Outcome of transpedicular screw fixation in surgical treatment of isthmic spondylolisthesis in adults

Isthmic lumbar spondylolisthesis is a complex orthopedic and neurosurgical problem. Between 1995 and 2000, twenty three adult patients with symptomatic isthmic lumbar spondylolisthesis who failed to respond to conservative treatment were operated upon by posterolateral fusion and transpedicular screw fixation combined with a variety of decompressive procedures; namely, decompressive laminectomy, excision of fibrocartilaginous pseudoarthrotic mass and/or foraminotomy when indicated by preoperative imaging studies and operative findings. The surgical results were evaluated at an average follow up of 21 months. Nineteen patients had favorable clinical outcome. Solid fusion was evident in 20 patients. Individual clinical symptoms showed variable degrees of improvement. Low back pain improved at variable degrees in 91.3%, sciatica improved in 89%, intermittent claudications improved in 75% and neurological deficits improved in 87.5%. Loosening of screws was the commonest complication encountered occurring in 2 patients. In this study, posterolateral fusion combined with an appropriate decompressive procedure and instrumentation by transpedicular screws without reduction for isthmic spondylolisthesis in adults resulted in a high fusion rate and favorable clinical outcome

Surgical outcome of acute traumatic intracranial hematomas in pediatric age group

Fifty patients had traumatic intracranial hematomas in pediatric age group were treated surgically. The surgical outcome was evaluated for survivals during 12 months after injury. They constituted 6% of all pediatric head injuries required hospital admission. 32 patients had acute epidural hematoma, 10 had acute subdural, hematoma, and 8 had acute intracerebral hematoma. Good recovery was achieved in 84% of patients who had acute epidu ral hematoma, while high mortality was reported in those who had acute subdural and acute intracerebral hematomas [50% and 3 7.5% respectively]. Correlation between post resuscitation GCS scores and outcome was parallel together, as good recovery was achieved in 89% with no mortality in patients presented with G.C.S scores of 13-15, while good recovery was 13% with 53% mortality in those presented with GCS scores of 3-8. Presence of systemic injuries and shock had adverse influence on the outcome, as mortality was higher in patients who had systemic injuries than in those had head injury alone [40% and 17.5% respectively] and mortality was also higher in. patients who had shock on admission than in those had head injury alone [44% and 17% respectively]

Outcome of severe closed head injury in adult patients

A series of one hundred severely closed head injured adult patients who were admitted to Benha University Hospitals were studied for mechanism of injury, presence of traumatic subarachnoid hemorrhage [TSAH] on initial CAT scans and clinical course. The relation ship of each of these factors then correlated with the outcome. Favourable out came was highly evident in patients sustained nonmotorvehicle related injwy then these sustamied motor veluile related injwy [93% and 39% while mortalty was [4% and 37.5 respectively]. The presence of traumatic subarachnoid hemorrhage [TSAH] on initial CAT scans has been shown to be associated with unfavourable outcome, it has been found that unfavourable outcome was 39% in survivals while mortality was 39%, but those with injury alone had 10% unfavourable outcome and mortality was 24%. The patients associated with prolonged coma had higher proportion of unfavourable outcome than those associated with short duration of coma [78% and 22% respectively]. The ultimate outcome of all the patients was 54% favourable and 18% unfavourable while mortality was 28%