Reporting disclosures to the reader in plastic surgery journal publications

BACKGROUND:

With the associations between investigators and funding sources becoming increasingly complicated, conflicts of interest may arise that could potentially cause biases in the reporting of results.

OBJECTIVE:

To determine the number of published plastic surgery articles that lack reporting of disclosures.

METHODS:

An online review of four major North American plastic surgery journal publications from January 1, 2007 to December 31, 2007, was performed. For identification and to provide anonymity, journals were assigned a letter from A to D.

RESULTS:

Of the 1759 articles reviewed, 726 (41%) were included. Disclosure was not reported in 368 (51%) articles: Journal A (n=10, 3%), Journal B (n=153, 85%), Journal C (n=193, 93%) and Journal D (n=12, 32%). Journals differed significantly in their reporting of disclosure (P<0.01).

CONCLUSION:

In the plastic surgery journals reviewed, the lack of documentation of disclosures was frequent. To ensure identification of bias in plastic surgery publications, a section dedicated to disclosure statements is recommended for each published article.     

Transpedicular plate fixator as effective system of spine stabilisation: biomechanical characteristics

Introduction  Zespol fixator, which was created in Poland by Ramatowski and Granowski, has an angular stable connection of screws and plate. These properties of this plate fixator, that is effective and not an expensive system of osteosynthesis of shaft of long bone widely used in Poland, impelled us to adapt it as a transpedicular plate fixator of spine. Aim  The aim of our in vitro study was to measure loads acting on spine stabilized by transpedicular plate fixator and to determine if its stability is comparable with uninjured spine. We also hypothesized that the spine stability with examined fixator had similar properties as spine fixators constructed with screws and rods. Materials and methods  We tested its biomechanical properties and compared it with a CD device by using specimens of four human spines. Each spine with damage induced in laboratory conditions was stabilised by one of those stabilisers in one (L4–L5) or two (Th12–L2) motion segments and subsequently were subject to load. The spines without and with one of transpedicular stabilization were subject to an unsymmetrical shift of +3/−4 mm for extension–compression and symmetrical shift for bending, in the frontal plane (+0.14/−0.14 rad) and the sagittal plane (+0.11/−0.11 rad), respectively. Results  Loads during extension–compression and bending in the sagittal plane were similar to the uninjured spine for short stabilization by using both stabilizers and amounted to 92.3 and 98.26%, respectively, of the load range sums of healthy spines. For long stabilization these loads amounted to 93.2 and 84.4%, respectively. Only following short and long stabilization for both devices in case of bending in the frontal plane the increase in loads up to 144.2 and 163.3% of the range sums of uninjured spines was achieved. Conclusion  It corroborates the fact that the application of the modified Zespol device for spine stabilisation provides the possibility of restoring its load transfer capacity similar to that in the healthy spine and comparable with the CD device. The study was carried out with financial support of statutory fund from Collegium Medicum in Bydgoszcz and University of Technology and Agriculture in Bydgoszcz. We declare that our experimental study was carried out on complying with the current law and the ethics commission’s approval.     

Characteristics of an extended internal fixation system for polysegmental transpedicular reduction and stabilization of the thoracic, lumbar, and lumbosacral spine

The Kluger internal fixator, with its artificial fulcrum outside the operative site, had to be extended for multisegmental use. Three different prototypes, called Central Bar (CB), Double Bar I (DB I) and Double Bar II (DB II) were designed, which were fully compatible with the existing reduction system. To evaluate the ability of these newly developed systems to provide primary stability in a destabilized spine, their stiffness characteristics and stabilizing effects were investigated in multidirectional biomechanical stability tests and compared with those of the clinically well-known Cotrel-Dubousset (CD) system. The investigations were performed on a spine tester using freshly prepared calf spines. The model tested was that of an intact straight spine followed by a defined three-column lesion simulating the most destabilizing type of injury. Pure moments of up to 7.5 Nm were continuously applied to the top of each specimen in flexion/extension, left/right axial rotation, and left/right lateral bending. Segmental motion was measured using a three-dimensional goniometric linkage system. Range of motion and stiffness within the neutral zone were calculated from obtained load-displacement curves. The DB II attained 112.5% (P = 0.26) of the absolute stiffness of the CD system in flexion and enhanced its stability in extension by up to 144.3% (P = 0.004). In axial rotation of the completely destabilized spine, this system achieved 183.3% of the stiffness of the CD system (P < 0.001), and in lateral bending no motion was measured in the most injured specimens stabilized by the DB II. The DB I, which was the first to be designed and was considered to provide high biomechanical stability, did not attain the stiffness standard set by the CD system in either flexion/extension or axial rotation of the most injured spine. The study confirms that it is worthwhile to evaluate in vitro the biomechanical properties of a newly developed implant before its use in patients, in order to refine weak construction points and help to reduce device-related complications and to better evaluate its efficacy in stabilizing the spine. Received: 15 August 1998 Revised: 31 July 1998 Accepted: 27 October 1998     

Hyperbaric oxygen in the treatment of postoperative infections in paediatric patients with neuromuscular spine deformity

The aim of this study is to evaluate possible benefits of hyperbaric oxygen (HBO) therapy in the treatment of deep postoperative infections in six high risk paediatric patients with neuromuscular spine deformity. The study involved review of medical records including radiology, office visits, and telephone contacts for six patients, referred for postoperative HBO therapy in 2003–2005. Infection control and healing without removal of implants or major revision surgery with a minimum of 2-year follow-up after index surgery were considered to represent success. All infections were resolved. Median time for wound healing, normalisation of blood tests and antibiotic weaning were 3 months. Radiological bony fusion, intact implants without any signs of radiolucent zones were seen in all cases at a mean follow-up of 54 months (37–72). Side effects of HBO treatment were minor. HBO is a safe and potentially useful adjuvance in the treatment of early deep postoperative infections in complex situations with spinal implants in high risk paediatric patients.     

胸腰段脊柱脊髓重度损伤及相关解剖学研究

目的：了解腰段脊神经的解剖特点及这些解剖特点在胸腰段脊柱脊髓重度损伤时的诊断和治疗意义。方法：通过20例局解研究观测腰段脊神经与椎体平面之间的关系，脊神经的形态及移位情况。随访143例胸腰段脊柱脊髓损伤病人，对比观测环行减压和单纯椎板减压的效果。结果：腰段脊神经与椎体平面有相对固定关系，L1脊神经到L5脊神经逐渐增粗，它们在冠状面上虽可向对侧移位但不超过中线，环行减压组有8例术后神经功能障碍进一步加重。结论：胸腰段骨折行环行减压时要特别注意保护脊神经，避免过分牵拉加重损伤。     

Diffuse idiopathic skeletal hyperostosis of the cervical spine: an underestimated cause of dysphagia and airway obstruction

Background context

Diffuse idiopathic skeletal hyperostosis (DISH) is a common but underdiagnosed condition relating to ossification of spinal ligaments that can cause compression of the esophagus and trachea. According to case reports, dysphagia or airway obstruction resulting from DISH is a rare occurrence.

Purpose

This study was intended to identify all published cases of dysphagia and/or airway obstruction resulting from DISH to increase the epidemiologic/clinical knowledge of these related conditions.

Study design

A systematic review of the literature was performed.

Methods

The articles resulting from the systematic PubMed/EMBASE search of the literature were closely read, and predefined parameters were scored.

Results

The search yielded a total of 118 articles (95 case reports and 23 case series) describing 204 patients with dysphagia and/or airway obstruction resulting from DISH. The number of cases demonstrated a steady increase from 1980 to 2009. This might be a real effect not ascribable to publication bias or expansion of the medical literature alone.

Conclusions

Diffuse idiopathic skeletal hyperostosis as a cause of dysphagia and/or airway obstruction may be an increasing and underappreciated phenomenon. Diffuse idiopathic skeletal hyperostosis should be included in the differential diagnosis of dysphagia and airway obstruction.     

经椎间孔椎间融合术治疗腰椎退变性疾病的临床研究

目的分析经椎间孔椎间融合术（transforaminal lumbar interbody fusion,TLIF）手术治疗腰椎退变性疾病的临床资料与手术疗效。方法对2004年1月-2008年6月经TLIF手术治疗的26例病例进行回顾性分析。均采用TLIF方法通过一侧椎间孔抵达椎间盘间隙摘除椎间盘,处理椎间隙后置入椎间融合器。结果所有患者术后平均下床活动时间为4．5d。1例患者术后出现切口皮缘坏死,经清创缝合后愈合;1例患者出现健侧神经根牵拉伤,门诊随访4个月后恢复;其余患者均获得6～36个月随访,平均18．3个月。采用改良MaeNab标准评价随诊结果显示优良率达到92．3％。采用JOA下腰痛评分显示优良率达到92．24％。结论TLIF手术技术具有手术创伤小、恢复活动能力快、术后并发症少及疗效好等优点,是治疗腰椎退行性疾病非常有效的方法之一。     

3D打印人工椎体在胸腰椎肿瘤整块切除后重建中的应用

目的探讨3D打印人工椎体在胸腰椎肿瘤全脊椎整块切除术中应用的可行性。方法2016年12月至2019年9月对33例胸腰椎体恶性肿瘤患者采用后路全脊椎切除术治疗,男25例,女8例;年龄15~76岁,平均58.0岁。病变部位:胸椎29例,腰椎4例。累及节段:单节段30例,双节段2例,三节段1例。肿瘤类型:原发恶性肿瘤6例,转移性肿瘤27例。27例转移性肿瘤患者术前Tomita评分2~5分,平均3.9分;修正的Tokuhashi评分9~15分,平均11.1分。依据全脊椎切除术中重建方式不同,将33例胸腰椎体恶性肿瘤患者分为3D打印人工椎体重建组(21例,采用3D打印人工椎体进行前柱重建)和钛网重建组(12例,采用钛网植入同种异体骨进行重建)。主要观察指标为脊髓神经损害和疼痛恢复程度,肿瘤局部控制率及假体下沉发生率等。术后24 h、术后3个月疼痛视觉模拟评分(visual analogue scale,VAS)与术前比较采用配对设计t检验。结果全部病例随访3~31个月,平均10.9个月。3D打印人工椎体重建组术中出血量(3255.6±1981.9)ml(t=2.042,P>0.05)、手术时间(5.6±1.4)h(t=0.591,P>0.05)、术后引流量(655.6±223.6)ml(t=0.118,P>0.05)与钛网重建组的差异均无统计学意义。两组患者术前、术后24 h和3个月VAS评分的组间差异均无统计学意义(P>0.05);两组患者术后24 h和3个月均较术前明显改善,差异均有统计学意义(P<0.05)。33例患者中31例(97.0%)末次随访时Frankel分级有至少1个等级的改善。随访期间钛网重建组12例患者中5例(41.7%)影像学显示不同程度的下沉,而3D打印人工椎体重建组21例患者未出现假体下沉表现,两组下沉发生率的差异有统计学意义(χ^2=10.313,P=0.013)。结论3D打印技术制造的多孔钛人工椎体具有良好的生物相容性和机械稳定性,可以用于椎体切除后的重建。     

陈旧性颈椎过伸伤伴脊髓损伤的临床研究

目的 探讨陈旧性颈椎过伸伤伴脊髓损伤患者的临床特点及其转归.方法 回顾性分析30例陈旧性颈椎过伸伤患者的临床资料,从损伤到就诊时间为3个月～8年,根据就诊时间分为三组,第1组:3～6个月,17例;第2组:6～12个月,8例;第3组:12个月～8年,5例.分别在术前、术后3个月、术后1年进行JOA评分,观察神经功能的改善率,比较各组的恢复情况.26例行颈椎前路减压植骨内固定术,4例行颈椎后路减压植骨内固定术.结果 三组之间的患者例数构成存在显著性差异.30例均获随访,随访时间18～39个月,平均23个月.术后1年,第1组平均改善率为23.8%,第2组平均改善率为53.9%,第3组平均改善率为54.3%.术后3个月、术后1年,第1组和第2组、第1组和第3组的JOA评分存在显著性差异,第2组和第3组无显著性差异.结论 陈旧性颈椎过伸伤伴迟发性脊髓损伤的发生在时间上有逐渐减少的趋势,迟发性脊髓损伤发生越早的患者损伤越严重,手术后的恢复越差.     

Surgical treatment of spondylodiscitis in the cervical spine: a minimum 2-year follow-up

Cervical spine spondylodiscitis is a rare, but serious manifestation of spinal infection. We present a retrospective study of 20 consecutive patients between 01/1994 and 12/1999 treated because of cervical spondylodiscitis. Mean age at the time of treatment was 59.7 (range 34–81) years, nine of them female. In all cases, diagnosis had been established with a delay. All patients in this series underwent surgery such as radical debridement, decompression if necessary, autologous bone grafting and instrumentation. Surgery was indicated if a neurological deficit, symptoms of sepsis, epidural abscess formation with consecutive stenosis, instability or severe deformity were present. Postoperative antibiotic therapy was carried out for 8–12 weeks. Follow-up examinations were performed a mean of 37 (range 24–63) months after surgery. Healing of the inflammation was confirmed in all cases by laboratory, clinical and radiological parameters. Spondylodesis was controlled radiologically and could be achieved in all cases. One case showed a 15°kyphotic angle in the proximal adjacent segment. Spontaneous bony bridging of the proximal adjacent segment was observed in one patient. In the other cases the adjacent segments radiologically showed neither fusion nor infection related changes. Preoperative neurological deficits improved in all cases. Residual neurological deficits persisted in three of eight cases. The results indicate that spondylodiscitis in cervical spine should be treated early and aggressive to avoid local and systemic complications.     

胸腰椎三柱同时损伤内固定方法的实验与临床初步观察

利用传感器及电测技术,采用新鲜人体胸腰段脊柱标本,评价后路短节段内固定器Steffee钢板、前路Kaneda器械、前路Kaneda与后路CD棒联合应用及后路节段性椎板下钢丝固定哈氏撑开棒四种手术在植骨状态下,治疗脊柱完全性三柱损伤提供的生物力学稳定能力。Steffee、Kaneda器械及节段性椎板下钢丝固定的哈氏撑开棒手术在这种严重损伤类型各有力学弱点,Steffee后伸、Kaneda前屈、节段性椎板下钢丝固定的哈氏撑开棒旋转明显失稳,前后路联合手术在轴压、前屈、后伸、侧弯、旋转五种运动方式皆能提供良好的稳定性。以此方法治疗1例腰椎半椎体切除与1例腰椎肿瘤全切除,随访1年,脊柱稳定,植骨融合满意。作者建议,在脊柱三柱损伤时宜采用前后路联合固定手术。     

改进型EdWards器械固定不稳定胸腰椎骨折的生物力学评价

目的评价改进型Edwards器械modifiedEdwardsinstrumentationMEI固定不稳定胸腰椎骨折即刻和承受周期性载荷后的稳定性,并与CCD器械相比较。方法在12具新鲜成人胸腰椎标本T9～L5的L1椎体上制备楔形骨折模型,分为两组,分别采用MEI和CCD内固定器恢复脊柱的稳定性。对固定后的脊柱施加0.5Hz的疲劳载荷共1500次,然后评价正常、损伤、固定和周期性加载后胸腰椎节段进行前屈/后伸、左/右侧弯和左/右旋转等运动时的稳定性,经脊柱三维运动测量系统测出脊柱节段的运动范围。结果1L1椎体压缩骨折后,胸腰椎在6个运动方向上均出现不稳。2MEI固定后,T12～L2节段前屈、后伸和侧弯运动的范围均小于对照组,但轴向旋转运动范围大于对照组;周期性加载后胸腰椎节段在所有方向上的运动范围均有所增加,以右侧弯最为明显P<0.01。3CCD固定后,T12～L2节段在6个方向上的运动范围均显著减小;与对照组相比,周期性加载后胸腰椎节段的运动范围也显著减小均P<0.05,但右侧弯除外。4CCD固定后,T12～L2节段左旋、疲劳后侧弯及旋转运动范围明显小于MEI固定组P<0.01或P<0.05。结论MEI固定可为脊柱前屈、后伸和侧弯运动提供即刻稳定性,但不能恢复旋转运动的稳定性;在周期性加载后,胸腰椎节段侧弯运动的稳定性丧失。而经CCD固定后,侧弯和旋转运     

Management of thoracolumbar spine trauma: An overview

Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Controversies exist regarding the appropriate radiological investigations, the indications for surgical management and the timing, approach and type of surgery. This review provides an overview of the epidemiology, biomechanical principles, radiological and clinical evaluation, classification and management principles. Literature review of all relevant articles published in PubMed covering thoracolumbar spine fractures with or without neurologic deficit was performed. The search terms used were thoracolumbar, thoracic, lumbar, fracture, trauma and management. All relevant articles and abstracts covering thoracolumbar spine fractures with and without neurologic deficit were reviewed. Biomechanically the thoracolumbar spine is predisposed to a higher incidence of spinal injuries. Computed tomography provides adequate bony detail for assessing spinal stability while magnetic resonance imaging shows injuries to soft tissues (posterior ligamentous complex [PLC]) and neurological structures. Different classification systems exist and the most recent is the AO spine knowledge forum classification of thoracolumbar trauma. Treatment includes both nonoperative and operative methods and selected based on the degree of bony injury, neurological involvement, presence of associated injuries and the integrity of the PLC. Significant advances in imaging have helped in the better understanding of thoracolumbar fractures, including information on canal morphology and injury to soft tissue structures. The ideal classification that is simple, comprehensive and guides management is still elusive. Involvement of three columns, progressive neurological deficit, significant kyphosis and canal compromise with neurological deficit are accepted indications for surgical stabilization through anterior, posterior or combined approaches.     

Meta-analysis in medical research: potentials and limitations

Meta-analysis, the statistical combination of results from several studies to produce a single estimate of a treatment effect or size of an association, continues to attract controversy. We illustrate and discuss the promises and limitations of meta-analysis. Meta-analysis of clinical trials can prevent delays in the introduction of effective treatments or lead to the timely identification of adverse effects. However, meta-analyses are liable to numerous biases, both at the level of the individual study and the selection of studies for inclusion in meta-analysis. The biases and confounding factors that threaten the validity of individual studies will also affect meta-analyses of observational studies. We argue that meta-analyses should only be performed within the framework of systematic reviews that have been prepared using methods that minimize bias and address the combinability of studies.     

前路人工椎体撑开矫正胸腰段陈旧性骨折后凸畸形

 目的 探讨前路人工椎体撑开矫正胸腰段陈旧性骨折后凸畸形的有效性与安全性。方法回顾性分析2009年8月至2011年8月应用前路人工椎体撑开矫正胸腰段陈旧性骨折后凸畸形13例患者的病历资料,男4例,女9例;年龄38~62岁,平均(53.3±7.6)岁。T₁₂ 5例,L₁ 6例,L₂ 2例。所有手术均由同组医生完成,采用侧前方入路,术中切除病椎及其上、下椎间盘,保留邻椎骨性终板,置入合适大小的人工椎体,并利用其良好的可延伸性进行主动撑开矫正后凸畸形。随访观察指标包括手术时间、出血量、后凸Cobb角变化、植骨融合情况、疼痛视觉模拟评分(visual analog scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)及并发症等。结果 所有患者均获得12~28个月的随访,平均(18±5.5)个月。随访12个月时所有患者均获得骨性融合。后凸Cobb角从术前平均33.9°±7.2°(22°~53°)恢复至末次随访时平均7.3°±4.8°(2°~16°),VAS评分由术前平均(6.4±0.9)分(5~8分)降低至平均(1.5±0.8)分(0~3分),ODI由术前平均50.5%±10.8%(38%~78%)降低至平均10.9%±4.9%(4%~22%),差异均有统计学意义。结论 应用人工椎体撑开的前路手术治疗胸腰段陈旧性骨折后凸畸形具有矫正角度大、对神经干扰少、损伤小、固定节段少等优势,可获得满意的矫形效果与临床近期疗效。     

Metal levels in corrosion of spinal implants

Corrosion affects spinal instrumentations and may cause local and systemic complications. Diagnosis of corrosion is difficult, and nowadays it is performed almost exclusively by the examination of retrieved instrumentations. We conducted this study to determine whether it is possible to detect corrosion by measuring metal levels on patients with posterior instrumented spinal fusion. Eleven asymptomatic patients, with radiological signs of corrosion of their stainless steel spinal instrumentations, were studied by performing determinations of nickel and chromium in serum and urine. Those levels were compared with the levels of 22 patients with the same kind of instrumentation but without evidence of corrosion and to a control group of 22 volunteers without any metallic implants. Statistical analysis of our results revealed that the patients with spinal implants without radiological signs of corrosion have increased levels of chromium in serum and urine (P < 0.001) compared to volunteers without implants. Corrosion significantly raised metal levels, including nickel and chromium in serum and urine when compared to patients with no radiological signs of corrosion and to volunteers without metallic implants (P < 0.001). Metal levels measured in serum have high sensibility and specificity (area under the ROC curve of 0.981). By combining the levels of nickel and chromium in serum we were able to identify all the cases of corrosion in our series of patients. The results of our study confirm that metal levels in serum and urine are useful in the diagnosis of corrosion of spinal implants and may be helpful in defining the role of corrosion in recently described clinical entities such as late operative site pain or late infection of spinal implants.     

Imaging diagnosis of cervical spine and spinal cord injuries in children

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Post operative infections of the spine: technique,indications and results of the surgical treatment - A retrospective study of 90 cases

Post operative infection in spine surgery is a well known complication. The authors studied a series of 90 patients in accordance with an homogenous strategy based on the excision of necrotic and infected tissues, associated with appropriate antibiotics.The results are analyzed according to the degree of infection (which is based on the type of germs and their associations), and type of patients, the delay in diagnosis and the anatomical extension of the infected lesions.Making a difference between superficial and deep infection is of no therapeutic value and may lead to wrong and inadequate treatment.One must separate the common infections (which are due to germs as staphylococcus aureus or others from the urinary or digestive tract), and severe infections (which are either due to a per operative massive and deep contamination, or associated with patient's poor general condition).This series is mainly about posterior approaches to the spine, with or without osteosynthesis. Technical problems for treatment depend on the site of infection, particularly at the thoracic kyphosis level, or at the lumbar level where the muscle necrosis can be extensive. At the cervical level, the infection of an anterior approach mandates a check on the respiratory and digestive tracts.Removing the osteosynthesis is not mandatory in post operative spinal infections, as it may induce severe mechanical destabilization. An anterior approach is not necessarily required in the case of a posterior infection, except with massive contamination of an anterior graft. In some cases, posterior lumbar interbody fusion can lead to the indication for anterior cage removal.Pseudarthrosis of an infected spine, initially treated to obtain fusion, is still the worst complication. In case of previous posterior infection, even a severe one, fusion can still be obtained through a secondary anterior or posterior approach for grafting, with or without osteosynthesis.In this series, there was no neurological complication due to infection.However, eight diceases occured in weak patients with neurological involvement. This points out the importance of the general treatment associated with the surgery, and the necessity of a thorough assessment. a thorough assessment.Résumé Les infections post-opératoires représentent une complication largement documentée dans le domaine de la chirurgie du rachis. Les auteurs étudient une série de 90 patients traités selon une stratégie homogène basée sur l'excision des tissus nécrosés et infectés associée à l'utilisation d'un traitement antibiotique adapté. Les résultats sont analysés en fonction du degré d'infection (basé sur le type de germe et leurs associations) de l'état des patients, du délai pour le diagnostic et de l'étendue anatomique des lésions infectieuses. L'opposition entre infection superficielle et profonde semble sans intérêt sur le plan thérapeutique et peut conduire à un traitement insuffisant ou mal adapté.Il est important de séparer les infections classiques (qui sont dûes à des germes comme le staphylocoque doré ou d'autres germes provenant de la sphère urinaire ou digestive) et les infections sévères (qui sont soit dûes à une contamination per-opératoire massive et profonde ou associées à des patients dont létat général est déficient).Cette série est principalement basée sur les abord postérieurs du rachis avec ou sans ostéosynthèse. Les problèmes techniques pour le traitement dépendent du site de l'infection: aux niveaux thoracique et lombaire, la nécrose musculaire peut être très extensive. Au niveau cervical, l'infection d'un abord antérieur impose de vérifier l'intégrité du tractus aéro-digestif.L'ablation initiale du matériel n'est pas nécessaire dans beaucoup de cas d'infections post-opératoires car elle peut induire des destabilisations sévères et des complications mécaniques supplémentaires. Un abord antérieur n'est pas forcément nécessaire en cas d'infection postérieure mises à part les contaminations massives d'une greffe antérieure ou une infection d'une cage intervertébrale réalisée pour une fusion intersomatique par voie postérieure.La pseudarthrose des greffes sur un rachis infecté qui a été traité initialement pour obtenir une fusion reste encore la plus sévère des complications. Dans les cas d'infections postérieures même sévères, la fusion peut être encore obtenue secondairement grâce à un abord antérieur ultérieur ou même un abord postérieur pour des greffes complémentaires avec ou sans ostéosynthèse.Dans cette série, les auteurs ne signalent aucune complication neurologique dûe à l'infection. Néanmoins, 8 décès sont à déplorer chez des patients fragiles avec signes neurologiques initiaux. Ceci souligne l'importance du traitement général associé à la chirurgie et la nécessité d'un bilan complet de ces malades.EBJIS Congress, Leuven