THE EUROPEAN SPINE CENTER

Transcription

1 THE EUROPEAN SPINE CENTER Created in 1987 by Charles Picault, Jean Claude de Mauroy and Jean Jacques Lalain, Spine Center of Lyons pursues the big tradition of the Orthopaedics of Lyons in the field of the scoliosis represented by Pierre Stagnara and Claude Régis Michel. Numerous doctors notably Italian were able to take advantage of this experience and the Lyons center became in 1990 : European Center. Recently the development of the activity in Italy made necessary the creation of an autonomous structure. 1 - Why an European Spine Center? The treatment of the pathologies of the spine remained in the 20 century the privilege of some big specialized centers such as Berck and Lyons in France, because these pathologies were often associated to the tuberculosis and to the poliomyelitis and required a particular equipment. At present, these pathologies disappeared and idiopatic forms allow a treatment of nearness. For example, the conservative orthopaedic treatment of the idiopatic scoliosis concerns 2 for one thousand the population that is for births a year in France and in Italy about 1200 cases to deal every year. It is so about a MEDICINE OF SPECIALITY. The European Spine Center allowed the passage of a medicine of speciality to a medicine of nearness in the same conditions of security of precision of protocols and performance appraisal.

2 2 - The ORTHOPAEDIC TREATMENT OF LYONS This treatment of vertebral deformations: scoliosis, kyphosis, spondylolisthesis and lumbago is more than 50 years old. It contains : A time of reduction by plastered brace, A time of contention by adjustable removable brace moulding of which is realized by the doctor, An adapted rehabilitation, A directed sports activity. Protocols clarify : Indications : for example, juvenile period for scoliosis, while one prefers Milwaukee's brace in prepuberal period not to restrain the chest. The realization of the various stages of the treatment and notably the braces, of which we shall publish later the various technical index cards. The surveillance of the treatment : for example time of bearing of the brace and the test of ablation. 3 - OBJECTIVES RESPECT FOR PROTOCOLS All the associates, the doctors, physiotherapists, orthotists follow the same protocol which is modified only according to a precise study of results. COMMON COMPUTERIZATION A specific computer software was developed, it allows a precise surveillance of treatments and stake in common files for a large-scale statistical treatment. The book on the orthopaedic treatment of scoliosis published in 1997 represents one of the most important world statistics. TRAINING An annual day is organized in Lyons and relieved locally on each of the sites. It is dedicated to all the co-workers and opened to all the interested professionals. QUALITY CONTROL Every month an audit is realized in each of the associated sites. A visit is organized for the most difficult cases.

3 4 - STATISTICS Within the framework of the orthopaedic medicine more than patients are followed(logical) in France and in Italy. -Back pains constitute more than a third of the patients seen in consultation and we realize about 500 conservative orthopaedic treatments every year. For lumbago : the majority of treatments are realized between 35 and 55 years, usual age of the instability. For the median and paramedian slipped discs, the conservative orthopaedic treatment allows to avoid surgery in 90 % of cases. -Scoliosis constitutes the second group with more than 250 realized orthopaedic treatments every year. One notes at present an increase of the treatments of rotatory dislocation of the adult because of the ageing of the population. On more than revised children 2 years after the ablation of the brace and for which the treatment was realized according to the protocol, failures with necessity of resorting to surgery are only 16 cases. -Kyphosis constitute 15 % of our patients. The conservative orthopaedic treatment when it is begun in time in period by juvenile growth allows to cure the kyphosis, that is to restore an angulation in physiological limits. -Spondylolisthesis is rarer. The conservative orthopaedic treatment allows the pursuit of a high-level sports activity in period of juvenile growth without risk of worsening of the sliding.

4 5 - THE SPECIFICITIES OF THE ORTHOPAEDIC MEDICINE The room of plaster cast been a part integral of the doctor's practice, it is equipped : -Of a suspension serving for stabilizing the head during the moulding which is realized by the doctor, -Of Abbott's frame allowing segmental correction of scoliotic abnormalities and correction of sagittal abnormalities in dorsal position under traction. The room of drying adjacent to the room of plaster cast contains : -A rest bed with water mattress to avoid the deformations of plaster cast, -An ergonomic seat for the drying without compression of the inguinal fold, -A cannon with warm air -An air-dryer if several children have to dry at the same time. Information system in network contains : the possibility of integrating photos and digital X- rays into the file of the patient, the photography being sometimes more important than the radiography. For the conservative treatments, programmed controls are directly transferred on a spreadsheet allowing the statistical treatment with regard to the general average realizing a real test of decision. Program contains besides the management of controls: it is indeed indispensable to see again at most every 6 months the braces which were realized. The development of the video and at present the CD ROM, allowed us to film all the technical acts and notably the rehabilitation. These videos are adapted:

5 To the patient who after the first consultation can acquire a CD rom explaining the realization of its treatment, To the practitioner, mostly corresponding liberal physiotherapist, who can update his university study. The Internet site connects all the centers of which each chargeable to a specific aspect of our action. 6 - PREVENTION IN PROFESSIONAL ENVIRONMENT In France, 1 % of the salary mass is dedicated to professional training and in this context some begun seek us to insure a training in the prevention of back pains. We created a company of professional training : DOMINENS, animated by an ergonomist and who intervenes in this precise context. The best knowledge of the world of the work is a fundamental element for all the practitioners taking charge of the spine. 7 - CURRENT CONSTITUTION The European Spine Center regroups around the patient all the actors of the treatment: doctors, surgeons, physiotherapists, engineers orthosists, ergonomist The patient who consults has at his disposal the complete range of the treatments of the spine: rheumatology, vertebral manipulation, rehabilitation, conservative orthopaedic treatment In France, we have 3 sites: Lyons, Mulhouse and recently Nice. In Italy, 4 sites: Piacenza, Bari, Palerme and Messine have just joined. In Spain, 2 sites: Madrid and Barcelona are integrated into the training.