Sacroiliac joint pain after lumbar fusion. A study with anesthetic blocks.

Low back pain persisting or appearing after a technically successful lumbar fusion challenges clinicians. In this context, the sacroiliac joint could be a possible source of pain, but the frequency of its responsibility is not really known. We used sacroiliac anesthetic blocks, the gold standard for diagnosis, to determine this frequency. Our second goal was to search predictive factors for a positive block. Our prospective series consisted of 40 patients with persistent low back pain after a technically successful fusion who received a sacroiliac anesthetic block under fluoroscopic control. The diagnostic criterion was a relief of more than 75% of the pain on a visual analog scale. We found a 35% rate of positive blocks. The only criterion that characterized these patients was a postoperative pain different from the preoperative pain in its distribution ( p =0.017). A free interval of more than 3 months between surgery and appearance of the pain had an indicative value ( p =0.17). An increased uptake in the sacroiliac on bone scintigraphy or a past history of posterior iliac bone-graft harvesting had no significant value ( p =0.74 and p =1.0, respectively). The sacroiliac joint is a possible source of pain after lumbar fusion. The anesthetic block under fluoroscopic control remains the gold standard.

[Gamma-ray angioencephalography and computerized tomography of the brain in tumoral pathology. Comparative results]. / Gamma-angio-encéphalographie et tomodensitométrie encéphalique en pathologie tumorale. Résultats comparatifs.

Gamma-ray angioencephalography and computerized tomography (CT) were used to explore 151 patients with suspected intracranial tumour. The reliability of each method for the aetiological, topographical and pathological diagnosis was evaluated. The results obtained showed that the two methods correlated well and supplemented each other, bringing the proportion of positive diagnosis of intracranial tumour to more than 90%. While CT remains the first-choice examination to detect expansive lesions, gamma-ray angioencephalography represents the finest physiopathological approach and provides the most precise information on the nature of the tumour.

Cerebrovascular accident and abnormal focus of hyperactivity revealed by dynamic study in scintiangioencephalography.

A 75-year-old female was admitted to the hospital for suspicion of a cerebrovascular accident. An important focus of hyperactivity was noted during a dynamic study by scintiangioencephalography, consistent with a highly vascular tumor, but corresponding in fact to a focal transitory hyperfusion with accompanying intense neuronal activity.