Morphologic evaluation of the lower cervical vertebrae and its surgical applications among Egyptians

Lower cervical spine stabilization necessitates precise knowledge of different osseous morphometric measures of the cervical vertebrae for accurate and safe application of fixation devices. Human cadaveric studies revealed significant variability world wide raising the issue of possible differences among races. This study was conducted on 28 osseous cadaveric models to obtain morphometric measurements among Egyptians. For posterior measures, 1.6 mm Kirschner wires were inserted in the cervical pedicles and lateral masses bilaterally to assess different linear and angular measurements. Linear measurements of the vertebral body were also assessed and presented. All result was correlated with their surgical importance for both posterior and anterior lower cervical spine surgery. The results of this study revealed morphometric differences between Egyptians and other races. Although most of these differences are not statistically significant, yet it raises the necessity of extreme accuracy that should be considered in insertion of posterior cervical pedicle and lateral mass screws concerning, the point of insertion, length, diameter, sagittal and transverse angles in and offsets. For anterior surgery, the transverse, sagittal and vertical measurements of the vertebral body should be precisely assessed for safe and adequate decompression as well as defining the ideal lengths of screws for anterior plating of the lower cervical spine

Clinical and functional outcome of multiple laminotomy technique in the treatment of lumbar spinal stenosis

Lumbar spinal stenosis is the narrowing of the osteoligamentous vertebral canal causing compression of the neural elements within the spinal canal. the lateral recesses, or intervertebral foramina. Surgery aims to decompress the nervous structures, particularly the nerve roots. without compromising vertebral stability. Different surgical modalities have been implicated with different success rates. The purpose of this study is to assess the clinical and functional outcome after multiple laminotomy in treatment of lumbar spinal stenosis. Fifty-six patients with lumbar canal stenosis were operated on using the multiple laminotomy technique after adequate unsuccessful conservative treatment. Far lateral superior and inferior laminotomies limited to one half of the superior lamina and one quarter of the inferior lamina together with the intervening ligamentum flavum were performed. Attention was given to lateral recess and root canal decompression. In 8 patients multiple laminotomies failed to achieve adequate decompression due to absolute stenosis, and were excluded from the results. Patients were followed up for a mean period of 27.63 +/- 10.56 months and assessed according to the Japanese Orthopaedic association [JOA] score. Satisfactory [excellent and good] results were obtained in 87.5% of the patients with mean recovery rate of JOA score of 65% [P<0.000] Six minor dural tears without residual neurological signs were recorded. Permanent neurological [root] injury was recorded in only 2 patients. Results of the present study proved multiple laminotomy technique to be the procedure of choice for mild to moderate developmental and degenerative stenosis

modified ring fixator device in the treatment of intertrochanteric femoral fractures under local anaesthesia

In 19 high-risk patients intertrochanteric fractures were treated with a case by case pre-operatively assembled ring fixator according to the patient's own neck shaft angle of the healthy side under local anaesthesia. in the Orthopaedic Surgery Department of Mansoura University Hospital between January 2005 and July 2006. They were selected because of their high surgical or anaesthetic risk, and evaluated by radiographs immediately after operation. and at 3 week interval follow up visits, there was early lost follow up for one death due to medical causes unrelated to the surgical procedure. A short intraoperative time [25 minutes], no need for blood transfusion. fast ambulation and an average hospitalization of 3 days. were noted. All fractures healed within 17 weeks. 'All patients had a superficial pin tract infection but deep one was seen in one patient [5%]. and in 3 patients the fracture united with a limb shortening of 15 mm [10-20 mm]. No implant failures or limitation of knee movements were recorded. There were 16 good results, two acceptable and one poor result at final follow up. This multi-planner ring fixator can be used successfully for the treatment of elderly high-risk patients with intertrochantertc fractures providing satisfactory stability and early weight-bearing