[Long-term results of interbody anterior arthrodesis in the treatment of common low back pain. Importance of preoperative discography findings]. / Résultats à long terme des arthrodèses inter-somatiques antérieures dans le traitement de la lombalgie commune. Importance des données de la discographie pré-opératoire.

The results of 50 anterior interbody arthrodeses performed for incapacitating chronic low back pain with disc degeneration were assessed with a mean follow-up of seven years and a rate of examination of 74.5 per cent. Systematic pre-operative discography was made of the levels above and below the fused region. The overall functional results were assessed using a new scale of evaluation which showed that only half of the patients were definitely improved at the latest follow-up examination. The outcome in relation to pain radiating to the lower limbs seemed to be the same as in low back pain and there was therefore no need for any posterior procedure. The factors that improved the success rate were an effective fusion, which was obtained in 80 per cent of cases at the first attempt and a healthy disc at the new effective lumbosacral level. The factors that diminished the success rate were mainly those relating to social and working activity, mainly the effects of accidents at work. Even though the results were less than perfect, interbody fusion, which the authors continue to practise, cannot be excluded from the therapeutic methods used to manage low back pain.

A natural history of Dupuytren's contracture treated by surgical fasciectomy: the influence of diathesis (76 hands reviewed at more than 10 years).

Fifty-six patients (51 males and 5 females) were reviewed more than 10 years after surgical fasciectomy for Dupuytren's disease (average 12 years 7 months). 76 hands were operated upon (20 bilateral cases) for a total of 137 fingers (out of 152 affected digits). The average pre-operative score based on Tubiana's classification was of 4.28. To-date, at maximum follow-up time, it is of 2.45. 34 recurrences occurred before re-operation (i.e. 45%), whereas at maximum follow-up, 74% of hands are still defective, although only 22% cause functional impairment. The method of improvement ratio classifies patients into two categories: satisfactory results and failures. This original method of qualification emphasizes three negative factors: recurrences, initial severity of disease, and failure to achieve full finger extension post-operatively. Results as a whole are in accordance with those mentioned in literature. Improved results depend on early surgery for severe cases, which must therefore be diagnosed at an early stage. Surgery often sets back the disease, without curing it. Further efforts in fundamental research on the etiology of this disease will be needed.

[Results of intersomatic arthrodeses in essential lumbalgia]. / Les résultats des arthrodèses intersomatiques effectuées pour lombalgies essentielles.

The results of 50 intersomatic arthrodeses, performed via an anterior approach, because of chronic, disabling low back pain with degenerative disc disease, was evaluated with a mean follow-up of 7 years (revision rate = 74.5 p. cent). Preoperative exploratory discography of the overlying and underlying vertebrae was systematic. The overall functional results evaluated according to an original quotation scale, show that only less than half of the patients who were operated upon are markedly improved at maximum follow-up. The clinical course of pain radiating to the lower extremities and associated with disabling lumbalgias, seems to be on a par with the course of lumbalgias and does not require a posterior surgical approach. Factors improving the success rates are an effective fusion (in first intention in 80 p. cent of the cases) and a healthy neo-joint from a discographic standpoint; factors that deteriorate the long-term success rate (and not short-term), essentially socio-professional ones (work related accidents). The contribution of the discographic data is emphasized: they anticipate the deterioration of the neo-joint discs, which, when present, causes most of the functional failures. Although these results are imperfect, arthrodesis (the authors remain faithful to the intersomatic arthrodesis), may not be completely excluded as treatment of essential disabling lumbalgias, resisting to medical and physiotherapeutic treatments.