Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis.

In order to establish a sagittal plane curve reference table for standing subjects examined laterally, we determined an easily reproducible standard posture. A sample of 100 healthy subjects from 20 to 29 years of age, was chosen (43 women, 57 men). The reciprocal angulations of each vertebral body in relation to the others were fed into a digitalizer and studied by computer. The study particularly concerns maximum kyphosis, maximum lordosis, sacral base slopes, and the tilt of intermediate vertebral bodies. The dispersion of the results is remarkably wide and, within the extreme values, the distribution is irregular. Individual correlations of these values are often dispersed, but spinal morphotypology. For considerable lengths, average values cannot be used as norms, given the wide span of values. Only the extreme limits are useful for the appreciation of curves as excessive, insufficient, or inverted.

[Mesenteric neurofibromatosis. Apropos of a case]. / Neurofibromatose mésentérique. A propos d'une observation.

The authors report a case of severe Recklinghausen's disease, revealed early in infancy, by spinal deformities and then by severe dislocations with kypho-scoliosis surgically treated by anterior and posterior fusion. Other localisations of neurofibromatosis were present, especially bones and skin. During the disease's course a wide sub-cutaneous tumor of the chest wall was removed. Two years later a large abdomino-pelvic tumor of the mesentery was discovered and also removed. Histologic examination showed it to be related to Recklinghausen's disease and malignant. The authors analyse the risk of malignant degeneration of this tumor with relation to previous surgical treatment.

[Megaspondylodysplasia : orthopaedic management (author's transl)]. / La mégaspondylodysplasie : aspects orthopédiques.

The authors describe three cases of megspondylodysplasia, an original syndrome first described in 1972. This congenital lesion is associated with severe kyphoscoliosis, multiple hemimelic enchondromatoses of the spine, hands, feet, knees and hips and hypertrophy of half of the body. In the discussion, differentiation between this syndrome and other diseases such as Ollier's or Mafucci's disease is described. Surgical correction on such a severely deformed spine is dangerous to the spinal cord.

[Anterior strut grafting in kyphosis and kyphoscoliosis (author's transl)]. / Greffes antérieures en étai dans le traitement des cyphoses et cyphoscolioses.

The authors have reviewed 58 cases submitted to strut grafting in the concavity of the curve. There were 44 kyphoscolioses and 12 kyphoses. The average follow-up was more than two years and the average pre-operative deformity was 127 degrees. The average improvement was 38 degrees and the secondary loss was only 3 degrees. The results are analysed with regard to the surgical technique used. In some cases, posterior fixation was added and the graft was either from the tibia, the fibula or a rib. In 16 cases a secondary fracture of the graft was found. It appeared between the fourth and tenth post-operative months. During this period, reduction of the graft was seen. The graft was found to thicken later at about the eighteenth post-operative month. It is concluded that the technique is worthwhile provided it is associated with posterior internal fixation, and that an external brace is worn for at least eighteen months after operation.

[Major scoliosis, over 100 degrees, in adults. 183 surgically treated cases]. / Scolioses majeures de l'adulte supérieures à 100 degre's 183 cas traités chirurgicalement

Most severe scoliosis and kyphoscoliosis are not unfrequent in European countries. The purpose of their treatment is not only cosmetic but, often, vital. Patients are hypotrophic and their vital capacities usually very poor. Since 1952, the authors have treated (partial, reduction and fusion) 183 patients: with curves above 100 degrees (101 degrees-203 degrees). Reduction was obtained by distraction cast or halo-traction. Surgical treatment (one or two stages) used Harrington rods and fusion with a large amount of iliac bone. These procedures are dangerous for the medullary function. Controls must be performed during the operative distraction. Follow up studies demonstrated the stability of the obtained reductions.

[Critical evaluation of the surgical treatment of vertebral lesions due to neurofibromatosis. 31 cases (1954-1973)]. / Evaluation critique du traitement chirurgical des lésions vertébrales de la neurofibromatose

Scoliosis is a complication of spinal lesions in neurofibromatosis, and leads frequently to major deformities with dislocations. The authors conducted a critical study of 31 cases surgically treated during the 1954-73 period of time. The techniques of spine straightening and of arthrodesis were recalled. The authors conclude that in case of moderate deformity (less than 100 degrees) Harrington's operation was satisfactory enough when correctly conducted. In case of severe dislocation and kyphosis, straightening was obtained after long lasting casts and halo tractions. Then posterior fusion using Harrington's rods had usually to be completed by anterior, transthoracic fusion for better solidity.