Transoral Decompression and Posterior Fusion for Unstable Os Odontoideum and Cord Compression: Case Report

The authors present the one case of a 22-year-old man admitted with intermittent quadriparesis and respiratory difficulty. On investigation, atlantoaxial instability and upper cervical cord compression due to abnormal soft tissue were revealed. We have performed transoral decompression and biopsy, and then posterior transarticular facet screw fixation with interspinous wiring and fusion. We could obtain immediate and long-term postoperative stability with Philadelphia collar only. The pathologic examination reveald connective soft tissue hypertrophy due to chronic mechanical irritation.

Blood Glucose Level and Neurological Outcome in Head-Injured Patients

The authors had analysed retrospectively a series of 286 consecutive patients with head injury who were admitted to the department of neurosurgery. Dong Gang Hospital between March and July, 1992. 59 cases underwent craniotomy for evacuation of intracranial hematoma and/or placement of subarachnoid bolt for intracranial pressure monitoring under general anesthesia. Patients with a Glasgow Coma Scale(GCS) Score of 8 or less had significantly higher serum glucose levels postoperatively than patients with GCS score of 12 to 15(p<0.05). Patients who subsequently remained in a vegetative state or died had significantly higher glucose levels postoperatively than patients who had good outcome or moderate disability(p<0.05). Among the more severely injured patients(GCS Score< or =8), a serum glucose level greater than 200mg/dl on admission is associated with a significantly worse outcome(p<0.05). The results suggest that severely head-injured patients frequently showed hyperglycemia and the elevted serum glucose level may worsen the neurological outcome in such patients.