Comparison of long terms follow up results in patients with cervical disk disease treated with anterior PEEK cage implantation and without it in Rasoul Akram Hospital.

BACKGROUND: Anterior interbody fusion of the cervical spine have become the gold standard for treating spinal diseases, hence the aim of this study was to compare long term follow up results in patients with cervical disk disease treated with anterior PEEK cage implantation and without it in anterior approach. METHODS: Retrospectively 63 patients with known cervical discogenic disorders who went under surgery with and without cage implantation were enrolled. The neurological examination and neurologic function were assessed by using the Japanese Orthopedic Association (JOA) scoring system and neurological cervical spine scale (NCSS) before and 8 years after surgery in each patient and at the end all complications were recorded. RESULTS: In the first group, there were 15 males and 14 females (mean age: 49±10 years) and in the second group there were 27 male and 7 female (mean age: 47±9 years). The NCSS score was significantly different between two groups after surgery (p = 0.035) but there was no significant difference before surgery (p = 0.163). No statistical significance difference was also observed in JOA score and complications before and after procedure, but JOA post surgery score between two groups had significant difference (p = 0.047). CONCLUSION: In conclusion, present study showed that PEEK cage implantation is a highly useful alternative to the conventional treatment methods.

Multiple nails in the brain: an unusual suicidal attempt.

We describe dangerous multiple self-inflicted brain-penetrating injuries caused by a nail gun device after a suicidal attempt for the first time in Iran. At the first forensic visit, we could not explain the manner of injuries. The authors reviewed the literature on the topics, and clinical presentation, radiographic findings, and forensic medical records are discussed.

Is Tokuhashi score suitable for evaluation of life expectancy before surgery in Iranian patients with spinal metastases?

BACKGROUND: One of the most important selection criteria for spinal metastases surgery is life expectancy and the most important system for this prediction has been proposed by Tokuhashi. The aim of this study was to evaluate predictive value of the Tokuhashi score for life expectancy in Iranian patients with spinal metastases one year after diagnosis. METHODS: From February 2007 to March 2009, of 180 patients suffering spinal metastatic tumors, 71 patients were excluded. This left a study population of 109 patients with known malignant metastases to spine (56 females and 53 males; mean age, 57 ± 12 years). Tokuhashi revised evaluation system for the prognosis of metastatic spinal tumors was used for all patients. The survival period predicted by this system for the prognosis and the actual survival period after 1 year follow up were evaluated. RESULTS: The predicted survival according to Tokuhashi prognostic scoring system was less than 6 months in 38(34.9%) patients, 6-12 months in 39(35.8%) patients and 1 year or more in 32(29.4%) patients. 39 (35.8%) patients died at first six-month of the follow up, 28(25.7%) patients at the second six-month period and 42(38.5%) patients were alive at the end of the year. There was no significant difference between predicted and actual survival time (p = 0.116). CONCLUSIONS: Present study showed that the Tokuhashi revised scoring system may be practicable and highly predictive preoperative scoring system for patients with spinal metastases in Iran.