This study was conducted to determine the safety and efficacy of multilevel anterior cervical corpectomy and stabilization using fibular allograft in patients with cervical myelopathy. Thirty-six patients underwent this procedure for cervical myelopathy caused by spondylosis (20 patients), ossified posterior longitudinal ligament (four patients), trauma (one patient), or a combination of lesions (11 patients). The mean age (+/- standard deviation) of the patients was 58 +/- 10 years and 30 of the patients were men. The mean duration of symptoms before surgery was 30 +/- 6 months and 11 patients had undergone previous surgery. Prior to surgery, the mean Nurick grade of the myelopathy was 3.1 +/- 1.4. Seventeen patients also had cervicobrachial pain. Four vertebrae were removed in six patients, three in 19, and two in 11 patients. Instrumentation was used in 15 cases. The operative mortality rate was 3% (one patient) and two patients died 2 months postoperatively. Postoperative complications included early graft displacement requiring reoperation (three patients), transient dysphagia (two patients), cerebrospinal fluid leak treated by lumbar drainage (three patients), myocardial infarction (two patients), and late graft fracture (one patient). One patient developed transient worsening of myelopathy and three developed new, temporary radiculopathies. All patients achieved stable bone union and the mean Nurick grade at an average of 31 +/- 20 months (range 0-79 months) postoperatively was 2.4 +/- 1.6 (p < 0.05, t-test). Cervicobrachial pain improved in 10 (59%) of the 17 patients who had preoperative pain and myelopathy improved at least one grade in 17 patients (47%; p < 0.05). Twenty-six surviving patients (72%) were followed for more than 24 months and stable, osseous union occurred in 97%. These results show that extensive, multilevel anterior decompression and stabilization using fibular allograft can be achieved with a perioperative mortality and major morbidity rate of 22% and with significant improvement in pain and myelopathy.

SUMMARY A series of twenty-nine patients with cord cavitation were treated by syringoperitoneal shunt. Twenty-two of them showed improvement after operation, five were unchanged and two worsened. Operation was performed in patients with post-traumatic cystic myelopathy, idiopathic syringomyelia, intramedullary tumours associated with cysts, and patients who had developed cystic myelopathy in association with spinal arachnoiditis. Pain improved in twenty patients, sensory symptoms and signs in eleven and weakness in ten.Cord cavitation was first described in 1564' although the aetiology and natural history of the disease is variable. The surgical treatments that have been proposed are also widely varied and include direct syrinx decompression, aspiration of the fluid from the syrinx, and syringostomy. Gardner2 performed decompression of the hindbrain with closure of the obex and this procedure has been the surgical treatment of choice in many centres for the foramen magnum dysplasia associated with idiopathic syringomyelia. All of these procedures carry a recognisable morbidity and mortality.

La fouille au cœur des villages actuels est un complément indispensable aux interventions dans les champs sur les habitats ruraux si l’on veut comprendre la question complexe du village médiéval. Les surfaces sont plus restreintes et les contraintes plus importantes, mais aboutissent à des résultats quelquefois inattendus comme le montre l’exemple de Villiers-le-Bel, au nord de Paris. Deux secteurs de l’ancien village ont fait l’objet de plusieurs fouilles. Le premier, en partie aval, voit dès l’époque carolingienne un secteur dense évoluer sans grandes modifications jusqu’à la fin du XIIe siècle. La pétrification de l’habitat, tardive (XIIIe-XIVe siècles) restreint la surface de l’habitat, mais s’inscrit dans la continuité de son organisation. Le secteur de l’église nous présente à l’inverse une grande complexité marquée par l’interpénétration des fonctions funéraires, seigneuriales, cultuelles et de l’habitat. Le scénario retenu à l’issu des fouilles est surprenant. Un cimetière d’origine mérovingienne bordé d’un habitat s’étoffe fortement à l’époque carolingienne avant d’être investi au XIe siècle sur sa partie la plus ancienne par un habitat seigneurial fossoyé. L’hôtel seigneurial accueille dans son enceinte, élargie au XIIe siècle, un vaste prieuré avec son église. La construction d’une nouvelle église, plus étendue au XIIIe siècle au détriment du fossé seigneurial, puis la désaffection de l’habitat seigneurial détruit au profit du prieuré aboutit à la situation inverse du départ : une parcelle dominée par une vaste église avec un cimetière paroissial en partie déplacé dans un autre secteur du village.

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I am as proud to participate in this In Memoriam honouring Dr. Harry Botterell today as I was to serve as his Junior House Surgeon exactly 44 years ago when a rotation through "D" O.R. at Toronto General Hospital was an exhilarating introduction to a man who changed my life profoundly. His obituary notice in The Toronto Globe & Mail said he touched the lives of many; we can confidently add that he shaped the academic and professional careers of several of Canada's leading neurosurgeons. Dr. Botterell's very significant contributions to our discipline, to Medicine, to Education will be highlighted by others but I was invited to chronicle Dr. Botterell's life history. Since it would be next to impossible for me to think of Harry Botterell simply in terms of his curriculum vitae, I will also share with you some personal recollections illustrating how Dr. Botterell more than "touched" the lives of his Chief Residents. Many could match or embroider these reflections of a privileged residency with Harry Botterell that now return, as Charlie Drake might say, "with startling clarity" and if you accept that memory is not retrieval but reconstruction of the past, you will be more inclined to forgive any liberties I may take with the details. Edmund Henry (Harry) Botterell was born in Vancouver, British Columbia, the oldest of the four children of John Esterbrook and Louise (Armstrong) Botterell, on February 28, 1906. His early education at Ridley College School in St. Catharines, Ontario was followed by attendance at McGill University for a year. Returning to Winnipeg, where the family now lived, to support his widowed mother after his father's early death, he subsequently received his M.D. degree from the University of Manitoba, graduating with honours in 1930. After postgraduate training as Resident Surgeon at Winnipeg General Hospital and then as Resident Physician at Montreal General Hospital, Dr. Botterell came to the University of Toronto and the Toronto General Hospital. He had been persuaded to move eastward by William Boyd, Professor of Pathology in Winnipeg and in Toronto he served as demonstrator in anatomy with Professor J.C.B. Grant and as tutor in physiology with Professor C.H. Best. Many of us will confess how much our own Royal College Certification and surgical practice owe to the textbooks of these three illustrious authors! On December 23, 1933 Harry Botterell married Margaret Talbot Matheson, the daughter of the Most Rev. Samuel Pritchard Matheson and Alice Talbot of Winnipeg. During 1934-35 Dr. Botterell was a Fellow at the National Hospital, Queen Square, London, England, legendary centre for neurological training in the classical tradition of careful clinical observation. At "Queen Square" he was a clerk for the great Gordon Holmes. Then, in 1935-36, he served as a research fellow in Professor John Fulton's laboratory at Yale University, engaged in experimental neurophysiology of the primate cerebellum and in pioneering work on the physiology of tremor. He EDMUND HENRY ("HARRY") BOTTERELL OC OBE MD M...