Purpose of the study: It is currently accepted (particularly since the work by Katz et al.) that a number of factors can potentially influence the functional outcome obtained after surgical treatment of lumbar canal stenosis (LCS). Among these factors are comorbid conditions and the notion of perceived health appear to be predominant. Little work has however been focused on the influence of these same factors on the qualitative and quantitative expression of functional impairment expressed by patients before their treatment. This possible link might have an intrinsic impact on the assessment of the outcome obtained after medical or surgical treatment of LCS. We wanted to examine this question.

Material and methods: Two hundred twenty patients referred to our orthopaedic surgery consultations were included in this prospective observation study, irrespective of the type f treatment eventually proposed (medical or surgical) or the type of lumbar stenosis. Patients who had had prior spinal surgery and those treated for LCS due to spinal deformity were excluded. The degree of the functional symptoms was determined with the SF36 and a self-administered questionnaire specifically designed and validated for the evaluation of LCS. Comorbidity factors were studied individually and with the following scores: the ASA score, the FCI (Functional Comorbidity Index), the CIRS (Cumulative Illness Rating Scale, and the ICED (Index of co-existent Diseases). Univariate and multivariate analysis was used to search for correlations between expressed functional impairment and comorbid factors.

Results: Expression of a functional impairment was significantly associated with a high number of comorbidity factors. This correlation was tighter when there was no additional compressive discal factor and when the functional neurological symptoms were longstanding. The type of comorbid factor analysed did not have an impact on these results

Conclusion: The presence of comorbid factors is significantly associated with more severe expression of functional impairment related to LCS. This effect could also influence the functional outcome after treatment of LCS and should be taken into consideration.

Purpose of the study: Primary bone tumors of the sacroiliac joint are difficult to diagnose. We present the procedure used to resect these tumors and reconstruct the pelvic ring, and the carcinological and functional outcome.

Materials and Methods: This was a retrospective analysis of a consecutive series of patients treated for a tumor of the iliac bone or of the sacrum which involved the sacroiliac joint. Tumor grading was based on the Enneking classification and the functional outcome on the MSTS score.

Results: From 1986 to 2003, 24 patients were treated for a a tumor involving the sacroiliac joint. Six with invasion of the sacral body. The histology was osteosarcoma (n=8), chondrosarcoma (n=8), malignant hystiocytofibroma (n=3), Ewing’s sarcoma (n=2), schwannoma (n=1), leiomysarcoma (n=1) and haemangiopericytoma (n=1). Seventeen patients were given neoadjuvant chemotherapy. A wide crest approach was used to access both aspects of the pelvic ring. Neurological sacrifice was required in six patients. Operative time was 5.27 hours on average. Reconstruction was achieved with an autograft and instrumentation. The resection was wide in 11 cases, marginal in 12, and contaminated in one. The mean follow-up was 4.77 years. Ten patients died from their disease. Survival was correlated with the quality of the resection and with the initial tumor stage. Hemisacrectomy did not affect survival. Bone healing was achieved in 13 patient, ten who survived. The mean MSTS score was 48% at last follow-up in 14 survivors. For the nine patients who did not require neurological sacrifice, the mean score was 58%. For the five other patients, the mean score was 38% This score was 65% in patients with bone healing and 8% in those with nonunion.

Discussion: The survival of patients with a tumor of the sacroiliac joint is basically related to the histological diagnosis and the quality of the resection. If the disease can be controlled, the method of the reconstruction proposed here enables bone healing with a satisfactory functional result when neurological sacrifice can be avoided.

The treatment of developmental dysplasia of the hip diagnosed after the first year of life remains controversial. A series of 36 children (47 hips), aged between one and 4.9 years underwent gradual closed reduction using the Petit-Morel method. A pelvic osteotomy was required in 43 hips (91.5%). The patients whose hips did not require pelvic osteotomy were among the youngest. The mean age at final follow-up was 16.1 years (11.3 to 32). The mean follow-up was 14.3 years (10 to 30).

At the latest follow-up, 44 hips (93.6%) were graded as excellent or good according to the Severin classification. Closed reduction failed in only two hips (4.3%) which then required open reduction. Mild avascular necrosis was observed in one (2.1%).

The accuracy of the reduction and associated low complication rate justify the use of the Petit-Morel technique as the treatment of choice for developmental dysplasia of the hip in patients aged between one and five years.