The authors report a case of apophysial fracture of the odontoid process in association with paresis of the upper extremities in a 5-year-old child. The fracture was treated by gradual guided self-reduction without anaesthesia, followed by a Minerva jacket cast immobilisation. Reduction was anatomical, and the neurological problems regressed within 48 hours.

Level IV. Therapeutic study.

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We conducted a micro-CT analysis of subchondral bone of the vertebral end-plates after application of compressive stress. Thoracic and lumbar vertebral units were instrumented by carrying out left asymmetric tether in eleven 4-week-old pigs. After 3 months of growth, instrumented units and control units were harvested. Micro-CT study of subchondral bone was performed on one central and two lateral specimens (fixated side and non-fixated side). In control units, bone volume fraction (BV/TV), number of trabeculae (Tb.N), trabecular thickness (Tb.Th), and degree of anisotropy (DA) were significantly higher, whereas intertrabecular space (Tb.Sp) was significantly lower in center than in periphery. No significant difference between the fixated and non-fixated sides was found. In instrumented units, BV/TV, Tb.N, Tb.Th, and DA were significantly higher in center than in periphery. BV/TV, Tb.N, and Conn.D were significantly higher in fixated than in non-fixated side, while Tb.Sp was significantly lower. We noted BV/TV, Tb.N, and Tb.Th significantly lower, and Tb.Sp significantly higher, in the instrumented levels. This study showed, in instrumented units, two opposing processes generating a reorganization of the trabecular network. First, an osteolytic process (decrease in BV/TV, Tb.N, Tb.Th) by stress-shielding, greater in center and on non-fixated side. Second, an osteogenic process (higher BV/TV, Tb.N, Conn.D, and lower Tb.Sp) due to the compressive loading induced by growth on the fixated side. This study demonstrates the densification of the trabecular bone tissue of the vertebral end-plates after compressive loading, and illustrates the potential risks of excessively rigid spinal instrumentation which may induce premature osteopenia. Keywords: asymmetric tether; trabecular bone; compression; micro-CT; spineThe pathophysiology of intervertebral disc degeneration has been widely studied.1-3 It has been demonstrated that chronic compression can modify mechanical, histologic, biochemical, and cellular properties of the intervertebral disc.4-7 Moreover, relationships have been established on one hand between disc degeneration and the architecture of trabecular vertebral bone, 8,9 and on the other hand between cell death in annulus and bone mineral density of the vertebral end-plate.10 Moore et al. 9 showed, in an adult ovine model, that an experimental outer annular tear was associated with an increase in the number of trabeculae, while their thickness and the intertrabecular space decreased. The authors linked these changes to alterations in the biomechanical behavior of the local structures. Simpson et al. 8 showed a close relationship between disc degeneration and trabecular architecture of the adjacent vertebral bodies, where bone volume fraction increased with the degree of degeneration. Gruber et al. 10 found a significant correlation between the percentage of cell death in the annulus and the bone mineral density of the vertebral end-plate as estimated by using a densitometer in an aging sand rat model...

Black-grain mycetomas are fungal and cannot be healed by antifungals only.We conducted this study to determine the interest of carcinologic surgery only in the management of those black-grain mycetomas.We led a retrospective study concerning 44 patients over a period of 52 months. The mean age of patients was 32.5 years. The main location of mycetomas was the foot (21 cases), the ankle (10 cases), the knee (8 cases), the leg (3 cases), the chest, the back and the pulp of the fourth finger once each. The bone was affected in 21 cases. The surgery consisted in a carcinologic excision or amputation depending on the extension of the lesion and the degree of bony infringement, with ganglionic cleaning out in case of lymphadenopathy. In the average retrospect of 25.5 months, we noted 8 cases of recurrences among which 2 on the amputated patients and 6 on the patients treated by carcinologic excision. The surgery constitutes the main therapeutic issue of the fungal mycetomas.

We observed densification of the trabecular network in the centre of the VEP overlying the nucleus pulposus, partly related to thinner hyaline cartilage. Densification is associated with more anisotropic architecture that could cause lower mechanical strength in this area. This study provides new information on the microarchitecture of the SCB of the VEP which will make it possible to validate future models.