[Evaluation of the Tokuhashi Score value for the life expectancy of patients with spinal metastases]

Life expectancy of patients with spinal metastasis is an important factor to manage these patients. Tokuhashi is a scoring system which was the sum of the points of six items: 1.general condition, 2. number of extraspinal bone metastasis, 3. number of metastasis in the vertebral body, 4. presence or absence of metastasis to major internal organs, 5. site of the primary lesion, 6. the severity of palsy. This score can predict survival time. Our study is going to evaluate predictive value of Tokuhashi score in order to select more useful treatment for patient with spinal metastases. This study is cohort. We had 109 patients with spinal metastasis that selected from February 2007 to March 2009.Tokuhashi score is determined for all patients. We compare the predicted survival from this score with actual survival. Analysis based on Kaplan_Meier, Cox regression and McNemar tests. The predicted survival, based on Tokuhashi score, in 38 patients was less than 6 months, in 39 patients, 6-12 months and 1 year or more in 32 patients and the actual survival was: 39 patients died at first 6 months of the follow up, 28 at the second six-month period and 42 patients were alive at the end of the year. No significant difference was seen between predicted and actual Survival time [p=0.116]. Present study showed that the Tokuhashi revised scoring system may be practicable and highly predictive preoperative scoring systems for patients with spinal metastases. Our study showed the Tokuhashi score system can highly predict the survival of patients with spinal metastasis and it is a trustful tool to use for management of these patients

Comparison of long terms follow up results in patients with cervical disk disease treated with anterior PEEK cage implantation and without it in Rasoul Akram Hospital

Anterior interbody fusion of the cervical spine have become the gold standard for treating spinal diseases, hence the aim of this study was to compare long term follow up results in patients with cervical disk disease treated with anterior PEEK cage implantation and without it in anterior approach. Retrospectively 63 patients with known cervical discogenic disorders who went under surgery with and without cage implantation were enrolled. The neurological examination and neurologic function were assessed by using the Japanese Orthopedic Association [JOA] scoring system and neurological cervical spine scale [NCSS] before and 8 years after surgery in each patient and at the end all complications were recorded. In the first group, there were 15 males and 14 females [mean age: 49 +/- 10 years] and in the second group there were 27 male and 7 female [mean age: 47 +/- 9 years]. The NCSS score was significantly different between two groups after surgery [p=0.035] but there was no significant difference before surgery [p=0.163]. No statistical significance difference was also observed in JOA score and complications before and after procedure, but JOA post surgery score between two groups had significant difference [p=0.047]. In conclusion, present study showed that PEEK cage implantation is a highly useful alternative to the conventional treatment methods

Evaluation of ventriculoperitoneal shunt malfunction regarding ventricular catheter placement

Shunting procedures specifically ventriculoperitoneal shunts are the main line of treatment for management of hydrocephalus despite available new techniques and systems of shunting. Associated complications should be recognized and managed properly, but the most recognized complications are shunt obstruction which its prevalence through surgical approach is discussed here. Two approaches [frontal and parietal] are used to insert ventriculoperitoneal shunt. In this study we retrospectively examined patterns of shunt failure in patients with symptoms of shunt malfunction. Factors analyzed included site of failure, time from shunt placement or last revision of failure, age of patient at time of failure, infection and primary etiology of hydrocephalus. Two approaches were compared to determine which one is more associated with shunt failure. 250 patients with symptoms of shunt malfunction over 4 years period were retrospectively examined, in 126 cases who were shunted through frontal approach, 48 cases and in 124 patients whose shunts were inserted through parietal approach 64 cases of malfunction observed. All data was analyzed with SPSS software and with T-test, and then the failure rate for frontal versus parietal approach was compared. Significant difference in malfunction rate between these two approaches regardless of underlying cause of ventriculoperitoneal shunt failure was observed, with the less failure rates through frontal approach. Although proximal obstruction is the most common cause of ventriculoperitoneal shunt failure and frontal approach demonstrated less failure rate, but as it is known placing the catheter tip away from the choroids plexus is the most important factor avoiding obstruction