[Surgical treatment of spondylolisthesis in Gabon]. / Traitement chirurgical du spondylolisthésis au Gabon.

PURPOSE: Spondylolisthesis is a spinal disease revealed by lombalgia and/or lombosciatalgia, which may persist under medical treatment and physiotherapy. Indications for surgery are impairing symptoms and emergency conditions. We report outcome in 21 patients (14 women, 7 men, aged from 30 to 60 years old) who underwent surgery for isthmic (n = 10) and degenerative (n = 11) spondylolisthesis. Radiographic staging was: I in seven patients, II in ten, and III in four. METHOD: Many techniques were used: simple laminectomy (n = 4), Gill's operation (n = 4), Lapras' technique (n = 4), and Roy-Camille instrumentation (n = 9). RESULTS: Immediate and long-term postoperative follow-up of sixteen patients confirm good results: excellent outcome in eleven patients, good in four, and fair in one. CONCLUSION: Considering social and economic factors, we prefer Lapras' technique which provides very satisfactory results.

[Early anterolateral surgery for tuberculosis of the lower cervical spine with neurological complications in adult. Our experience in Gabon]. / Chirurgie antéro-latérale précoce du rachis cervical inférieur dans la spondylodiscite tuberculeuse avec troubles neurologiques chez l'adulte. Notre expérience au Gabon.

OBJECTIVE: To report our therapeutic experience with tuberculosis of the lower cervical spine with neurological complications in 9 adults in Gabon. PATIENTS AND METHODS: A retrospective study of these 9 adults treated for progressive Pott's tetraplegia or paraplegia from 1982 to 1998 was conducted. The medical treatment consisted of the early administration in the first 3 patients of rifampin, isoniazid and ethambutol for 18 months; and, in the remaining 6 patients, of rifampin, isoniazid, ethambutol and pyrazinamide for 6 months. This medical treatment was systematically started 3 weeks before surgery in 7 patients, once the disease had been diagnosed radiologically. Two patients with an acute onset of paraplegia underwent surgery on an emergency basis. The standard anterior approach was used: debridement was done in 3 cases, to establish the diagnosis; 6 patients underwent radical surgery for severe neurological deficit and spinal instability. Average follow-up time was 40.6 months. RESULTS: Three patients were found to be functionally and neurologically normal at follow-up examinations. Eight of the nine patients recovered sufficiently to walk unaided. One patient was able to get about on crutches. After 3-4 months, a satisfactory consolidation was already observed, with reduction of kyphosis in 4 cases. All patients were considered medically cured by the Antituberculous Center. CONCLUSION: Early radical surgery, as primary procedure, in conjunction with a six-month chemotherapeutic regimen (four drugs) seems to be adequate for the management of tuberculosis of the lower cervical spine with neurological complications and spinal instability, in our setting.

[How to manage intracranial empyemas in the absence of computerized tomography?]. / Quelle attitude adopter devant les empyèmes intracrâniens en l'absence de tomodensitométrie?

BACKGROUND: Intracranial, and especially subdural, empyemas are a medical emergency usually requiring surgical intervention. We suggest herein a protocol for their management in areas where CT is not yet available. MATERIALS AND METHODS: 16 patients with supratentorial empyemas (6 epidural abscesses, 6 subdural empyemas and 4 with both) diagnosed by surgical intervention in our department between 1986 and 1995 were studied. The etiological features were frontal sinusitis (7 cases), mastoid infection (1), trauma (5), previous operations (2) and unknown (1). Three patients were in a normal state of consciousness, 8 were drowsy and 5 were in a coma. Antibiotic treatment was empirical in 6 patients and specific in 10 patients. Surgical treatment was by multiple burr holes in 9 patients, small craniotomies in 3 patients, major craniotomies in 3 patients and by exploration of a previous craniotomy in 1 patient. A catheter was used for drainage in 12 patients. RESULTS: Average follow-up was 2.7 years. Two patients died, 3 had seizures and 11 were able to lead a normal life. CONCLUSION: We recommend a regime of 2 or 3 antibiotics as an initial treatment. A number of factors including ecological environment, availability of drugs and financial circumstances of each patient should be considered when determining the treatment to be used. Surgical techniques vary according to the surgeon's experience. In our medical centre, drainage via burr-holes is the initial method of treatment for supratentorial empyemas.

[Primary lymphoma of frontoparietal localization in the cranial vault. Report of a case]. / Lymphome primitif de la voûte du crâne de localisation fronto-pariétale. Un cas.

The authors report an exceptional case of primary malignant non-Hodgkin's lymphoma of cranial vault, with intra(extradural)-extra-cranial extension. The duration of symptomatology before surgery was six months. The main clinical and radiological particularities were: large soft-tissue mass (17 x 12 cm); extensive osteolytic lesions of the left frontal and parietal bones, with intratumoral calcifications; contribution of meningeal and scalp vessels. Surgery was performed to relieve progressive intracranial compression. According to the international working formulation, it was classified as an intermediary malignant tumor. Unfortunately, the patient died of a traffic accident, six weeks after his discharge.

[Diagnostic problems with cerebral vascular accidents in Gabon]. / Problèmes de diagnostic des accidents vasculaires cérébraux au Gabon.

This retrospective study covers a period of eleven years (1977-1988). It concerns 365 patients who developed a cerebrovascular accident or stroke and originated from different provinces of Gabon. The authors report their experiences in order to emphasize the diagnostic problems and the need of computerized tomography.

[Vertebral tuberculosis in Gabon. Anatomo-clinical aspects, diagnostic and therapeutic problems, 107 cases from 1976 to 1986]. / La tuberculose vertébrale au Gabon. Aspects anatomo-cliniques, problèmes diagnostiques et thérapeutiques, 107 cas de 1976 à 1986.

This retrospective study covers a period of 10.5 years (february 1976 to november 1986). It concerns 107 patients who contracted tuberculous spondylitis and originated from different provinces of Gabon. The authors report their experiences in order to emphasize the frequency of the disease, diagnostic and therapeutic problems. In Gabon, tuberculosis of the spine occupies the third position (3%), after the pulmonary form (90%) and ganglionic form (3.8%). In also represents 83.6% of the osteoarticular tuberculosis. The average age is 22 years, 55% of the patients were less than 20 years. The zone of maximum predilection, in decreasing order, is thoracic spine (36.4%), lumbar spine (33.6%), thoraco-lumbar region (10.3%). The 107 patients totalized 257 vertebral bodies destroyed (an average of 2.4 bodies per patients). On the clinical field the sick seek advice at an advance stage of the disease with gibbosity (38.3%) and neurologic deficits (21.5%). The diagnosis proof often followed the therapeutic results. There were three therapeutic modalities: medical (all patients), surgical (6 patients) and orthopedic (44 patients). The therapeutic indications improved with the available of more material and qualified staff. In children the treatment remains classic. The authors discuss the surgical indications in adults. The therapeutic results in patients treated and followed for over one year were satisfactory. Unfortunately, most patients were lost to follow-up. They suggest public health means of decreasing the frequency of the disease.