RESUMO
BACKGROUND: Cervical alignment is associated with myelopathy and quality of life. Anterior cervical discectomy and fusion (ACDF) aims to decompress neural structures and optimise cervical alignment. This study examines the quantitative impact of the hyperlordotic 15° ACDF cage on cervical alignment, and compares it to that of the standard lordosis cage. METHODS: A retrospective analysis of radiographical parameters of cervical alignment was conducted in 80 consecutive ACDF patients from two institutions between 2013 and 2017. Forty received 15° cages, 40 received standard cages. Pre- and post-operative Cobb angles and sagittal vertical axes (SVA) were generated from radiographical imaging utilising the SurgimapTM program. Changes in lordosis and SVA were compared within and between groups, and the significance of the change evaluated using the Student t-test. RESULTS: In both groups, post-operative device level, segmental, and global Cobb angles were superior to preoperative values (P<0.05), especially among patients with preoperative kyphosis (P<0.05). Trends suggested greater changes in lordosis in the 15° group, but they did not reach statistical significance (P=0.06-0.23). However, subgroup analyses indicated greater device level Cobb angle change in patients less than 65 yo (P=0.049), and those with preoperative lordosis (P=0.003). Neither standard nor hyperlordotic cages significantly improved SVA in this study. CONCLUSIONS: Hyperlordotic and standard cages both improve cervical lordosis segmentally and globally. Hyperlordotic cages were not shown to be statistically superior to standard cages in this study. Prospective studies featuring consistent imaging modalities are necessary to further delineate their utility.
RESUMO
Papillary tumour of the pineal region (PTRR) is one of the new tumour entities to be included in the latest World Health Organization classification of central nervous system tumours. We report two illustrative patients, a 25-year-old female who presented following a head injury sustained from a fall due to gait disturbances, and a 42-year-old man who presented with headaches. Histology of both cases showed distinct papillary growth patterns with lining of the papillae by multi-layered cuboidal to columnar cells, prominent perivascular rosette and focal true rosette formation. Immunohistochemistry exhibited strong cytokeratin immunoreactivity in addition to CD56, focal S100, glial fibrillary acidic protein and neuron specific enolase positivity which supported a diagnosis of PTPR in both patients. Postoperatively, both patients underwent courses of adjuvant radiation therapy. One patient reported local recurrence of the tumour 23 months after surgery. While PTPR may have been misdiagnosed in the past, clear and consistent characteristics are beginning to be elucidated in the published reports and literature, which have been reviewed. As a relatively new distinct clinicopathological entity, prognostic data are limited and guidelines for treatment protocols are still being investigated in view of its propensity for local recurrence.
