Purpose: Chronic compartment syndrome of the forearm is considered to be exceptional but may be underestimated. Compartment syndrome of the upper limb is recognized but generally considered to be non-specific compared with acute Wolkmann syndrome. Chronic compartment syndrome, or “subacute compartment syndrome” is also well known but often associated with exertion of the lower limbs in athletes. The association of a compartment syndrome of the upper limb and a chronic compartment syndrome was just recently described since the first publication appears to be the paper by Tompkins in 1997. Scare reports have reported a few cases since then.

Material and methods: We report our personal experience with ten cases with a minimum follow-up of six months.

Results: Compared with the literature, the analysis of our series provides an explanation of the clinical, diagnostic, and therapeutic features of chronic exercise syndromes of the forearm.

Discussion: A better awareness of this pathological condition will probably enable earlier and more surgical care of these athletes who are handicapped by these syndromes well known in the motocross world as “forearm tetany” or “armpump””.

Purpose: Eary results of a prospective study of a homogeneous group of 45 patients treated by electrical stimulation of the posterior cords for refractory chronic pain subsequent to postoperative fibrosis demonstrated good results (function and pain relief) in 77% of patients with a mean follow-up of 51 months. We further examined the technique treating certain cases of post-surgical refractory chronic lumbar radiculaglia using spinal cord neurostimulation and posterior spinal restabilisation during the same procedure.

Material and methods: Results of a small series of eight patients, mean age 48 years were examined at a mean follow-up of 11 years. Five of the patients were manual labourers and five were occupational accident victims. All had a history of endocanal surgery (narrow lumbar canal, disc hernia). These eight patients had lumbar and radicular pain which were chronic and refractory to conservative treatment. The usual preoperative tests were: percutaneous epidural neurostimulation for radiculalgia by deafferentation and immobilisation test with a corset for lumbalgia. Chronic neurostimulation of the posterior cords was indicated if either test was positive. Metronic ITREL II or III was used. Posterior restabilisation was performed by arthrodesis with a posteriolateral graft, or for more recent patients, by dynamic lumbar neutralisation (Dynesys). Neurostimulation and posterior stabilisation were performed during the same operative procedure.

Results: This therapeutic association enabled four of the patients to resume their occupational activities. Two patients were retired. Radiculalgia: At last follow-up, antalgic effect of neurostimulation persisted for six patients. For one, radiculalgia recurred at eight years. For the last patient, despite rigorous preoperative selection, pain recurred early at two years. Lumbalgia: Improvement persisted at last follow-up in four of the eight patients. Lumbalgia recurred in three at eight to eleven years. This time corresponds to the usual duration of arthrodesis efficacy due to the development of a neo-junction, the reason for which we extened our indications for dynamic neutralisation. The last patient developed a neojunction at two years and underwent extension of the arthrodesis with good antalgesia at ten years.

Conclusion: Combining electrical stimulation and spinal restabilisation in the same procedure provides a real antalgesic effect for certain patients with postoperative lumboradicular pain. The quality of the results are less favourable for lumbalgia because the effect of the arthrodesis is less long-lasting. It is hoped that the new Synergy electrode, with promising effect on radiculalgia and lumbalgia and which is currently under evaluation, will meet its expectations.

Purpose: We report the clinical and radiological course in a continuous series of 194 patients treated by the same team between 1996 and 2001 for thoracolumbar fracture. Cotrel frame instrumentation and Boëhler corset immobilisation were used.

Material and methods: In this series of 65 women and 129 men, age range 16 – 77 years, we retained one year follow-up at least for inclusion in the study. More than 85% of the patients were retained for study and the final analysis concerned 150 patients who were contacted.

All patients were in Frankel class E. In compliance with the SOFCOT 1995 Symposium, the method described by Rosset and Laulin and the international classification described by Magerl were applied to pre-operative x-rays to search for the pathogenic mechanism involved. The radiological analysis was conducted on preoperative, immediate post-operative, 1-month, 3-month, and last follow-up x-rays. The course of spinal kyphosis and angular deformation of the trauma zone and the subjacent disc were analysed. In addition to the overall series, patients with limit therapeutic indications, according to the local kyphosis and trauma-induced regional angular deformation, were also studied.

Results: For the initial indication of choice, type A1 fracture, gain in reduction was minimal for the constraining treatment. For type A3 fractures, posterior displacement of the posterior wall was not a contraindication because the posterosuperior reduction could be achieved by ligamentotoxis in the majority of the cases The gain in correction of spinal kyphosis was greater in these patients. Nevertheless, for this type of fracture, spinal kyphosis greater than 15° was an implicit sign of a potential posterior distraction lesion where osteosynthesis might be indicated, especially since the USS fixator uses a parallel assembly and authorises short instrumentations.

Conclusion: The Boëhler technique is a safe, minimally invasive and low-cost method for the treatment of thoracolumbar spine fractures, which enabled 30% correction of the spinal kyphosis. This method retains its indications for type A fractures.

Purpose: The purpose of this work was to determine the role of orthopaedic treatment as a function of initial criteria of instability and potential risk of secondary restabilisation after healing of the common anterior vertebal ligament in patients with bipediculated C2 fractures and to compare the results of surgical treatment using CE pediatric fixation of C1-C3 fractures associated with C1-C3 graft to those with C2-C3 arthrodesis using posterior screw plate fixation with a pedicular screw in C2.

Material and methods: This was a retrospective analysis conducted in patients treated over a ten year period. There were 57 patients treated by two different orthopaedic surgery teams. There were 33 women and 24 mean, mean age 37 years with a maximum follow-up of 12 months. Clinical and radiographic findings were the same before treatment and at last follow-up. The surgical indication was for rupture of the common posterior vertebral ligament as assessed differently by two different surgical teams.

Results: Orthopaedic treatment was given to 65% of the patients (72% and 62% for the two teams). Clinical outcome in these patients was good or excellent in 69% and 79% resepectively for the two teams. Surgical treatment was given in 35% of the cases. Cervical CD fixation produced 100% fair clinical results and 40% very good and good radiographic results with the other 60% being acceptable. For the C2-C3 plate with a pedicular screw in C2, the clinical outcome was good or very good in 53% with 34% fair and poor results and 73% good and very good and 27% poor radiographic results.

Discusssion: This work demonstrated that indications or orthopaedic treatment can be extended, following the work by Roy-Cammille on the instability of these lesions introducting thus the notion of spontaneous anterior restabilisation due to healing of the common anterior vertebral ligament. For the choice of the technique, arthrodesis by cervical CD fixation remains a safe and sure technique despite the logical loss of C2-C3 rotation. Plate screw fixation with a C2 pedicular screw is more attractive but remains technically difficult.

Purpose: Thoracoscopic spinal surgery may be less aggressive than classical open surgery. We relate our experience over the last five years, analysing complications observed.

Material and methods: Between 1995 and 2000, 68 patients underwent thoracoscopic spinal surgery. There were 34 men and 34 women, mean age 30.2 years (13–69). We analysed indications, preoperative anaesthesia parameters, peroperative and postoperative parameters and pulmonary, vascular, neurological and instrumental complications.

Results: Indications were: metastatic compression in three patients, disc herniation in eight with five calcified discs, fracture in 25, anterior release for scoliosis in 32 with inter-somatic graft in 20. Mean duration of the hospital stay was 19.6 days (7–48). There were three fractures with lung contusion that were excluded from the analysis although thoracoscopic surgery was possible. The analysis thus included 61 right and four left thoracoscopies. Four to nine trocars were used. There were three cases of intercostal nevralgia. Operation time depended on the underlying disease: 18 min for scoliosis, 2 hr 40 min for fractures, 4 hr 15 min for discal herniation (2 h 20–7 h 15). Blood loss was less than 200 cc for scoliosis, a mean 533 cc for fractures, and 800 cc for metastases. There were no pulmonary, vascular or instrumental complications. The image amplifier was used to monitor all osteosyntheses. We had one patient whose neurological situation worsened after resection of a transdural calcified thoracic herniation. Stay in the intensive care unit after surgery was 3.4 days, the drain was removed at 3.26 days and had collected 1240 cc. Postoperative paint was assessed for patients who had undergone thoracoscopy alone and who had no other disease (19 fractures and 8 herniation cases). level three antalgesics were required for 3.2 days. There were no vascular complications or signs of phlebitis. One residual atelectasia of the lower right lobe occurred in a female patient with major traumatic contusion, and pleural effusion was observed in three. One patient developed a contralateral pneumothorax that was punctured after release of major scoliosis (Cobe 92°). Residual pleural effusion after withdrawing the drain was aspirated at 48 hours. There were no infections.

Discussion: Thoracoscopy allowed the planned procedure in all patients. Blood loss was much lower than with classical open surgery. Pain was controlled better and the cosmetic effect was exceptional. Function was recovered rapidly by fracture patients. the quality of the anterior release for the scoliosis patients was equivalent to that obtained with classical techniques.

Conclusion: The complication rate was lower than that usually observed for similar procedures using classical techniques.

Purpose: Since the introduction of spinal cord stimulation for the treatment of chronic neuropathies (Shealy, 1967), further development has identified indications. The objective of this prospective multicentric protocol was to quantify clinical and economical results in a homogeneous group of rigorously selected patients.

Material and methods: In 1999, nine university hospital centres recruited 43 patients (22 men, 21 women, mean age 50.8 years) with chronic postoperative neuropathic sciataligia insufficiently controlled by antiseizure and antidepressor (tricyclic) drugs. There were 34 unilateral cases and nine bilateral cases and 60% of the patients also had lombalgia. Diagnosis was established on the basis of history taking, clinical signs, and anatomic and electrophysiological findings. Indications for spinal cord stimulation were determined in a pluridisciplinary context including a psychological evaluation. A temporary test was made before implanting the programmable neurostimulator (Itrel®II or Itrel®3, Medtonic) in order to check that the induced paresthesia involved the painful territory. Included patients were assessed before implantation then at six (39 patients), 12 (30 patients) and 24 months after institution of the stimulation. At each follow-up visit, the clinical effect was assessed with validated pain scales (visual analogue scale, McGill Pain score, Oswestry incapacity score). Economical data were obtained from the medical file, patient interviews, and a specific therapeutic follow-up chart. Preliminary results (mean follow-up 10 months) are presented.

Results: Clinical scores improved 40 to 50% one year after implantation of the neurostimulator. There was significant relief of sciatalgia: on the visual analogue scale the mean pain score (7.8/10 before implantation) was 2.7/10 (p < 0.05) and 3.6/10 (p < 0.05) at six and 12 months after implantation. Drug prescriptions (antiseizure, antidepressors) were reduced by 70%. Residual treatments were prescribed for lumbalgia which was relieved little by stimulation. Annual expenditures (drugs + visits + non-drug treatments) was reduced by 1578 euros per patient (mean). Hospitalisation rate fell from 26% to 10% and the rate of resumed occupational activities was 11%

Discussion: Assessment of 24 patients after implantation of a neurostimulator will complete these early results.