Modified open-door laminoplasty for treatment of neurological deficits in younger patients with congenital spinal stenosis: analysis of clinical and radiographic data.

OBJECT: Multilevel anterior cervical decompressive surgery and fusion effectively treats cervical myeloradiculopathy that is caused by severe cervical spinal stenosis, but degenerative changes at adjacent vertebral levels frequently result in long-term morbidity. The authors performed a modified open-door laminoplasty procedure in which allograft bone and titanium miniplates were used to treat cervical myeloradiculopathy in younger patients with congenital canal stenosis while maintaining functional cervical motion segments. Pre- and postoperative magnetic resonance imaging and/or computerized tomography myelography were performed to assess changes in cervical spinal canal dimensions. Pre- and postoperative flexion-extension radiographs were compared to determine the residual motion of the targeted operative segments. METHODS: Twenty younger patients (average age 37.7 years) underwent modified open-door laminoplasty for treatment of myelopathy or myeloradiculopathy related to significant cervical spinal stenosis with or without associated central or lateral disc herniation or foraminal stenosis. These surgeries were performed during a 2-year period and follow-up review remains ongoing (average follow-up period 21.6 months). Reconstructive procedures were performed on an average of 4.1 levels (range three-six). Operative time averaged 186 minutes (range 93-229 minutes). Average blood loss was 305 ml (range 100-650 ml). No cases were complicated by neurological deterioration, infection, wound breakdown, graft displacement, or hardware failure. The patients' Nurick Scale grade improved from a preoperative average of 1.8 to a postoperative average of 0.5. Pre- and postoperative sagittal spinal diameter averaged 11.2 mm (8-14 mm) and 16.6 mm (13-19 mm), respectively. The sagittal compression ratio (sagittal/lateral x 100%) increased from 48% pre- to 72% postoperatively. The spinal canal area increased an average of 55% (range 19-127%). In patients in whom pre- and postoperative flexion-extension radiographs were obtained, 72.7% residual neck motion was maintained. No patient developed increased neck or shoulder pain. Neurological symptoms improved in all patients, with total relief of myelopathy in 50% and partial improvement in 50%. CONCLUSIONS: Modified open-door laminoplasty with allograft bone and titanium miniplates effectively treats neurological deficits in younger patients with congenital and spinal stenosis. Although long-term results are unknown, short-term results are good and there is a low incidence of complications.

Two-portal endoscopic carpal tunnel release surgery: report of early experience.

Endoscopic carpal tunnel release is increasingly performed to treat median nerve entrapment neuropathy at the transverse carpal ligament. Proponents of these procedures claim that there are early postoperative advantages to be gained by the patient in the form of decreased pain and weakness, thus facilitating an earlier return to function. However, serious complications associated with the use of these techniques have been reported, especially during the surgeon's purported initial steep learning curve. A prospective analysis of the authors' first 51 cases using a two-portal endoscopic technique was conducted to determine whether these learning curve complications occurred. The authors did experience a learning curve; however, it was not significant. They encountered no serious complications and patient satisfaction was very high. It is concluded that the procedure is relatively easy to learn and safe to perform.

Cervical kyphotic myelopathy in a child with Morquio syndrome.

A child with Morquio syndrome developed severe cervical kyphosis causing myelopathy. Decompression of the spinal cord was accomplished by an anterior approach using multilevel corpectomies and stabilization with calvarial bone grafts and halo immobilization. The case reported is unique in that cervical cord compression resulted from an uncommon degree of cervical kyphosis rather than the usual atlantoaxial instability seen in patients with Morquio syndrome. The operative procedure described shows another example of the usefulness of calvarial bone grafts for cervical spine fusions in children.

Allelic deletions on chromosome-17 and mutations in the p53 gene in tumors metastatic to brain.

Metastasis associated with tumor progression denotes more aggressive tumor behavior, more malignant histology, and worsening patient prognosis. Brain is one of the common sites to which solid tumors metastasize. Since mutations in the tumor suppressor gene p53 are associated with tumor progression to malignancy in various cancers, we examined the molecular genetic profile of the p53 gene and also analyzed allelic losses of various genes on the short arm of chromosome 17 (17p) in 10 metastatic brain tumors (4 breast, 3 renal, 1 lung, 1 esophageal, and 1 squamous cell carcinoma) and in two of the primary tumors (I breast, 1 renal) corresponding to two of the 10 metastases. Six of the 10 metastatic tumors (4/4 breast, 1/1 esophageal and 1/1 squamous cell carcinoma) contained allelic loss and/or mutations of the p53 gene. The p53 gene profile was identical in both of the primary tumors and their corresponding metastases that were examined. If borne out by a larger series of analysis on tumors, especially from breast, as well as from other organs, detection of chromosome 17/p53 alterations may be of substantial clinical significance in predicting the metastatic potential of primary tumors.