History of cervical spine surgery: from nihilism to advanced reconstructive surgery.

STUDY DESIGN: Review of literature. OBJECTIVES: To review and analyze the evolution of cervical spine surgery from ancient times to current practice. The aim is to present an accessible overview, primarily intended for a broad readership. METHODS: Descriptive literature review and analysis of the development of cervical spine surgery from the prehistoric era until today. RESULTS: The first evidence for surgical treatment of spinal disorders dates back to approximately 1500 BC. Conservative approaches to treatment have been the hallmark for thousands of years, but over the past 50 years progress has been rapid. We illustrate how nations have added elements to this complex subject and how knowledge has surpassed borders and language barriers. Transferral of knowledge occurred from Babylon (Bagdad) to Old Egypt, to the Greek and Roman empires and finally via the Middle East (Bagdad and Damascus) back to Europe. Recent advances in the field of anesthesia, imaging and spinal instrumentation have changed long-standing nihilism in the treatment of cervical spine pathologies to the current practice of advanced reconstructive surgery of the cervical spine. A critical approach to the evaluation of benefits and complications of these advanced surgical techniques for treatment of cervical spine disorders is required. CONCLUSION: Advances in surgery now permit full mechanical reconstruction of the cervical spine. However, despite substantial experimental progress, spinal cord repair and restoration of lost functions remain a challenge. Modern surgeons are still looking for the best way to manage spine disorders.

Evaluation of PCR-RFLP (based on ITS-1 and HaeIII) for the detection of Leishmania species, using Greek canine isolates and Jordanian clinical material.

It is possible to detect and distinguish Leishmania parasites using PCR-RLFP - a combination of PCR and analysis of the fragment-length polymorphism seen when the amplicons are digested with one or more restriction enzymes. In the present study, clinical samples from 24 Jordanians suspected to have cutaneous leishmaniasis and cultures set up using leishmanial parasites from five Greek dogs were investigated using PCR, in which the internal-transcribed-spacer-1 (ITS1) region of the parasites' ribosomal-RNA gene was amplified, followed by HaeIII digestion of the resulting amplicons. The cultures, which were all maintained in Leibowitz L-15 medium with 20% foetal calf serum, were each investigated as serial dilutions. Using the PCR-RLFP analysis, each culture was identified as L. donovani and each was found positive for this parasite with a mean sensitivity of 66%-100% (depending on the culture dilution tested), a specificity of 100%, a mean positive predictive value of 100%, and a negative predictive value of 74.6%-100%. When simulated clinical samples, created by mixing human blood with known numbers of L. donovani promastigotes, were investigated, the PCR-RFLP gave optimal results (with a value of 100% each for sensitivity, specificity and positive and negative predictive values). When the real clinical samples (25 lesion aspirates and 20 samples of peripheral blood from 24 Jordanian patients) were investigated using the molecular method, 20 (84%) of the patients were found to have lesion aspirates that were PCR-RFLP-positive for L. major (although, by microscopy, only six were found to have amastigote-positive lesion aspirates). None of the blood samples from the Jordanian patients, however, was found PCR-positive.

Radiation-induced meningioma.

We report a case of radiation-induced meningioma that appeared 12 years after the discovery and treatment of a posterior fossa medulloblastoma. The features of the case that support the diagnosis of radiation-induced meningioma are discussed.

[Spinal cord compression due to thoracic spinal chondroma. A study of 2 case and a review of the literature]. / Compression médullaire par chondrome rachidien thoracique. Etude de 2 cas et revue de la littérature.

We report two cases of thoracic spine chondroma in two girls aged 14 and 12 years. The lesion was revealed by signs of spinal cord compression and affected T1 and T7 respectively. Chondroma is a benign bone tumour, fairly frequent in the extremities but very rare in the spine. It accounts for 2.8% of benign bone tumours and 12% of all bone tumors. 3.6% to 4% of chondroma are located in the spine. Out of 51 cases reported in the literature 21 had been revealed by spinal cord compression, with an age range of 5 to 76 years. In all cases of spinal cord compression magnetic resonance imaging (MRI) is necessary as first-line examination, but CT scans are still useful in the diagnosis and post-operative follow-up of spinal chondroma because of the osteo-cartilaginous nature of these tumors. The purpose of this study was to report two new cases of spinal cord compression by thoracic spine chondroma and to review the literature.

Fronto-orbital sphenoidal fibrous dysplasia.

We report the clinical, radiological, and histological features of an 8-year-old boy with an unusual presentation of fronto-orbital sphenoidal fibrous dysplasia. The various forms of fibrous dysplasia are outlined and the differential diagnosis discussed. An approach to surgical management is proposed.