Image-Guided Spinal Steroid Injections.

This paper has been written to stimulate the radiologist to consider the various aspects of spinal steroid injections as therapeutic procedures. Special emphasis is placed on needle guidance, asepsis, and possible problems involved. It constitutes a highly practical and variously illustrated and informative guide for the choice of steroids and various spinal joint approaches. It details the following target areas: lumbar facet joints, cervical facet joints, costovertebral joints, C1-C2 joint, intervertebral discs, epidural space, and interspinous bursa. Safety is the key element of the above-mentioned techniques. The radiologist must pay special attention to the omnipresent risk of iatrogenic infection.

CT scans and arthro-CT scans.

The study of the cartilage is relatively easy with modern imaging. If the interpretation of MRI cartilage remains difficult arthro-CT images are easy to obtain. Arthro-CT is much preferable to simple arthrography. These two steps are in fact complementary: the global study of the joint is made with arthrography while the accurate assessment of cartilage is obtained with thin CT native slices acquired in an adapted plane and completed with reformatted images. The detection of small lesions, such as a faint thinning of the cartilage, or a focal fissure is only possible with a long and meticulous examination. The pathological value of the images still depends on the clinical examination, because of the high incidence of asymptomatic chondromalacia in elderly patients. The assessment of the cartilage overlying osteochondritis or osteochondral fractures is of particular clinical interest. The detection of post-traumatic cartilaginous lesions may also be valuable in medicolegal problems.

Facet joint block for low back pain: identifying predictors of a good response.

This preliminary study was conducted to identify a facet joint syndrome in low back pain. Ninety maneuvers and symptoms were compared between patients relieved (responders) and those unrelieved (nonresponders) after intraarticular blocks. Fifty-one patients participated in the study; 11 were excluded from evaluation because of unsuccessful injection into the joints as planned. Of the 40 patients included, 20 had four joints anesthetized, 16 had two joints anesthetized, and four had three joints anesthetized. Twenty-two were responders, 17 of whom had more than 90% relief of pain. Only a few variables were more frequent in the responder group: older age, absence of exacerbation by coughing, relief when recumbent, absence of exacerbation by forward flexion and when raising from this flexion, absence of worsening by hyperextension, and extension-rotation. When four of these seven variables were present in the same patient, sensitivity was 81.8% and specificity 77.8%, but this discriminant power must be evaluated in a new population.

Directivity patterns of a moving thermoelastic source in solid media.

Generation of ultrasonic displacements under the thermoelastic effect has the advantage of being contactless and nondestructive. Unfortunately, the directivity and energy of the sound field of such a source are limited. In order to change these parameters the authors use a moving thermoelastic source by moving the laser beam on the solid surface. Moving the laser beam allows control of the ultrasonic beam directivity and an increase in the energy of the sound field. For this purpose, a large impulse of dye laser deflected by an acoustooptic cell working under the Bragg mode is used. Experimental results, in an aluminum sample give good agreement with the theoretical prediction.

[A criterion of validity of the x-ray computed tomographic measurement of femoral neck anteversion]. / Un critère de validité de la mesure tomodensitométrique de l'antéversion du col fémoral.

A wrong patient's position on the CT scan table may lead to mistakes in the measurement of femoral neck anteversion. We present an experimental demonstration using a wood manufactured femur model. If the slices are performed with flexion of the thigh, the measurement is lower than the true value. Thus, to check the measurement on the picture of added slices, it is necessary to have a superimposition of the pictures of the upper part and the lower part of the femur. Otherwise, the measure is wrong and the mistake depends of the direction of the shifting: --if the lower part of the femur is higher, the anteversion measure is lower than expected. --if the lower part of the femur is lower, the anteversion measure is higher.

Case report 627: Septic arthritis of lumbar facet joint as initial manifestation of spondylodiscitis.

In summary, septic arthritis of a lumbar facet joint has been rarely discussed in the literature [1, 4]. In this case report the histological and bacteriological diagnosis was established by percutaneous needle biopsy guided by fluoroscopy and the response to treatment was confirmed by CT scans.

[The labrum acetabular. Apropos of 121 arthrographies of the hip in adults]. / Le bourrelet cotyloïdien. A propos de 121 arthrographies de la hanche chez l'adulte.

The authors report a retrospective study of 121 arthrographies of the hip in adults, excluding prostheses. The study was based on normal pathological values for angular measurement of the labrum acetabular: ECB angle (mean value: 15 degrees) enlarging the lateral cover of the head of the femur, VCE angle (mean value: 30 degrees) and a mean global VCB angle of 45 degrees. A certain equilibrium was observed between the covering capacity of the acetabulum and the covering capacity of the labrum acetabular. Numerous anomalies of the labrum were observed, including fissures in about 30% of cases. A large number of fissures were associated with other degenerative anomalies of the hip joint. A few fissures resulting in detachment of a strip of labrum were isolated and the possibility of their traumatic etiology and their pathogenic nature in clinical symptoms are discussed.

[Lumboradiculalgia and calcified disk hernia]. / Lomboradiculalgie et hernie discale calcifiée.

In the context of a particular case report, the authors recall that calcified discs may be responsible for root pain, hyperalgic sciatica or lumbago. In the present case, the pain responded to intra-discal injection of long-acting corticosteroids. The authors compare this case to 10 other personal cases and 16 cases reported in the literature.

[Unilateral isthmic lysis in x-ray computed tomography]. / Lyse isthmique unilatérale en tomodensitométrie.

Condensing pediculolaminar hypertrophy of mechanical origin is known as "Dahu's sign". Dahu's sign corresponds to hypertrophy of the vertebral hemi-arch found by CT scan and leads to suspicion of controlateral lysis of the isthmus. It is the CT scan equivalent of vertebral "anisocorism" by conventional radiology.

[Notches of the acetabulum roof. Incidence: anatomoradiological correlation]. / Encoches du toit du cotyle. Fréquence: corrélation anatomoradiologique.

An unselected group of patients with rheumatoid affections presents radiologic evidence of a notch of acetabulum roof in about 20% of cases. The anatomic substratum of this variant is described and should be recognized to avoid a mistaken diagnosis of periarticular lacuna.

[The dural sheath in the sitting and standing position during saccoradiculography. Apropos of 150 cases]. / Etude du fourreau dural en position assise et debout au cours de la saccoradiculographie. A propos de 150 cas.

Lateral images were studied in the sitting and standing positions during a continuous series of 150 radiculographies, in patients presenting with a symptomatology suggestive of herniated disk or lumbar stenosis. In 67% of cases the dural sac was abnormally reduced at the level of the inter-somatic spaces, due to disk protrusion or intracanalar protrusion of posterior soft tissues. In 23% of cases, an absolute canalar stenosis with anterior-posterior decrease to less than 10 mn in the standing position existed. This was due in 65% of cases to an isolated or predominant posterior impression, the latter appearing in the standing position in only 55% of cases. Saccoradiculography is the only procedure allowing study of the dural cul-de-sac in the standing position. It should be carried out if a narrow lumbar canal is suspected clinically, even if investigations in the lying position, such as CT scan or MR imaging show normal canalar dimensions.

[Descending quasi-axial projection of the disk during discography. Principles]. / L'incidence quasi-axiale descendante du disque au cours de la discographie. Principes.

The authors describe a new view of the discography comparable to the axial CT imaging of the disc, so they used the name of "quasi-axial" view. They point the landmarks of this new picture.

[Realization of an incidence of the bicipital groove under the control of televised scopy]. / Réalisation d'une incidence de la gouttière bicipitale sous contrôle de la scopie télévisée.

A method is described for control of a bicipital groove projection using a tele-controlled table with centering guided by direct screen imaging: the patient is placed in contralateral anterior oblique position with the arm in antepulsion to project the groove into the supraspinal fossa on a lateral scapular image.

[Quasi-axial descending incidence in lumbar discography. Clinical evaluation in proved hernia]. / Incidence quasi-axiale descendante au cours de la discographie lombaire. Evaluation clinique sur hernie avérée.

The authors study the diagnostic accuracy of quasi axial view during discography about 136 discs with proved herniation. It is a good helm to the frontal and lateral views.

[Spontaneous fracture of the sternum]. / Fracture spontanée du sternum.

Spontaneous fractures of the sternum are unusual. They can simulate cardio-thoracic emergencies. A case of stress fracture of the sternum and of the femoral neck in a patient with corticosteroid induced osteoporosis is reported and the peculiar value of CT assessing the absence of tumoral mass is emphasized.

[Osteonecrosis of the femoral head. MRI study of 60 cases]. / L'ostéonécrose de la tête fémorale. Etude par IRM de 60 cas.

Normal and pathologic femoral heads have been studied by MRI at 1.5 Tesla. The study was centered upon avascular necrosis (53 lesions). Twenty normal subjects and three patients with algodystrophy were examined. The osteonecrosis patterns were established from known lesions. A low signal rim surrounds an upper polar zone of conserved (Type I) or decreased (Type II) signal. The lesions age correlates significantly with their type: amongst type I lesions, 6 are asymptomatic and the 21 others have a mean age of 5.5 months; Type II lesions have a mean age of 12.7 months. Fourteen lesions were not seen on plain radiographs and six were not detected by bone scan. The older lesions with femoral head deformation are better depicted by standard radiologic techniques. Conservatively MRI is the most efficient examination for recent avascular necrosis lesions.

[X-ray computed tomographic aspects of lumbar articular synovial cysts with intraspinal development]. / Aspects tomodensitométriques des kystes synoviaux articulaires lombaires à développement intrarachidien.

CT scan imaging findings are described in 22 patients with lumbar spine joint synovial cysts, of intraspinal development, provoking sciatica or lumbosciatica from nerve compression in spinal canal. Diagnosis was suggested by a mass at the posterior joint level, of variable density, sometimes with peripheral calcification, presenting a vacuum appearance on occasions, and with enhanced image with contrast. Differential diagnosis is from excluded hernia and postoperative fibrosis. Posterior intraarticular arthrography can confirm diagnosis and allow treatment with prolonged action corticoid infiltrations.

[Desmoid fibroma of the abdominal wall. Apropos of a case]. / Fibrome desmoïde de la paroi abdominale. A propos d'un cas.

A case of desmoid fibroma of anterior abdominal wall, an exceptional benign tumor, is reported. Based on results of CT scan imaging of this lesion, differential diagnosis of other expansive processes of abdominal wall are discussed. This benign tumor is a potentially serious lesion due to its infiltrating character and the high incidence of recurrence. The need for total surgical excision is emphasized.

[Arthritis of the wrist disclosing osteoid osteoma of the capitate bone]. / Arthrite du poignet révélatrice d'un ostéome ostéoïde du grand os.

A 22-year-old woman with an osteoid osteoma of capitate bone presented initially with arthritis of wrist. Bone scan imaging and digital subtraction angiography allowed diagnosis of a nidus. This case draws attention to articular manifestations of osteoid osteoma.