Anterior cervical discectomy and fusion with titanium cages for simple or multilevel herniated discs and spur of the cervical spine: Report of 2 cases and experience in Bali.

This report presents two cases of cervicobrachialgia and radiculopathy due to multiple cervical herniated discs and spur formation that dealt with anterior cervical discectomy and fusion (ACDF) using different titanium interbody cages. The description of the clinical presentation, magnetic resonance imaging (MRI) appearances and management strategy are discussed. Both cases showed chronic neck pain and radiating pain from the shoulder to the arm. They had a history of blurry vision, cluster head ache, weakness, and numbness on the shoulder for 2 years. MRI revealed multiple herniated discs between C4-7 and accompanied by the spur formation leading to the narrowness of the spinal canal and its foramina bilaterally. ACDF were performed and complete decompression of the spinal canal and its foramina were carried out. Twin M-cages (Ammtec Inc.-Japan) were placed in the first case at C5-7 levels and single cage of Smith Robinson (SR) was placed in the second case at C5-6 levels. There were no more blurry vision, cluster headache, weakness, and numbness, immediately after surgery. To our knowledge, this is the first reported cases of ACDF, using twin M-cages and single SR cage in Indonesia, with improvement immediately after surgery. Cervical spondylosis can present with cervicobrachialgia and radiculopathy and surgical treatment produces good functional outcome.

Management of unusual dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease) in a developing country: Case report and review of the literature.

Dysplastic cerebellar gangliocytoma or Lhermitte-Duclos disease (LDD) especially in children are extremely rare. In this report we add one further case to this rare entity. A three year old boy with a history of cerebellar and brain stem compression signs was presented in unconscious condition. Computerized tomography (CT) scan revealed a well defined lesion mixed with area of calcification in the right cerebellum and severe obstructive hydrocephalus. Ventricular shunting was performed followed by gross total tumor removal three days after shunting. In the follow up period, the patient showed almost total resolution of all neurological deficits. MRI has been an imaging tool to preoperatively diagnose this disease; otherwise it would be uncertain preoperative diagnosis. However, in this report we would like to emphasize that not all uncertain diagnosis of LDD leads to palliative treatment. Well demarcated lesion may account for the safe surgical resection of this disease.

A comparative study of bilateral laminotomy and laminectomy with fusion for lumbar stenosis

Laminectomy with fusion and bilateral laminotomy as a fenestration method have been used to improve pain, neurogenic claudication and neurological impairment in lumbar stenosis. To date it is not known whether the two surgical procedures have the same effectiveness in this degenerative disease. This is a retrospective review of 105 consecutive patients with lumbar stenosis who underwent surgery at the Sanglah General Hospital, Bali between 2005 and 2008. The aim of this study was to compare the results of bilateral laminotomy and laminectomy with fusion for canal decompression in lumbar stenosis. The study consisted of 46 patients who underwent bilateral laminotomy and 59 patients treated by laminectomy with fusion. The follow up ranged from 3-36 months. The outcome was evaluated by the Visual Analog Scale (VAS), Neurogenic Claudication Outcome Score (NCOS), and the Oswestry Disability Index (ODI) scores. The means of postoperative VAS for both groups were 2.6 + 0.9, postoperative NCOS for both groups were 64.0 + 13.9 and postoperative ODI for both groups were 24.4 + 7.9. There was no clinical deterioration and side effect from the operative procedure. Our results show that bilateral laminotomy and laminectomy with fusion are equally effective over a short follow up. However, bilateral laminotomy is a less invasive procedure.

Lateral orbitotomy for traumatic optic neuropathy and traumatic opthalmoplegia: Is it beneficial?

This was a retrospective study of 12 eye injuries concomitant with closed head injury, that were treated by the authors in Sanglah General Hospital, Bali during 2008. The purpose of this study was to evaluate the efficacy of lateral orbitotomy for nerve compression in eye injuries. Optic nerve compression at the optic canal can cause traumatic optic neuropathy; and nerve compression of 3rd, 4th and 6th nerves at the superior orbital fissure can cause traumatic ophthalmoplegia. Optic nerve decompression with steroids or surgical interventions or both have therefore been advocated to improve visual prognosis in traumatic optic neuropathy. To date it is not known whether lateral orbitotomy is beneficial in these traumatic injuries. There were 12 patients in this study, consisting of 11 males and 1 female with diagnosis of traumatic optic neuropathy in 10 patients and traumatic ophthalmoplegia in 2. Lateral orbitotomy procedures were done and all patients were also given high doses of steroids preoperatively. The mean visual improvement ratio was 43.3 ± 22.3. Ten patients improved (83.3 %) and 2 patients did not. There were no clinical deterioration and side effects from the operative procedure. This study suggests that lateral orbitotomy may possibly be beneficial as treatment for traumatic optic neuropathy and ophthalmoplegia.