• COMPARING OUTCOMES OF ANTERIOR CERVICAL DISCECTOMY AND FUSION IN WORKMAN’S COMPENSATION VERSUS NON-WORKMAN’S COMPENSATION POPULATIONS

    INTRODUCTION: The purpose of this study is to analyze the functional outcome of anterior cervical discectomy and fusion (ACDF) between patients who had a work related injury versus patients who did not have a work related injury. METHODS: Eighty consecutive patients undergoing ACDF were analyzed. The same surgeon performed all the surgeries using the Smith-Robinson technique. The indications ACDF were cervical myelopathy or radiculopathy due to herniated nucleus pulposus and /or cervical spondylosis that did not respond to conservative treatments. There were 30 work related injury patients (Group I), and 50 non-work related injury patients (Group II).
  • IS A TITANIUM SPACER A SUBSTITUTE FOR A BONE GRAFT IN DEGENERATIVE CERVICAL SPINE DISEASES? LONG TERM RESULTS IN 279 CONSECUTIVE CASES

    INTRODUCTION: Stabilization of the cervical motion segment after anterior surgical decompression is an accepted surgical procedure. Bony fusion is achieved by inserting an autologous bone graft into the cervical disc space. However, harvesting of bone is related with morbidity (infection, fracture, and pain at the donor site). In the literature a pseudarthrosis rate between 4% and 26% is reported. In order to avoid donor site morbidity and to lower the rate of pseudarthrosis, we inserted an interbody titanium spacer instead of a bone graft. PATIENTS AND METHOD: We performed surgery in 279 consecutive cases with cervical disc degeneration between 05/91 and 12/95. Mean age was 48 yrs (23yrs to 74yrs). Indication was root compression in 83% and radiculo-myelopathy in 13%. Exclusion criteria was previous trauma with instability.
  • MICROSURGICAL TRANSDURAL DISCECTOMY WITH LAMINOPLASTY FOR CERVICAL DISC HERNIATION

    INTRODUCTION: Surgical treatment for myelopathy caused by cervical disc herniation (CDH) has been performed usually by an anterior decompression and fusion. In the cases of CDH associated with multilevel stenosis of the cervical canal, however, increased motion at the adjacent disc of the previous fusion site does create additional problems later on. Microsurgical transdural discectomy with laminoplasty has a dramatic advantage in the treatment of CDH combined with narrowed spinal canal. This report is a preliminary description of the clinical efficacy of this approach in 26 patients with myelopathy caused by CDH.
  • VALUE OF MAGNETIC RESONANCE IMAGING IN FORECASTING MOTOR & FUNCTIONAL RECOVERY FOLLOWING CERVICAL SPINAL CORD INJURY

    INTRODUCTION: The appearance of the damaged spinal cord following injury correlates with the initial neurologic deficit as given by the ASIA grade and manual muscle test (M.M.T.) as well as with recovery of M.M.T. scores. Currently, there are no studies which assess the value of MRI in predicting motor recovery and functional recovery in acute tetraplegia. The purpose of this study was to determine whether the use of MRI to quantify cervical spinal cord damage improves the ability to predict motor and functional recovery following spinal cord injury (SCI).
  • THE MECHANISM OF CERVICAL FACET JOINT BLOCK: A CADAVERIC STUDY

    INTRODUCTION: Facet joint blocks are commonly done procedures in the diagnosis and treatment of axial neck pain. Aprill., et al. have reported relief of axial neck pain with facet injection in patients with evidence of whole motion segment degeneration and disc degeneration alone. They have stated that relief of pain after a facet joint block is a positive confirmation of a painful facet joint. Indeed, the anterior element, the disc, is a potential pain generator. What then is the mechanism by which a posterior element block (facet joint block) relieves anterior element pain or whole motion segment pain? Whatever the mechanism, it must involve the dorsal root ganglion.
  • HYDROSTATIC LOADS WITHIN A CERVICAL INTERBODY FUSION CAGE: AN IN VITRO MODEL

    PURPOSE: Cervical interbody fusion devices offer surgeons another technique to perform interbody spine fusions. Animal and early clinical studies have yiel We hypothesize that hydrostatic forces within the intervertebral fusion cages may provide a stimulus for bone graft revascularization and incorporation within the fusion cage. Hydrostatic lo METHODS: Five human cervical spines consisting of three motion segments were rigidly potted at the cephalad and caudal ends. A 10 mm diameter interbody fusion device (Tapered Cervical Interbody Fusion Device, Sofamor Danek, Memphis, TN) was then inserted, using standard technique, into th 44
  • COMPLICATIONS OF POSTERIOR CERVICAL FUSIONS UTILIZING LATERAL MASS PLATES AND SCREWS

    INTRODUCTION: Previous studies have reported a low complication rate with posterior cervical fusions utilizing lateral mass plates and screws. To verify and test this hypothesis, we review 87 cases of posterior cervical plating using lateral mass screws in 84 patients. Complications and complication rates are identified and compared to earlier reports. METHODS: The complications in 87 consecutive cases from 11/16/93 to 3/17/98 that had been treated by two surgeons with lateral mass screws and plates were identified retrospectively by chart review. Patients averaged 54 years of age with a range of 19 to 85, with an average 12 months of follow up. Fifty-six patients had multiple indications for surgery, and all but 18 required one or more procedures in addition to posterior cervical fusion.
  • RETRO-ODONTOID FIBROCARTLAGINOUS MASS ASSOCIATED WITH ATLANTO-AXIAL INSTABILITY: PATHOGENESIS AND SURGICAL TREATMENT

    INTRODUCTION: Non-tumoral condition at the craniocervical junction is more common than was formerly recognized but it is difficult to diagnose clinically. We treated seven patients who developed retro-odontoido pseudotumor associated with instability of the atlanto-axial joint. Our cases differed a little from what had already been reported by Sze and Crockard. It is intriguing to speculate that mechanical dysfunction and instability may have been the underlying cause of the formation of the fibrous tissue , with hypertrophy of connective tissue elements as the abnormal response to chronic stresses. The advantage of MR imaging of the craniocervical junction is evident and it graphically and dramatically demonstrates the retro-odontoid pseudotumor and it allows repeated pre- and postoperative investigations. The pseudotumor regarded as a new entity which was easily examined by MR imaging when symptoms showed high cervical myelopathy due to atlantoaxial instability.