Midline posterior microendoscopic discectomy. Is it the future procedure of choice?

This is prospective study of 20 cases with solitary unilateral lumbar and lumbosacral disc prolapse were managed in Al-Azhar University Hospital, Ain, Shams University Hospital and Al-Sahel Teaching Hospital from January 2005 to January 2007. All the cases were operated by posterior midline microendoscopic discectomy procedure, utilizing microendoscopic tubular retractor system [METR'x] and Destandeau method. The postoperative clinical outcome was assessed according the MacNab's criteria. We assessed the factors which affect the outcome including the age, the value of clinical evaluation, pre operative MRI, degree of disc prolapse and duration of symptoms. Complication in the form of dural tear, discitis and superficial wound infection were recorded. We compare the result of our study to those reported in literature and the result of open microdiscectomy. Endoscopic lumbar discectomy is considered an alterative option of traditional open discectomy in appropriately well trained and experienced hands for appropriately selected patients

Evaluation of cerebrospinal fluid diversion procedures in treatment of pediatric midline posterior fossa tumors

Neurosurgeons still divided in their opinions concerning the best way to manage obstructive hydrocephalus secondary to posterior fossa tumors. Some authors proposed a preoperative indwelling cerebrospinal fluid shunt as the most advantageous method for the subsequent surgical approach to the tumor. Others proposed direct approach to the posterior fossa tumor, when possible, or external ventricular drainage, when necessary. This study aimed to evaluate the role of cerebrospinal fluid diversion procedures in treatment of hydrocephalus due to midline posterior fossa tumors in children. Eighty-eight patients were included in this retrospective study. They were classified into two groups: 22 patients operated for direct tumour attack without CSF diversion and 66 patients operated for CSF diversion before tumour attack. The later group was further subdivided into three subgroups according to the method of CSF diversion; V-P shunt, ETV, and EVD. This study carried out in the Neurosurgery Department, at Suez Canal University Hospital in the period between March 1995 and February 2005. The use of CSF diversion procedure was associated with improvement of hydrocephalus in 70% of patients while direct tumour attack was associated with improvement of hydrocephalus in 31% of patients. The best results were found in ventriculoperitoneal shunt [100%] followed by endoscopic third ventriculostomy [60%] then the external ventricular drainage [31%].The use of CSF diversion is beneficial in treatment of hydrocephalus due to midline posterior fossa tumour in children

Clinical and radiological outcomes of posterior lumbar interbody fusion with carbon fiber cage in comparison to posterior lumbar interbody fusion with iliac bone graft

This prospective, controlled, randomized clinical study critically compared the clinical and radiological outcomes in patients surgically treated by PLIF with carbon fiber cage versus those treated by PLIF with iliac bone graft. In the period between May 2004 and April 2006, sixty patients underwent posterior interbody fusion of the lumbar spine with transpedicular screw fixation for the treatment of their degenerative segmental instability. In half of then PLIF was done using carbon fiber cage and in the other half PLIF was done using iliac bone graft. Participants were evaluated pre-operatively and post-operatively at 3, 6, 9, and 12-month intervals. Pain was scored by a VAS for both lower limb and back pain both preoperatively and postoperatively. The clinical outcomes were compared using the Prolo economic and functional rating scale and the fusion status was compared using the radiological criteria of fusion proposed by Brantigan. By 12 months follow up period, 65% of the study group expressed clinical success. Prolo scale showed clinical outcomes of patients who were treated with PLIF with carbon cage are better than those treated with PLIF with iliac crest graft but this was not statistically significant. The radiographic evaluation for bone union showed that 43% of the iliac bone group had no fusion, but 80% of cases of the cage group revealed sound fusion. Complications were matched in the 2 groups except for collapse and iliac crest harvest complications that prevail in the iliac crest group. PLIF with Carbon cage gives better fusion on radiology than PLIF with iliac bone graft, but no statistical difference in the clinical outcome. Carbon cage use precludes complications associated with iliac bone harvesting