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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Surgical and radiologic anatomy 6 (1984), S. 195-201 
    ISSN: 1279-8517
    Keywords: Spinal canal ; Tomography ; X-ray ; Lumbar vertebrae ; Cauda equina ; Spinal stenosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé La gouttière radiculaire consitute la partie latérale du canal rachidien quand il est trifolié: c'est un espace ostéo-ligamentaire, monovertébral, indéformable dont les mesures sont reproductibles. Son anatomie a été étudiée sur 50 rachis lombaires entiers de sujets anatomiques et sa radio-anatomie précisée par les tomographies sagittales et par des tomographies computérisées de ces pièces anatomiques et par les tomographies sagittales de 25 individus témoins asymptomatiques. Cette gouttière, exceptionnelle dans la partie supérieure du canal lombaire, a été retrouvée dans 72% des cas en L4 et toujours en L5 et en S1. Son diamètre sagittal, qui doit être mesuré en regard du bord supérieur du pédicule, a un diamètre minimal théorique de 3 mm à 3,8 mm suivant le niveau vertébral. 13% des vertèbres étaient asymétriques, et il n'existe pas de relation significative entre le diamètre sagittal médian du canal rachidien et les diamètres des gouttières radiculaires. La tomographie sagittale conventionnelle donne deux types d'images suivant l'évasement de cette gouttière et fournit les meilleures mesures (92% de mesures concordantes), si sa technique est rigoureuse. La tomographie computérisée transversale est moins fiable car le positionnement du plan de coupe reste la première cause d'erreur dans les mesures, mais elle permet de préciser les rapports des éléments nerveux avec cette gouttière. Cette sémiologie radio anatomique s'appliquera à la reconstruction sagittale par tomographie computérisée quand cet examen donnera des images osseuses aussi fines que la tomographie conventionnelle.
    Notes: Summary The radicular canal is the lateral portion of the spinal canal when it is trefoil. It is a bony and ligamentary, monovertebral and indeformable space, the measurements of which are reproducible. The anatomy of this radicular canal has been studied in the whole of the lumbar vertebrae of 50 anatomical subjects. Its radiological anatomy has been defined by sagittal and computerised tomographies of these anatomical specimens, while sagittal tomographies were done for 25 control individuals devoid of symptoms. This canal, exceptional in the upper part of the lumbar canal, has been found in 72% of the cases in L4 and always in L5 and Sl. Its sagittal diameter, which when measured must take into account the upper margin of the pedicle, has a theoretical minimal diameter of 3 mm to 3.8 mm, according to the vertebral level. 13% of the vertebrae were asymmetrical and no significant relationship exists between the median sagittal diameter of the spinal canal and the diameters of the radicular canals. Conventional sagittal tomography provides two types of images, according to the shape of the mouth of this canal and furnishes the best measurements (92% of the measurements were concordant), as long as the technique is followed closely. Transverse computerised tomography is less reliable, for the positioning of the section plane still remains the principal cause for error in measuring, but it provides a definition of the relations of the nerve elements with this canal. This radiological study will be suitable for sagittal reconstruction by computerised tomography, once this kind of examination can produce pictures of bones as detailed as those of conventional tomography.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Surgical and radiologic anatomy 6 (1984), S. 12-15 
    ISSN: 1279-8517
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusion L'étude de 50 rachis lombaires de sujets anatomiques et de 25 individus asymptomatiques nous a permis de préciser l'anatomie de la gouttière radiculaire lombaire, le lieu le plus propice à sa mesure, sa fréquence, et ses dimensions normales. Elle nous autorise aussi à recommander une méthode de mesure de ces gouttières, fiable, par tomographies conventionnelles, qui dans l'état actuel des techniques nous apparaît plus précise que la tomographie computérisée; cette méthode sera par ailleurs transposable à la reconstruction sagittale par scanner, quand cette dernière donnera régulièrement des images suffisamment nettes. Ces bases anatomiques et radio-anatomiques nous fournissent depuis cette étude un critère utile pour dépister les sténoses de la partie latérale du canal rachidien lombaire, responsable d'échecs de la chymonucléolyse et relevant du traitement chirurgical.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-0932
    Keywords: Occipito-atlantal dislocation ; Unstable injuries ; Posterior occipito-cervical fusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We present the case of a patient with traumatic atlantooccipital dislocation. The initial neurological examination showed no abnormalities. Dislocation was the result of rapid deceleration in a motor vehicle accident. The mechanism of injury was hyperextension/rotation, probably combined with a distraction force. Only a few cases of atlantooccipital dislocation without neurological involvement have been reported. Every report pointed out difficulties of initial diagnosis. Special attention should be directed toward the atlanto-odontoid-basion relationships as seen on lateral radiographs. Prompt recognition and surgical stabilization are essential to avoid further neurological injury.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-0932
    Keywords: Hernie discale lombaire ; Chimionucléolyse ; Chymopapaïne ; Sujet âgé ; Lumber disc herniation ; Chemonucleolysis ; Chymopapain ; Elderly
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Very few reports in the literature have dealt with lumbar disc herniation in the elderly and its treatment by chymopapain chemonucleolysis. Between September 1981 and May 1991, 42 patients aged between 60 and 80 years were treated by chemonucleolysis for lumbar disc herniation. The clinical symptoms and signs, similar to those observed in younger patients, were well correlated with a clear picture of discal herniation on the CT scan without any associated stenosis. At the last follow-up (mean 4.5 years) satisfactory results were obtained in 78% of the patients. No complication were observed. It is concluded that in the rare cases of discal herniation in the elderly, chymopapain chemunucleolysis should be considered as a safe and efficacious alterbative to surgery.
    Notes: Résumé Très peu de travaux ont été consacrés jusqu'ici à la hernie discale du sujet âgé et à son traitement par la chimionucléolyse à la chymopapaïne. Entre septembre 1981 et mai 1991, 42 patients porteurs d'une hernie discale lombaire et âgés de 60 à 80 ans ont été traités par chimionucléolyse. Les symptômes cliniques et les signes d'examen, semblables à ceux observés chez les patients plus jeunes étaient en bonne concordance avec une image de hernie discale bien définie sur le scanner sans aucune sténose associée. Au dernier contrôle 4 ans et 1/2 en moyenne des résultats satisfaisants ont été obtenus chez 78% des patients. Aucune complication n'a été observée. En conclusion, dans les rares cas de hernie discale chez les sujets âgés, la chimionucléolyse à la chymopapaïne doit être considérée comme une alternative à la chirurgie, à la fois efficace et dépourvue de danger.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-0932
    Keywords: Chemonucleolysis ; Intervertebral disc ; Sciatica ; Stenosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The aim of this study was to determine whether the results of chemonucleolysis are related to the size of the disc herniation and to the dimensions of the spinal canal. Short and long-term results (average follow-up 4 and a half years) of 148 patients were evaluated. Measurements made with a divider included the size of the disc herniation related to the sagittal diameter of the spinal canal at the discal level and the transverse interligamentous diameter at the level of the facet joints. The morphology of the lateral recess was also assessed. Measurements were initially made by five observers and were repeated eight times and on eight computed tomography (CT) scans in order to assess intra- and interobserver variability. Measurements of the entire series were then made by the two observers demonstrating a good intra- and interobserver reproducibility. Of the 148 patients 74% had an overall successful result. No significant difference was disclosed when comparing the various parameters of the clinical results with the size of the herniation. Similarly, a lack of correlation was also found between the clinical results and the dimensions of the spinal canal and of the lateral recess. In this series, the results were not significantly influenced by the size of the herniation or the morphology of the spinal canal.
    Type of Medium: Electronic Resource
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