Transoral cervical corpectomy with the aid of the microscope.

The transoral transpharyngeal approach to the upper cervical spine is useful in symptomatic cases of chronic atlantoaxial dislocation not reducible by other means. Spontaneous healing and fusion in such patients results in an anterior deformity or gibbus which indents the ventral surface of the spinal cord. This lesion is best approached anteriorly, with the neck in a neutral or extended position. Previously reported complications of the transoral operation, especially vertebral artery laceration, can be avoided through used of the microscope. The technique is described and 2 cases are presented. Spinal stability was not disrupted in either, and cord decompression was accomplished.

Abdominal lavage in blunt trauma.

A technique for abdominal lavage is described and was used to evaluate the abdomen of 671 multiple trauma victims. In 44 per cent (299 cases) there was a bloodstained return and these were regarded as positive. Patients with a positive result underwent exploratory laparotomy which revealed that 89 per cent had significant intra-abdominal trauma requiring a surgical procedure, 8 per cent had trauma which did not require any active surgical correction and 3 per cent had no abdnormal findings. Of all the lavages performed, there were 0-11 per cent false positive and 0-03 per cent false negative results. The value of the test in the context of multiple trauma is emphasized.