[Arthroscopic treatment of dorsal ganglion cyst at the wrist. About 54 cases]. / Résection arthroscopique des kystes synoviaux dorsaux du poignet: à propos de 54 cas.

INTRODUCTION: Ganglion cyst of the wrist can, some time, need surgery. Different arthroscopic technical procedures have been described. We report our experience in all articular resection of dorsal ganglion cyst of the wrist. OBJECTIVES: Evaluation of efficiency of resection of dorsal ganglion cyst of the wrist by of arthroscopic resection of the pedicle. METHODS: Fifty-four cysts of 52 patients have been evaluated retrospectively. Operative data, pain, strength, recurrence and complications have been collected. RESULTS: Average follow up was 28 months (6 to 78). Return to work was 8,8 days, operative time 41 minutes (25 to 90). In 67% cases, the operation was judged easy. Three surgeries had to be performed open. Complications were one hematoma and one neurodystrophy. Pain decrease from 3,37 to 1,76 on analogical pain scale. Flexion was 89% of opposite side, extension 88%. Sixteen recurrences (29.7%) were found. Sixty percent of those recurrences occurred during the first year experience. But independently of experience, the operative performance was foun difficult in 1 time on 3. CONCLUSION: Endoarticular arthroscopic resection of the pedicle of ganglion cyst is not so reproducible. In experimented hands, it remains a difficult procedure after a long learning curve with a recurrence rate 3 times higher from what is reported in literature for open surgery. For our discharge, our long follow-up can contain some cases of de novo cyst explaining this high rate, the learning curve is certainly the main reason for our high recurrence.

[Arthroscopic treatment of dorsal wrist ganglia.] / Traitement arthroscopique des kystes synoviaux dorsaux du poignet.

Incidentally discovered in 1987, arthroscopic treatment of dorsal wrist ganglia is based on our knowledge of their physiopathology which in turn benefits from the arthroscopic wrist evaluation. Dorsal wrist ganglia arise in the radiocarpal space from the dorsal part of the scapholunate ligament and migrate along the dorsal wrist capsule. According to their position above or under the dorsal intercarpal ligament, their cutaneous projection may vary. The basis of the arthroscopic treatment of wrist ganglia is, as with open surgery, the capsular resection in front of their origin. Arthroscopic resection is made either from dorsal radio-carpal or midcarpal approaches with little morbidity. Scars are unnoticeable, wrist mobility and strength close to normal by three months, which is the delay for dorsal wrist pain, always very limited, to disappear. The recurrence rate is however still debatable. Close to zero in some series, we had almost 20% recurrence rate in our series, with half of patients who reccur after two years follow-up. This variability in the recurrence rate also exists with open techniques. The only prospective and randomized study available to date found no differences between the two techniques, according to the recurrence rate.

[Arthroscopic treatment of dorsal wrist ganglia]. / Traitement arthroscopique des kystes synoviaux dorsaux du poignet.

Incidentally discovered in 1987, arthroscopic treatment of dorsal wrist ganglia is based on our knowledge of their physiopathology which in turn benefits from the arthroscopic wrist evaluation. Dorsal wrist ganglia arise in the radiocarpal space from the dorsal part of the scapholunate ligament and migrate along the dorsal wrist capsule. According to their position above or under the dorsal intercarpal ligament, their cutaneous projection may vary. The basis of the arthroscopic treatment of wrist ganglia is, as with open surgery, the capsular resection in front of their origin. Arthroscopic resection is made either from dorsal radio-carpal or midcarpal approaches with little morbidity. Scars are unnoticeable, wrist mobility and strength close to normal by three months, which is the delay for dorsal wrist pain, always very limited, to disappear. The recurrence rate is however still debatable. Close to zero in some series, we had almost 20% recurrence rate in our series, with half of patients who reccur after two years follow-up. This variability in the recurrence rate also exists with open techniques. The only prospective and randomized study available to date found no differences between the two techniques, according to the recurrence rate.

[Long-term influence of associated arthrodesis on adjacent segments in the treatment of lumbar stenosis: a series of 127 cases with 9-year follow-up]. / Influence à long terme de l'arthrodèse associée sur les niveaux adjacents dans le traitement des sténoses lombaires.

PURPOSE OF THE STUDY: Little is known about the impact of posterolateral arthrodesis on adjacent levels. In order to examine this question, we analyzed the radiological evolution of the lumbar spine in patients treated for lumbar stenosis, comparing cases where posterolateral arthrodesis was used with the other cases. Our aim was to determine whether the long-term radiographical modifications were affected by the arthrodesis. MATERIAL AND METHODS: Among our series of patients presenting with lumbar stenosis between 1984 and 1992, we retained two groups: patients in group 1 (n=46) who underwent single-level decompressions at L4-L5 or L4-L5 and L5-S1 level; and patients in group II (n=81) who underwent decompressions on the same levels associated with posterolateral arthrodesis extending from L4 to the sacrum with or without instrumentation. We compared the course of the two levels above the decompression (L2-L3 and L3-L4) between the two groups. We compared three radiological parameters: disc height, intervertebral slipping, and intersegmental mobility. We also examined the correlations between radiological modifications and functional outcome. Mean follow-up for these 127 patients was 9 years. RESULTS: The two groups were comparable for age, gender, follow-up, and presurgical functional score, disc height and intervertebral slipping at equivalent levels. At last follow-up, disc narrowing was observed at L2-L3 and L3-L4; it was significantly greater in the group with complementary arthrodesis. At L3-L4, intervertebral slipping also worsened more in the arthrodesis patients. Use of osteosynthesis significantly increased the risk of developing such radiological lesions. These lesions were associated, solely in the arthrodesis group, with poorer functional outcome. CONCLUSION: Our findings allow the conclusion that, despite the effect of physiological aging, the observed long-term degenerative lesions in patients undergoing treatment of lumbar stenosis are related to the associated arthrodesis which increases their frequency and severity, deteriorating the functional outcome.