As both life expectancy and average population age continue to rise, so too does the incidence of cervical spine (c-spine) injuries. C-spine fractures are associated with high morbidity and mortality, but the question is how best to treat them? This review is to compare the safety and efficacy of c-spine immobilisation in a rigid collar with other treatment modalities in elderly population. Available literature was reviewed to determine how treatment efficacy is assessed, with particular focus on whether osseous union or fibrous non-bony union should be considered as a successful outcome. This study was designed in accordance with PRISMA guidelines. Pubmed/Medline databases were selected for analysis. When considering patients over the age of 65, it is unclear whether management with a collar is safer than operative management or immobilisation with HALO vest. However, amongst studies that further subdivide elderly patients according to age there is more of a consensus; it appears that in those under the age of 75, operative management is safer, whereas in those over the age of 85, immobilisation in a collar is associated with lower mortality rates. Between the ages of 75-85 there is less clarity. Osseous union occurs more commonly in patients managed operatively, but fibrous non-bony union was not associated with any adverse outcomes in these studies. Conclusion: At present, there are no randomised controlled trials that have tried to delineate whether management in a collar is safer or more effective than other treatments such as HALO vest or operative fixation. However, evidence from various cohort studies does suggest that "elderly" patients with c-spine fractures should not be considered as one homogenous cohort, but should instead be subdivided according to age. Interestingly, these studies suggest that fibrous non-bony union may be an adequate treatment outcome in older. Further research into this complex field is required.
41 patients with clinical features of discogenic sciatica during the last 25 years, proved later on by investigations and imaging to be a nondiscogenic in origin, The aim of the study is to inform spinal surgeons of possible differential diseases that mimic discogenic sciatica. All patients present clinically with a sciatica. They were recorded and treated accordingly and sent for investigations. Patients proved to have discogenic sciatica were excluded. Others further investigated and followed until finding a cause for the symptoms and recorded as nondiscogenic sciatica syndrome. 22 individual aetiologies were found to cause nondiscogenic including infectious, traumatic, oncogenic, degenerative, metabolic and ischemic causes. In conclusion a proper history and thorough physical examination, in addition to imaging and investigations were very useful in detecting the exact etiology of sciatica. The pain pattern and the related clinical features were the guide for the diagnosis. High index of suspicion is vital to achieve the definite diagnosis to avoid missing the diagnosis of nondiscogenic sciatica. One should maintain a high index of suspicion in patients with intractable sciatica.
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