Posterior lumbar osteotomy for flat back in adults.

Several studies describe sagittal realignment for flat back and related kyphotic decompensation. Official guidelines for sagittal and the frontal realignment have not been developed. In this retrospective study, the authors examined 10 patients with flat back syndrome and treated a related kyphotic decompensation syndrome by posterior wedge osteotomy. The authors' goal was to determine the efficacy of one-level osteotomy on sagittal and frontal realignment. The effectiveness of osteotomy performed mainly in L3 or L4 was measured in terms of radiographic sagittal and frontal alignment. Sagittal unbalance was improved in all patients. The correction is related to the restitution of lumbar lordosis (5 degrees of lordosis allows 1 cm of sagittal correction). However, frontal balance is difficult to restore or even to maintain. In one patient, it was worsened and required repeated operation. One-level lumbar osteotomy is a safe procedure to correct sagittal unbalance. Peroperative lordosis correction allows reliable correction planning. The remaining problem is planning for frontal balance correction.

[Clinical imaging of osteo-condensed metastases]. / Imagerie clinique des métastases ostéocondensantes.

INTRODUCTION: Due to the occurrence of osteoblastic metastases in the course of various cancers, particularly in the course of prostate cancer, we are faced with diagnosis and follow-up issues different from those associated with lytic metastasis. We therefore analyzed the respective advantages of imaging techniques. CURRENT KNOWLEDGE AND KEY POINTS: Most of the time, osteoblastic metastases are evidenced by standard radiography. Due to its ability to demonstrate metastases localization, extent and signs, CT scan is not only of value when osteoblastic metastases are suspected but also for patient's follow-up. MRI provides further information in regard to both the lesion content and osteoblastic degree. Though MRI must be performed after all other imaging procedures, it is of value for multiplanar study of the whole spine. FUTURE PROSPECTS AND PROJECTS: Studies focusing on either the lesion content and volume or helical CT are in progress and aim at better monitoring follow-up, while the objective of dynamic MRI studies is to better analyze lesion content.

Local control after surgical treatment of spinal metastatic disease.

Surgery was carried out on 118 patients with spinal metastatic diseases; 80 operations were palliative and 38 were curative. All patients who survived 1 year or more and all those who had local recurrence before dying (total n = 58) were included in this study. The aim of the study was to identify the factors that determine the success of local control in order to develop a new technique that could prevent local recurrence. From among the different factors that may influence the oncological result, a retrospective study concentrated particularly on the following items: sex of the patient, location and extension of the tumor on the spine, tumor involvement on the vertebra itself, and quality of tumor excision. These factors seem to have no or little influence on local control. However, sensitivity of the primary cancer to adjuvant treatments (e.g., chemotherapy, radiation therapy, hormonotherapy) and correct timing of the radiation therapy, which must be performed after, rather than before, surgery, seem to improve local control significantly. The authors therefore suggest two options for treatment. When the primary cancer is sensitive to adjuvant treatments, 'palliative' surgery with posterior fixation and nerve decompression seems sufficient to attain good function and adequate oncological results. On the other hand, when the primary cancer is resistant to adjuvant treatment or when the lesion recurs after radiation therapy, more aggressive surgery must be carried out. Complete excision of the tumor after embolization, with may be even associated local chemotherapy, is required. However, even when this is carried out, local control is difficult to achieve.

Hydroxylapatite-coated Diapason screws: first clinical report.

We report our preliminary experience with 27 patients who underwent surgery for posterior spinal arthrodesis using the hydroxylapatite-coated Diapason screws. Each of the patients was considered to have a condition that was mechanically risky from the surgical standpoint. The results were good for patients with lytic spondylolisthesis and were excellent for patients with osteoporosis, but were generally less successful for patients requiring "long lever arm" fixations and those with degenerative scoliosis.

[Surgical treatment of spinal metastases]. / Traitement chirurgical des métastases vertébrales.

Spinal metastasis often lead to two main complications: back pain and para or tetraplegia. Performed alone radiotherapy may be too slowly efficient to allow a neurological recovery. Laminectomy may improve the neurological signs but does not induce any change on root pain and it increases instability. A surgical procedure by a posterior approach including laminectomy and fixation by plates and transpedicular screws fits these two goals: decompression and stabilisation. The first 189 cases are reported: the first month lethality is about 15%. 81% of fixations remained unchanged. 21 out of the 62 patients with loss of autonomy recovered an ability to walk. Besides this palliative surgery, a total spondylectomy has been done 13 times in order to perform a curative surgery for unique metastasis of cancers with long life expectancy. An early walking is often possible and after healing of the wound, a complementary treatment with radio or chemo therapy may be started without any risk of pain or neurological compression.

[Surgical treatment of spinal metastases by stabilization using posterior plates screwed into the vertebral pedicles]. / Traitement chirurgical des métastases du rachis par stabilisation à l'aide de plaques postérieures vissées dans les pédicules vertébraux.

Ninety spinal metastases were treated by plating using a posterior approach. Fifty were thoracic or thoraco-lumbar, 11 in the upper cervical spine, 14 in the lower cervical spine and fifteen in the lumbar spine. Surgical fixation was followed by radiotherapy, chemotherapy or hormone therapy, when indicated. In the upper cervical region a special plate was screwed into the occiput. In the lower cervical spine fixation was accompanied by anterior vertebrectomy at the same procedure. In the entire series good stability was obtained in nine out of ten cases. Mortality during the first post-operative months was about 10 to 15 p. 100 dependent on the level. Two thirds of the patients gained some benefit from the operation. Cases with paraplegia and loss of independence had less favourable results than others. The ideal indications are threatened collapse of vertebrae, recent neurological impairment of severe pain resistant to conservative treatment.

[Recent fractures of the odontoid. Prognostic factors]. / Fractures récentes de l'odontoïde. Facteurs de pronostic.

A review of 92 recent fractures of the odontoid process suggests that they can be divided into two groups: stable fractures requiring no more than orthopedic treatment, and unstable fractures requiring surgery. Basing themselves on four main prognostic factors (direction and level of the fracture, distance between the fragments and age of the patients), the authors propose three types of surgical treatment differing in complexity and functional results: posterior C1-C2 arthrodesis, simple lacing with nylon threads and, quite recently, direct screwing by the antero-lateral approach.

[Diffuse eosinophilic fasciitis (Shulman's syndrome). Apropos of a case disclosed by spinal cord compression]. / Fasciite diffuse à éosinophiles (syndrome de Shulman). A propos d'une observation avec compression médullaire révélatrice.

The case of Shulman's syndrome reported in this article is unusual, because of the topography of the lesions and the lethal course. The perivertebral fasciitis, which was pseudotumoral in appearance, induced a myelomalacia by compression of the cervical spinal cord. In addition, the autopsy revealed severe tissue eosinophilia, cutaneous sclerodermiform sclerosis and pharyngoesophageal lesions unusual in this disease. The pathogenesis of the syndrome is discussed.