[Common lumbosciatic syndrome of the elderly. Report of 67 cases]. / Les lombosciatiques communes du sujet age. A propos de 67 cas.

BACKGROUND: The common lombosciatic is a disease observed at all ages. To the elderly, clinical data, treatment, clinical outcome and prognosis present sometimes some peculiarities. AIM: Report of lombosciatic in the elderly. METHODS: It is a retrospective study including 67 cases of sciatica concerning old patients over 65 years presenting with common lombosciatica, hospitalized between January the 1-st, 2000 and December 31 st, 2004. RESULTS: The mean age of our patients is of 71.2 years, sex ratio female/male of 1.88. A chronic lumbago is found at 16.34% of our patients and a starting factor pains in 14.3% of cases. Pain is of progressive installation in 93.4 % of cases. Mechanical in 77.5 % of cases and impulsive in 55 % of cases. Sciatica was unilateral in 67.3% of cases and interesting the root L 5 in 40.8 % of cases. Physical exam find a painless attitude in 26.5% of cases and a spasm of spinal muscles in 65.3%. The average of schöber index is of 2.4 cms + 1.18. Lasègue is present in 36.7 % of cases. Neurological exam find overdrawn signs in 8 % of cases, sensory signs in 61.2% of cases. No cauda equine syndrome was individualized in our series. Lumbar spine X-rays, made in 98 % of cases, show a L5-S1 disc impairment in 83.6% of cases, a scoliotic attitude in 22.4 % of cases, a spondylolithesis of L4L5 in 26,5 % of cases and lumbar cannal stenosis in 12.2% of cases. Lumbar densitometry, realized in 22.4% of cases, shows a herniated disc in 27.2% of cases, and a lumbar canal stenosis in 27.2% of cases. The MRI, made once, was normal. During their hospitalization, 87.7% of patients received NSAID's, 18.4% of them analgesics drugs (landing I, II , III) and 79.6 % epidurals infiltrations. All our patients observed bed rest. A physiotherapy was prescribed for 44.9 % of them. A good outcome was quickly noticed in 85.7% of the patients. A therapeutic failure was observed at 14.3 %. 6% underwent surgery. Only 102 % of the non operated patient had pain recurrence. CONCLUSION: Nowadays sciatica is a frequent pathology either in oung or in geriatric population. Nevertheless it is necessary to eliminate a tumoral or infectious sciatica that can be misleading by the condition of the old age and by the frequent associated pathologies at such age.

Melorheostosis and FGF-23: is there a relationship?

Melorheostosis is a rare chronic bone disease of unknown etiology that often affects lower limbs. Onset usually occurs in childhood or early adolescence. The diagnosis relies on the radiographic finding of hyperostosis within or around the cortex responsible for a "flowing wax" appearance. To our knowledge, Fibroblast growth factor-23 (FGF-23) levels have not yet been quantified in melorheostosis. We report an unusual case of this disease for whom the diagnosis of fibrous dysplasia had been wrongly made for a long period of time and the FGF-23 concentration has been found very high without any disturbance of serum phosphate.

Clinical impact of somatostatin receptor scintigraphy in the management of tumor-induced osteomalacia.

OBJECTIVE: Tumor-induced osteomalacia (TIO) is a rare condition due to phosphate wasting secondary to the release of a phosphatonin, fibroblast growth factor-23. Attempts to identify the tumor by physical examination and/or conventional imaging are sometimes unrewarding. In such cases, somatostatin receptor scintigraphy with octreotide has been successfully proposed. METHODS: Two case reports and a review of the literature allow to demonstrate the diagnostic usefulness of octreotide and the therapeutic value of somatostatin. RESULTS: Octreotide studies were positive in 79% of 24 reported TIO, including our 2 cases. In one of our patients with incomplete removal of the tumor, octreotide therapy was unable to improve hypophosphatemia, despite a decrease in fibroblast growth factor-23 levels by 30%. Similar results were achieved in most of the reported cases. Surgical procedures were effective in these cases and resulted in complete clinical and biochemical recovery. CONCLUSION: We highlight the impact of somatostatin receptor evaluation in the management of TIO.