Surgical treatment of degenerative disc disease (DDD) has been widely modified in the last decade. The clinical evaluation of back pain has been improved by the use of functional scores and VAS. The discography is an adjunct for decision-making, but CT scan and MRI are the keys to evaluate the aging process. The conservative treatment with physiotherapy and exercise programs is always the first and very useful treatment. Percutaneous therapy like facets injection, laser, IDET, radiofrequency in the disc can be a solution in some specific cases. Their efficacy has been evaluated in different studies and is sometimes controversial but there aren’t contraindications for further treatment and their complication rate is low. Dynamic posterior stabilization devices using pedicular screws and ligament tension band are proposed to try to put the disc in rest and some histological analyzes confirmed this hypothesis. Interspinous devices have been evaluated since many years but there indications need to be established as the literature available doesn’t provide clear indication criteria. Partial disc replacement is a new challenge for DDD. Many devices have in clinical evaluation but only few have prospective studies demonstrating their efficacy. The PDN was the pioneer and as the other in the evaluation process it has to solve the problem of the stability of the device. The last products on the market are promising. The total disc replacement is the last solution before fusion. Many studies including prospective and randomized have demonstrated the efficacy of total disc replacement. The indication is the key point of success. The training to perform the approach safely is mandated. Finally the fusion: anterior, posterior or combined is the ultimate solution to treat DDD. This was the gold standard and is still the most widely used treatment. As a dead end fusion is used only if other solutions cannot be proposed or used. DDD therapy has to be considered with the help of an algorithm including all motion preservation treatment before fusion.
We report two cases of epicondylitis of the elbow occurring after treatment with fluoroquinolone antibiotics. Both patients had intense pain which appeared very shortly after the first dose of the drug and was not relieved by conservative treatment. Ultrasonography revealed extensive inflammatory lesions with pseudonecrotic areas. MRI confirmed the lesions and also showed a subclinical abnormality of the adjoining tendons. The persistent nature of the pain was the indication for surgical release of the extensor mechanism. After operation pain disappeared completely and the patients were able to return to their normal activities. Lesions of the tendo Achillis are a well-known side-effect of treatment with fluoroquinolone. Our two cases show that such lesions may occur elsewhere. They also indicate the need for caution when prescribing these antibiotics to patients at risk of tendon lesions, such as top-level sportsmen or patients on dialysis or steroid treatment.