Automated percutaneous lumbar discectomy versus chemonucleolysis in the treatment of sciatica. A randomized multicenter trial.

A randomized clinical trial was conducted to compare the results of automated percutaneous discectomy with those of chemonucleolysis in 141 patients with sciatica caused by a disk herniation; 69 underwent automated percutaneous discectomy and 72 were subjected to chemonucleolysis. The principle outcome was the overall assessment of the patient 6 months after treatment. Treatment was considered to be successful by 61% of the patients in the chemonucleolysis group compared with 44% in the automated percutaneous discectomy group. At 1-year follow-up, overall success rates were 66% in the chemonucleolysis group and 37% in the automated percutaneous group. Within 6 months of treatment, 7% of the patients in the chemonucleolysis group and 33% in the discectomy group underwent subsequent open surgery. The complication rates of both treatment groups were low, with the exception of a high rate of low-back pain in the chemonucleolysis group (42%). The results of this trial confirm previous controlled studies on chemonucleolysis and suggest that controlled studies should be carried out before automated percutaneous discectomy can be considered a useful intervention.

[Occult fractures of the sacrum in aged osteoporotic patients]. / Fractures occultes du sacrum chez le sujet âgé ostéoporotique.

We are reporting 4 cases of unnoticed sacral fractures in osteoporotic women. Their mean age was 73 years. Only in one case the fracture was seen on a standard X-Ray. On the other hand, hyperfixation with isotopes on the sacrum formed a very characteristic H-shaped image. In two of these patients, the sacral fracture was confirmed by tomodensitometry, but this examination was unavailing in the third patient. In the 4th case, hyperfixation of the isotope was not significant. Only a guided bone biopsy and the favorable evolution of the disease enabled the diagnosis of sacral fracture.

[Vertebral compression with intrasomatic vacuum images. Apropos of 2 cases with histological control by trocar biopsy]. / Tassements vertébraux avec images de vide intra-somatique. A propos de deux observations avec contrôle histologique par biopsie au trocart.

The significance of a gas shadow, known as an intra-somatic space, seen in cases of vertebral compression is discussed in relation to two cases with histological confirmation by means of trocar aspiration biopsy of the vertebra. The presence of this image is in favour of a neoplastic or infectious aetiology; however, in view of the limited experience, histological confirmation by aspiration biopsy of the vertebra is indicated in the presence of one or more reasons for suspecting a neoplastic aetiology. The most satisfactory pathophysiological hypothesis to explain the appearance of an intra-somatic space is that this image generally appears in cases of osteoporotic vertebral compression complicated by a certain degree of osseous ischaemia.

[Indigenous Legionnaires' disease. Importance of clinical symptoms (author's transl)]. / Maladie des légionnaires autochtone. Importance dudiagnostic clinique.

The first case of legionnaires' disease indigenous to France is reported. Since rapid bacteriological and/or serological diagnostic procedures are lacking, the disease should be suspected clinically in patients presenting with febrile pneumonia typically associated with neurological, digestive and renal disorders. Antibiotic treatment with erythromycin should be initiated as early as possible.