Comparison of Quality-of-Life after the Three Different Techniques of Transpedicular Screw Fixation (TPSF) in Lumbar Spondylolisthesis (LS): Results of a Therapeutic Cohort Study.

Background: Transpedicular screw fixation in lumbar spondylolisthesis remains debatable for which aspects that provide better quality of life outcomes such as procedure of convention, navigation-assisted or mini-open technique. Objective: To analyze the clinical outcomes and assess pre-operative versus postoperative quality-of-life outcomes of patients diagnosed with LS who underwent three different techniques of spinal fusion. Material and Method: A prospective cohort study was conducted with 60 patients with LS who received conventional TPSF or navigation-assisted TPSF or mini-open TPSF at Prasat Neurological Institute between 2010 and 2012. The 12-month follow-up patients were recruited for a structured interview regarding social life, mental health, functional capacity or an independent living status. The quality-of-life measurement was determined using Oswestry Disability Index (ODI) and the Short Form-36 Health Survey (SF-36). Results: Comparisons of quality of life outcomes declared significant differences through the 12-month follow-up evaluation. According to ODI, navigation-assisted group presented with significant level of faster recovery than conventional and miniopen groups at one week (p = 0.031) and one month (p = 0.008) after surgery. At one year follow-up, the navigation-assisted technique was noted to have a significant better improvement (p = 0.033 and mean ODI scores = 5.8) compared with conventional and mini-open techniques (mean ODI scores = 8.7 and 10.6, respectively). Moreover, SF36 assessment indicated considerably improvement at 12 months after surgery. In addition, the finding reveals no statistically significant differences among three techniques. Conclusion: Overall, three different techniques provide the positive outcomes of quality of life. The 12-month follow-up of quality of life measures based on ODI suggest that the navigation-assisted technique was significantly associated with wellrecovered at one week and one month after surgery. However, in terms of clinical outcomes, they do not make any considerable differences to patient care within the 12-month follow-up period.

Laminectomy and postero-lateral mass plating for multilevel cervical spondylotic myelopathy.

There are many procedures in treating patients with multilevel cervical spondylotic myelopathy (CSM). Successful treatment of multilevel CSM requires adequate decompression and stability of the cervical spine that prevents further neurological deterioration. Multilevel laminectomy and instrumentation with lateral mass plates is associated with minimal morbidity, provides excellent decompression of the spinal cord, produces immediate stability of the cervical spine, prevents kyphotic deformity, and precludes further development of spondylosis at fused levels. Neurological outcome is equal or superior to multilevel anterior procedures because of minimal complication and prevent spinal deformity associated with laminoplasty or noninstrumented laminectomy. From the study of 7 patients with multilevel CSM who were treated with multilevel laminectomy and posterolateral mass plating. The neurological outcome of all 7 patients was improved without complications after follow-up for 6 months.

Atlanto-occipital dislocation: a case report and review of the literature.

Although traumatic atlanto-occipital dislocation is perceived to be an uncommon injury frequently resulting in death, improvements in emergency management of the patient in the field, rapid transport, and better recognition have resulted in more survivors of atlanto-occipital dislocation in the past 2 decades. Infrequent observation of patients with atlanto-occipital dislocation and missed diagnosis may impair outcomes of patients with this unusual injury. The case of atlanto-occipital dislocation that is presented here is particularly interesting because the patient was missed diagnosis for eight months after the accident. He came to Prasat Neurological Institute by wheel chair with tetraparesis and could not help himself. After investigation by cervical spine radiograph and MRI of the cervical spine confirming the diagnosis, he was operated on the following day. The plates were fixed in the occipital bone and lateral mass of the cervical spine on both sides, craniectomy of the occipital bone at the foramen magnum and laminectomy C1 for decompression, then auto bone graft was fused at the occiput and C2. After the operation the patient was sent for 3 months physical therapy, he improved well and gained power of the extremities and could walk with a walker.