Degenerative cervical myelopathy caused by posttraumatic severe atlantoaxial dislocation over 10 years in patients with right vertebral artery hypoplasia: A case report of successful management.

INTRODUCTION: Degenerative cervical myelopathy caused by long-standing neglected AAD is rare, especially in severe cases. Combined with the exceptional right vertebral artery hypoplasia condition, treatment must be integrated into multitherapy to avoid fatal complications. CASE: A 55-year-old man presented with degenerative cervical myelopathy caused by posttraumatic severe atlantoaxial dislocation for more than 10 years in patients with right vertebral artery hypoplasia. After treatment with halo traction and C1 lateral mass, as well as C2 pedicle screw fixation combined with bone autoplasty, the condition was resolved. CONCLUSION: This is an extremely rare and severe condition (anatomical damage, long-term sequelae, degree of paralysis on admission, and complete hypoplasia of the right vertebral artery). The treatment strategy is consistent with early favorable outcomes.

Transarticular Screw Fixation in the Treatment of Severe C1-C2 Dislocation: A Case Series Report.

BACKGROUND: To aim of the present paper was to evaluate the results of halo traction and transarticular screw fixation combined with bone autoplasty in patients with severe atlantoaxial dislocation. CASE PRESENTATION: This is a retrospective study of severe cases of atlantoaxial dislocation in nine patients (six men and three women) treated with preoperative halo traction and posterior C1-C2 transarticular screw fixation combined with bone autoplasty from June 2006 to June 2011 at the Saint Paul Hospital (Hanoi). The mean age of patients was 37.48 ± 13.753 years (range, 26-50 years). The possibility of fixing dislocation using a halo apparatus was investigated through a series of preoperative halo corrections performed within a span of 1-2 weeks. For transarticular screw fixation, two transarticular screws were used that were positioned according to the Magerl technique. For bone autoplasty, an iliac crest bone graft approximately 3 × 2 cm in size was used. The postoperative assessment of clinical improvement was performed using the neck disability index (NDI), the American Spinal Injury Association (ASIA) impairment scale, and the visual analog scale (VAS) measurement instruments, through the gradation of atlantoaxial dislocation, and via the clivoaxial angle(CAA) index and the space available for cord (SAC) index after 6 months. The image diagnosis demonstrates that all the cases of atlantoaxial dislocations are unstable and correspond to the Fielding and Hawkins type III dislocation. Eight patients underwent complete reduction using the halo fixation device. In one patient, the C1-C2 displacement was manually reduced during surgery. CT scanning revealed that the accuracy of screw placement was 94.4%. The bone fusion rate was 100% after 6 months. Based on the ASIA impairment scale, the preoperative examination of patients revealed grade C injuries in seven patients and grade D injuries in two patients. After surgery, all patients had grade D injuries. Six months after surgery, four patients had moderate self-reported neck disability (30%-48%) and five patients reported mild disability (10%-28%); that is, the patient perception of the neck problem improved. In the postoperative phase, all patients showed an improvement in VAS pain scores and the SAC score returned to the normal range in all patients. The CAA returned to normal in only seven patients; in the other two patients, the CAA returned to a value that was close to normal (145° and 149°). CONCLUSION: Through halo traction combined with transarticular screw fixation and bone autoplasty, noticeable postoperative improvements were attained based on the clinical scores for NDI, ASIA, and VAS, as well as SAC and CAA.

Triad of meningothelial meningioma, rhabdoid meningioma and ependymoma: successful management of an extremely rare case.

An 8-year-old girl was admitted with four limb weakness for 2 months. Hyperactive reflexes were observed in all four limbs, and positive Hoffmann's signs were revealed. An MRI spine with the coronal slide detected two tumors, first in the intradural and intramedullary space at the C2-C4 level and the second in the intradural and extramedullary space at the C5-C7 level. Axial T1W contrast MRI brain showed a tumor in the left parietal region. The patient underwent spine surgery first and following by brain surgery. No invasive lesions were remarked during surgery. Histological findings showed meningothelial meningioma and ependymoma from the spine and rhabdoid meningioma from the brain. Two months after the second surgery, the patient recovered fully with no symptoms and was able to participate in all regular activities in life. This work is the first report of a mixed tumor with distinct spinal meningioma and ependymoma components occurring in the cervical spinal cord at the C2-C7 level and coexisting with cranial meningioma. The remarkable result was that the patient fully recovered without any symptoms after receiving two surgeries.

Thinning and drilling laser-assisted hatching in thawed embryo transfer: A randomized controlled trial / 대한생식의학회지

OBJECTIVE: In frozen and thawed embryos, the zona pellucida (ZP) can be damaged due to hardening. Laser-assisted hatching (LAH) of embryos can increase the pregnancy rate. This study compared thinning and drilling of the ZP before frozen embryo transfer (FET). METHODS: Patients were randomly allocated into two groups for LAH using thinning or drilling on day 2 after thawing. Twenty-five percent of the ZP circumference and 50% of the ZP thickness was removed in the thinning group, and a hole 40 µm in diameter was made in the drilling group. RESULTS: A total of 171 in vitro fertilization/intracytoplasmic sperm injection FET cycles, including 85 cycles with drilling LAH and 86 cycles with thinning LAH, were carried out. The thinning group had a similar β-human chorionic gonadotropin-positive rate (38.4% vs. 29.4%), implantation rate (16.5% vs. 14.4%), clinical pregnancy rate (36.0% vs. 25.9%), miscarriage rate (5.8% vs. 2.4%), ongoing pregnancy rate (30.2% vs. 23.5%), and multiple pregnancy rate (7.0% vs. 10.6%) to the drilling LAH group. There were no significant differences in pregnancy outcomes between subgroups defined based on age (older or younger than 35 years) or ZP thickness (greater or less than 17 µm) according to the LAH method. CONCLUSION: The present study demonstrated that partial ZP thinning or drilling resulted in similar outcomes in implantation and pregnancy rates using thawed embryos, irrespective of women's age or ZP thickness.