single posterior approach for vertebral column resection in adults with severe rigid kyphosis

Correction of severe kyphosis is a challenging operation in spinal surgery. A two stage operation has been commonly used: anterior release and decompression followed by posterior correction and fusion. We describe the posterior vertebral osteotomy technique for eorrecticfn of severe and rigid kyphosis through posterior-only approach. Twelve patients [six male and six female] with severe and rigid kyphotic deformity of the thoracic spine were treated by posterior vertebral column resection using a single posterior approach. The apex level of kyphosis was at the upper thoracic in five patients, the lower thoracic in four patients and mid thoracic in three patients. There was old fracture in one patient, congenital deformity in six, tumor in three and neurofibromatosis in two patients. After posterior vertebral column resection, segmental posterior instrumentation was used for correction of the kyphotic deformity. Complications and radiographic findings were analyzed to evaluate clinical outcomes and radiologic changes of posterior vertebral column resection in patients with angulated kyphotic deformity. The major curve correction was averaged 31.66 ° [SD=15.69] [45%]. The resection was performed at the involve level in every patient. Posterior segmental fusion was achieved in average 8.9 [SD=1.7] segments. Anterior reconstruction was with titanium mesh cage in two and with cancellous chip packing in other patients. There were no neurologic complications after six month. Bony fusion achieved in all patients, and there was no correction loss. Satisfactory correction is safely performed by posterior vertebral column resection with a direct visualization of the circumferentially decompressed spinal cord. Although the performance is technically laborious, it offers good correction without jeopardizing the integrity of the spinal cord

Evaluation of argyrophilic nucleolar organizer region staining in predicting the behavior of meningiomas

The number of argyrophilic nucleolar organizer regions [AgNOR] correlates with cellular proliferative activity. Comparing nonrecurrent, recurrent, atypical and malignant meningiomas we studied the value of the routine applicability of the AgNOR count in the prognostication of this tumor. Two hundred and thirty-eight meningiomas were reviewed blindly and graded using WHO grading schema. Eighty-one cases were selected and arranged in six groups according to clinical data and grading: 14 benign non-recurrent meningiomas; 14 primary benign recurrent meningiomas and their subsequent benign recurrences; 14 atypical; 11 malignant and 14 spinal meningiomas. Silverstained slides were prepared and mean median and standard deviation of AgNOR dots determined. There was a proportionate increase of AgNOR dots with increasing tumor grade. There was a significant difference between benign non-recurrent tumors versus benign recurrent [P<0.0001] and atypical or malignant [P<0.0001] tumors. A difference was also noted between the recurring tumors versus malignant ones [P= 0.002] but no significant difference was seen between recurrent and atypical; atypical and malignant; intracranial and intraspinal; and primary of recurring meningiomas with their subsequent recurrences. A mean AgNOR count of <2.3 could separate benign tumors from atypical or malignant meningiomas with 93% specificity; and 93% of tumors with benign histology had no recurrence potential if their mean AgNOR count was less than 1.8. This study indicates that in meningioma, the AgNOR count has a good correlation with tumor grading and recurrence, which may aid pathologists and clinicians in predicting tumor behavior