Report of my experience with French leading experts of spine surgery.
Naoyuki Kuga, M.D.
Department of orthopedic surgery, Kyushu university

I was a boy interested in unknown everything. Later, my interest changed a dream of foreign life as a doctor. It was fortunately realized to visit France in April 01 as an exchange fellow of AFJO.

For my request of spine surgery, Pr. Cottalorda introduced me two hospitals: Hotel Dieu in Nantes and the Beaujon hospital in Paris (Clichy). Pr. Passuti, the boss of the orthopedic department in Hotel Dieu, is one of the most famous surgeons specialized scoliosis surgery. He is an experienced clinician as well as a researcher developing a biomaterial bone comprising hydroxyapatite, which shows excellent results of fusion as a graft with bone marrow. Not only a supreme technician but also a respectable kindness features him. It impressed me that he gave intensively many useful techniques during operations to an Egyptian visitor for study of spine surgery. In the Beaujon hospital, many spinal operations are practiced by Pr. Deburge and Pr. Guigui, famous and positive surgeons. Pr. Guigui has a passion to correct kyphotic deformity by vertebral wedge osteotomy.

They are skillful in using the Cotrel-Dubousset-Horizon instruments, which are well suitable for large and solid vertebrae of the French. The polyaxial screws fix firmly the vertebrae, and the solid rods maintain perfectly the corrected form. However, I wonder why the long and perfect correction is always necessary for the severely degenerated spine. The degenerative spinal deformity may be resulted as a compensation of one or few abnormal segments to keep the balance of body. The body of over-middle-aged persons has usually many problems: neurogenic and myogenic muscle weakness, joint contracture and deformity of limbs, and dysfunction of several organs - heart, lungs, eyes, etc. All parts of the body are closely related in function, and they work together on a certain balance. A sudden correction of the spinal column should cause some degree of change of this balance. If the reformed column could not acquire a new balance because of some problems mentioned as above, it would tend to return to the condition before correction, even if the instruments keep the reformed form. Not a few instruments' failures suggested me this hypothesis. I think that, for the treatments of unstable and deformed spine with severe degeneration, it would be important to respect the total body balance with limited treatments for the most abnormal and responsible segments rather than to correct perfectly and fix all the unstable and deformed segments.

This visit to France impressed me the variety and incompleteness of surgical treatments of spinal diseases. But I confirmed that many surgeons try to improve the results by their unique and original methods, which are progressing now. I hope that the most effective and the least invasive method of treatments for every spinal disease will be completed in the future, with minimum sacrificed patients.

Pr. Passuti
Pr. Guigui
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