Cervical arthroplasty versus anterior cervical decompression and fusion

Background: Anterior cervical decompression and fusion (ACDF) is a common procedure in neurosurgical practice to manage the cervical cord/nerve roots compression by intervertebral disk herniation / osteophytic formation. However, cervical total disk replacement (TDR) progressively became a feasible alternative to ACDF in surgical practice. This procedure is thought to have many advantages compared to classical ACDF. The aim of the present study is to investigate if TDR is superior as outcome measures than ACDF, by reviewing the published data available to date.Methods: We searched several electronic databases up to December 2010. Outcomes sought includes pain relief, functional capacity, quality of life, adjacent disk disease, secondary surgeries, kinematics/range of motion, return to work, adverse events, potential candidacy rate for surgery. We selected mainly randomized controlled trials.Results: Compared to ACDF, TDR has superior or equal clinical outcomes, a lower incidence of adjacent disc disease (radiological +/- clinical), lower rate of secondary revision surgeries, supplemental fixation or adjacent segment reoperation, superior spine kinematics, which is maintained over time, earlier return to work. On the other hand, the presented studies have shown that TDR exposes the patients to more frequent postoperative events and have an inferior candidacy rate compared to ACDF. We did not have access to straight –forward economic data, but TDR seems to be more costly than ACDF.Conclusions: TDR already represents a well-established technique in the armamentarium to manage the cervical disc herniation, a method required to be handled by any surgeon involved in spinal care

Longitudinal volumetric MRI study of pituitary gland following severe traumatic brain injury

Purpose: Previous studies have suggested that the hypopituitarism following traumatic brain injury (TBI) is more prevalent than traditionally thought. The objective of this study was to characterize longitudinal MRI morphometric changes of pituitary gland in patients with severe TBI.Materials and methods: Fourteen patients who had suffered a severe TBI (Glasgow Coma Score=3 - 8) underwent MRI at three time points: Time 1 (mean=31. 5 days), Time 2 (98. 0) and Time 3 (185. 5). The pituitary gland volume was quantified by manually tracing on T1-weighted magnetic resonance images. Data from TBI patients were compared to 14 age- and sex-matched uninjured controls. The relationships between pituitary volumetric measures and patient demographics, length of respiratory support and coma, and presence of intracranial hemorrhage or skull fractures were also analyzed.Results: Following TBI, the pituitary volumes were significantly greater at all three time points: Time 1: median=665mm3, range=460-830mm3, p=0. 007; Time 2: 694mm3, 467-866mm3, 0. 007; and Time 3: 655mm3, 444-795mm3, 0. 015, compared with controls (504mm3, 433-591mm3). At Time 1, pituitary volume was increased in 10 out of 14 patients. Of these, early pituitary enlargements persisted up to six months in nine patients. Pituitary enlargements were negatively correlated with GCS, but not with other variables.Conclusion: Following a severe TBI, early pituitary enlargement found in most of our patients persisted in the chronic phases. Our data suggest a potential role of MRI morphometry in early prediction of pituitary dysfunction following head trauma, but further studies including hormonal measurements are necessary for validation

Longitudinal volumetric MRI study of pituitary gland following severe traumatic brain injury

Abstract Purpose: Previous studies have suggested that the hypopituitarism following traumatic brain injury (TBI) is more prevalent than traditionally thought. Conclusion: Following a severe TBI, early pituitary enlargement found in most of our patients persisted in the chronic phases. Our data suggest a potential role of MRI morphometry in early prediction of pituitary dysfunction following head trauma, but further studies including hormonal measurements are necessary for validation