Management of Type II Odontoid Fracture for Osteoporotic Bone Structure: Preliminary Report.

AIM: Anterior transodontoid screw fixation technique is generally chosen for the management of type II odontoid fractures. The nonunion of type II odontoid fractures is still a major problem especially in elderly and osteoporotic patients. Eleven osteoporotic type II odontoid fracured patients were presented in this article. MATERIAL AND METHODS: We have divided 11 patients in two groups as classical and Ozer's technique. We have also compared (radiologically and clinically) the classical anterior transodontoid screw fixation (group II: 6 cases) and Ozer's transodontoid screw fixation technique (group I: 5 cases) retrospectively. RESULTS: There was no difference regaring the clinical features of the groups. However, the radiological results showed 100% fusion for Ozer's screw fixation technique and 83% fusion for the classical screw fixation technique. CONCLUSION: In conclusion, we suggest that Ozer's technique may help to increase the fusion capacity for osteoporotic type II odontoid fractures.

The major complications of transpedicular vertebroplasty.

OBJECT: Vertebroplasty is a well-known technique used to treat pain associated with vertebral compression fractures. Despite a success rate of up to 90% in different series, the procedure is often associated with major complications such as cord and root compression, epidural and subdural hematomas (SDHs), and pulmonary emboli, as well as other minor complications. In this study, the authors discuss the major complications of transpedicular vertebroplasty and their clinical implications during the postoperative course. METHODS: Vertebroplasty was performed in 12 vertebrae of 7 patients. Five patients had osteoporotic compression fractures, 1 had tumoral compression fractures, and 1 had a traumatic fracture. Two patients had foraminal leakage, 1 had epidural leakage, 1 had subdural cement leakage, 2 had a spinal SDH, and the last had a split fracture after the procedure. RESULTS: Three patients had paraparesis (2 had SDHs and 1 had epidural cement leakage), 3 had root symptoms, and 1 had lower back pain. Two of the 3 patients with paraparesis recovered after evacuation of the SDH and subdural cement; however, 1 patient with paraparesis did not recover after epidural cement leakage, despite cement evacuation. Two patients with foraminal leakage and 1 with subdural cement leakage had root symptoms and recovered after evacuation and conservative treatment. The patient with the split fracture had no neurological symptoms and recovered with conservative treatment. CONCLUSIONS: Transpedicular vertebroplasty may have major complications, such as a spinal SDH and/or cement leakage into the epidural and subdural spaces, even when performed by experienced spinal surgeons. Early diagnosis with CT and intervention may prevent worsening of these complications.

A new transodontoid fixation technique for delayed type II odontoid fracture: technical note.

BACKGROUND: A different transodontoid screw fixation technique was studied in delayed type II odontoid fractures. This study presents observations on a different transodontoid fixation technique to remove and decrease the amount of sclerotic layers to accelerate the fusion process after the operation. METHODS: Ten cases of chronic type II odontoid fractures were operated on via transodontoid screw fixation between 2000 and 2007 which were admitted 6 weeks or later after the trauma. Four of these 10 delayed patients were operated on using a new anterior transodontoid screw fixation technique, whereas the other 6 delayed patients were operated on using classical anterior transodontoid screw fixation. RESULTS: Four delayed cases with type II odontoid fracture operated on via this new technique had good results throughout the minimum 38 months' follow-up period. We did not observe nonunion, infection, and/or other complications such as vascular or brain-stem injury. CONCLUSION: Transodontoid screw fixation should be considered as a preferable treatment modality. This surgical intervention may be an alternative to conservative treatment even for cases with delayed type II odontoid fractures.

Excision of an asymptomatic cervical intradural neurenteric cyst through the anterior approach: a study of two cases and a review of the literature.

BACKGROUND: Spinal neurenteric cysts are very rare lesions, especially after the second decade of life. They account for 0.3% to 0.5% of all spinal tumors and occur most commonly in ventral locations. The cysts are usually removed via a posterior approach. PURPOSE: To present the clinical and radiologic results of patients with spinal neurenteric cysts who were treated via anterior approach procedures. STUDY DESIGN: This report is composed of two cervical neurenteric cyst cases that are compared with published studies. METHODS: We present two patients, 41- and 39-year-old women, each with a cervical intradural neurenteric cyst. Both of these patients had apparent neck pain without neurological deficit. MRI revealed neurenteric cysts located at C7 and C7-T1 levels. After anterior corpectomy, the intradural cysts were removed, and then fusion was performed. RESULTS: The postoperative period went well. The follow-up cervical MRI studies were performed at 3, 6, and 18 months postoperatively, and there were no abnormalities found. CONCLUSIONS: This study has led to the conclusion that although neurenteric cysts are rare in adults, they can still be present with only persistent neck pain and without neurological deficits. This may lead to misdiagnosis. The importance of MRI is not controversial in the early diagnosis. An anterior approach may be considered the first preference for surgical technique in patients with ventrally located neurenteric cysts.

Recurrent radiculopathy caused by epidural gas after spinal surgery: report of four cases and literature review.

STUDY DESIGN: The article presents and discusses 4 cases in which symptomatic epidural gas developed after different surgeries on the lumbar spine. OBJECTIVE: To raise spinal surgeons' awareness of this potential problem. SUMMARY OF BACKGROUND DATA: Vacuum phenomenon (gas accumulation in an intervertebral disc) is relatively common. Gas can also spontaneously enter and collect in the epidural space, but symptomatic epidural gas after spinal surgery is very rare. To date, only 5 such cases after lumbar surgery have been reported. METHODS: The primary disorders in the 4 new cases were disc extrusion at L2-L3 (Case 1), disc degeneration and herniation at L4-L5 (Case 2), stenosis of the lumbar spinal canal (Case 3), and disc herniation at L5-S1 with spinal canal stenosis (Case 4). The corresponding surgeries performed were L2-L3 microdiscectomy, L4-L5 microdiscectomy with instrumentation, right unilateral hemilaminotomy with complete instrumentation, and L5-S1 microdiscectomy. All 4 patients developed unexpected postoperative complaints of low back and radicular pain. Each was investigated with computed tomography and magnetic resonance imaging. The images revealed epidural gas collections compressing the thecal sac and/or nerve roots. RESULTS: Conservative management was effective in all but 1 case. In the latter case, computed tomography-guided needle aspiration was performed, but this did not resolve the problem. Surgery led to a favorable outcome, and follow-up lumbar computed tomography showed no epidural gas. CONCLUSION: Epidural gas after lumbar surgery is very rare but can cause unexpected postoperative back or radicular pain. Combined computed tomography and magnetic resonance imaging should be used to identify the problem and rule out other disorders. Conservative treatment should be the first-line approach but surgery is often necessary if this does not resolve the problem.