Further cranial settling of the upper cervical spine following odontoidectomy - Report of two cases

A variety of diseases may affect the craniovertebral junction and require a decompressive and fusion procedure. Craniovertebral junction instability is expected after a fusion procedure. The authors describe two patients with basilar invagination who underwent transoral odontoidectomy and occipitocervical fixation. Despite an uneventful immediate postoperative course, further cranial settling of the C-2 vertebral body (VB) was demonstrated. One patient experienced neurological deterioration and required a second decompressive procedure, whereas the second patient was asymptomatic and required no additional surgery. It was concluded that the odontoidectomy may have led to horizontal separation of the C-1 lateral masses, resulting in further cranial settling of the C-2 VB, Preservation of one aspect of the C-1 anterior arch minimizes C-1 lateral mass offset and, in turn, further cranial settling of the C-2 VB. In addition, a more rigid fixation of C-2 may minimize the possibility of horizontal separation of the C-1 lateral masses after transoral odontoidectomy

Cervical disc herniations: When to fuse?

The choice of surgical treatment for cervical disc herniations is still controversial. The objective of this retrospective study is to compare the clinical and radiological results after cervical discectomy with and without fusion. Clinical and radiological status after anterior cervical discectomy with and without fusion in 160 cases were reviewed. Clinical outcome analysis was performed using modified Prolo's scale. Overall outcome showed a 86.9% good outcome. The rate of good outcome after anterior cervical discectomy (ACD) and anterior cervical discectomy with fusion (ACDF) was 86.3% and 85.7%, respectively. There was no difference between Prolo's scales of patients treated with ACD and ACDH (p > 0.05). The mean Prolo's score in patients with one-level and two-level cervical disc herniation treated with ACD was 8.746 +/- 0.983 and 6.600 +/- 1.174 (p 0.05). Comparison of Prolo's scores of patients with one-level cervical disc herniation underwent ACD and ACDH showed no significant difference (p > 0.05), whereas there was a significant difference between Prolo's scores of patients with two-level cervical disc herniation who underwent ACD and ACDF (p < 0.0001). The overall fusion rate was 69%. The fusion rate was 64.3% and 89.2% after ACD and ACDF, respectively (p < 0.05). These results showed that a fusion procedure is not necessary for one-level cervical discectomy

A retrospective review of cervical corpectomy: indications, complications and outcome

Background. Cervical corpectomy is a common spinal surgery procedure used to decompress the spinal cord in numerous degenerative, traumatic and neoplastic conditions. The aim of this study was to investigate the indications, complications and outcomes in past cervical corpectomy cases at one centre

Lumbar disc herniations - An outcome analysis of 1473 operated patients

This is a retrospective review of 1473 consecutive cases with virgin lumbar disc herniation operated on using an open conventional discectomy technique. The mean follow-up duration was 4.6 years. A single discectomy was performed in 85.1% of cases, a two-level discectomy in 14.1%, and a three-level discectomy was performed in 0.6% of cases. An additional laminotomy was performed in 7.9% of cases. Herniated disc was located at L4-5 and L5-S1 levels in 78.9% of the cases. Disc herniation was protruded and extruded in 59.7% and 40.3% of cases, respectively. Outcome analysis was perfomed using Prolo's functional and economical rating scale, and 88.1% of cases was found to be in a good condition, 8.8% in a moderate condition, and 3.1% of cases was found to be in poor condition. The most favorable outcome was observed in L5-S1 level disc herniations, and in extruded disc herniations. A good outcome in two-level disc herniations was 79.2%, and 22.2% in three level disc herniations. The overall recurrence rate was 3.7%, whereas the rate of recurrence in cases with additional laminotomy was 5.08%. It can be concluded that the best results was seen in single level disc herniations, in L5-S1 disc herniations, and in extruded disc herniations. Also it is concluded that as the number of discectomy and laminotomy increases, the rate of successful outcome decreases

The role of facet join angle in spondylolisthesis - A radiologic study

Several factors play a role in the etiology of the degenerative spinal processes. This study examined the role of facet angle in the etiology of degenerative spondylolisthesis and lumbar spinal stenosis. In order to measure the facet angles, computerized tomographic scans of 18 patients with degenerative spondylolisthesis and 11 patients with lumbar spinal stenosis were reviewed and the results were compared with the results of the control group. A significantly more sagittal orientation was found in facet joint angles of the patients with degenerative spondylolisthesis and with lumbar spinal stenosis, when compared with the control group. It is concluded that more sagittal orientation of the facet joint angle may play a role in the pathogenesis and progression of the degenerative spondylolisthesis, and that this fact should be taken into consideration in cases which need extensive decompression for degenerative spondylolisthesis