Diaphragm paralysis from cervical disc lesions.

An opera singer, who "made her living with her diaphragm", developed a post-traumatic unilateral radiculopathy due to cervical disc lesions, C3 to C6. During one year of severe neck and left arm pain she gradually lost the ability to sing difficult operatic passages which brought an end to her music career. Following a three level anterior cervical decompression and fusion, the neck and arm pain was immediately relieved. One week later her voice and singing ability returned to its full strength and power permitting her to resume her activities as a vocalist. The diagnosis of paresis of the left hemi-diaphragm as part of the cervical disc syndrome was implied by postoperative retrospective inference.

Posterior lumbar interbody fusion updated.

Based on over 45 years' experience in the surgical treatment of lumbar disc disease, it is recommended that the following operations be eliminated: the simple discectomy, which may cure the sciatica but not the back pain; the "decompressive laminectomy," which leaves the patient with painful instability and nerve-root scarring; and chemonucleolysis, which does not provide permanent relief of either low-back or leg pain. The PLIF technique is the answer to treatment of diseases of the lumbar spine and may be the operation of the future.

Progressive idiopathic anterior dislocation of the upper cervical spine with severe myelopathy.

Three unusual and rare cases are reported with progressive anterior dislocation of the cervical spine of unknown etiology causing severe myelopathy. Spinal pathology was confined to a single level and at different locations in each case. Narrowing of the spinal canal resulted in three different neurological syndromes, each requiring a different operative approach: one anterior, one posterior, and one both. Two patients made complete functional recovery. One patient died 3 days after operation of aspiration pneumonia.

Spondylolisthesis: treatment by laminectomy and posterior interbody fusion.

Spondylolisthesis is a hereditary anomaly of the spine, often associated with intractable pain in the back and lower extremities. The diagnosis is commonplace. Approximately 5% to 7% of the population in the United States has the anomaly. This percentage varies with country and race. In patients who seek medical aid for symptoms of low back pain, 10% will have a pars defect. Laminectomy of the entire separate neural arch and a posterior interbody fusion is a superior operation for spondylolisthesis. It is a difficult operation, requiring a high degree of technical skill, but when properly performed, it is possible to attain a more rapid recovery with a lower morbidity and higher percentage of permanent cures.

Gas-sterilized cadaver bone grafts for spinal fusion operations. A simplified bone bank.

Cadaver bone for spinal fusion operations is as safe as autografts. The author's 35 years' experience using cadaver bone for interbody spinal fusion operations has led to the development of a simplified bone bank method. Unsterile bone removed from young, fresh cadavers is cut into appropriate sizes and shapes, washed clean, packaged and sterilized with ethylene oxide gas, then aerated and stored at room temperature. The results of spinal fusion, both cervical and lumbar, using 187 gas-sterilized bone grafts in 58 patients operated on over the past year and half, were reviewed and compared with fusions using autografts or banked bone from proven methods. The rate and percentage of fusion of gas-sterilized bone was comparable to other bone grafts with no untoward complications.

Removal of giant clival chordoma by an anterior cervical approach.

Chordoma, a primary malignant neoplasm of the cerebro-spinal axis, is difficult to diagnose and impossible to cure. The only effective treatment is early radical surgical removal, regardless of its size or location. A giant, 65gm tumor arising from the clivus, C1 and C2 vertebrae was successfully removed with low morbidity. The surgical technique is described and compared to other operations with their advantages and disadvantages. A plea is made for surgical removal as the initial treatment for these lesions to prevent fatal intracranial metastasis.

Metastatic disc infection and osteomyelitis of the cervical spine. Surgical treatment.

Two cases of vertebral osteomyelitis and discitis in the cervical spine are presented, both having arisen from hematogenous spread to the spine. Bacteriologic diagnosis was established in 1 patient, but the infection had subsided in the other. Both patients were treated with anterior debridement and fusion, and a supplemental posterior wiring and fusion was performed in the second case to reduce kyphotic angulation. In the second case, both the anterior and posterior surgery were performed while the patient was under the same anesthetic. Satisfactory results were achieved in both cases.