We report 57 cases of the Klippel-Feil syndrome. Five had type I congenital cervical fusion, 48 type II and 4 type III. The symptoms and signs varied considerably. Patients with C2-C3 fusion often had symptoms associated with odontoid dysplasia and occipito-cervical instability. Twenty-one had progressive neurological symptoms and 19 were operated on: 3 had occiput-C3 posterior arthrodeses, 2 a single level fusion, 1 a laminectomy and anterior arthrodesis, and 13 had laminoplasties. Degenerative changes at the unfused segment and a narrow bony canal are high risk factors in the development of neurological compromise.

We reviewed 45 patients who had undergone repeated open operations for lumbar disc herniation. There were 26 men and 19 women with a mean follow up of 4.3 years. Twenty-fourpatients had had one previous discectomy, 12 had 2, and 9 had 3 or more; 11 needed a fusion without instrumentation. Residual or re-extruded disc hernias, either sub-or transligamentous, were frequently found at revision. Good to excellent results were obtained in 64%. Those who had a first-time revision had earlier improvement and better results. Complete removal and a thorough search for herniated disc material is essential when carrying out the initial operation for extruded or sequestrated herniation. At revision, removal of as much as possible of the remaining nucleus and annulus, but with minimal invasion of the posterior elements, is crucial for improving the outcome. R~sumfi. Notre dtude porte sur 45 patients ayant subi ~t plusieurs reprises une discectomie lombaire. Ce groupe itait composd de 26 hommes et de 19 femmes suivis pendant 4,3 ansen moyenne (de 1 gt 8 ans). Vingt-quatre patients avaient ddjit dt~ operas une fois, 12 deux fois et 9 trois fois ou plus. Une arthrodbse dtait indiqu~e dans 11 cas. Les rdinterventions ont montri que des hernies rdsiduelles ou ri-expulsdes, sous-ligamentaires ou trans-ligamentaires, dtaient souvent retrouvdes. 64% (29/45) des patients ont eu de bons ou d'excellents rdsultats. Les patients n 'ayant subi qu' une seule rdintervention se sont rdtablis plus rapidement et ont prdsent~ de meilleurs r~sultats. Nous tenons ~ souligner qu 'iI est essentiel de procider gz Reprint requests to: H. Baba l'ablation complkte et ~ la recherche mdticuleuse de tousles mat~riaux discaux hernids lors de la premikre intervention, en particulier pour les hernies expuls~es ou siquestrYes. En cas de r~in-tervention il convient d'enlever autant d'anneau et de noyau rdsiduel que possible, quoique plus moddrdment en arrikre, pour obtenir les meilleurs rdsultats.