Clinical and Radiological Review of a Semi-Constrained Cervical Disc Replacement with a Ceramic-Ceramic Articulation with a Minimum Seven Years Follow-Up.

PURPOSE OF THE STUDY Artificial cervical disc replacement (CDR) has emerged as a viable treatment alternative to fusion for the management of symptomatic compressive radiculopathy and potentially for cervical myelopathy. The aim of our study was to evaluate the clinical and radiological outcomes of patients treated with a second generation semi-constrained CDR with a ceramicceramic articulation. MATERIAL AND METHODS A prospective cohort study of all patients undergoing a cervical disc replacement for cervical disc pathology, during the period from April 2007 to April 2011 using a ceramic-ceramic disc replacement comprised the study group. 52 patients were available for final clinical and radiological follow-up. Both, clinical and radiological evaluation were performed at each clinical visit at 6 weeks, 6 months, 12 months, 2 years, 5 years and 7 years. RESULTS There were a total of 52 patients, with 44 single level cases and 8 two level cases. The NDI improved significantly (p < 0.05) from a mean preoperative score of 56 % to a score of 20% at final follow-up. The mean preoperative mobility at the index level unit was 12.2 ± 4.5°, this decreased to 7.9 ± 3.2° at six weeks, but slightly increased to 12.9 ± 2.9° at final follow-up (gain not significant). Heterotrophic ossification (HO) was noted in 13 (25%) patients. CONCLUSIONS Cervical disc replacement with a ceramic-ceramic bearing surface is a viable option in the treatment of variety of cervical pathologies. This ceramic-ceramic interface may eliminate the potential problems of metallosis and poly-wear but further longer-term results should be studied. Key words: Cervical spine; disc replacement; ceramic articulation; neck disability; heterotrophic ossification.

Obesity and recurrent intervertebral disc prolapse after lumbar microdiscectomy.

INTRODUCTION: The primary aim of this study was to investigate the relationship between obesity and recurrent intervertebral disc prolapse (IDP) following lumbar microdiscectomy. METHODS: A retrospective review of case notes from 2008 to 2012 was conducted for all patients who underwent single level lumbar microdiscectomy performed by a single surgeon. All patients were followed up at two weeks and six weeks following surgery, and given an open appointment for a further six months. RESULTS: A total of 283 patients were available for analysis: 190 (67%) were in the non-obese group and 93 (32.9%) in the obese group. There was no statistical difference in postoperative infection, dural tear or length of stay between the non-obese and obese groups. Recurrent symptomatic IDP was seen in 27 patients (9.5%) confirmed by magnetic resonance imaging. Nineteen (10.0%) were in the non-obese group and eight (8.6%) in the obese group (p>0.8). CONCLUSIONS: In our study, obesity was not a predictor of recurrent IDP following lumbar microdiscectomy. Our literature review confirmed that this study reports the largest series to date analysing the relationship between obesity and recurrent IDP following lumbar microdiscectomy in the British population.

Management of suspected neuroleptic malignant syndrome.

OBJECTIVE: Neuroleptic Malignant Syndrome (NMS) is a rare but potentially lethal form of drug-induced hyperthermia. The objective of this paper is to provide data regarding early and suspected cases as well as offer guidelines for managing this condition. Knowledge of suspected cases will lead to early recognition and prompt management of this condition in the future. METHOD: To address the gap in knowledge, we present 2 case reports of patients with early NMS-like symptoms. The case reports are followed by a brief review of the literature on differential diagnoses, risk factors, early signs and treatment data. CONCLUSIONS: The most rational approach to treating NMS entails a hierarchy of interventions determined by the severity and progression of symptoms.

The effect of testosterone on psychopathology and sexual function in a paranoid schizophrenic self-castrate.

It has been suggested that the administration of androgens to paranoid schizophrenics who castrate themselves because of religious delusions and sexual guilt might exacerbate the psychosis and increase the risk of further self-mutilation. We administered testosterone enanthate to such a case intermittently during his 12 week hospital stay and studied simultaneously, psychopathology (Brief Psychiatric Rating Scale and clinical assessment), hormone levels and sexual behaviours. Sexual behaviours increased in line with increased serum testosterone levels; psychopathology declined. Following his discharge, he was managed on a regime of phenothiazines and monthly testosterone injections. After one year, he was enjoying normal heterosexual activities (without guilt) although his extreme religiosity had not declined.