Lumbar facet joint block: computed tomography guided technique compared with fluoroscopy guided technique using the posterior approach: a comparative study

Facet joint is a main source of chronic low back pain with a prevalence of 16.7%. Clinical examination and imaging are insufficient to diagnose facet joint syndrome [30% accuracy and 45% false positives]. Facet joint block is the gold standard in diagnosis of facet joint syndrome. It can also relieve pain for up to 6 months. It can be done under computed tomography [CT] or fluoroscopy. To identify which imaging modality is more suitable to guide the procedure of lumbar facet joint block, fluoroscopy or CT. Thirty four lumbar facet joints represented by 12 patients were injected in the radiology department, Suez Canal University Hospital, Ismailia, Egypt from 1/2005 to 1/2006. All cases were suspected of having facet joint syndrome based on clinical or radiological data. After clinical examination and reviewing lumbar images to identify target facets, every patient underwent facet joint block under either CT or fluoroscopy. Fluoroscopy was more successful in guiding the injections [success rate 77.7% compared with 31.25% in CT guidance]. It is also faster [6.6 minutes per joint compared with 10.9 minutes for CT guidance]. Less number of trials were required [1.7 trial compared with 6.6 trials with CT guidance]. Fluoroscopy exposed the patients and the radiologist to much irradiation [21.3 rad compared to 0.3 rad in CT guidance]. Decreased bone density and laminectomy impair fluoroscopy guidance. CT guidance is difficult in patients with marked arthropathy and coronally oriented joints [8 trials compared with 5.6 for normally appearing joints]. Fluoroscopy should be the primary choice for guiding lumbar facet joint block. It is more successful and faster. Its disadvantages include much irradiation to patients and radiologists, and difficulty in patients with laminectomy and decreased bone density. CT can then be used to guide the block

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