lateral extracavitary approach all through posterior

The Lateral extra cavitary approach [LECA] is a one stage approach allowing simultaneous ventral and dorsal exposure in the more familiar prone position without repositioning of the patients. It provides the ability to re-attack the ventral graft site after application of dorsal instrumentation. The neural elements are visualized early in the procedure allowing safe decompression. The aim of this work was to study the safety and technical difficulties of the LECA in different spinal pathology and the value of using a midline skin incision. 40 patients with different spinal pathology including trauma, tumours, infections, deformity and thoracic disc prolapse were treated via the LECA. 37 patients were operated via mid-line skin incision and only 3 patients via the hockey stick incision. All patients had decompression, anterior column reconstruction and posterior stabilization simultaneously. Mean follow up period was 21 months. Neither significant perioperative complications nor mortality were reported. The midline skin incision is more cosmetic and offers good exposure. The LECA is a safe approach better than combined anterior and posterior approaches

Single-stage anterior-posterior stabilization of unstable lower cervical fractures

The objective of this work was to evaluate the applicability, safety and the results of single-stage combined anterior-posterior decompression and fusion for highly unstable lower cervical spine injuries. Between January 2004 and May 2006, 16 patients with unstable lower cervical spine injuries were included in this study. There were 12 males and 4 females with a mean age of 38.89 years [range 18-58 years]. All patients presented with traumatic multicolumn instability and kyphotic deformity; they underwent anterior subtotal cervical corpectomy and autgenous tri-cortical iliac bone graft and anterior plates were placed, Lateral mass plating with autograft [morselized iliac crest] fusion was performed in the same surgical setting. The mean follow-up period was 28.4 months [range 24-32 months]. Fusion was determined to be successful in all patients. Although the short-term morbidity rate reached 18.75%, No significant long-term morbidity was noticed, there were no clinically significant hardware complications and no patient required repeated operation. We strongly consider a single stage combined approach in unstable lower cervical injuries with 3-column involvement by providing immediate rigid internal fixation to both the anterior and posterior columns, eliminating the need for halo immobilization postoperatively and preventing anterior plate failure or strut graft extrusion

Post operative spondylodiscitis, stabilization and fusion

Tweleve patients with postoperative spondylodiscitis [POD] not responding to conservative treatment, were managed by early surgical debridment of the infected necrotic tissue, transpedicular fixation and fusion and early mobilisation. Their mean age was 41.4 years old [range 28-65], 7 males and 5 females. Diagnosis was achieved 2 weeks to 3 months after disc surgery. The POD was diagnosed clinically, Laboratory by elevated erythrocyte sedimentation rate [ESR] values and radiologically by magnetic resonance imaging. According to the sensitivity studies of the obtained pathogens, systemic antibiotics were given, followed by early mobilisation of all patients in a light spinal corset. All patients experienced immediately reduced back pain and leg pain allowing them to leave their bed and start mobilisation during the first postoperative day. After a mean follow-up of 9 months [range 6-24 months] only one case was using analgesics. None had deteriorated, and all were ambulatory without bladder or bowel disturbances. Bacteriological diagnosis was obtained in 75% of the patients. Elevated ESR values returned to normal ranges within 30 to 60 days [mean 45 days] after reoperation. Early surgical removal of the necrotic and infected tissues and transpedicular stabilization of the affected spinal segment supported by specific antibiotic therapy should be considered as an effective means to treat POD, thereby avoiding a prolonged period of unpleasant immobilisation for the patient

Cage versus autogenous tricortical iliac bone graft in the treatment of single level cervical disc prolapse

A total of 48 patients with single level cervical discogenic radiculopathy were randomly divided into two groups. Patients in Group A [24 patients] underwent anterior cervical discectomy and fusion with a cage filled with autogenous iliac cancellous bone], and patients in Group B [24 patients] were treated with discectomy and autogenous iliac crest graft [AICG] fusion. There were 30 men and 18 women with a mean age of 41.2 years [range, 25-62]. We evaluated the patients for cervical lordosis, the amount of interspace collapse and fusion status on the basis of X-rays, the patients neurological and functional outcomes were assessed on the basis of Odom's criteria. The two groups had similar clinical results and fusion rates. However, the loss of cervical lordosis [2.5°] was less in the cage group than in the autograft group [5.25°]. Additionally, the anterior interspace collapse [1.53 mm] in the cage group was less than the collapse recorded in the autograft group [2.72 mm]. The operative time, the blood loss and hospitalization time was less in the cage group. In conclusion, our results showed that the cage is superior to the autograft in maintaining cervical interspace height and cervical lordosis after one-level anterior cervical decompression procedure with reduction of the operative time and no bone graft donor site complications