[The "de Sèze" magnetic imaging]. / Le "de Sèze" magnétique.

The authors propose that a coronal STIR sequence with large FOV, similar to the de Sèze projection, including lumbar spine, sacrum, pelvis and hips should be obtained in all patients as part of the lumbar spine MRI protocol. For an additional few minutes of scanning time, this additional sequence could demonstrate the presence of lesions (hips, pelvis, sacrum, SI joints, retroperitoneum...) that would otherwise go undetected on standard sagittal and axial MRI images of the lumbar spine.

[Normal and abnormal imaging of the foot's extensor system]. / Imagerie normale et pathologique du système suro-achilléo-plantaire propulseur du pied.

The extensor system of the foot is mainly composed by a powerful engine, the triceps surae muscle, equiped with a very sophisticated driving belt, the unit Achilles tendon-posterior part of calcaneus bone-plantar aponeurosis, in continuity with the fibrous skeleton of the triceps surae. The exact knowledge of the anatomy of this fibrous skeleton allows us to understand the occurence of the main anatomical lesions of the extensor system and its imaging. On these solid bases, it's possible to divide the lesions of the foot's extensor system in different subtypes with, for each one, a typical clinical feature, a characteristic imaging and an codified treatment. The pair radiography-ultrasonography is enough for diagnosis and follow-up of the majority of lesions. The others need MRI.

Ultrasound of the ankle.

Because of their size and superficial location the ankle tendons can be well evaluated with ultrasound (US). The excellent definition of the modern high frequency probes allows us to consider US the technique of first choice in their assessment. Basic US appearances correlate well with the MRI findings. Since US can diagnose most tendon disorders including tendinopathies, tears, dislocations and enthesopathies MRI is less often utilized. US can easily depict the main ankle ligaments. The basic US appearance of ligament tears is well known. US can be considered an inexpensive and accurate technique in the evaluation of ankle sprains.

[Ultrasonography of muscles and tendons]. / Echographie des muscles et tendons.

Technical progress, namely in the field of US probes, allow a more accurate study of muscles and tendons. The US appearance of muscles and tendons is closely related to their fibrous structure. Knowledge of the anatomy of fibrous structures helps understand normal and abnormal images. A wide range of lesions, of muscles and tendons, including trauma (luxation and rupture), infection, tumors as well as degeneration (tendinitis) is presented.

[Ultrasonography of tendons and ligaments of foot and ankle]. / Echographie des tendons et des ligaments du pied et de la cheville.

UNLABELLED: The main ligaments and tendons of the ankle and the hind-foot can now be studied by US. This simple and safe technic constitutes a more and more reliable alternative to MRI and CT scan. AIMS: Know the normal US appearance of the tendons and ligaments of the ankle and the hind-foot, and how to study them with US. Know their main usual pathological appearance.

[The medial collateral ligament of the knee]. / Le ligament latéral interne du genou.

Injuries of the medial collateral ligament (MCL) of the knee are easily diagnosed on clinical grounds. These lesions are generally treated conservatively. Radiological examinations are generally unhelpful. However, injuries of the MCL may be associated with those of many other ligaments of the knee in the case of complex strain of the knee so that the clinical diagnosis may be challenging; in some cases, surgical repair of associated lesions is indicated. In these cases of multiple ligamentous injuries, a radiological study of ligamentous abnormalities may be of interest. The anatomical background and the different radiological findings including those of X-rays, US, arthrography and MRI, obtained in patients with injuries of the MCL, are described; radiological differentiation of ruptures of the MCL with or without knee instability is emphasized.

[Rupture of the distal tendon of the biceps brachialis: apropos of 43 cases]. / Les ruptures de l'extrémité inférieure du biceps brachial. A propos de 43 cas.

PURPOSE OF THE STUDY: Rupture of the distal tendon of the biceps is an uncommon occurrence. 43 cases were analyzed in a multicentric study in order to define etiological factors and treatment of this lesion. MATERIAL AND METHODS: 43 cases were reviewed from Fort de France, Paris, Marseille, Lyon and Suresnes. There were only male patients with an average age of 50 years. The mechanism of injury, the clinical and radiographic features, the anatomical findings and the results of surgical treatment were analyzed. 4 patients were treated conservatively and 39 surgically. In 28 cases, anatomical reattachment of the tendon was performed. In 11 cases the tendon was simply attached to the brachialis anterior muscle. RESULTS: The mechanism of injury in all patients was passive extension against active flexion 17 patients had sustained injury while engaged in sports activities and 17 during domestic activities. Most of the patients were diagnosed clinically. Ultrasound and CT scan was useful in cases seen a long time after injury. In 34 cases avulsion of the bicipital tuberosity was found. Subjective results were good in 28 cases and poor in 5 cases. Objective testing was performed one year after injury using the criteria described by Baker: flexion and suppination force (maximum force) and endurance (ability to perform repeated contractions). Following attachment to the brachialis anterior, there was an average loss of 33 per cent of flexion strength and 52 per cent of supination strength. Following anatomical reattachment, the loss was 5 per cent for flexion and 15 per cent for supination. There were two cases of radial nerve palsies and 1 case of radio-ulnar synostosis. DISCUSSION: Attachment of the biceps brachialis tendon to the brachialis anterior muscle is unable to restore supination force. Complications only occur following anatomical reattachment. Radial nerve palsies can be avoided by using two separate incisions as described by Boyd. CONCLUSION: Surgical reinsertion onto the radial tuberosity restore more strength. Attachment to the brachialis muscle can be sued in cases seen a long time after injury.

[Significative reduction of secondary effects of radicular myelography using an ultra-fine puncture needle]. / Réduction significative des effets secondaires de la saccoradiculomyélographie par l'utilisation d'une aiguille de ponction ultra-fine.

The authors report the adverse reactions to myelography in two groups of patients. The only difference was the spinal needle size: 20 G (0.9 mm) in the first group versus 26 G (0.45 mm) in the second one. In the second group the adverse reactions appear 3 to 10 less frequent and 3 to 5 less lasting.

[Diagnostic value of saccoradiculography and scanner in lumbar stenoses]. / Valeur diagnostique de la saccoradiculographie et du scanner dans les sténoses lombaires.

Radiculographic X-rays and CAT scans of 60 patients operated on for stenosis of the lumbar canal were analyzed separately and retrospectively by rheumatologists, a radiologist and surgeons working jointly, without knowledge of findings revealed by surgery. Comparison of findings with a detailed surgical report reveals that in the case of central lumbar canal stenosis, CAT scan provides a higher degree of reliability (72%) in diagnosis than does radiculography (56%). With lateral stenosis of the lateral cleft, reliability of both tests is identical (62%). The diagnostic deficiencies of these two examinations are discussed as well as diagnostic criteria employed and possible avenues of research. Currently, in the case of stenosis of the lumbar canal, it is still necessary to perform both of these examinations in combination and to accept the fact that, in certain cases, only one of the two tests reveals the stenosis, to be able to attain a preoperative rate of correct diagnosis greater than 80%.

[Computed tomographic measurement of the angle of torsion of the femoral neck. Experimental reliability study on dry bone]. / Mesure tomodensitométrique de l'angle de torsion du col fémoral. Etude expérimentale de fiabilité sur os sec.

To assess the accuracy of CT scanning measurements of femoral anteversion, 35 adult dried femora were studied by CT scan and direct measurement. The angle of the femoral neck was measured directly and the angle of anteversion by photography and by CT scanning. The accuracy of the CT scanning measurement was between 3 degrees and 4 degrees, which is consistent with other published findings. There was no significant difference between photographic and CT scanning measurements. The accuracy and reliability of the method does not alter if there is coxa valga or an increased angle of anteversion. The determination of the axis of the femoral neck remains the most difficult feature, as in other techniques of assessment.

[Unusual indications for scanning in osteoarticular pathology]. / Quelques indications particulières du scanner en pathologie ostéo-articulaire.

The authors take stock of current applications of the scanner in osteoarticular pathology. At first (1978-1983 approximately), only the vertebral column could be studied by this technique. Now, almost all the osteoarticular system is susceptible to study. Established examples are: study of the sacrum, of the traumatized acetabulum, of the femoropatellar apparatus, and measurement of torsion in the lower limbs. New applications are: study of the back of the foot, of the patellar cartilage, of the glenoid cavity, of the bones and soft parts of the hand, three-dimensional reconstructions, scanning radiology. The authors index and analyse these new techniques.

[X-ray computed tomographic exploration of cervico-brachial neuralgia. Value of the intravenous injection of contrast media]. / Exploration tomodensitométrique des névralgies cervico-brachiales. Intérêt de l'injection intraveineuse de produit de contraste.

Cervicobrachial neuralgias can now be easily evaluated by computerized tomography of the cervical spine due to recent technical progress (improved resolution, ultra-thin cuts, precise localization by computed radiography), and especially the use of intravenous contrast material, thus avoiding intrathecal metrizamide. The authors describe normal findings obtained by this method as well as disk herniations and disco-uncarthrosis. On the basis of this initial study of 35 patients (7 disk herniations and 16 disco-uncarthrosis), this method could be employed following routine studies as the first preoperative examination for cervicobrachial neuralgia. Thus, the indications for cervical myelography would decrease, limiting the use of a more invasive procedure and patient discomfort.

[Cervical spondylolysis. 7 cases. Review of the literature]. / Les spondylolyses cervicales. 7 cas. Revue de littérature.

Seven cases of cervical spondylolysis are reported one of them with cervical myelopathy, and the literature is reviewed. The particular anatomical features of the articular processes observed in 4 cases, as well as the many characteristics common to cervical and lumbar spondylolysis, suggest that both diseases might be caused by acquired fatigue fractures of the isthmus due to abnormal stress in patients predisposed by neural rich malformations.

[Computed x-ray tomographic evaluation of cervico-brachial neuralgia with intravenous injection of contrast media]. / Exploration tomodensitométrique des névralgies cervico-brachiales, avec injection intraveineuse de produit de contraste.

Investigation of the cervical epidural space by a CT scan is facilitated by its filling following intravenous injection of a contrast medium. The spinal ganglia and nerve root sheaths are visualized as negative images in the intervertebral foramen. A herniated disc is seen as a focal protrusion of the anterior epidural space presenting a clearer center (60 to 80 HU) than at the periphery (100 to 120 HU). Disco- osteophytic protrusion is seen as an arthritic hypertrophy of the uncus and a more widespread overlapping of the disc, often with a posterior body osteophytosis. The spinal cord and subarachnoid space are also visualized more clearly than when injections are not given. This technique is proposed as the initial examination after standard films, for preoperative investigation of a resistant cervicobrachial neuralgia .

[Chemonucleolysis in the treatment of sciatica caused by herniated disk]. / La chimionucléolyse dans le traitement des sciatiques par hernie discale.

Chemonucleolysis is an effective treatment of sciatica due to herniated lumbar disc after conservative treatments have failed. Provided the proper technique is applied and the patients are well selected (complete herniation or herniation within a narrow spinal canal being excluded), surgery can be avoided in the majority of cases. Chemonucleolysis does not in any way complicate subsequent surgery if required and post-nucleolysis surgery gives the same results as first intention surgery. The method, therefore, should not be regarded as an alternative to surgery but as the last stage of conservative treatment. Allergic reactions are the only true side-effects and require special precautions.

Treatment of lumbar disc herniation by chymopapain chemonucleolysis. A report on 120 patients.

Ninety of 120 patients with herniated lumbar discs who received an intradiscal injection of chymopapain achieved successful recovery. Sixteen of the 21 patients who underwent subsequent surgery had a good result. Study of the unsuccessful cases showed that disc sequestration and lateral stenosis were the major organic causes of failure. Certain radiologic criteria suggestive of sequestration and of important segmental stenosis are described. They appear to be a contraindication to chemonucleolysis. Psychogenic pain components and the failure of the enzyme to hydrolyse the nuclear proteoglycans in a few cases were the other two causes of poor results. A survey of postchemonucleolysis computed tomographic scans suggested that, although capable of digesting nuclear material in most cases, chymopapain may also work through an "anti-inflammatory" mechanism.

[Chemonucleolysis in the treatment of sciatica from herniated lumbar disc (author's transl)]. / La chimionucléolyse dans le traitement des sciatiques discales. 120 observations.

A proteolytic enzyme was used to dissolve the nucleus pulposus in 140 cases of sciatica from herniated lumbar disc. The results were satisfactory in 75% of 120 patients followed up for more than 6 months. This percentage of success, similar to that obtained with surgical excision of the disc, can only be achieved with a rigourous technique and, more importantly, with strict selection of the patients. Chemonucleolysis is indicated only for patients with unquestionable clinical and radiological evidence of herniated disc, in which case it can be considered as the ultimate medical treatment of sciatica associated with this lesion. No serious complications were observed in our series, but the risk of allergic reaction must be borne in mind.