[Fracture luxation of the cervical spine in patients with ankylosing spondylitis: six cases]. / Fracture luxation du rachis cervical chez des patients atteints de spondylarthrite ankylosante: à propos de six cas.

BACKGROUND AND PURPOSE: Treatment of cervical spine fracture in patients with ankylosing spondylitis is difficult. Biomechanical changes related to ossified ankylosing spondylitis spine make cervical spine fractures highly unstable. They cover the entire width of the spine inducing multidirectional instability and the risk of neurological injuries. Treatment is more difficult that in the nonossified spine. Different treatments have been proposed including anterior stabilization, posterior stabilization, or both. METHODS: We reviewed retrospectively six cases of cervical fracture dislocation in patients with ankylosing spondylitis. RESULTS: There were five cases of C6C7 fracture dislocation and one case of C4C5 fracture dislocation. Four patients had neurological impairment at diagnosis. All patients underwent surgery. Two had anterior stabilization: one patient died and the other achieved bone healing. Four patients had anterior and posterior stabilization combined with a cervical brace for three months, for two and a halo cast for two, others because of persistent instability, with neurological injury in one. A neurological improvement was obtained in four patients. One patient was lost to follow-up. CONCLUSION: Surgical management of selected patients with ankylosing spondylitis and cervical spine fractures is challenging. Combined anterior and posterior stabilization should be considered for these fractures. A cervical brace must be associated with surgical treatment. With appropriate management, outcome can be favorable.

Preoperative percutaneous injection of methyl methacrylate and N-butyl cyanoacrylate in vertebral hemangiomas.

PURPOSE: To investigate the usefulness of preoperative percutaneous injections in vertebral hemangiomas. METHODS: Four patients presented with complicated vertebral hemangioma (spinal cord compression in three cases, intermittent spinal claudiction in one case). A three-part treatment was performed: initially, arterial embolization in three cases; 1 day later, percutaneous injections of methyl methacrylate into the vertebral body to strengthen it and of N-butyl cyanoacrylate into the posterior arch to optimize hemostasis during surgery; finally, the day after percutaneous injections, decompressive laminectomy and epidural hemangioma excision (when present). RESULTS: Laminectomy was performed with minimal blood loss. The epidural component present in three cases was excised without any difficulty. The follow-up (average, 20 months) showed no evidence of vertebral collapse. CONCLUSION: Percutaneous injections of methyl methacrylate and N-butyl cyanoacrylate might be useful before surgery for vertebral hemangiomas.

Percutaneous vertebroplasty with acrylic cement in the treatment of a Langerhans cell vertebral histiocytosis.

A 25-year-old man developed multiple eosinophilic granuloma of bone including vertebral and sacral localization. Radiotherapy was initially administered. One year later, a relapse occurred in another vertebrae which was previously irradiated. Percutaneous vertebroplasty was, for the first time to our knowledge performed, in this indication, with a good clinical result with follow-up now for one year. We emphasize that such treatment is permissible only in symptomatic, progressive lesions, with threatened decompensation of spinal stability. This technique should be used only on an adult.

Long-term efficacy of percutaneous drill-biopsy under computed tomography guidance of osteoid osteomas of the hip and femur. A review of seven cases.

UNLABELLED: En bloc surgical excision of osteoid osteomas of the hip and femur is difficult because of problems with tumor boundary identification and the need to use internal fixation or bone grafting. We report our experience with seven cases treated by percutaneous drill-biopsy under computed tomography guidance. PATIENTS: Six adults and one child with a mean age of 22 years treated since 1995. All seven patients reported insomnia due to pain during a mean of 10 months, improved by aspirin or other nonsteroidal anti-inflammatory agents. The tumor was seen on plain radiographs in four cases and on computed tomography scans in all seven cases. Magnetic resonance imaging was diagnostic in only two cases. The tumor was in the femoral neck in four patients, in the acetabulum in one, in the proximal femur in one, and at the distal diaphyseal-metaphyseal junction of the femur in one. METHOD: A trephine was used to remove the tumor under computed tomography guidance during a short general anesthesia. RESULTS: No serious complications were recorded. Full weight bearing was allowed starting at the forty-eighth hour in six of the seven patients. Immediate pain relief and a full recovery were obtained in every case. Results were excellent in four patients and good in three after a follow-up of 14 to 44 months. CONCLUSION: Percutaneous drill-biopsy of osteoid osteomas is a valuable alternative to conventional surgery in patients with tumors at sites that are difficult to access. The technique allows early weight bearing and ensures a full recovery.

["Spontaneous" hematoma of the psoas in Gaucher's disease]. / Hématome "spontanéc" du psoas au cours de la maladie de Gaucher.

The authors report a case of iliac muscle haematoma responsible for inguinal pain in a patient with Gaucher's disease type I. This exceptional cause of pain must now be considered side by side with the classical femoral head osteonecrosis and infectious coxitis. Magnetic resonance imaging appears to be the most sensitive and most specific examination for the aetiological diagnosis of hip pain in Gaucher's disease. In the absence of thrombocytopenia and franck abnormality of coagulation, the spontaneousness of the haematoma is discussed.

[Imaging of synovial lesions, neoplastic or non-neoplastic]. / Imagerie des affections synoviales, tumorales ou non.

The purpose of this paper is to present the contribution of imaging in the assessment of synovial diseases, especially in the differentiation between infectious synovitis and rheumatoid arthritis, and in the diagnosis of tumoral and pseudotumoral synovial lesions (idiopathic (osteo)chondromatosis, pigmented villonodular synovitis, synovial hemangioma, lipoma arborescens...).

[Normal and pathological aspects of the glenoid labrum in opaque arthro-scanner]. / Aspects normaux et pathologiques du bourrelet glénoïdien en arthroscanner opaque.

The morphology of the glenoid labrum was studied by CT arthrography in 88 patients. These were divided in 2 groups. In the first group, the patients underwent CT arthrography for a clinical instability of the shoulder. The second group was the reference group to study the morphology of the glenoid labrum, it included patients with rotator cuff tears or other pathology of the shoulder, without clinical instability. We described the normal labrum which presents important morphologic variations. Its study may be difficult because of the proximity of capsular structures of the shoulder, mainly the gleno-humeral ligaments. The normal variants and the pathologic aspects of the labrum were studied: the clefts, tears and degenerative phenomenous. The cleft aspect was studied comparatively in the instable population and in the reference population.

[Malignant melanoma of soft tissues. Apropos of a case]. / Le mélanome malin des tissus mous. A propos d'une observation.

A case of malignant melanoma of the quadriceps tendon is reported. This is an uncommon soft tissue sarcoma of melanocytic origin. The appearance on MRI depends on its melanin content. The microscopic appearance is distinctive and prognosis is poor. This tumor should be kept in mind when a nodular lesion is detected in specific tendon or aponeurosis.

[Spinal tuberculosis. Study of clinical and radiological aspects from a series of 82 cases]. / La tuberculose vertébrale. Etude des aspects cliniques et radiologiques à partir d'une série de 82 cas.

We present a retrospective study of 82 cases of spinal tuberculosis diagnosed over the last 30 years. An increasing incidence of this disease not related to HIV infection has become apparent since 1992. 24% of patients were born outside continental France. The intradermal reaction was negative in 10% of patients. Discovertebral lesions detected in 93% of patients was the most frequent radiological presentation. Spondylitis with osteolysis or bone sclerosis at single or multiple levels was seen in the others. Tuberculous lesion of the posterior arch was associated in 10% of patients. In most cases CT scan showed a fragmentary vertebral destruction which was characteristic of the disease. MRI revealed the precise extent of the lesions into the spinal canal. Morphologic features suggestive of the tuberculous nature of paravertebral abcesses could be demonstrated when slices were performed in the axial or coronal plan. Tuberculous involvement of the spine is still a frequent disease. The main clinical and radiological findings are presented.

[Lateral radiculography in the vertical position for the diagnosis of narrow lumbar canal]. / Intérêt de la radiculographie de profil en station verticale pour le diagnostic de canal lombaire étroit.

Results obtained in 66 cases emphasize the value of lateral imaging to increase sensibility of radiculography in the diagnosis of narrow lumbar canal. In all cases, in fact, the anteroposterior diameter of the opacified canal diminished in the standing position in proportions varying from 20 to 50%, and furthermore, in 20% of patients diagnosis was only possible from this image. Narrowing of the canal was considered as being present in patients with an anteroposterior canal diameter in the standing position that was less than 11 mm in corrected values. This image appears therefore to be an essential one, particularly as clinical symptomatology of narrow lumbar canal is very often atypical (62% of cases). Moreover, contrary to widespread opinions, computed tomography is sometimes less sensitive than radiculography in this type of disorder.

[X-ray computed tomographic diagnosis of connective tissue tumors of the stomach of extrinsic development. Apropos of 6 cases]. / Le diagnostic tomodensitométrique des tumeurs conjonctives de l'estomac à développement extrinsèque. A propos de 6 observations.

Computed tomography findings appear to be very useful for the diagnosis of exogastric tumors on the basis of six cases: 4 leiomyosarcomas, 1 leiomyoblastoma and 1 schwannoma. The diagnosis of these usually large tumors arising within the gastric wall is often difficult through baryum opacification of the stomach (U.G.I.) owing to their exogastric growth. In the same way, endoscopy usually fails to evidence these tumors. Computed tomography permits to rule out an extrinsic tumor such as a hepatic or pancreatic one for instance and then to demonstrate the tumor originates within the gastric wall. The hypervascular pattern associated in most cases with central necrosis is demonstrated through contrast medium injection, what is a very typical and relatively constant-finding in these tumors.

[Nonfunctioning nesidioblastoma of the pancreas in children. Apropos of a case]. / Le nésidioblastome non sécrétant du pancréas de l'enfant. A propos d'une observation.

A new case of nonfunctional nesidioblastoma in a 13-year-old girl is reported. The diagnosis was made with imaging, including radiographs of the abdomen, ultrasound and computed tomography. Complete resection of the pancreatic tumor was possible. The patient has no symptoms 8 months later.

[Palliative treatment of neoplastic jaundice by a percutaneous transhepatic endoprosthesis. Apropos of 73 cases]. / Traitement palliatif des ictères néoplasiques par endoprothèse transhépatique percutanée. A propos de 73 observations.

Seventy three patients with malignant obstruction of the extrahepatic bile ducts were submitted to palliative drainage through percutaneous transhepatic endoprosthesis (P.T.E.). Complications occurred within the first month following the procedure in 13 patients (18%) and 8 of them died (10%). Cholangitis was the main complication resulting, from dysfunction of the endoprosthesis due to an incorrect placement of the stent in most cases. On the other hand, not any significant vascular complication such as previously reported following P.T.E., was encountered in our series. Late complications are mainly due to endoprosthesis obstruction (5 cases) or dislodgement (2 cases). The mortality rate within the first month following P.T.E. is 19%, resulting from either a complication of the procedure (11%) or the underlying disease (8%). The mean survival of these 73 patients, is 4, 7 months. When considering only the 59 patients who are alive one month following the procedure, the mean survival (post-operative deaths excluded) is 6 months. According to our experience P.T.E. remains a valuable palliative procedure when other endoscopic or surgical methods either have failed or cannot be resorted to provided a correct placement of the stent allowing for a good bile drainage can be achieved. Thus P.T.E. is able to provide in many cases the same long-term survival as palliative surgery, allowing the patients to resume their normal daily activity.

[Imaging of pigmented villonodular synovitis]. / Imagerie de la synovite villo-nodulaire pigmentée.

Pigmented villonodular synovitis is a rare disease which is usually benign but sometimes causes wide articular destruction. Since its clinical signs and symptoms are not specific, the disease may remain undiagnosed, sometimes for long periods. The diagnosis is generally confirmed at pathology, but it can now be strongly suggested by modern imaging methods. Standard radiography may be normal, with a variety of images. Arthrography with an opaque material points to the diagnosis in only two-third of the cases. Ultrasonography is non-specific. Computed tomography may be strongly suggestive of pigmented villonodular synovitis in cases with high density synovia; when coupled with arthrography, it provides detailed information on lesions of the cartilage and on extension of the synovial process. The most sensitive and specific method is magnetic resonance imaging, the most characteristic sign being low-intensity signal areas on T1- and T2-weighted sequences, corresponding to haemosiderin-loaded nodules. Performed after standard radiography, magnetic resonance imaging is the best examination method for the diagnosis and pretherapeutic evaluation of suspected villonodular synovitis.

[Malpighian carcinomas of the thoracic esophagus. Pretherapeutic computed tomographic evaluation]. / Carcinomes malpighiens de l'oesophage thoracique. Bilan scanographique préthérapeutique.

Fifty cases of epidermoid carcinoma of the thoracic oesophagus were examined by computed tomography (CT). The tumor was located in the lower third of the oesophagus in 15 cases, in the middle third in 24 cases and in the upper third in 11 cases. More than two-thirds of these patients underwent complete surgical exploration. CT provided valuable information on the size of the tumor, its extension to the mediastinum and the presence of distal metastases, but lymph node involvement often remained undetected. Nevertheless, the resectability of the lesions could be predicted in a fairly large number of cases. A new CT classification based on the TNM system is suggested. According to the criteria used, this new system significantly improves staging, with results that are close to the pTNM classification of the American Joint Committee on cancer.

[Value of peroperative endoscopy in treating giant lumbosacral meningocele]. / Intérêt de l'endoscopie per-opératoire dans le traitement d'une méningocèle géante lombo-sacrée.

Lombosacral meningocele may be responsible for sciatica, low backache, cauda equina syndrome according to their localization and size. When they are symptomatic, the surgical purpose is to close the communication between the meningeal sac and the cyst. For giant meningocele, acute localization of the communication may be difficult. In such cases, peroperative endoscopy may be useful. We present a case of sciatica related to a giant meningocele extended from L2 to S2. MRI, CT scan and myelography were unable to localize the communication. We used peroperative endoscopy for direct visualization of the communication in order to minimize the surgical approach. An intrathecal nerve root was found strangulated in the communication suggesting an original kind of nerve root suffering. The communication was only closed. The patient made an uneventful recovery with complete relief of symptoms. Magnetic resonance imaging 3 months later showed a significant decrease of the meningocele without any further radicular compression.

[Sacral nerve root cysts. Discussion on the mechanism of nerve root suffering. Apropos of 4 cases]. / Kystes périradiculaires sacrés. Discussion du mécanisme de souffrance radiculaire. A propos de quatre observations.

Low back pain, sciatia or perineal chronic pain are sometimes related to perineural sacral cysts. Surgical treatment is difficult and may lead to pain or neurological worsening. We report four cases of symptomatic perineural cysts; three of them where operated on with two good results and one increasing perineal pain. Anatomical and radiological description are reviewed. From a therapeutical point of view, we can distinguish two clinical types of radicular suffering. Perineural cyst can cause a commun radicular extrinsic compression; in such a case surgical operation will improve radicular pain. The cystic nerve root can present an intrinsic suffering because of on intradural dilaceration. Then surgery must be avoided specially when many roots are involved because it may worsen the pluriradicular suffering.

[Video-assisted thoracoscopic surgery]. / La chirurgie vidéo-assistée du rachis thoracique.

We describe our experience with video-assisted thoracoscopic surgery (VATS). Twenty-nine patients were operated on with this technique for various anterior thoracic spinal lesions. There were 6 cases of disc herniation with simple resection, 6 with acute thoracic fractures requiring anterior grafting and stabilization, 7 old fractures and malunions treated by corporectomy, grafting and anterior stabilization in 3, 4 with spinal metastases that were resected and stabilized, 3 with a paravertebral spinal tumor (2 schwannomas and 1 chondroblastoma), and 3 osteoid osteomas that were resected with anterior grafting in one case. Indications for these procedures are specified and the technical considerations discussed for each group of pathologies. We had three complications: one conversion to thoracotomy in a case of spinal metastasis, one pleural effusion, and one incomplete resection of a thoracic disc herniation. We emphasize the need for minimally invasive approaches in spinal surgery.

[Correlation of diameters measured by x-ray computed tomography and intraparietal extension of squamous cell carcinoma of the thoracic esophagus. Apropos of 101 anatomoradiologic comparisons]. / Corrélations entre diamètres mesurés par tomodensitométrie et extension intra-pariétale des carcinomes malpighiens de l'oesophage thoracique. A propos de 101 confrontations anatomo-radiologiques.

In order to assess the value of tomodensitometric classification of squamous cell carcinomas of the upper esophagus, which has been recently advocated, we compared the CT-measured diameters and the extent of intraparietal invasion in 101 tumors. According to selected criteria (superficial -T1- tumors: not apparent or less than 10 mm; tumors infiltrating incompletely the muscularis -T2- ; mass less than 10 to less than 20 mm in diameter; tumors extending beyond the muscularis -T3, T4- : diameter greater than or equal to 30 mm), 84/101 tumors were correctly assessed. The positive predictive value for T2 tumors was 73% in the 10 to less than 20 mm diameter range, and 71% for T3 and T4 tumors in the 20 to less than 30 diameter range. Starting from 30 mm, this value was 96% for T3 and T4 tumors. At the close of this study, it appeared that the classification criteria proposed did not have to be modified. CT-scanning is worth using jointly with ultrasonographic endoscopy (more performing when analysing small tumors) for pre-treatment classification of carcinomas of the upper esophagus, owing to the fact that the extent of wall infiltration is one of the elements which need be taken into account when planning therapy: direct surgery or, possibly, combined preoperative radio- and chemotherapy.

[Diagnostic value of spinal puncture-biopsy in non-infectious spinal diseases. Apropos of 41 cases]. / Valeur diagnostique de la ponction-biopsie vertébrale dans les affections rachidiennes non infectieuses. A propos de 41 cas.

To evaluate the diagnostic value of percutaneous vertebral biopsy in noninfectious diseases of the spine, we retrospectively studied 41 cases seen between 1985 and 1992. The level of the lesion was lumbar in 29 cases, thoracic in 11, and cervical in one. There were 19 crush fractures, 11 lytic lesions, six sclerotic lesions, and three mixed lesions. The biopsy was done because of an abnormal magnetic resonance imaging signal in one patient and because of epiduritis in another. The thoracic and lumbar biopsies were done under x-ray guidance using the technique developed by Laredo and Bard. Computed tomography guidance was used for the cervical biopsy. There were no adverse events. The final histological diagnosis was metastatic disease in 17 cases (41.5%), myeloma or plasmacytoma in six cases (14.7%), primary vertebral neoplasia in two cases (4.8%), lymphoma in one case (2.4%), osteoporosis in nine cases (22%), Paget's disease in three cases (7.4%), amyloidosis in one case (2.4%), aseptic osteitis in one case (2.4%), and vertebral necrosis in one case (2.4%). A second biopsy procedure was done in three patients (surgically in two cases and percutaneously in one) because of discrepancies between histological findings and other data. The final diagnosis was metastatic disease in all three patients. Overall, the diagnostic yield of percutaneous vertebral biopsy was 92.6% and varied little with initial roentgenographic or computed tomographic findings. However, yield was only 56% for the diagnosis of tumorous lesions, with variations according to roentgenographic and computed tomographic changes, 90.1% for osteolytic lesions, 66.6% for mixed lesions, 47.4% for crush fractures, and 16.6% for sclerotic lesions.(ABSTRACT TRUNCATED AT 250 WORDS)