Anterior Cervical Discectomy and Fusion with Stand-Alone Trabecular Metal Cages as a Surgical Treatment for Cervical Radiculopathy: Mid-Term Outcomes

STUDY DESIGN: Retrospective case cohort study done between 2002 and 2012. PURPOSE: To assess the mid-term clinical and radiological outcomes of 1-level and 2-level anterior cervical discectomy and fusion (ACDF) with stand-alone trabecular metal cages. OVERVIEW OF LITERATURE: ACDF is the gold standard surgical treatment for cervical degenerative disease. The usual surgical practice is to use an anteriorly placed fusion plate with or without interdiscal cages. METHODS: Patients between 36 and 64 years of age diagnosed with cervical radiculopathy who underwent ACDF using stand-alone trabecular metal cages with at least 3 years follow-up were included in this study. Recorded clinical outcomes included residual axial neck pain, radicular arm pain, upper extremity weakness, and upper extremity altered sensation. Visual Analogue scores were also recorded. Fusion was assessed by lateral radiographs looking for bone breaching and radiolucent lines around the device at the latest follow-up. RESULTS: Ninety patients were included in the study. Fifty-one patients underwent 2-level surgery and 39 patients underwent 1-level surgery. Mean age was 44±10.4 years and mean follow-up time was 4.5±2.6 years. Patients reported excellent or good outcomes (90%), as well as improvements in axial neck pain (80%), radicular arm pain (95%), upper extremity weakness (85%), and upper extremity altered sensation (90%). Most patients (90%) progressed to fusion at the 1-year follow-up. The reoperation rate was 3.6%. There was no reported persistent dysphagia, voice complaints, dural tear, or tracheal or oesophageal perforation in any of the patients. One patient developed a deep methicillin-resistant Staphylococcus aureus infectious infarction of the spinal cord, which was treated with antibiotics. Recovery was complete at the 1-year follow up. CONCLUSIONS: Mid-term results show that surgical treatment with ACDF with trabecular metal cages is a safe and effective treatment of single and 2-level cervical disc radiculopathy and neck pain.

Perceptions and attitude towards lumbar puncture [LP] among parents in Kuwait

To assess the knowledge, understanding and acceptance of lumbar puncture [LP] among parents of pediatric patients in hospitals Questionnaire- based cross sectional survey Department of Pediatrics in three hospitals in Kuwait, namely, Al-Amiri, Al-Adan and Al-Jahra hospital Three hundred and fifty-eight parents of children admitted with various underlying diagnoses A self-administered questionnaire. Rate of acceptance of LP, characteristics of parents accepting and refusing LP, reasons for rejecting LP and means to improve LP acceptance among parents in Kuwait. A total of 358 parents responded to the questionnaire. Only 15.3% agreed for LP, 42.5% did not agree and 42.2% preferred taking a second opinion. Relationship to the child, nationality and educational level of the parent were significantly associated with acceptance of LP [p < 0.05]. The majority [79.1%] answered that LP is unsafe because it might cause complications like paralysis [46.2%], pain [16.6%], infertility [17.2%], and deterioration of child's health [12.8%]. Out of the parents who did not accept LP, 67.0% said that they might have changed their mind, if the procedure was fully explained by a doctor with the use of a diagram. Another group [66.0%] felt that the media can help to increase the acceptance of LP among parents. Parent's refusal of LP is a common problem among parents in Kuwait. The main reasons are lack of knowledge and the misconception that this is a harmful procedure. There is a great need to educate parents about the safety of LP in children