[Charcot's disease of the lumbosacral joint in spinal cord injury: a case report]. / Arthropathie neurogène de la charnière lombosacrée chez un paraplégique : à propos d'un cas.

OBJECTIVE: Comment on spinal damage in Charcot's disease. OBSERVATION: We report on a paraplegic patient with T9 spinal cord injury who developed destructive arthropathy of the lumbosacral joint. DISCUSSION: Charcot's disease occurs sporadically during the progression of certain chronic neurological diseases. It affects the limbs and the spine, where it causes major disc and vertebral damage. In cases of spinal cord injury, Charcot's disease must be considered when faced with the appearance of spinal deformity or the aggravation of neurological symptoms. Treatment of Charcot's disease requires spinal osteosynthesis for the relief of neurological compression and the re-establishment of spinal stability.

[Two key describers of the sacro-acetabular relationships: the angles of sacral and acetabular incidence]. / Deux descripteurs clé des relations sacro-cotyloïdiennes : les angles d'incidence sacrée et cotyloïde Mise en évidence par le logiciel De-Visu.

PURPOSE OF THE STUDY: Implantation of total hip arthroplasties raises several important questions concerning the relationship between the orientation of the lumbosacral joint and the acetabular-femoral joint; in other words, between the position of the patients trunk and the orientation of the acetabula. To elucidate better these complex relationships, we conducted a morphometry study on a sample of 51 dry pelves: pelv 26 female and 25 male specimens. MATERIAL AND METHODS: Three-dimensional coordinates of 47 homologous points were recorded for each pelvis. Data were then processed with De-Visu, a graphic visualization software. Seven parameters were compared: sacral slope, sacral incidence, and five parameters quantifying the three-dimensional orientation of the acetabula. RESULTS: The graphic modelization enabled an integral 3-D visualization of each pelvis. The sagittal view enabled simultaneous visualization of the sacrum, the sacroiliac joints, the acetabula, and their alignments, as well as the variability of their spatial relation. The position reference chosen to simulate the upright position aligned the anterior iliac spines and the superior pubic point. This position was found pertinent because the mean value of the sacral slope (41.8) and the sacral incidence (54) were not different from published series. The sacral slope was the most strongly correlated with the acetabular parameters. It exhibited a positive correlation with sagittal acetabular slope (r=0.59) and acetabular inclination (r=0.59). It exhibited a negative correlation with acetabular anteversion (R=0.45). The correlation with the sagittal acetabular slope was very strong for anteversion (r=0.92), and rose with acetabular inclination (r=-0.66). The angle formed by the two acetabular axes was highly variable (37). The correlation between this angle and inclination was very high in males (r=-0.88) and non-significant in females. There was however a very strong correlation with anteversion in females (r=-0.74) which was non-significant in males. This contrasting finding was related to the wide spread of the inclination values in males and anteversion values in females. DISCUSSION: We demonstrated a new sagittal parameter: the acetabular incidence. The summit of this angle is the center of the acetabulum. The sides are the pelvic thickness and the acetabular axes. This parameter was negatively correlated with the sacral incidence. It account simultaneously for the sagittal position of the sacrum in relation to the acetabula and for the degree of acetabular anteversion and inclination. We have demonstrated that the geometric sum of these two angles, sacral incidence and acetabular incidence, is equivalent to the sacro-acetabular angle demonstrated by Lazennec and Saillant. These authors showed that the sacro-acetabular angle is the sum of two positional parameters, the sacral slope and the sagittal acetabular tilt (or slope). The three angles -- sacral incidence, acetabular incidence, sacro-acetabular angle -- are anatomic angles which do not vary with the pelvic position.

[Asymptomatic blunt vertebral artery injury after cervical spine nonpenetrating trauma]. / Thrombose asymptomatique de l'artère vertébrale au cours des traumatismes fermés du rachis cervical.

OBJECTIVE: To show the possibility of vertebral injury after cervical spine trauma. METHOD: We observed 2 cases of asymptomatic thrombosis of the vertebral artery after cervical fracture. DISCUSSION: Thrombosis of the vertebral artery is acute in 20% of cases of cervical trauma. It may be asymptomatic. Magnetic resonance angiography is the best noninvasive investigation for such cases to systematically detect the complication. Treatment with anticoagulants or antiaggregants should be initiated.

[Nonsurgical treatment of tennis elbow]. / Les traitements non chirurgicaux de la tendinopathie des épicondyliens.

OBJECTIVE: To review the literature on nonsurgical treatment of tennis elbow. METHODS: We searched Medline for all randomized controlled trials (RCTs), controlled clinical trials (CCTs) and literature reviews published from 1966 to December 2003 on nonsurgical treatment of tennis elbow. We used the keys words controlled clinical trial, tennis elbow on lateral epicondylitis, and treatment. We found 46 reports of RCTs and CCTs on 14 nonsurgical treatments and 11 literature reviews. RESULTS: Corticosteroid injection is the best treatment option for the short term. However, beneficial effects persisted only for a short time, and the long-term outcome could be poor. For the long term, physiotherapy (pulsed ultrasound, deep friction massage and exercise programme) was the best option but was not significantly different from the "wait-and-see" approach. Some support is offered for the use of topical nonsteroid anti-inflammatory drugs, at least for the short term. There is insufficient evidence to support or refute the use of acupuncture, extracorporeal shock wave therapy, manipulation, orthoses, low-energy laser, glycosaminoglycan polysulfate injection, botulinum toxin injection, or topical nitric oxide application. CONCLUSION: Further trials, with use of appropriate methods and adequate sample sizes, are needed before conclusions can be drawn about the effects of many of the treatments for tennis elbow and their ability to change the condition's natural course.

The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients.

The anatomic pelvic parameter "incidence" - the angle between the line perpendicular to the middle of the sacral plate and the line joining the middle of the sacral plate to the center of the bicoxo-femoral axis - has been shown to be strongly correlated with the sacral slope and lumbar lordosis, and ensures the individual an economical standing position. It is important for determining the sagittal curve of the spine. The angle of incidence has also been shown to depend partly on the sagittal anatomy of sacrum, which is established in childhood while learning to stand and walk. The purpose of this study was (1) to define the relationship between the sacrum and the angle of incidence, and (2) to compare these parameters in three populations: young adults, infants before walking, and patients with spondylolisthesis. Forty-four normal young adults, 32 infants not yet walking and 39 patients with spondylolisthesis due to isthmic spondylolysis underwent a sagittal full-spine radiography. A graphic table and the software for bidimensional study of the sacrum developed by J. Hecquet were used to determine various anatomic and positional parameters. Comparison tests of means, and multiple and partial correlation tests were used. A study of the reliability of the measurements using factorial plan methods was performed. The sagittal anatomic parameters of the sacrum were found to have a close relationship with the pelvic parameter of incidence angle, and therefore with the sagittal balance of the spine. The anatomy of the sacrum in spondylolisthesis patients is particular in that some features are much like those of young infants, but it is more curved and the incidence angle is significantly larger. There is a close relationship between angle of incidence and the slip of spondylolisthesis. All the parameters of young infants are significantly smaller than those of adults. It can be concluded that the sagittal anatomy of the sacrum plays a key role in spinal sagittal balance. The sacral bone is an integral a part of the pelvis and constitutes the undistorted part of the spinal curves. Organization of sagittal curves during growth can be followed up by looking at the sacrum. The sacrum in the spondylolisthesis group differs from the normal, and the greater angle of incidence and sacral slope in this group could predispose to vertebral slip.