Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · Oct 2001
[Degenerative lumbar spondylolisthesis treated with isolated intersomatic arthrodesis: results of 30 cases with an average 4-year follow up].
Degenerative spondylolisthesis of the osteoarthritic spine can lead to severe invalidating back pain, decompensating a clinical situation previously well controlled with drugs. Hypothesizing that such invalidating spinal pain might be related to the unstable olisthy, we treated our patients with isolated intersomatic arthrodesis without reducing the displacement. We present here our results in a retrospective analysis of 39 patients who underwent surgery between 1981 and 1992. ⋯ Strut plates screwed onto the vertebral bodies enabled intersomatic fusion in all cases. Stabilization of the olisthy alone, without correction of the displacement nor release of the canal, successfully relieved pain in all cases of severe radiculalgia due to osteoarthritic spondylolisthesis and even provided improvement of lumbar pain in patients with various levels of discopathy. Unstable olisthy would thus be the major cause of invalidating pain, particularly radiculalgia in these patients.
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Rev Chir Orthop Reparatrice Appar Mot · Oct 2001
[Subfascial lipomatous tumors: management in a series of 37 consecutive cases].
The prognosis of subfascial lipomatous soft tissue tumors depends greatly on their histological type ranging from benign lipomas that cause little local or general problems to the severe prognosis of liposarcomas that exhibit both local and distant extension. However, the clinical presentation of the two types of tumors may be similar and thus quite misleading, sometimes leading to inappropriate management and severe consequences. The main objective of this study was to determine whether the preoperative work-up in patients treated for musculoskeletal tumors within our recruitment zone is adequate, allowing appropriate therapeutic decisions. In addition, we wanted to know what explorations are most pertinent for the differential diagnosis between benign and malignant subfascial lipomatous soft tissue tumors. ⋯ The clinical course of the benign lipomas and the sarcomas in this series confirm the radically different prognosis of these two tumors, both in terms of local extension and survival. Inadequate management in the initial diagnostic stages-i.e. lack of MRI with contrast injection, biopsy and multidisciplinary interpretation prior to treatment-raises the risk of higher morbidity, particularly a significantly greater number of reoperations, and progression to a higher grade of malignancy for two tumors. Our retrospective analysis enabled us to develop a decision making tree for patients with subfascial lipomatous tumors. Prospective validation will be necessary.