Surgical management of traumatic thoracic spondyloptosis: review of 2 cases.

Spondyloptosis due to trauma is a very rare injury typically associated with motor vehicle accidents and typically at the lumbosacral junction. This report describes two patients with T6-7 and T12-L1 spondyloptosis secondary to trauma. The former was a 36-year-old man who was pinned under a 200 kg hay bale, suffering immediate paraplegia and undergoing successful posterior reduction and stabilization via a single stage posterior approach.

The influence of fracture mechanism and morphology on the reliability and validity of two novel thoracolumbar injury classification systems.

Study Design: The Thoracolumbar Injury Severity Score (TLISS) and the Thoracolumbar Injury Classification and Severity Score (TLICS) were prospectively evaluated.

Objectives: To compare the reliability and validity of the TLISS and TLICS schemes to determine the importance of injury mechanism and morphology to the identification and treatment of thoracolumbar fractures.

Summary Of Background Data: Two novel algorithms have been developed for the categorization and management of thoracolumbar injuries: the TLISS system emphasizing injury mechanism and the TLICS scheme involving injury morphology.

Magnetic resonance imaging clarity of the Bryan, Prodisc-C, Prestige LP, and PCM cervical arthroplasty devices.

Study Design: Prospective, randomized, controlled and double-blinded study on imaging of artificial discs.

Objective: The purpose of this study is to compare postoperative imaging characteristics of the 4 currently available cervical arthroplasty devices at the level of implantation and at adjacent levels.

Summary Of Background Data: Cervical arthroplasty is being performed increasingly frequently for degenerative disc disease and, in most cases, with frank neural compression.

The presence of necrosis and/or microvascular proliferation does not influence survival of patients with anaplastic oligodendroglial tumours: review of 98 patients.

Accurate prognosis for patients with anaplastic oligodendroglial gliomas is increasingly difficult to make. Characterisation of these tumours remains challenging, increasing proportions of oligodendroglial diagnoses in gliomas are reported, and no WHO 2000 grade IV exists for them, so that highly anaplastic tumours can only be grouped with glioblastoma (GBM) or with grade III oligodendroglioma, which have differing clinical behaviour. Longer survival times reported for patients with glioblastoma containing an oligodendroglial element (GBMO) suggest that a grade IV for oligodendroglial tumours might exist.

Risk factors and prophylaxis for deep venous thrombosis in neurosurgery.

Acceptance is increasing for pharmacological prophylaxis against deep vein thrombosis (DVT) and pulmonary embolism (PE) for most types of surgery, but its use remains controversial in neurosurgical patients because of the threat of catastrophic hemorrhage. Consequently, mechanical measures such as sequential calf compression and graduated compression stockings are currently the preferred prophylaxis for neurosurgical patients. However, some patients remain at high risk despite these measures and may require prophylaxis with low molecular weight heparins or unfractionated heparin.

Complications with cervical arthroplasty.

Object: Spinal arthroplasty is becoming more widely performed in the treatment of degenerative cervical disc disease. Although this new technology may offer benefits over arthrodesis, it also requires that the surgeon acquire new operative techniques, and new potential complications are introduced. To determine the incidence and distribution of perioperative complications, the authors analyzed their early data obtained in a series of patients treated with the Bryan Cervical Disc prosthesis.

Posterior cervical decompression and fusion for circumferential spondylotic cervical stenosis: review of 50 consecutive cases.

Purpose Of Study: This study presents a clinical and radiological evaluation of 50 consecutive patients with symptomatic spondylotic cervical myelopathy and circumferential spinal cord compression who were managed with a single stage wide posterior laminectomy and lateral mass instrumented fusion.

Methods Used: 50 consecutive patients (33 male, 17 female) over a 4 year period presenting with symptomatic cervical myelopathy due to circumferential cervical spondylotic spinal stenosis were evaluated and operated upon by a single surgeon and followed in a prospective fashion. All patients underwent pre- and postoperative clinical, radiological and MRI evaluation.

What progress has been made in surgical management of patients with astrocytoma and oligodendroglioma in Australia over the last two decades?

Background: Most primary brain cancers are associated with a dismal prognosis because of their aggressive behaviour and high mortality. Surgical resection with adjuvant radiotherapy is a major treatment for these cancers but little has been published about their surgical management in Australia.

Objective: To determine changes since 1977 in demographic characteristics, tumour frequencies, surgical management, morbidity and survival for 1,339 patients discharged with astrocytoma (A) and oligodendroglioma (O), which comprise the majority of primary brain cancers, recorded prospectively in northern Sydney neurosurgery databases.

Cervical arthroplasty after previous surgery: results of treating 24 discs in 15 patients.

Object: The potential role of cervical arthroplasty in patients who have undergone previous cervical surgery is unknown. The authors performed a prospective study involving nonrandomized clinical and radiological assessment in patients who had undergone either previous posterior cervical foraminotomy or anterior interbody fusion and who suffered new or persistent arm/neck symptoms related to neural compression.

Methods: During a 30-month period, 15 patients who had previously undergone cervical spinal surgery underwent cervical arthroplasty that involved placement of the Bryan disc for neck or arm symptoms related to cervical disc disease.

Multiple cerebral and leptomeningeal metastases from ovarian carcinoma: unusual early presentation.

Although virtually any systemic malignancy is capable of metastasizing to the brain, ovarian carcinoma, one of the more common female genital malignancies, is one of the rarer forms of brain metastases. In general, the outcome for ovarian carcinoma with brain metastases is extremely poor as most of these patients have widespread lesions elsewhere. This report describes the first known case of multiple cerebral and leptomeningeal metastases as the initial manifestation of ovarian carcinoma in a 41-year old woman who presented with a one-week history of headache, vomiting and confusion.

Posterior cervical lateral mass screw fixation: analysis of 1026 consecutive screws in 143 patients.

Objective: This study evaluates the results and complications of 1026 consecutive lateral mass screws inserted in 143 patients by a single surgeon.

Methods: Over a 50-month period, a total of 1026 lateral mass screws were placed in 143 patients ages 12-96 years (56 females and 87 males), with these records retrospectively reviewed. Screw position was evaluated by computed tomography (CT) scanning postoperatively, with screw positions assessed for facet, foraminal, or foramen transversarium violation.

Cervical arthroplasty complicated by delayed spontaneous fusion. Case report.

The authors describe the case of a 55-year-old woman who presented with a left C-6 radiculopathy and neck pain and in whom there was evidence of disc/osteophyte compression of the left C-6 nerve root. The patient underwent a C5-6 anterior cervical decompression and placement of a Bryan disc prosthesis. More than 7000 cervical discs have been inserted worldwide.

Reversal of anterior cervical fusion with a cervical arthroplasty prosthesis.

This case report describes a 38-year-old-man who initially underwent a C5-C6 anterior cervical decompression and interbody fusion and plating for a right C6 radiculopathy. Within a few months of his surgery, he developed bilateral C7 radiculopathies, with imaging confirming adjacent segment foraminal stenosis. Repeat imaging suggested some subsidence of the original interbody graft but no overt pseudoarthrosis, and flexion/extension films showed no evidence of movement at the fused level.

Protection of the C1 posterior arch in atlantal lateral mass fixation: technical case report.

Screw fixation of the C1 lateral mass is a relatively new technique designed to allow for C1/C2 fixation in scenarios where transarticular screw fixation is not safe or possible. In order to place the screw at the base of the C1 arch, it has been recommended to drill at the junction of the C1 posterior arch and the lateral mass of C1, to accommodate the screw head. This may, however, weaken the C1 arch, making it prone to fracture.

Spinal epidural abscess: appearance on magnetic resonance imaging as a guide to surgical management. Report of five cases.

Spinal epidural abscess is associated with considerable rates of morbidity and mortality despite its infrequent occurrence. Advances in magnetic resonance (MR) imaging technology have allowed easier diagnosis of this potentially devastating condition. It is also possible to predict the intraoperative appearance of each case of spinal epidural abscess prior to the procedure, based on the MR findings.

Cervical arthroplasty in the management of spondylotic myelopathy: 18-month results.

Object: Cervical spinal cord compression managed via an anterior approach with an arthrodesis may be associated with a decreased range of motion and accelerated adjacent-segment degeneration. Artificial cervical disc replacement may address these problems.

Methods: The author presents a series of 11 patients (seven men and four women, ages 31-55 years) with anterior cervical decompression and placement of a total of 15 artificial disc prostheses.

Prophylaxis for deep venous thrombosis in neurosurgical oncology: review of 2779 admissions over a 9-year period.

Object: Management of disease in patients undergoing neurosurgical treatment for tumors requires balancing the competing risks of hemorrhage and thrombosis. The authors compared the incidence of clinically apparent deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients admitted for treatment of intracranial and spinal tumors at three institutions. At the public hospital (the Royal North Shore Hospital [RNSH]) nonsequential calf compression was used, and at the other two private neurosurgery services sequential calf compression with low-molecular-weight heparin was used in patients undergoing spinal surgery.

Two-level artificial disc placement for spondylotic cervical myelopathy.

This report describes a 49-year-old woman who presented with a myeloradiculopathy with two-level spinal cord compression. She underwent C5-6 and C6-7 anterior cervical decompressions and placement of two Bryan disc (Medtronic Sofamor-Danek. Memphis, TN) prostheses.

Haemorrhagic brain metastasis from a thymic carcinoma.

Brain metastasis from thymic carcinoma is extremely rare, and there is still no consensus regarding the best management of thymic metastasis to the central nervous system. Here, we report the first-known Australian case. A review of the current literature and the characteristics of thymic tumours with brain metastasis indicate that aggressive management may be able to improve long-term outcomes for these patients.

A quarter of a century of neurosurgery: the value of a relational database to document trends in neurosurgical practice of a tertiary referral hospital.

Objective And Importance: Increasing interest in evidence-based medicine has created a demand for accurate and accessible information on activity and trends in clinical practice. A database of all neurosurgery admissions at a teaching hospital maintained by a scientist has been utilised to examine changes in practice and complications from 1977 to 2001.

Methods: A relational database, set up in 1982, now contains an unbroken record of all neurosurgical admissions at Royal North Shore Hospital (RNSH) since 1976.

Management of massive calcified transdural thoracic disk herniation.

Thoracic disk herniation is a not uncommon pathology faced by the spinal surgeon. The management of massive intradural thoracic disk herniation with ventral cord compression is problematic both in terms of obtaining adequate decompression and ensuring no subsequent leakage of cerebrospinal fluid. A 54-year-old woman presented with a 10 year history of back pain and left leg pain.

Cervical arthroplasty in the management of spondylotic myelopathy.

Cervical spinal cord compression managed via an anterior approach with an arthrodesis is associated with a decreased range of motion and accelerated adjacent segment degeneration. Artificial cervical disc replacement may address these problems. A series of seven cases (three women, two men; age 31-55 years) of anterior cervical decompression and placement of an artificial disc prosthesis is presented.