early-onset scoliosis.Between January 2011 and January 2015, 19 children were treated with magnetically-controlled growing rods (MCGRs) and underwent distraction at three-monthly intervals. The mean age of our cohort was 9.1 years (4 to 14) and the mean follow-up 22.4 months (5.1 to 35.2). Of the 19 children, eight underwent conversion from traditional growing rods. Whole spine radiographs were carried out pre- and post-operatively: image intensification was used during each lengthening in the outpatient department. The measurements evaluated were Cobb angle, thoracic kyphosis, proximal junctional kyphosis and spinal growth from T1 to S1.The mean pre-, post-operative and latest follow-up Cobb angles were 62 (37.4 to 95.8), 45.1 (16.6 to 96.2) and 43.2 (11.9 to 90.5), respectively (p < 0.05). The mean pre-, post-operative and latest follow-up T1-S1 lengths were 288.1 mm (223.2 to 351.7), 298.8 mm (251 to 355.7) and 331.1 mm (275 to 391.9), respectively (p < 0.05). In all, three patients developed proximal pull-out of their fixation and required revision surgery: there were no subsequent complications. There were no complications of outpatient distraction.Our study shows that MCGRs provide stable correction of the deformity in early-onset scoliosis in both primary and revision procedures. They have the potential to reduce the need for multiple operations and thereby minimise the potential complications associated with traditional growing rod systems. Cite this article: Bone Joint J 2016;98-B:1240-47.


Degl'Innocenti S.,University of Florence | Filimberti E.,University of Florence | Magini A.,University of Florence | Krausz C.,University of Florence | And 5 more authors.
Fertility and Sterility | Year: 2013

Objective To evaluate post-thawing sperm parameters in a large series of men cryopreserving for different cancers and oligospermia. Design Retrospective observational study. Setting Semen cryopreservation laboratory. Patient(s) Six hundred twenty-three patients undergoing semen cryopreservation for cancer or oligospermia who discontinued banking. Intervention(s) None. Main Outcome Measure(s) Postcryopreservation sperm motility and viability. Result(s) In oligospermic men, recovery of motile sperm after cryopreservation was possible in only a few out of the 219 samples cryopreserved for this problem. Similarly, independent of the reason for which cryopreservation was required, if one basal semen parameter fell below the 5th percentile of the World Health Organization reference values, recovery of motile and viable spermatozoa after thawing was low. Among samples cryopreserved for cancer, those with testicular cancer showed the lowest basal semen quality and recovery after thawing. In cases of hematological cancers or other types of cancers, motility recovery was similar to that of non-cancer-related samples. Receiver operating characteristic analyses demonstrate that basal progressive and total motility predict the recovery rate of motile sperm after thawing with high accuracy, sensibility and specificity. Conclusion(s) Our study demonstrates the ability of prefreeze semen parameters to predict cryosurvival in terms of sensitivity and precision. Using this information, the clinician could perform appropriate counseling about the future possibilities of fertility for the patient. © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.


PubMed | Montecatone Rehabilitation Institute, Spinal Unit, University of Rome La Sapienza, University of Rome Tor Vergata and 2 more.
Type: Journal Article | Journal: Spinal cord | Year: 2016

Retrospective observational study.The objective of this study was to determine the rehabilitation potential and the extent to which it is realized in a cohort of spinal cord injury patients using the Spinal Cord Injury-Ability Realization Measurement Index (SCI-ARMI) and to study the clinical factors that influence this realization.Two spinal units in Italy.Consecutive patients were assessed at the end of an in-patient rehabilitation program using the Spinal Cord Independence Measure and the International Standards for Neurological Classification of Spinal Cord Injury. On the basis of these data and of the age and gender of the patients, we calculated the SCI-ARMI score. Regression analyses were performed to study the relationship between clinical factors and the extent to which rehabilitation potential is realized.We examined the data for 306 patients. Most patients were discharged without having reached their rehabilitation potential, with an SCI-ARMI score <80%. SCI-ARMI scores at discharge were positively influenced by etiology and the lesion level and correlated negatively with lesion severity and the presence of complications during rehabilitation.The SCI-ARMI is an effective tool that can be used to measure the achievement of rehabilitation potential in SCI patients and to identify groups of patients who are at risk of not meeting their rehabilitative potential.


Lombardi G.,Spinal Unit | Celso M.,Spinal Unit | Mencarini M.,Spinal Unit | Nelli F.,Spinal Unit | Del Popolo G.,Spinal Unit
Spinal Cord | Year: 2013

Objective: To evaluate the clinical and urodynamic impact of intravesical electrostimulation (IVES) on incomplete spinal cord injury (SCI) patients suffering from chronic neurogenic non-obstructive urinary retention (N-NOR).Methods:One-hundred and two patients underwent at least 28 consecutive daily IVES sessions because objective evidence of detrusor acontractility instead of hypocontractility was detected. Diary entries written at various stages by each patient were compared (7 days before the IVES cycle, 15-21 days into the cycle and 7 days before its end). Responders were patients with a mean 50% reduction in both the number of daily catheterizations and post-void residual urine. Responders underwent further urodynamics at the end of the IVES cycle; patients experiencing first sensation of bladder filling, and the mean volume of first sensation of bladder filling per ml, Qmax ml s-1, among others, were evaluated. Nineteen individuals who repeated another IVES round were included in this study.Results:Thirty-eight subjects (37.2%) responded to IVES and of those, 83.3% recovered the first sensation of bladder filling after the IVES round. Nineteen responders repeated IVES within 1 year, owing to loss of efficacy. They obtained similar voiding symptoms improvement and urodynamic results as after the first IVES cycle. A timespan of <2 years from SCI to IVES, and the presence of first sensation of bladder filling at baseline represented significant predictive parameters for IVES success (P<0.05) using χ 2-test.Conclusions:IVES represents a possible therapeutic option for incomplete SCI patients with N-NOR. © 2013 International Spinal Cord Society All rights reserved.


Objectives:To describe the presence of sperm in the prostatic urethra as a stand-alone ejaculation entity and to assess its characteristics.Methods:Thirty-three patients with anejaculation during sexual stimulation were enroled. Penile vibratory stimulations were carried out following bladder catherization and instillation of a pink buffering medium (Ferticult). Two-step catheterisation was then performed: a catheter was inserted through the urethral sphincter into the prostatic urethra to aspirate its content, and then bladder catheterisation was performed to collect the Ferticult. The procedure was repeated in some patients after at least 1 week. The characteristics of the semen collected from each organ were analysed and compared.Results:A total of 42 trials were obtained from 22 patients. Sperms were found in the prostatic urethra in 21 samples (50%) from 12 patients (11 with spinal cord injury, 1 with diabetes). The colour of all 21 prostatic urethra sperm samples differed from the Ferticult. Sperm motility was greater in 8 samples, sperm count was higher in 10 and pH was different in 10, compared with the bladder samples. The higher overall quality of the sperm allowed cryopreservation in 10 prostatic urethra samples compared with only 5 bladder samples. Four of the five patients who underwent repeated trials had a reproducible pattern of prostatic urethra ejaculation.Conclusion:The presence of sperm in the prostatic urethra most probably results from ‘ejaculation dyssynergia’, a lack of coordination between bladder neck and external sphincter. Sperm from the prostatic urethra should be systematically sought to improve the outcome of assisted reproduction.Spinal Cord advance online publication, 21 June 2016; doi:10.1038/sc.2016.78. © 2016 International Spinal Cord Society


Lombardi G.,Spinal Unit | Musco S.,Spinal Unit | Celso M.,Spinal Unit | Ierardi A.,Spinal Unit | And 3 more authors.
Spinal Cord | Year: 2013

Objectives:To compare the efficacy of intravesical electrostimulation (IVES) versus sacral neuromodulation (SNM) in patients with incomplete spinal cord lesions (SCL) and neurogenic non-obstructive urinary retention (N-NOR).Methods:In this retrospective study, 77 N-NOR patients underwent IVES (minimum 28 sessions), then after returning to voiding baseline symptoms, percutaneous first stage of SNM (lasting for minimum 4 weeks). After the two neuromodulation treatments, responders were categorized as patients experiencing both a 50% reduction of volume per catheterization per ml and a 50% reduction in number of catheterizations per day when comparing the 7-day voiding diaries at the end of both procedures to baselines. New urodynamics were performed subsequently. Responders to first stage of SNM underwent permanent SNM.Results:Forty-eight patients responded to neither of the treatments, whereas 29 responded to both IVES and first-stage SNM. No significant statistical differences (P>0.05) were detected in the voiding diaries. Following the two procedures, the first sensation of bladder filling was either maintained or recovered by all responders, whereas the same 11 patients reached a bladder contractility index of >100. The 29 IVES responders lost their clinical benefits in a mean follow-up of 9.6 months. Only 10 out of the 29 patients became nonresponsive to permanent SNM, in a mean follow-up of 54 months.Conclusion:A strict correlation in terms of clinical and urodynamic patterns was demonstrated in patients with incomplete SCL and N-NOR, following IVES and first stage of SNM. However, voiding improvement through IVES was short-term when compared with the effects of permanent SNM. © 2013 International Spinal Cord Society. All rights reserved.


Lombardi G.,Spinal Unit | Musco S.,Spinal Unit | Celso M.,Spinal Unit | Del Corso F.,Spinal Unit | Del Popolo G.,Spinal Unit
Spinal Cord | Year: 2014

Objective:To determine the success rate of percutaneous first stage of sacral neuromodulation (SNM) and the efficacy and safety of permanent SNM for incomplete spinal cord lesion (SCL) patients suffering from chronic neurogenic non-obstructive urinary retention (N-NOR).Method:From January 2003 to December 2012, 85 individuals underwent the percutaneous first stage of SNM. Subsequently, only responders who reached a concomitant reduction by at least 50% of volume per catheterization and in the number of catheterizations per day comparing their 7-day voiding diaries at baseline underwent permanent SNM. Final follow-up was conducted by April 2013.Results:Thirty-six individuals responded to percutaneous first stage of SNM. Post-surgery urodynamics documented all patients experiencing first sensation of bladder filling. A statistically significant increase in Qmax ml per sec and decrease in post-voiding residual urine per ml were documented. (P<0.01). First sensation of bladder filling at baseline represented a statistically significant parameter for the success of the first stage SNM (P<0.05). Eleven out of 34 patients at follow-ups were 'inconstant responders' because they returned to similar baseline voiding symptoms, but responded again with an implant on the controlateral S3 sacral root. Two failed twice and responded once again after an S4 sacral root implant. All but one failure occurred more than 3 years after the previous implant. Other drawbacks were resolved telemetrically.Conclusions:Research is needed to increase the success rate of the first stage SNM on incomplete SCL patients with N-NOR. Permanent SNM is highly efficacious in the medium follow-up. © 2014 International Spinal Cord Society.

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