[Foraminal lumbar hernia. Diagnostic and therapeutic aspects (apropos of 40 cases)]. / Hernies foraminales lombaires. Aspects diagnostiques et thérapeutiques (à propos de 40 cas).

This study was based upon a retrospective analysis of 40 case-histories of foraminal lombar disc herniations. Patients presented an isolated femoral neuralgia 3 times out of 4, were males twice out of 3 and were about fifty. Computed Tomographic Scanning oriented precisely the diagnosis for half the cases but only suggested it for the other 50 per cent. Computed Tomographic Scanning of lumbar discography was executed 5 times and confirmed the foraminal lumbar disc herniation. MRI executed 18 times confirmed the foraminal lumbar disc herniation by sagittal, axial and frontal-oblique views. 7 patients recovered with medical treatment. 4 patients with a subligamentous lumbar disc herniation recovered with percutaneous treatment. 29 patients underwent surgical treatment. The classical intervertebral foramina approach by complete facetectomy and arthrodesis was replaced by more conservative technics regarding bony structures: extraforaminal lumbar disc herniation was removed by paraspinal approach, whereas foraminal lumbar disc herniation was removed by a combined approach associating an interlaminar approach with a paraspinal one.

Normal and disrupted lumbar longitudinal ligaments: correlative MR and anatomic study.

The posterior and anterior longitudinal ligaments of the lumbar spine appear on magnetic resonance (MR) images as thin lines of very low signal intensity in all spin-echo sequences. They cover the periphery of the outer fibers of the anulus fibrosus on sagittal images. The lumbar spine of 17 patients with 19 disk herniations was prospectively evaluated with MR imaging, and these findings were correlated with surgical findings. At surgery the posterior ligament was found to be disrupted in eight cases and intact in 11. Absence of a low-signal peripheral line around the herniated nucleus pulposus (HNP) was the most reliable sign of ligament rupture (no false-negative or false-positive findings). The peripheral line appeared to be interrupted in four cases, two of which were falsely positive. The two false-positive cases were related to a chemical shift artifact between epidural fat and the HNP. Presence of a normal and continuous peripheral line outlining the HNP excluded ligament disruption. The overall sensitivity for detecting disruption was 100%, and the specificity was 78%.

[Recalibration of the lumbar canal, an alternative to laminectomy in the treatment of lumbar canal stenosis]. / Le recalibrage du canal lombaire, alternative à la laminectomie dans le traitement des sténoses du canal lombaire.

A technique is described for widening the lumbar vertebral canal in the treatment of lumbar stenosis. This method, which preserves part of the posterior arches, has the aim of avoiding the instability which accompanies extensive laminectomies of the whole lumbar spine. The preservation of the posterior arches allows a ligamentoplasty to be made with dacron in stable spines and a combined fusion with internal fixation applied to the posterior arches to be made in cases of spondylolisthesis. The results of a prospective series of 32 patients have confirmed the effectiveness of the method both on the stenosis and on the post-operative spinal stability.