S. Fuentes

Aix-Marseille Université, Marsiglia, Provence-Alpes-Côte d'Azur, France

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Publications (223)225.71 Total impact

  • Revue de Chirurgie Orthopédique et Traumatologique 10/2015; 101(6):S66-S71. DOI:10.1016/j.rcot.2015.07.001
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    ABSTRACT: Introduction: Interbody fusion is the gold standard treatment for the management of numerous diseases of the spine. Minimally invasive techniques may be more beneficial than conventional techniques. The main goal of this study was to report the one-year postoperative results of a series of posterior lumbar interbody fusions by a minimally invasive technique in relation to improvement in functional outcome, interbody fusion and morbidity. Materials and methods: Between January 2012 and May 2013, 182 patients treated by minimally invasive posterior transforaminal lumbar interbody fusion (TLIF) were included in this prospective multicenter study. Clinical assessment was based on a comparison of the preoperative and one-year postoperative Oswestry (ODI), SF-12 and Quebec Scores and the Visual Analog Scale (VAS). Surgical and postoperative follow-up data were evaluated. Radiological assessment was based preoperative and one-year postoperative full spine teleradiographs. Interbody fusion at one-year was systematically evaluated by CT scan. Results: One hundred and eighty-two patients were included, mean age 58.9 years old. Surgery lasted a mean 101minutes, mean preoperative bleeding was 143mL, and mean radiation exposure was 247.4 cGy/cm(2). The rate of postoperative complications was 7.7%. The ODI, the Quebec Score, the SF-12 and the VAS were all significantly improved at one-year (P<0.0001). The rate of fusion was 72.6% at the final follow-up. There was no significant difference in functional outcome between patients with and without fusion. Discussion: The one-year postoperative radiological results and functional outcome of minimally invasive posterior lumbar fusion are satisfactory. The benefits of this minimally invasive approach are mainly found in the first 6 postoperative months. Successful radiological interbody fusion was not correlated to functional outcome at the final follow-up. Level of evidence: IV.
    Orthopaedics & Traumatology Surgery & Research 09/2015; DOI:10.1016/j.otsr.2015.07.001 · 1.26 Impact Factor
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    Revue de Chirurgie Orthopédique et Traumatologique 09/2015; 101(5):402-405. DOI:10.1016/j.rcot.2015.06.005
  • M. Lagier · M. Briere · H. Giorgi · S. Fuentes · B. Blondel · P. Tropiano ·

    Revue de Chirurgie Orthopédique et Traumatologique 09/2015; 101(5):420-422. DOI:10.1016/j.rcot.2015.06.010
  • M Afathi · E Peltier · T Adetchessi · T Graillon · H Dufour · S Fuentes ·
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    ABSTRACT: Minimally invasive surgery has expanded over the past two decades and was initially used for the treatment of lumbar disc herniation. Later, this approach was used to treat other spine pathologies, as well as to perform spinal fusion and extended spinal decompression. In this study, we report our experience regarding the use of a minimal surgical approach in the treatment of intradural extramedullary spinal cord tumours. Between January 2008 and July 2013, 18 patients with an intradural extramedullary tumour were included in the study (13 thoracic, 4 lumbar and one cervical tumours). The mean age was 59 years. We operated on 11 meningiomas, 6 neurinomas and one ependymoma. All patients underwent minimally invasive surgery using a tubular retractor system to perform a hemilaminectomy in order to access the spinal canal. Fifteen patients had a neurological deficit and 7 suffered from radicular pain prior to surgery. Gross completed resection was performed in all patients. Mean time of surgery was 95min. Blood loss was less than 200cc. Fifteen patients out of 18 were able to get up the day after surgery. Mean hospital stay was 6 days. There were no complications. A minimal surgical approach using a tubular retractor permits an effective resection of intradural extramedullary tumours. This procedure may be a useful tool to decrease the risk of secondary spine instability and postoperative kyphosis, and could also be used for spinal junctions and in fragile patients. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Neurochirurgie 08/2015; 61(5). DOI:10.1016/j.neuchi.2015.05.001 · 0.41 Impact Factor
  • M Lagier · M Briere · H Giorgi · S Fuentes · B Blondel · P Tropiano ·
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    ABSTRACT: We report a case of allergic reaction after total cervical disc arthroplasty. A 52-year old woman was operated on for right C6 cervicobrachial neuralgia secondary to C5-C6 disc disease with foraminal stenosis. A cobalt-chromium-molybdenum total disc prosthesis had been implanted two years earlier. The patient was referred to our institution for recurrence of axial neck pain associated with abdominal patches of erythematous itching rash and swallowing disorder. Allergy tests confirmed type-4 allergic reaction to chromium. Symptoms decreased after removal of the prosthesis with secondary fusion. Delayed allergic reaction is uncommon in spine surgery, but should be considered in case of recurrence of initial symptomatology associated with non-spinal signs. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Orthopaedics & Traumatology Surgery & Research 07/2015; 101(5). DOI:10.1016/j.otsr.2015.05.005 · 1.26 Impact Factor
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    ABSTRACT: To date there is no consensus on therapeutic indications in adolescent idiopathic scoliosis (AIS) with curvature between 30° and 60° at the end of growth. The objective of this study was to assess outcome in patients with moderate AIS. A multicenter retrospective study was conducted. Inclusion criteria were: Cobb angle, 30-60° at end of growth; and follow-up > 20 years. The data collected were angular values in adolescence and at last follow-up, and quality of life scores at follow-up. A total of 258 patients were enrolled: 100 operated on in adolescence, 116 never operated on, and 42 operated on in adulthood. Mean follow-up was 27.8 years. Cobb angle progression significantly differed between the 3 groups: 3.2° versus 8.8° versus 23.6°, respectively; P < 0.001. In lumbar scoliosis, the risk of progression to ≥ 20° was significantly higher for initial Cobb angle > 35° (OR=4.278, P=0.002). There were no significant differences in quality of life scores. Patients operated on in adolescence showed little radiological progression, demonstrating the efficacy of surgical treatment for curvature greater than 50°. Curvature greater than 40° was progressive and may require surgery in adulthood. Lumbar scoliosis showed greater potential progression than thoracic scoliosis in adulthood, requiring fusion as of 35° angulation. IV, retrospective study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Orthopaedics & Traumatology Surgery & Research 07/2015; 101(5). DOI:10.1016/j.otsr.2015.05.004 · 1.26 Impact Factor
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    ABSTRACT: Background: Metastatic disease of the spine requires a multidisciplinary and comprehensive approach to patient care, especially, for patients in a lot of pain with neurological deficit or spinal instability requiring surgical stabilization. Objectives: The purpose of the study is to report our experience on 34 patients who underwent spinal metastasis resection. We used a single-stage posterior approach with vertebral body reconstruction by an expandable titanium cage and a posterior instrumentation. The parameters assessed were neurologic status, OMS score, angle of sagittal deformity, and morbidity. Methods: Between January 2011 and June 2014 we performed a monocentric consecutive case review of 34 patients with vertebral body tumor. All of them underwent a single-stage vertebrectomy with circumferential reconstruction and an arthrodesis by posterior approach. Results: 34 patients underwent a single stage surgery by posterior approach, including 30 thoracic lesions and 4 lumbar lesions. Pre operatively, sixteen patients presented a neurologic impairment. The mean follow-up was 13.7 months [1-32m]. No neurologic impairment was observed in the 34 cases. At the last term of follow-up, neurologic status was improved in 23 cases. OMS score was improved in 23 cases (67.6 %), and worsened in one case. Before surgery, the average of visual analogic scale was 8.94/10 [7-10] and decreased to 2.62/10 [1-5] after surgery. Single posterior approach surgery significantly reduced the average sagittal deformity to 10.0° (0.01-19.96; P = 0.013, Mann-Whitney test). Conclusion: Our outcomes suggest that it will be more efficient to perform an aggressive approach in spinal metastatic treatment in order to improve quality of life.
    World Neurosurgery 07/2015; DOI:10.1016/j.wneu.2015.06.072 · 2.88 Impact Factor
  • S Boissonneau · R Faguer · C Joubert · S Fuentes · P Metellus ·
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    ABSTRACT: Breast cancer, after lung cancer, is the second major cause of brain metastases. In breast cancer, the prognosis is closely linked to the molecular subtype of the primary tumor. Targeted therapies, with or without cytotoxic treatment, have significantly modified overall survival in these patients. We report, the case of a patient suffering from breast cancer with brain metastasis in whom the biological documentation of the metastatic disease permitted to tailor the systemic treatment. Analysis of the surgical specimen revealed an immunohistochemical HER2 positive staining, which was not found in the primary tumor and therefore warranted trastuzumab administration. Another interesting insight based on this case report was to underline the phenotypic heterogeneity of the metastatic disease and its potential dynamic course as illustrated by the dissociated response to trastuzumab on body TEP-TDM in this particular patient. This case report also highlights the new place of the neurosurgeon in brain metastases management, not only as a participant in local treatment but also as a physician who is in fact involved in the delineation of the global oncological strategy in these patients as well as medical oncologists and radiation oncologists. Copyright © 2015. Published by Elsevier Masson SAS.
    Neurochirurgie 07/2015; 61(4). DOI:10.1016/j.neuchi.2015.02.002 · 0.41 Impact Factor
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    ABSTRACT: Management of spinal kyphotic deformities remains challenging in order to achieve a complete correction of the deformity, stabilize the spine and restore a satisfactory sagittal alignment. The aim of this study was to report the results of a technique combining, during the same operative session: a percutaneous osteosynthesis (with or without decompression) and a minimal invasive corpectomy using an anterior approach. Twelve patients (mean age 54 years old) were included in this single center retrospective study. Kyphotic deformity was related to a trauma in 9 cases, to a tumor in 2 cases and was infectious in the last case. The level involved was L1 in 7 cases, T12 in 3 cases, T10 and L4 in 1 case each. First step of the surgical strategy was a routine posterior percutaneous osteosynthesis. In 5 cases, a complementary minimal invasive decompression was performed using tubular retractors. During the second step, an anterior corpectomy was performed and the vertebral reconstruction was done using telescopic vertebral body prosthesis. Once the last correction was achieved, final locking of the posterior instrumentation was performed. In the entire series, a short construct was done in 2 cases and a long construct was decided for the 10 other cases depending on the lesion. Mean surgical time was 246min [173-375] and postoperative blood transfusion was not necessary. Patients were discharged from the hospital on average at day 8 [4-25] according to associated lesions. Based on radiographic analyses, a significant restoration of the vertebral kyphosis (average 17°, P<0.001) and vertebral body height (27% on average, P<0.001) were obtained. Combination of these two minimal invasive techniques allows a circumferential spinal fixation with a low rate of complications and a satisfactory restoration of local sagittal deformity. This strategy is, in our experience, a valuable alternative to conventional techniques. Further studies with a longer follow-up will therefore needed in order to confirm these results. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Neurochirurgie 06/2015; 61(4). DOI:10.1016/j.neuchi.2014.10.113 · 0.41 Impact Factor
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    ABSTRACT: Treatment for recurrent and aggressive meningiomas remains an unmet medical need in neuro-oncology, and chemotherapy exhibits limited clinical activity, if any. Merlin expression, encoded by the NF2 gene, is lost in a majority of meningiomas, and merlin is a negative regulator of mTORC1. The sst2 somatostatin receptor, targeted by octreotide, is highly expressed in meningiomas. To investigate new therapeutic strategies, we evaluated the activity of everolimus (mTOR inhibitor), BKM-120 and BEZ-235 (new Pi3K/Akt/mTOR inhibitors), octreotide and a combined treatment (octreotide plus everolimus), on cell proliferation, signaling pathways, and cell cycle proteins, respectively. The in vitro study was conducted on human meningioma primary cells extracted from fresh tumors, allowing the assessment of somatostatin analogs at the concentration levels used in patients. The results were correlated to WHO grades. Further, everolimus decreased cell viability of human meningiomas, but concomitantly, induced Akt activation, reducing the antiproliferative effect of the drug. The new Pi3K inhibitors were not more active than everolimus alone, limiting their clinical relevance. In contrast, a clear cooperative inhibitory effect of octreotide and everolimus was observed on cell proliferation in all tested meningiomas, including WHO grades II-III. Octreotide not only reversed everolimus-induced Akt phosphorylation but also displayed additive and complementary effects with everolimus on downstream proteins involved in translation (4EB-P1), and controlling cell cycle (p27Kip1 and cyclin D1). We have demonstrated a co-operative action between everolimus and octreotide on cell proliferation in human meningiomas, including aggressive ones, establishing the basis for a clinical trial.
    Journal of Neuro-Oncology 05/2015; 124(1). DOI:10.1007/s11060-015-1812-3 · 3.07 Impact Factor
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    ABSTRACT: The incidence and significant morbidity of vertebral osteomyelitis (VO) are increasing despite the progress of diagnosis competences. Among the 50 cases of VO managed in our centers over the past 5 years, 84% of the cases were in men. The mean age was 55 years. Sixty-two percent of patients had comorbidities and risk factors: diabetes mellitus (24%), malignancy (16%), intravenous drug use (10%) and alcoholism (4%). A source of infection was identified in 66% of cases, including post-vertebral surgery infection (18%) and hematogenous infection (48%). The mean time to diagnosis was 36 days. Back pain were occurred in 90% of cases, fever (70%), neurological deficits (40%), epidural abscesses (32%), completed vertebral bone destruction (26%) and psoas abscess (12%). A single organism was isolated in 92% of cases. Gram-positive bacteria were identified in 76% of cases, while gram-negative bacilli (GNB) were found in 18% of cases. The presence of GNB was significantly associated with malignancy (p=0.041).
    05/2015; DOI:10.1016/j.nmni.2015.04.008
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    ABSTRACT: This study is to estimate the diagnostic accuracy of Tokuhashi and Tomita scores that assures 6-month predicting survival regarded as a standard of surgical treatment. We searched PubMed, EMBASE, European PubMed central, and the Cochrane library for papers about the sensitivities and specificities of the Tokuhashi and/or Tomita scores to estimate predicting survival. Studies with cut-off values of ≥9 for Tokuhashi and ≤7 for Tomita scores based on prior studies were enrolled. Sensitivity, specificity, diagnostic odds ratio (DOR), area under the curve (AUC), and the best cut-off value were calculated via meta-analysis and individual participant data analysis. Finally, 22 studies were enrolled in the meta-analysis, and 1095 patients from 8 studies were included in the individual data analysis. In the meta-analysis, the pooled sensitivity/specificity/DOR for 6-month survival were 57.7 %/76.6 %/4.70 for the Tokuhashi score and 81.8 %/47.8 %/4.93 for Tomita score. The AUC of summary receiver operating characteristic plots was 0.748 for the Tokuhashi score and 0.714 for the Tomita score. Although Tokuhashi score was more accurate than Tomita score slightly, both showed low accuracy to predict 6 months residual survival. Moreover, the best cut-off values of Tokuhashi and Tomita scores were 8 and 6, not 9 and 7, for predicting 6-month survival, respectively. Estimation of 6-month predicting survival to decide surgery in patients with spinal metastasis is quite limited by using Tokuhashi and Tomita scores alone. Tokuhashi and Tomita scores could be incorporated as part of a multidisciplinary approach or perhaps interpreted in the context of a multidisciplinary approach.
    Journal of Neuro-Oncology 05/2015; 123(2). DOI:10.1007/s11060-015-1794-1 · 3.07 Impact Factor
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    ABSTRACT: . While thoracolumbar fractures are common lesions, no strong consensus is available at the moment. Objectives . The aim of this study was to evaluate the results of a minimal invasive strategy using percutaneous instrumentation and anterior approach in the management of thoracolumbar unstable fractures. Methods . 39 patients were included in this retrospective study. Radiologic evaluation was based on vertebral and regional kyphosis, vertebral body height restoration, and fusion rate. Clinical evaluation was based on Visual Analogic Score (VAS). All evaluations were done preoperatively and at 1-year follow-up. Results . Both vertebral and regional kyphoses were significantly improved on postoperative evaluation (13° and 7° versus −1° and −9° P < 0.05 , resp.) as well as vertebral body height (0.92 versus 1.16, P < 0.05 ). At 1-year follow-up, mean loss of correction was 1°. A solid fusion was visible in all the cases, and mean VAS was significantly reduced form 8/10 preoperatively to 1/10 at the last follow-up. Conclusion . Management of thoracolumbar fractures using percutaneous osteosynthesis and minimal invasive anterior approach (telescopic vertebral body prosthesis) is a valuable strategy. Results of this strategy offer satisfactory and stable results in time.
    01/2015; 2015(6):1-6. DOI:10.1155/2015/639542

  • 01/2015; 6(8):493. DOI:10.5348/ijcri-201583-CR-10544
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    ABSTRACT: Management of spinal kyphotic deformities remains challenging in order to achieve a complete correction of the deformity, stabilize the spine and restore a satisfactory sagittal alignment. The aim of this study was to report the results of a technique combining, during the same operative session: a percutaneous osteosynthesis (with or without decompression) and a minimal invasive corpectomy using an anterior approach.
    Neurochirurgie 11/2014; 60(6). DOI:10.1016/j.neuchi.2014.10.006 · 0.41 Impact Factor

  • Neurochirurgie 11/2014; 60(6). DOI:10.1016/j.neuchi.2014.10.032 · 0.41 Impact Factor

  • Neurochirurgie 11/2014; 60(6). DOI:10.1016/j.neuchi.2014.10.008 · 0.41 Impact Factor
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    ABSTRACT: Results from clinical studies regarding the radiosensitivity of non-small cell lung cancer (NSCLC) brain metastases (BMs) are scarce and inconclusive. Indeed, little is known about the actual impact of the primary tumor molecular profile and radiological response to radiosurgery. We report here the analysis of a prospective patient cohort of NSCLC patients harboring BMs treated by gamma knife radiosurgery and investigated whether the primary tumor molecular phenotype had an actual impact on BM radiosensitivity. Two hundred sixty three patients were enrolled between January 2010 and April 2013. Molecular profile was available for 90 patients. Local and distant brain control was determined for these 90 patients harboring 173 BMs. Radiological assessment using MRI-scans was undertaken every 3 months after radiosurgery. Patient-, tumor- and treatment-related data were included. Log-rank test and Cox regression model were used to correlate molecular profile of the primary tumor and other clinical features to intracranial radiological control. In total, 48/90 (53.3%) of patients presented molecular alterations, 25/90 (27.8%) had KRAS mutations, 16/90 (17.8%) had EGFR mutations, 3/90 (3.3%) had ALK translocation, and 4 patients other genetic alterations. Overall, local and distant control was achieved in 83/90 (92.2%) and in 39/90 (43.4%) patients respectively. No local treatment failure was observed in EGFR mutant or ALK translocated tumor. One (4%) of the 25 KRAS mutated patients experienced a local failure. In the 42/90 patients (46.7%), local failure occurred in 4 cases (9.5%). Multivariate analysis demonstrated that EGFR mutation status and ALK translocation were independent predictors of better local control in patients treated by gamma knife radiosurgery. EGFR mutation and ALK translocation are independent prognostic factor regarding local control after Gama Knife radiosurgery in NSCLC patients with BM. The results provided here suggest that molecular profile of NSCLC patient might be taken in account in treatment decision strategy. Copyright © 2014. Published by Elsevier Masson SAS.
    Neurochirurgie 11/2014; 60(6). DOI:10.1016/j.neuchi.2014.10.033 · 0.41 Impact Factor
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    ABSTRACT: Metastatic spinal cord compression (MSCC) incidences are increasing. Our objective was to identify predictive factors involved in long-term survival after use of a surgical approach. We retrospectively analyzed all patients referred to our institution for MSCC who underwent surgery (N = 138). We identified patients with an overall survival (OS) rate greater than 2 years, compared their characteristics to the remaining patients, and performed recursive partitioning analysis (RPA). Median OS was 7.8 months (95 % confidence interval 4.4-11.2). Thirty-nine patients presented with OS ≥2 years. A comparative analysis found significant differences concerning the delay (first symptom-surgery, p < 0.001), number of systemic (p = 0.001) or bone metastases (p = 0.013), Karnofsky performance status (KPS) (p = 0.006), Frankel (p = 0.025), ASA scores (p < 0.001), weight loss (p = 0.003), hyperalgia (p = 0.002), chemotherapy use (p = 0.034), and primary tumor (p < 0.001). RPA classification identified six prognostic classes based on the ASA score, primary type, KPS, and systemic metastases. Long-term metastatic cancer survivor patients are an increasing population with specific characteristics.
    European Spine Journal 11/2014; 24(1). DOI:10.1007/s00586-014-3676-1 · 2.07 Impact Factor

Publication Stats

1k Citations
225.71 Total Impact Points


  • 2011-2015
    • Aix-Marseille Université
      • Faculté de Médecine
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2013
    • Hospital Centre University of Fort de France
      Fort Royal, Martinique, Martinique
  • 2001-2011
    • Assistance Publique Hôpitaux de Marseille
      • Service de neurochirurgie infantile
      Marseille, Provence-Alpes-Cote d'Azur, France
  • 2008
    • Hôpital Européen, Marseille
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2006
    • University Joseph Fourier - Grenoble 1
      Grenoble, Rhône-Alpes, France
  • 2000-2001
    • Hôpital d'instruction des armées du Val-de-Grâce
      Lutetia Parisorum, Île-de-France, France