The authors describe their experience with the Morscher titanium cervical plate with cancellous locking screws in the management of complex cervical spine disorders. Fifty patients (32 males and 18 females) with a mean age of 54 years (range 10 to 84 years) underwent anterior spinal fixation that extended two to five vertebral bodies, using a titanium cervical plate and autogenous bone graft. Surgeries were performed for a variety of reasons: one for a congenital lesion, five for spinal neoplasms, nine for trauma, and 35 for degenerative arthritides. Ten patients had symptomatic kyphoses due to previous laminectomy, failed anterior surgery, or trauma. Satisfactory fixation and fusion with no neurological deterioration was obtained in all but two cases. Specific complications included six cases of dysphagia, one of sepsis, one of Horner's syndrome, and one case in which the patient had a fatal myocardial infarction the night after surgery. At the end of the follow-up period, fusion was found to have occurred in all remaining cases with no outstanding implant-related problems.
✓ Synovial cysts occur infrequently in the spinal canal and are most often associated with degenerative facet joints. Despite the prevalence of degenerative spinal disease, symptomatic synovial cysts are extremely uncommon. There have been only two previously reported cases of subaxial degenerative synovial cysts of the cervical spine in patients who presented with a clinical picture of spinal cord compression. The authors report three additional patients treated for degenerative cervical synovial cysts who presented with myelopathy. In all three patients the cyst was successfully excised and a good clinical outcome achieved.
Total excision of tumour should remain the goal of treatment in patients with PCFM. Despite the recent advances in preoperative planning and surgical techniques, the morbidity associated with surgery remains significant. Notwithstanding, the majority of patients achieve a good outcome with surgical treatment.
Thirty-four patients with metastatic tumors of the spinal column exhibiting vertebral collapse and posterior element disease were treated by a single-stage operation combining decompression of the vertebral body with posterior spinal instrumentation. Attention is drawn to the use of computed tomographic scanning in planning the operative approach. The indications for surgery were neurological deficit in 32 patients and pain in 2; 14 patients received preoperative radiotherapy. Of the 21 patients who were nonambulant preoperatively, 67% walked again, 21% regained sphincter control, and 68% had less pain. The surgical mortality was 12%; wound infection and dehiscence occurred in 15%. These results indicate that a single-stage decompression and posterior stabilization may improve neurological function dramatically in patients with malignant cord compression. The operative morbidity and mortality is comparable to that of laminectomy.
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