Clinical Application and Surgical Results of Hollow Cage(RABEA(TM)) without Bone Graft in the One-Segment Cervical Spinal Interbody Fusion

OBJECTIVE: The authors report a result of application of cervical hollow cage(RABEA(TM)) without bone graft to the patients of one-level cervical spondylosis or acute cervical disc herniation to fill and stabilize a vacant space following anterior decompression. METHODS: Twenty-one patients from May 1999 to April 2001 had been taken procedure with cervical hollow cage system following anterior decompression and there had been no additional bone graft or screw fixation or fusion. Pain relief and clinical outcome were evaluated, and the intervertebral disc height and segmental angle for radiological assessment were examined. All patient were followed up for 12 months at least. RESULTS: The result was excellent in 14 cases(66.7%), good in 6 cases(28.6%) and poor in 1 case(4.8%). In the lateral projection, the mean of preoperative disc height and segmental angle were significantly improved after surgery and maintained during follow-up periods. No abnormal displacement were recorded at dynamic flexion and extension lateral X-ray and no cage rotation or retropulsion was noted in follow-up periods. Three patients(14.3%) was observed to subside of disc height on the postoperative periods and only one of their patients was dissatisfied with surgery. CONCLUSION: Cervical hollow cage is simple to perform and reduces the operation time. Besides clinical improvement, it improves mechanical stability and radiological profile as the physiologic level. The cervical hollow cage might be an alternative to traditional cervical interbody fusion with bone graft.

Treatment of Chronic Anal Fissure with Topical Nitroglycerin

PURPOSE: Lateral partial internal sphincterotomy is considered as the best surgical procedure of the idiopathic chronic anal fissure. Because the aim of surgery is to relieve sphincter spasm, and occasional minor incontinence following surgery has been reported, alternative chemical means of spasmolysis could be considered. Nitric oxide (NO) is known to be a major inhibitory neurotransmitter of the internal anal sphincter, so we investigated the effect of topical nitroglycerin for chronic anal fissure. METHODS: Twenty nine patients (19 women, mean age 36 years) with chronic anal fissure were treated with 0.2% nitroglycerin ointment. Pain score was quantitated with Visual Analog Scale (VAS) in regular time interval. Manometry was performed in five patients and maximum anal resting pressure (MARP) was measured before and 30 minutes after topical application of nitroglycerin ointment. All patients were re-examined and questioned regarding pain relief and side effects 2 years after cessation of treatment. RESULTS: All had appearances of chronicity and pain. There were 25 posterior and 12 anterior fissures. Pain was significantly abolished within 5 minutes after application of nitroglycerin ointment. Mean pain score (VAS) was 6.03 before, 0.69 30 min after, 0.58 1 week after, and 0.53 3 weeks after application of nitroglycerin ointment (P<0.001). MARP was markedly reduced 30 minutes after application of nitroglycerin from 166.2 15.1 cmH2O to 108.8 20.9 cmH2O (P<0.05). The 57% of patients (13/23) were effective for 2 years and 22% of patients (5/23) had recurred their symptom after cessation of nitroglycerin ointment. Two patients (9%), whose fissures had not healed completely within 3 weeks were requested for surgery and the other 2 patients (9%) had been operate due to the side effect of the ointment. Mild headache (7%) and dizziness (10%) were occured, but well tolerated when the dose was reduced. CONCLUSIONS: Topical application of nitroglycerin ointment seems to be an effective and safe alternative in the treatment of chronic anal fissure.

Multiple Hemangioblastomas on Cerebellum and Spinal Cord in a Patient of Von Hippel-Lindau Disease

Hemangioblastomas are rare benign tumor of the central nervous system that commonly occur in the posterior fossa around the 4th ventricle. In case of von Hippel-Lindau disease, hemangioblastomas involve multiple regions such as cerebellum, spinal cord and brainstem but, rarely show simultaneous involvement of cerebellum and spinal cord. We have experienced a case of multiple hemangioblastomas that were located at the cerebellum, cervical cord and conus medullaris and also had multiple lesions that a part of von Hippel-Lindau disease;retinal angioma, syringomyelia, multiple cyst on kidney and pancreas, renal cell carcinoma on left kidney. Hemangioblastomas on cerebellum and spinal cord were removed totally, retinal angioma was treated with laser photocoagulation and renal cell carcinoma was also totally excised. The authors report a case of von Hippel-Lindau disease had multiple located hemangioblastomas on cerebellum, cervical cord and conus medullaris with review of literature.