Résumé
Les cals vicieux post-traumatiques du rachis résultent le plus souvent d'un traitement orthopédique ou chirurgical inadapté. La douleur représente la principale indication d'un geste secondaire de reconstruction. A côté des formes principalement vertébrales, des formes avec implication neurologique peuvent se rencontrer en cas d'atteinte médullaire. Une atteinte neurologique secondaire ou un déficit neurologique progressif sont trés souvent associés à la persistance d'une compression médullaire ou à l'aggravation d'un cal vicieux (le plus souvent en cyphose). L'objectif du traitement chirurgical est de corriger la déformation, de réaxer le rachis et de restaurer sa stabilité. Il faut distinguer les atteintes primitives des atteintes secondaires car des lésions neurologiques supplémentaires peuvent être provoquées par une stratégie erronée, rendant nécessaire un geste neurochirurgical préalable ou simultané. L'objectif de nos mesures reconstructives qui visent à réaxer le rachis traumatisé tout en évitant l'atteinte des segments mobiles sains, ne peut presqu'exclusivement être réalisé que par une opération combinant les abords antérieur et postérieur. Les imperfections fondamentales proviennent du premier traitement. Dans le traitement primitif ou secondaire des lésions médullaires, on ne peut s'attendre à des résultats acceptables que si les facteurs suivants sont pris en considération: (1) identification préopératoire du type de lésion; (2) l'anatomie fonctionnelle du rachis (principes de la répartition des contraintes et du hauban); (3) maîtrise de toutes les voies d'abord (postérieures, postérolatérales et antérieures).
Summary
Post-traumatic malposition of the spine usually results in inadequate conservative treatment or in-correct surgical therapy. The main indication for secondary reconstructive measures in pain. Besides the predominant vertebragenic causes, neuropathic forms may be combined in spinal cord damage. Secondary neurological damage or progressive neurological deficits are combined with persistent spinal compression or increasing (mostly kyphotic) malpositions. The objective of the surgical treatment is to correct the malposition with reprofiling the spine and restoration of the stability of the axis organ. Attention must be paid to primary or secondary spinal lesions, since additional neurological lesions can be provoked when the strategy is wrong, and concomitant or prior neurosurgical interventions may become necessary. Almost exclusively, the objective of our reconstructive measures with reprofiling of the injured spine avoiding damage to healthy movement segments can be achieved only by a combined ventral and dorsal operation. The crucial shortcomings result from the first treatment. Acceptable treatment results can only be expected in both first and secondary treatment of spinal cord injuries when the following factors are taken into consideration: (1) pretherapeutic definition of the injury pattern; (2) the functional anatomy of the spine (load sharing and tension band principle); (3) mastery of all approaches (dorsal, dorsolateral, ventral) and the instrumentation.
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Harms, J., Stoltze, D. The indications and principles of correction of post-traumatic deformities. Eur Spine J 1, 142–151 (1992). https://doi.org/10.1007/BF00301304
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DOI: https://doi.org/10.1007/BF00301304