Pediatric intervertebral disc calcification.

Idiopathic calcification of the intervertebral disc is a rare condition in childhood, of unknown etiology. Calcifications are occasionally discovered on routine radiological examination, or on investigation of nonspecific symptoms such as neck pain, torticollis, fever, and radiculopathy. We report a case of a 7-year-old boy with intervertebral disc calcification. Clinical and radiological signs are discussed.

Cervical spondylotic myelopathy and radiculopathy treated by oblique corpectomies without fusion.

Oblique corpectomy (OC) is an alternative technique for the resection of spondylotic spurs ventral to the cervical spinal cord contributing to cervical spondylotic myelopathy (CSM) and cervical spondylotic radiculopathy (CSR). To evaluate the efficacy of OC for the treatment of cervical spondylotic myeloradiculopathy, we reviewed our experience with OC. Twenty-six patients, 18 males and 8 females, were studied. They averaged 51.3 years of age (range 30-72), Thirteen had myelopathy and 13, radiculopathy. Both magnetic resonance (MR) imaging and computed tomography (CT) were performed preoperatively to define the extent of pathology. The Modified Japanese Orthopedic Association (JOA) score was used to grade the quality of the outcome. Neurologic and radiologic results were assessed. Good and excellent results were observed in 76.9% of the cases with myelopathy. Improvement of radicular symptoms was noted in 84.6% of the cases with radiculopathy. Neuroimaging studies confirmed satisfactory anatomical decompression in all patients. Sagittal alignment decreased from 13 degrees to 12 degrees. The degree of postoperative recovery seemed to be directly related to the age and severity of the preoperative myelopathy. This surgical technique has shown excellent clinical outcomes with fast recovery and adequate anatomical decompression in patients with CSM and CSR.

Clivus fractures: clinical presentations and courses.

Fractures in the clivus region are usually associated with blunt head trauma. They may cause many cranial nerve deficits and vascular complications. The mortality rate is high because of brainstem trauma or vertebrobasilar occlusion. The diagnosis of clivus fracture (CF) is difficult with routine cranial radiography due to the presence of dense petrous temporal bones. Because of this, few cases have been described in the past. In this study, we report nine cases of CF observed and treated in our department during the last 5 years. Computed tomographic (CT) scanning revealed CF in nine of 2500 patients with head trauma (0.36%). The patients ranged in age from 17 to 68 years (mean 38.3). Five patients had had motor vehicle accidents, three were injured in falls, and one was a pedestrian injured by a motor vehicle. Five patients had longitudinal fractures and four had transverse fractures. Cranial nerve deficits were recorded in all patients. Deficits of cranial nerves VI and VII were the most frequently observed (six patients, 66.6%). We review the literature to highlight the differences in clinical presentation and the course in cranial nerve deficits. The diagnosis of CF is made by high-resolution, fine-cut CT using standard and bone window settings. Its presence should alert clinicians to the potential complications.

Growing skull fracture of the orbital roof: Report of two cases and review of the literature.

In this report, the authors describe two cases of growing fracture of the orbital roof. The aim is to draw attention to this rare complication and discuss the role of three-dimensional computed tomography in radiological findings and surgical planning. Relevant literature is also reviewed.

Effects of mexiletine, ginkgo biloba extract (EGb 761), and their combination on experimental head injury.

Lipid peroxidation (LP) and brain edema are important factors that produce tissue damage in head injury. The purpose of this study was to investigate the effect of mexiletine, gingko biloba extract (EGb 761), and their combination on LP and edema after moderate head trauma. Forty rats were randomly and blindly divided into four groups of ten animals each: control group (bolus injection of physiological saline), mexiletine group (50 mg/kg per injection), EGb 761 group (30 mg/kg per injection), and mexiletine plus EGb 761 group (50 mg/kg and 30 mg/kg per injection, respectively). The injections were given intraperitoneally at 1 h, 9 h, and 17 h after trauma. Twenty-four hours after injury, the rats were killed, and malondialdehyde (MDA) levels and brain water content were determined. Rats treated with mexiletine, EGb 761, and mexiletine plus EGb 761 had significantly lower MDA levels than the control group (P<0.01). The lowest MDA levels were measured in the mexiletine plus EGb 761 group. However, there was no significant difference in brain water content between treated groups and the control group (P>0.05). These findings show the usefulness of mexiletine and its combination with EGb 761 as a cerebroprotective agent in this model of experimental head injury.