[Comparative study of short-term results between total artificial disc prosthesis and anterior lumbar interbody fusion]. / Etude comparative des résultats cliniques à court terme de la prothèse discale lombaire et de l'arthrodèse lombaire antérieure.

PURPOSE OF THE STUDY: The purpose of this study was to examine short-term clinical results with a lumbar disc prosthesis in comparison with anterior interbody fusion for the treatment of chronic low-back pain resulting from disc degeneration. MATERIAL AND METHODS: This was a consecutive series of 32 patients who underwent surgery between 2002 and 2005 performed by the same surgeon. Patients were randomly assigned to one of two treatment arms: a Charité (Depuy) disc prosthesis was implanted in group 1; an intersomatic KLA cage (Scient'x) was implanted in group 2. All patients presented primary or postdiscectomy discopathy: Modic 1 or 2 on MRI and one level (L4-L5 or L5-S1) positive on discography. A visual analog scale (VAS) and the Oswestry test were noted preoperatively, at six months and at last follow-up and compared with Student's t test. The quantitative analysis was based on the rate of excellent results (60% gain on the VAS and 50% gain on the Oswestry), rate of return to work at three months and level of patient satisfaction. RESULTS: Patient follow-up ranged from one to three years. Mean age was 39 years in group 1 and 44 in group 2. The quantitative analysis showed an improvement in the VAS in both groups: 75% in group 1 and 67% in group 2. The difference was not statistically significant. For the Oswestry score, the gain in function was improved 51% in group 1 and 37% in group 2, with a statistically significant difference in favor of the prosthesis group (p=0.125). The qualitative analysis demonstrated that patient satisfaction (87 and 88%) was similar in the two groups, but with a clear difference for return to work at three months, with a better rate in the prosthesis group (61.5%) than the fusion group (42.8%). The rate of excellent outcome was greater in group 1 (77%) than in group 2 (55%). DISCUSSION: There is only one study in the literature, which can be compared with ours. Using the same methodology, that study observed less favorable results for the disc prosthesis than with anterior lumbar fusion. CONCLUSION: The lumbar disc prosthesis offers a possible alternative to lumbar arthrodesis for the treatment of severe disc degeneration at one level in the young subject. It has been found to enable more rapid and superior functional results.

[Segmental instrumentation in idiopathic scoliosis. Role of the upright frontal plate for determination of the area of fusion]. / Instrumentation segmentaire dans la scoliose idiopathique. Rôle du cliché de face debout dans la détermination de la zone á fusionner.

PURPOSE OF THE STUDY: To analyze post operative imbalance after C.D.I. (Cotrel Dubousset Instrumentation) for idiopathic scoliosis according to the fused area, particularly the lower level of fusion. To recall a classification for determination of fusion area based on preoperative standing coronal radiograph. PATIENTS AND METHODS: To be included in this study the patients had to have an adolescent idiopathic scoliosis, at least two years of post operative follow up. 122 patients met the criteria; mean follow up was 3 years, 5 months (minimum 2 years, maximum 9 years). Scoliotic curves were classified as single structural (81), double structural (41). Balance was clinically analyzed by plumbline, radiographically by a plumbline dropped from C7 to the sacrum and measuring deviation from the midpoint of the sacrum in centimeters. A curve with a deviation of 10 mms or less was considered as balanced. RESULTS: Imbalance in single structural curves was 70% when using stable vertebra (King) or "other vertebra" (beyond stable vertebra or one or two levels upper stable vertebra). Using end vertebra (J. Moe), (elected vertebra - C. Salanova) imbalance was 10%. In double structural (41 cas) imbalance was 50% using stable, or "other vertebra" 10% when elected vertebra was fused. DISCUSSION: In this study there was a strong relationship between the lower level of fusion and imbalance.

[Recurrent coxopathy, isolated manifestation of Gaucher's disease]. / Coxopathie récidivante, manifestation isolée d'une maladie de Gaucher.

A case of Gaucher's disease is reported in a 12 year-old girl. Presenting signs consisted of relapsing hip arthritis, while no splenomegaly was detectable. The authors comment the inflammatory or moderately hemorrhagic nature of articular fluid and the diagnostic value of an early decreased uptake on bone scintiscan. The value of magnetic resonance imaging for evaluating bone involvement is emphasized.

Detection of rubella virus in amniotic fluid by electron microscopy.

We report in this paper the observation of rubella virus by electron microscopy in an amniotic fluid sample, collected from a pregnant woman with rubella infection. Virological investigations by inoculation of cell cultures with amniotic fluid and fetal blood remained negative, due probably to the presence of neutralizing antibodies in the samples. Electron microscopy is a rapid but weakly sensitive method to detect viruses in clinical specimens. However, this unusual observation would indicate that in some cases electron microscopy could be a useful technique to evidence a fetal rubella infection.

Exaggerated femoral anteversion and acetabular development: experimental study in growing dogs.

Femoral excessive anteversion caused by femoral osteotomy in growing dogs is an accurate dynamic model of experimental acetabular dysplasia. Radiographic and CT scan examinations were performed throughout the growing period. Evolution showed an incomplete femoral detorsion. It induced acetabular developmental modification leading to an anterior and superior acetabular dysplasia. At the end of the growing period, hips were not dislocated, but signs of femoral and acetabular osteoarthritis were obvious, which shows the importance of mechanical force modification in the creation of experimental osteoarthritis. The links between hip osteoarthritis and exaggerated femoral anteversion are discussed. Might acetabular dysplasia be secondary to femoral anteversion, which could justify a corrective osteotomy during childhood? Our experiment leads to a better comprehension of this phenomenon.

[Osteoarthritis due to Kingella kingae. Apropos of 4 cases]. / Ostéoarthrites à Kingella kingae. A propos de quatre cas.

The authors describe for cases of osteoarthritis with Kingella Kingae, among children. This gram less than 0 germ, which is not well known, tends to be located in bones and joints. In the light of for observations and some of the cases yet observed, we could identified the clinical, biological, and bacteriological characteristics of this germ that has been just described.