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

Diffuse myelitis after treatment of cerebral aspergillosis in an immune competent patient

Presentation of an unusual case of cerebral aspergillosis in an immune competent patient who was treated successfully but symptoms and signs of a demyelinating process following initial recovery has been occurred. A 29-year-old male with focal seizure. Brain MRI revealed small multiple hemispheric and dural lesions. An open biopsy was conducted. Histological evaluation revealed hyphe-like structure in the necrotic area, within vessel walls, and lumina, suggestive aspergillus fumigatus. Furthermore, brancheal hyphae in potassium hydrxide15% and colonies on sabourud dextrose agar were observed. Based of the above findings the patient underwent anti fungal therapy. The patient recovered and continued a normal life however a follow up MRI was performed after 3 months from recovery. No significant abnormality was observed from the MRI procedure. One month later the patient developed signs and symptoms of spinal cord involvement which seemed to be the result of myelitis. A brain MR showed no abnormalities .Therefore it seemed reasonable to administer corticosteroid as a treatment for suspected active demyelinating process. During the above treatment, signs and symptoms of myelopathy disappeared and a whole spine MRI showed remarkable improvement

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