role of vertebral body collapse in the management of spinal cord compression

The management of malignant spinal cord compression has been reviewed and attention is drawn to the adverse effects of laminectomy. Data suggested that the presence of vertebral body collapse could have an important negative effect on the outcome of laminectomy. However, there was only scant evidence available in the literature to support that conclusion. 31 consecutive patients with thoracic spinal cord compression due to single metastasis treated by laminectomy are reported here. It is seen that the presence of vertebral collapse signified a much reduced chance of regaining the ability to walk, a much greater possibility of further neurological deterioration, and major increase in the incidence of postoperative spinal instability. The role of laminectomy in the management of such patients needs to be further questioned and alternative therapeutic measures such as radiotherapy, posterior spinal instrumentation or anterior surgery should be strongly considered in the presence of vertebral body collapse

Modification of Harrington instrumentation

3 cases with adolescent idiopathic scoliosis were treated using this modified Harrington distraction system. The average mean curve measured 65 degrees. All cases were right thoracic curves, operative time ranges from 2 to 2.5 hours including correction, instrumentation, sublaminar wiring and rib resection to improve the cosmetic appearance and provide a good amount of autogenous bone for grafting. POP jacket was applied for two months till rib reformation takes place. No evidence of either upper or lower hook problem. Also, the rod maintained its relation to the spine without evidence of rotation

Anterior corpectomy and posterior instrumentation for scoliosis in neurofibromatosis [a new technique]

8 cases of neurofibromatosis with dystrophic scoliosis were treated using this new technique. All patients [3 females and 5 males] were characterized by short angular dorsal curve with kyphosis. Preoperative X-ray and pulmonary functions were done. Surgical management involved anterior corpectomy [one or more, up to 3 bodies were removed] and posterior instrumentation with fusion. The posterior instrumentations used included Harrington distraction rod with or without compression system over the convexity of the curve or rectangular frame. Sublaminar wires were used at all levels in both types of instrumentations. Autogenous bone graft was taken from the prominent adjacent ribs. POP jacket was applied for 3 months to be followed by a brace for a minimum of 3 months till radiological evidence of union was established. This combined procedures were done as one stage procedure. All cases were fused. One case required relocation of upper hook. Average correction was 50%