The measure of radiographic pelvic and spinal parameters for sagittal balance analysis has gained importance in reconstructive surgery of the spine and particularly in degenerative spinal diseases (DSD). Fusion in the lumbar spine may result in loss of lumbar lordosis (LL), with possible compensatory mechanisms: decreased sacral slope (SS), increased pelvic tilt (PT) and decreased thoracic kyphosis (TK). An increase in PT after surgery is correlated with postoperative back pain. A decreased SS and/or abnormal sagittal vertical axis (SVA) after fusion have a higher risk of adjacent segment degeneration. High pelvic incidence (PI) increases the risk of sagittal imbalance after spine fusion and is a predictive factor for degenerative spondylolisthesis. Restoration of a normal PT after surgery is correlated with good clinical outcome. Therefore, there is a need for comparative prospective studies that include pre-and postoperative spinopelvic parameters and compare complication rate, degree of disability, pain and quality of life.

Bone echinococcosis is a rare parasitic disease. While treatment modalities vary considerably, combined surgical and medical approaches are the standard of care with a 17% risk of recurrence.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Purpose Osteoarticular infections due to methicillinsusceptible Staphylococcus aureus (MSSA) or its methicillin-resistant variant (MRSA) are feared due to treatment failures. According to clinical experience, Pseudomonas aeruginosa may reveal less long-term remission than S. aureus. Methods A case-controlled study comparing outcomes of osteoarticular infections due to P. aeruginosa vs S. aureus was performed at Geneva University Hospitals. Results A total of 111 S. aureus (including 37 MRSA) and 20 P. aeruginosa osteoarticular infections were analysed in 131 patients: arthroplasties (n=38), fracture fixation devices (n=56), native joint arthritis (n=7) and osteomyelitis without implant (n=30). The median active follow-up time was 4 years. The patients underwent a median number of two surgical interventions for P. aeruginosa infections compared to two for S. aureus (two for MRSA), while the median duration of antibiotic treatment was 87 days for P. aeruginosa and 46 days for S. aureus infections (58 days for MRSA) (all p>0.05). Overall, Pseudomonas-infected patients tended towards a lower remission rate than those infected with S. aureus (12/20 vs 88/111; p=0.06). This was similar when P. aeruginosa was compared with MRSA alone (12/20 vs 30/37; p=0.08). In multivariate logistic regression analyses adjusting for case mix, odds ratios (OR) for remission were as follows: P. aeruginosa vs S. aureus [OR 0.4, 95% confidence interval (CI) 0.1-1.2], number of surgical interventions (OR 0.6, 95% CI 0.5-1.0) and duration of antibiotic treatment (OR 1.0, 95% CI 1.0-1.0). Conclusions Despite a similar number of surgical interventions and longer antibiotic treatment, osteoarticular infections due to P. aeruginosa tended towards a lower remission rate than infections due to S. aureus in general or MRSA in particular.

Background: There is few medical literature regarding factors associated with remission after surgical and medical treatment of postoperative spine infections.Methods: Single-centre case-control study [2007][2008][2009][2010][2011][2012][2013][2014]. Cluster-controlled Cox regression model with emphasis on surgical and antibiotic-related parameters.Results: Overall, we found 66 episodes in 48 patients (49 episodes with metalwork) who had a median follow-up of 2.6 years (range, 0.5 to 6.8 years). The patients had a median of two surgical debridements.The median duration of antibiotic therapy was 8 weeks, of which 2 weeks parenteral. Clinical recurrence after treatment was noted in 13 episodes (20%), after a median interval of 2 months. In 53 cases (80%), the episodes were considered as in remission. By multivariate analyses, no variable was associated with remission. Conclusions:In patients with post-operative spine infections, remission is achieved in 80%. The number of surgical debridement or duration of antibiotic therapy shows no association with recurrence, suggesting that individual risk factors might be more important than the duration of antibiotic administration.

Objective: The present study aimed to investigate the relationship between the flexionrelaxation phenomenon asymmetry of lumbar muscles and trunk lateral Range of Motion (ROM) asymmetry in non-specific chronic low back pain (NSCLBP) patients. Summary of Background Data: Imbalance in trunk muscle activation between right and left sides can induce pain by loading the spine incorrectly, especially in NSCLBP patients. A previous study reported a greater asymmetry in the flexion-relaxation phenomenon of the erector spinae in NSCLBP patients than in asymptomatic participants (AP). Imbalance of muscle properties, such as trunk ROM, has been suggested as a possible cause of this observed asymmetry. Methods: Twenty-eight NSCLBP patients and twenty-two AP performed three standing maximal trunk flexions. Surface electromyography were recorded bilaterally for erector spinae longissimus and lumbar multifidus. A flexion-relaxation ratio was calculated for each muscle. The fingertip-to-thigh test was performed to assess trunk lateral ROM. Each parameter's asymmetry was calculated as the absolute difference between right and left sides. Results: NSCLBP patients present a significantly lower trunk lateral ROM than AP. Flexionrelaxation ratio asymmetry of the erector spinae was significantly greater in NSCLBP patients than in AP (p<0.05). Flexion-relaxation ratio asymmetry of the multifidus and trunk lateral ROM asymmetry were not significantly different between groups. Significant correlation (r = 0.49) between flexion-relaxation ratio asymmetry of Erector spinae and trunk lateral ROM asymmetry was observed only for NSCLBP patients. Conclusions: The present findings showed that flexion-relaxation ratio asymmetry of erector spinae longissimus is moderately correlated with trunk lateral ROM asymmetry. In addition, the results confirmed that NSCLBP patients present a reduced trunk lateral ROM, flexionrelaxation ratio asymmetry of the erector spinae which is correlated with trunk rotation. These findings suggested an imbalance spine loading which can contribute to the persistence of pain.

This prospective study is first to provide normative spino-pelvic values at the L5 level in an asymptomatic population, particularly in case of (LSV) sacralisation of L5 (N = 10) where L5I and L1-L5 lordosis appears to be 10° more important than in normal population. We propose L5I as a new spino-pelvic parameter to restore in case of L5-S1 disk disease. These normative values will help to control peri-operatively the adequate lordosis restoration, in the presence of LSV.

BackgroundLow back pain, especially nonspecific chronic low back pain (LBP), the leading cause of disability worldwide, represents both social and economic problems. Different therapeutic management techniques can be used, but their effects vary. Clinicians and researchers attribute the variation in the efficacy of therapeutic and management techniques to the heterogeneity of the nonspecific chronic low back pain population, and they agree that nonspecific chronic LBP must be subgrouped.ObjectiveThis study aims to identify nonspecific chronic LBP subgroups based on a multifactorial approach, including biomechanical, physical, and psychosocial data.MethodsA total of 100 nonspecific chronic LBP patients and 30 healthy participants aged between 18 and 60 years will be recruited for this prospective study. A psychosocial profile will be established using questionnaires on anxiety, depression, functional disability, pain, fear of pain, avoidance belief, and physical activity. A physical capacity evaluation will be conducted. It will evaluate flexibility of the hips, lumbar spine, and lateral thoracolumbar segment, as well as trunk (extensor and flexor) muscle endurance. The subjects will perform functional daily life activities, such as walking, object lifting, forward bending, sit-to-stand, stand-to-sit, balance, and usual postures. Full body kinematics, kinetics, and surface electromyography of the trunk and hip muscles will be assessed during these tasks. The clustering classification methods for the statistical analysis will be determined according to the data and will be used to identify the subgroups of nonspecific chronic LBP patients.ResultsData collection started in September 2017 and will be completed with the inclusion of all the participants (100 nonspecific chronic LBP and 30 control). The study results will be published in peer-reviewed journals and presented at relevant international conferences.ConclusionsNumerous studies have showed that the therapeutic management of nonspecific chronic LBP is difficult and has inconstant effects caused by the complexity and heterogeneity of nonspecific chronic LBP. Identifying subgroups with a multifactorial approach is more comprehensive and closer to the pathophysiology of nonspecific chronic LBP. It also represents benefit interests and a challenge both clinically and socially. The perspective of this study is expected to support clinicians for a more adapted therapeutic management for each subgroup.