[Epidural infiltrations in the treatment of lumbar radiculopathy. Apropos of 200 cases]. / Infiltrations épidurales dans le traitement de la radiculopathie lombaire. A propos de 200 cas.

INTRODUCTION: The authors report a prospective study on the treatment of radicular compression using epidural infiltrations. MATERIAL AND METHODS: An open study was performed on 200 patients suffering from radicular compression due to either herniated lumbar discs (124 cases), lumbar stenosis (32 cases) or segmental lumbar stenosis (44 cases) and treated by epidural infiltrations. RESULTS: Of the 200 patients studied, 74 per cent did not need subsequent surgical treatment. Therapeutic effect was influenced by several parameters: etiology of radicular compression: 65 per cent favorable results in herniated discs; 69 per cent in lumbar stenosis; and 91 per cent favorable results in segmental lumbar stenosis; age of patients: 100 per cent favorable in patients > 70 years, while only very few favorable results in patients < 20 years of age. Chronic or acute radicular pain: among the patients who had herniated discs requiring subsequent surgery, 65 per cent presented with acute lesions (pain for < 4 months). In patients with lumbar stenosis requiring surgery, 80 per cent had acute lesion and in patients with segmental lumbar stenosis, no patients complained of acute pain. DISCUSSION: Avoiding surgical treatment is not the only parameter which should be studied in evaluating the effectiveness of treatment. Lassale's pre and postoperative evaluation with a minimum 1 year follow up showed improvement in all non surgical cases. When compared to the literature, this study shows favorable long term results.

Perilunar dislocation of the carpus. A diagnosis still often missed.

A retrospective study of patients with dorsal perilunar dislocation of the carpus (DPD) from seven different centres has been made. There were 91 cases with adequate documentation and radiographs; of these, 61 attended for review between 12 months and 22 years (follow-up average: 42 months). Functional results were assessed by a modified Witvoet score (Witvoet & Allieu, 1973). There were only 33/61 good results. Statistical evaluation disclosed that, whatever the morphology of the initial injury, prognosis had a significant relation to the delay of time between accident and diagnosis (p less than 0.001) to the accuracy of reduction and its maintenance (p less than 0.025) and to the rotation degree of the semilunar bone (p less than 0.001). Authors conclude by saying that there is no problem in DPD itself. The problem exist in the fact that these injuries are still often missed and, subsequently, mismanaged.

Crush injury of the carpus.

Severe crush injuries affecting the bones of the carpus are rare. We review the nine cases that have previously been described and report four additional cases which we have treated and followed up. All 13 present remarkable similarities, with disruption of the carpal arch through the capitate-hamate articulation distally and the piso-triquetral joint proximally. Three slightly different variations of this pattern of fracture-dislocation are identified. The flexor retinaculum must be involved to allow the displacement which is seen, and there is usually an extensive laceration of the thenar eminence. Treatment by closed reduction is usually successful. Long-term follow-up shows that, in the absence of nerve or vascular damage, the results are surprisingly good.