Posterior longitudinal ligament suturation after lumbar discectomy provides postoperative a large intradural area: First report.

Background: Stability and flexibility of the spine are provided by the posterior longitudinal ligament (PLL). It plays a key role in the pathogenesis of lumbar disc herniation (LDH) by preventing disc protrusion. The effect of the suturing of the PLL on the intradural area was investigated. Patients and Methods: The patients were included in whom lumbar microdiscectomy was performed between January 2021 and July 1, 2022. The patients were randomly divided into two groups as PLLs were sutured and unsutured. Results: Forty-six (23 males and 23 females) patients were included. The PLLs were sutured in 22 patients (Group 1) and not sutured in 24 patients (Group 2). The levels, sides of LDHs, and ages and gender of patients were also analyzed in both groups, which were not statistically significant. Preoperative mean spinal intradural areas were 77.29 mm2 for the PLL unsutured group and 85.40 mm2 for the PLL sutured group (Groups 1 and 2). For patients in Groups 1 and 2, the postoperative mean spinal intradural areas grew to 134.73 mm2 and 96.12 mm2, respectively. The difference in preoperative mean spinal intradural regions between the two groups was not statistically significant; however, Group 1 showed a substantial difference (sutured PLL patients). Conclusions: This study first time indicates that suturing PLL has a protective and supportive role in patients who were operated on for LDH.

Introducing a new possible predisposing risk factor for odontoid type 2 fractures after cervical trauma; Ponticulus posticus anomaly of C1 vertebra.

OBJECTIVE: Ponticulus posticus is an anomaly of the atlas. Odontoid fracture type 2 fracture occurs by hyperflexion, hyperextension, lateral flexion, and a combination of these movements. The presence of Ponticulus Posticus anomaly may affect the occurrence of odontoid fractures of the C2 vertebra. In this study, the relationship between the presence of PP anomaly and occurring of the odontoid type 2 fracture was investigated. PATIENTS AND METHODS: Cervical CTs of a total of 14 patients with odontoid type 2 fracture were retrospectively evaluated for PP, and compared with 13 patients with cervical trauma without odontoid type 2 fracture. RESULTS: Ponticulus posticus anomaly was noted in 7 of 14 patients with odontoid type 2 fractures on the upper cervical CT; therefore, the prevalence was 50.%, but only 3 cases (23.07%) were seen in 13 patients of the control group. In binominal regression analysis showed that the presence of PP anomaly increases 12,075 times to occur odontoid type 2 fracture after cervical trauma. CONCLUSION: Ponticulus posticus is often not recognized, but this study shows that ponticulus posticus is a risk factor for odontoid type 2 fracture after cervical trauma.