Long term results of lumbar sequestrectomy versus aggressive microdiscectomy.

It remains unknown whether aggressive microdiscectomy (AD) provides a better outcome than simple sequestrectomy (S) with little disc disruption for the treatment of lumbar disc herniation with radiculopathy. We compared the long term results for patients with lumbar disc herniation who underwent either AD or S. The patients were split into two groups: 85 patients who underwent AD in Group A and 40 patients who underwent S in Group B. The patients were chosen from a cohort operated on by the same surgeon using either of the two techniques between 2003 and 2008. The demographic characteristics were similar. The difference in complication rates between the two groups was not statistically significant. During the first 10 days post-operatively, the Visual Analog Scale score for back pain was 4.1 in Group A and 2.1 in Group B, and the difference was statistically significant (p<0.005). The Oswestry Disability Index score was 11% in Group A and 19% in Group B at the last examination. The reherniation rate was 1.5% in Group A and 4.1% in Group B (p<0.005). We argue that reherniation rates are much lower over the long term when AD is used with microdiscectomy. AD increases back pain for a short time but does not change the long term quality of life. To our knowledge this is the first study with a very long term follow-up showing that reherniation is three times less likely after AD than S.

An unexpected complication of occipitocervical stabilization surgery: retropharyngeal hematoma.

BACKGROUND CONTEXT: To report a unique case of an unexpected complication of occipitocervical stabilization surgery that is retropharyngeal hematoma (RH). PURPOSE: Postoperative RH is a very rare complication and has never been reported after posterior occipitocervical surgery. STUDY DESIGN: Case report. METHODS: A 44-year-old woman being treated for rheumatoid arthritis for 20 years was admitted to our hospital in a wheelchair with the complaints of neck pain and weakness in both upper and lower extremities. She was diagnosed with basilar invagination, and occipitocervical (C0-C5) transpedicular fixation with osteosynthesis using iliac autograft was performed. The airway was seen as obstructed after extubation. The airway was maintained with laryngeal mask, and computed tomography revealed an RH. Emergent tracheotomy was performed. The patient was decannulated because of the resorption of RH after 10 days and was discharged. CONCLUSION: This patient is the first patient, to our knowledge, to be reported for unexplained RH after cervical posterior spinal surgery.

Chronic manganese toxicity due to substance abuse in Turkish patients.

BACKGROUND: Manganese toxicity may lead to a levodopa-resistant akinetic-rigid syndrome. Pathological changes occur mostly in the pallidium and stratium. MATERIALS AND METHODS: We report seven patients with a new form of chronic manganese toxicity due to long-term intravenous use of a solution consisting of ephedrine, acetylsalicylic acid and potassium permanganate as a psycho-stimulant, popularly known as "Russian Cocktail". RESULTS: The age of the patients ranged between 19 and 31 years, and the duration of substance abuse was between nine and 106 months. The onset of symptoms from first use ranged seven to 35 months. The initial symptom was impaired speech followed by gait disturbance and bradykinesia. In addition to these symptoms, choreic movements, ataxia presenting as backward falls and dystonia were also seen. Serum and urine samples revealed high levels of manganese. Hyperintense lesions on T1-weighted magnetic resonance imaging were seen in bilateral basal ganglia and brainstem, dentate nuclei, features consistent with manganese intoxication. CONCLUSION: Manganese toxicity, which may cause a distinctive irreversible neurodegenerative disorder, can be seen frequently with "Russian Cocktail" abuse, a substance which can be accessed very easily and at a low cost.

Posterior transodontoid fixation: A new fixation (Kotil) technique.

Anterior odontoid screw fixation or posterior C1-2 fusion techniques are routinely used in the treatment of Type II odontoid fractures, but these techniques may be inadequate in some types of odontoid fractures. In this new technique (Kotil technique), through a posterior bilateral approach, transarticular screw fixation was performed at the non-dominant vertebral artery (VA) side and posterior transodontoid fixation technique was performed at the dominant VA side. C1-2 complex fusion was aimed with unilateral transarticular fixation and odontoid fixation with posterior transodontoid screw fixation. Cervical spinal computed tomography (CT) of a 40-year-old male patient involved in a motor vehicle accident revealed an anteriorly dislocated Type II oblique dens fracture, not reducible by closed traction. Before the operation, the patient was found to have a dominant right VA with Doppler ultrasound. He was operated through a posterior approach. At first, transarticular screw fixation was performed at the non-dominant (left) side, and then fixation of the odontoid fracture was achieved by directing the contralateral screw (supplemental screw) medially and toward the apex. Cancellous autograft was scattered for fusion without the need for structural bone graft or wiring. Postoperative cervical spinal CT of the patient revealed that stabilization was maintained with transarticular screw fixation and reduction and fixation of the odontoid process was achieved completely by posterior transodontoid screw fixation. The patient is at the sixth month of follow-up and complete fusion has developed. With this new surgical technique, C1-2 fusion is maintained with transarticular screw fixation and odontoid process is fixed by concomitant contralateral posterior transodontoid screw (supplemental screw) fixation; thus, this technique both stabilizes the C1-2 complex and fixes the odontoid process and the corpus in atypical odontoid fractures, appearing as an alternative new technique among the previously defined C1-C2 fixation techniques in eligible cases.