In this prospective study 22 patients with painful disc herniations were randomized either to chemonucleolysis (CN) or automated percutaneous discectomy (APD). Preoperatively the Oswestry score was 44 points in the CN group and 41 points in the APD group. Except for a longer duration of preoperative leg pain in the APD group, clinical data were approximately the similar same in the two groups. In the APD group there was one intra-operative complication. Open revision surgery in the same segment was performed once in the CN group and twice in the APD group. Improvement of neurologic deficits and of Owestry score was significant in both groups. At 2 years after surgery the CN treated patients were significantly better with respect to Oswestry score, back pain and leg pain recurrence. Résumé Etude prospective de 22 patients avec hernie discale douloureuse. Randomisation entre un traitement par chimionucléolyse (CN) ou discectomie percutanée (APD). Avant l'intervention, le score d'Oswestry était de 44 points dans le groupe CN et de 41 points dans le groupe APD. A part une plus longue durée d'évolution douloureuse dans le groupe APD, les données cliniques étaient approximativement les mêmes dans les deux groupes. Il y a eu une complication opératoire dans le groupe APD. Une reprise chirurgicale classique fut né-cessaire une fois dans le groupe CN, et deux fois dans le groupe APD. L'amélioration du déficit neurologique et du score d'Oswestry fut significative dans les deux groupes. 2 ans après le traitement, les patients traités par chimionucléolyse avaient des résultats significativement meilleurs compte-tenu du score d'Oswestry et de la réci-dive de douleurs lombaires ou du membre inférieur.
We found a lower rate of loosening of total hip replacement in patients exercising sports, than in inactive people. Accidents of sport have never been the cause of fractures in our patients.
Prognostic statements regarding the improvement after nerve lesions are possible only to a limited degree. However, it was found that the motor function tended to recover earlier than sensibility. We could not determine with clinical evaluations why some patients showed an improvement of their lesion while others did not. As well no clear correlation between the EMG and VNC results and the recession of the symptoms could be established.
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