In situ posterolateral and fibular interbody fusion in high grade spondylolysthesis.

OBJECTIVE: High-grade spondylolysthesis and spondyloptosis management have various options. There were no large series reported to support any particular treatment modality. The aim of surgery is to get solid bony fusion to get relief of instability and its symptoms as well as relief of neurological symptoms. There are many treatment options which are associated with technical difficulties and high incidence of complications and failures. In situ transsacral fibular graft with posterolateral fusion along with posterior decompression is a good surgical option. It offers anterior and posterolateral fusion for instability pain and relief of neurological symptoms in most of the patients. It is technically simple, with no major surgery-related complications. MATERIALS AND METHODS: The cases of high-grade spondylolysthesis operated since 2008 with one year minimal follow up were included in this study. Six cases were operated during this period. All were females in their second and third decade of life. All of them had transsacral fibular grafting with posterolateral fusion and decompression. One of the cases had additional anterior procedure with sacral widening with bone graft. The clinical status and bony fusion has been assessed at the end of one year after surgery and also for assessing final outcome. RESULTS: All the patients had solid bony fusion with no progression of slip and are pain free and relived of neurological symptoms. conclusions: In situ transsacral fibular graft with posterolateral fusion and posterior decompression is technically simple surgical option with minimal risks and reliable outcome.

Outcome following anterior cervical discectomy in compensation patients.

This is a retrospective study aimed to analyse the clinical outcomes of patients following anterior cervical decompression and fusion for radiculopathy in worker's compensation, third party and non-compensable group. The outcome of 224 cases operated between 1991 to 1998 were analysed. Only patients with radiculopathy due to a cervical disc protrusion and spondylosis were included. There were 140 non-compensable patients, 58 worker's compensation and 26 third party. There was no statistical difference in radiological fusion between the three groups (P=0.46). The worker's compensation and third party claimant groups, had an 'excellent' outcome at 65% and 69% respectively, compared to the non-compensation group at 79% (P=0.042). Rates of poor outcome were high in the worker's compensation group (9%) compared with third party (4%) and the non-compensable group (5%). Financial incentives seem to significantly influence the outcome of cervical disc surgery in our patient population.

Intradiploic hematoma after skull fracture: case report and literature review.

BACKGROUND: Intradiploic hematoma of the skull was first reported in 1934. The pathogenesis of this lesion is unclear. It is a very rare benign reactive process occurring after minor head trauma, with only seven cases reported in the literature to date. CASE DESCRIPTION: A 3-year-old right hand dominant male presented with a non-tender parietal scalp swelling of a 1-year duration. History included a skull fracture located in the same region 24 months before presentation. Neurological examination was unremarkable. Pathological examination after curettage of the lesion revealed features consistent with organizing hematoma. CONCLUSIONS: The pathology of chronic diploic hematoma mimics aneurysmal bone cyst, giant cell tumor, giant cell reparative granuloma, fibrous dysplasia, eosinophilic granuloma, intradiploic epidermoid and dermoid cyst, cavernous hemangioma, circumscribed osteomyelitis, and tuberculous granuloma. Chronic diploic hematoma is a lesion that must be differentiated from various skull lesions both radiologically and histologically as it is amenable to treatment with a complete cure once excised.