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

Anterior cervical fixation in type-II traumatic spondylolisthesis of the axis: a report of eighteen cases, and discussing the rationale of management

Eighteen adult consecutive patients with type-II traumatic spondylolisthesis of the axis were included retrospectively in this study. The average age was 32.5 years. Fourteen were males and 4 were females. The cause of injury in all patients was road traffic accident but in 2 patients was a fall. Preoperatively, all patients were neurologically intact except two; one was tetra paretic and the other one was atypical brown Sequard's syndrome. Associated head trauma was reported in 5 patients and other cervical fractures in 5 patients. All patients were treated primarily with anterior C2/C3 auto graft and plating after closed reduction. Reduction was complete and healing was uneventful in all patients. there plating after closed reduction. There were no reported morbidity or mortality. Hospital stay was 8 days in 15 patients including the time of closed reduction. Both paretic patients recovered with minimal gait difficulty. Proper typing and grading of hangman's fractures is mandatory for a better management. Early surgical fusion is recommended for hangman's fractures of the effendi-type II and III. Anterior plating is a simple effective choice for hangman's fractures. It shortens hospital stay and skeletal tractions time