To evaluate the safety and efficacy of the far-lateral approach in the resection of ventral and ventrolateral upper cervical meningiomas. Overview of Literature: Upper cervical meningiomas are a common disease entity. These lesions can be surgically treated via many accesses. The far-lateral approach is a very appealing technique for these lesions. Methods: We assessed 23 patients with a mean age of 57.3±15 years. According to the Japanese Orthopedic Association (JOA) scale; eight patients had grade 0, nine had grade I, and six had grade II. All patients underwent plain radiography and magnetic resonance imaging of the cervical spine. The foramen magnum was involved in 10 patients, C1-2 in seven, C2-3 in four, and C3-4 in two. All patients were operated via the far-lateral approach. Results: Gross total resection was achieved in 21 patients. Sixteen lesions were psammomatous, five were fibroblastic, and two were meningothelial meningiomas. The mean operative duration was 135±40 minutes, while the mean operative blood loss was 450±210 mL, and the mean hospital stay was 4.3±2.2 days. At the final follow-up that was conducted at 27.6±21 months and as per the JOA score; 16 patients were classified into grade 0 and 7 into grade II. The condition of none of our patients deteriorated postoperatively. There was no significant correlation of the clinical outcome with tumor level, pathological subtype of the tumor, symptom duration, age, and sex. There was no significant correlation of tumor resection completeness with tumor level, tumor pathological subtype, or tumor topography (ventral or ventrolateral). Conclusions: The far-lateral approach is a safe and effective access for ventral and ventrolateral cervical meningiomas. It allows direct access to tumor with no spinal cord or nerve roots traction, and thus may yield a fairly better outcome than the standard posterior approach.

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Background Data: The role of surgical correction of sagittal plane deformity in cases of lytic spondylolisthesis is essential. While evidence is emerging of the possible short-and long-term benefits of restoring spinal balance, some surgeons have been concerned about the associated risks especially if instrumentation has to be used for reduction of the slipping. Purpose: To evaluate the Sagittal Balance improvement in surgical Treated Lowgrade Isthmic Lumbosacral Spondylolisthesis Study Design: Prospective clinical case study Patients and Methods: Twenty two patients with low-grades (<50%) of isthmic spondylolisthesis of lumbosacral junction (L5-S1) were managed by a surgical intervention aiming for correction of the deformity even with partial reduction of the slipping. Sagittal alignment at the lumbosacral junction was tried to be achieved by appropriate positioning of the patient during the surgery and by rod contouring. Posterior decompression of nerve structures by laminectomy in conjunction with posterior instrumented fusion from L5 to sacrum were also done. They were fourteen females and eight males with a mean age of 40.45 years. The mean follow up period was 20 months. Results: All patients achieved satisfactory results as regards the back pain, radicular pain and neurologic deficits. The mean preoperative estimated values of slip percentage, L1-S1 lordosis, sacral inclination angle and lumbosacral kyphosis were 30.2%, 48.8°, 46.04°, and 35°. The mean reconstructed values were 25%, 34.9°, 36.86°, and 28° postoperative. Pelvic version improved in patients with unbalanced spondylolisthesis as evidenced by decreased sacral slope [from 46.04 degrees to 36.86 degrees] (P<0.5). All patients could return to their normal activities of daily living. Conclusion:This study suggests that, the described technique can yield satisfactory clinical outcomes and substantial deformity correction using single posterior approach with proper patient position before surgery. (2013ESJ040)

Background data: The degenerative lumbar diseases form a burden on both the patients and the society. The development of the degenerative process is highly linked to the aging process as discussed by Kirkandly Willis where the degenerative spine passes through 3 phases of process that results in the degenerative diseases. The management of the degenerative spine deformities varies and depends on various factors. Traditional surgical management involves instrumentation, decompression and fusion processes. Oblique Lumbar interbody fusion ‘OLIF’ is a novel technique when used alone as in stand-alone OLIF ‘SA-OLIF’ it could achieve degenerative deformity correction along with neural decompression, however, the final aim of SA OLIF where solid fusion is required still is under evaluation and literature lacks the essential data for this approach. This study aims to assess the fusion of the SA-OLIF in the management of degenerative lumbar scoliosis. Study Design: A Prospective clinical case study. Objective: To assess the fusion rates in patients suffering from degenerative lumbar scoliosis ADS after SA-OLIF. Patients and Methods: Patients with ADS following a specific inclusion criterion underwent SA OLIF. Pre-, and Post-operative clinical data; back and leg pain ‘VAS score’ and ODI, radiological data; for fusion assessment. Intra-operative data: operative time, amount of blood loss, complications ‘intra-operative or post-operative’ and hospital stay were all analyzed and compared statistically. Results: A total of 28 patients and 30 levels were operated by SA OLIF, with mean age 50.54±6.05 included 14 males and 14 females. The mean operative time/min, blood loss/ml and hospital stay/day was 91.29±14.23, 195.54±42.299 and 2.78±0.875 respectively. The mean of Back Pain ‘VAS’, The mean of Leg Pain ’VAS’ and ODI changed from pre-operatively 7.36±0.98, 6.36±0.911and 68.615±8.72 to 4.07±1.01, 2.07±0.9 and 20.23±4.7 in 1-year respectively. In this study we had 92.9% fusion rates after 1-year. Operative complications occurred in 3 cases with segmental artery injury. Post-operative complications were 1 cage dislodgment immediately post-operative and 2 cases of cage subsidence after 1-year. Conclusion: SA OLIF can result in high rates of fusion. There are multiple factors that determine the rate of fusion such as the quality of the vertebrae and endplate preservation during the preparation procedure.

Background Data: Adult degenerative scoliosis has at its starting point the same broader definition of adult scoliosis, which is defined as a Cobb angle of greater than 10 degrees measured in the coronal plane. However, it is exclusive for adults who previously had normal spinal alignment. Such pathology with no specific etiology results from a combination of degenerative lumbar diseases. Oblique lumbar interbody fusion (OLIF) is one of the fusion techniques used. It was introduced to overcome the disadvantages of the commonly used interbody fusions like anterior (ALIF), lateral (LLIF), or posterior (PLIF) interbody fusions. OLIF can achieve spinal stability, correct alignment in coronal and sagittal balance anteriorly, and indirectly decompress neural structures with fewer complications related to traditional transpsoas or retropsoas approaches. Study Design: Prospective clinical case study. Objective: To assess the degree of coronal and sagittal deformity correction in patients suffering from degenerative lumbar spine deformities after stand-alone (SA) OLIF. Patients and Methods: Patients with ADS following specific inclusion criteria underwent SA OLIF. Pre-and postoperative clinical data (back and leg pain VAS and ODI), radiological data (spinopelvic parameters, segmental Cobb's angle, and anterior disc height), and intraoperative data (operative time, amount of blood loss, "intraoperative or postoperative" complications, and hospital stay) were all analyzed and compared statistically. Results: A total of 28 patients and 30 levels underwent operation by SA OLIF, with a mean age of 50.54 ± 6.05 years, including 14 males and 14 females. The mean operative time/min, blood loss/ml, and hospital stay/day was 91.

To demonstrate the details of the far-lateral approach (FLA) as a minimally invasive technique for the excision of the upper cervical anterolateral and anterior meningiomas and dumbbell schwannomas, and to assess the clinical and radiological outcomes. Methods: In this technical report and case series we report the FLA technique and patients who underwent the FLA for C1-C4 anterolateral and anterior meningiomas and dumbbell schwannomas between June 2007 and June 2020. All patients' relative preoperative demographic, clinical, radiographic, operative, histopathological, and perioperative complications and follow-up clinical and radiographic data were reported. Results: A total of 19 patients including 12 females and 7 males with a mean age 56.7 ±17.6 years and mean duration of symptoms 12.8 ±12.3 months were reported. 9 patients with anterolateral meningiomas, 5 with anterior meningiomas, and 5 with dumbbell schwannomas underwent uneventful FLA procedures. Gross total resection of tumors was reported in 17 patients (89.5%). Preoperative JOA score was normal in ten, grade-I in five, and grade-II in 4 patients, while at the last follow-up it improved to normal in seventeen and grade-I in two patients. Reported postoperative JOA scores at 6 months and at the last follow-up showed that all patients improved at least one grade on JOA scores. There was CSF leak in three patients and superficial wound infection in one. Conclusion:Our results advocate the far-lateral cervical approach as a minimally invasive technique in the resection of the upper cervical anterolateral and anterior meningiomas and dumbbell schwannomas as a safe and effective technique.

Background Data: Facet joint disorders are main source of chronic low back pain with a prevalence of 16.7%. Facet joint block is performed for diagnostic or therapeutic purposes and generally is carried out under computed tomography (CT) or fluoroscopy. Facet joint block is the gold standard in diagnosis of facet joint syndrome. It can also relief pain for up to 6 months. Purpose: To identify which imaging modality (CT or fluoroscopy) is more suitable to guide the procedure of lumbar facet joint block, and results in better relieve of symptoms. Study Design: Prospective analytic clinical case study. Patients and Methods: Sixty eight lumbar facet joints representing 24 patients were injected in the radiology department, Suez Canal University Hospital, Ismailia, Egypt from 1/2005 to 12/2010. All cases were suspected of having facet joint disorders based on clinical and radiological data. After clinical examination and reviewing lumbar images to identify target facets, every patient underwent facet joint block under either CT or fluoroscopy. Visual Analogue Scale was used to assess improvement of symptoms. Results: Fluoroscopy was more successful in guiding the injections (success rate 77.7% compared with 31.25% in CT guidance). It is also faster (6:37 minutes per joint compared with 10:54 minutes for CT guidance). Less number of trials were required (1.7 trial compared with 6.6 trials with CT guidance). Fluoroscopy exposed the patients and the radiologist to much irradiation (21.3 rad compared to 0.3 rad in CT guidance). Decreased bone density and laminectomy impair fluoroscopy guidance. CT guidance is difficult in patient with marked arthropathy and coronally oriented joints (8 trials compared with 5.6 for normally appearing joints). Both groups showed significant improvement of symptoms. Conclusion: Fluoroscopy should be the primary choice for guiding lumbar facet joint block. It is more successful and faster. Its disadvantages include much irradiation to patients and radiologists, and difficulty in patients with laminectomy and decreased bone density. CT can then be used to guide the block. Both techniques are effective in pain reduction. (2012ESJ035)

Background Data: Transforaminal Epidural Steroid Injection is one of the nonsurgical treatment methods for sciatic pain. The clinical outcome and predictive factors that affect its results are still under debate. Purpose: The purpose of this study is to evaluate the results of transforaminal epidural steroid injection and identify factors for predicting success. Study Design: A descriptive analytic cross sectional prospective study involving 45 patients with lumbar radiculopathy. Patients and Methods: Forty-Five patients with lumbar radiculopathy were prospectively followed up at 2 weeks and 6 months after Transforaminal Epidural Steroid Injection. The intensity of radicular pain was scored on the Visual Analog Scale (VAS). Outcome was classified as "respondent" when the pain diminished by 50% or more, "Non-respondent" for a diminution of less than 50%. Duration of symptoms, affected level, position of disc herniation, degree of nerve root compression, pain intensity, and body mass index were chosen as predictive factors to study. Results: The mean VAS scores were 7.381.11± before, 2.93 (SD 2.01) 2 weeks after the procedure, and 4.182.75± at 6 months follow-up. Outcome was graded as respondent in 31 patients (68.9%), and non-respondent in 14 patients (31.1%). Level and position of disc herniation, body mass index, and pain intensity were not predictive factors of radicular pain relief, whereas the symptom duration before the procedure and degree of nerve root compression were highly correlated with the pain relief outcome. Minor complications occurred in 2 patients. Conclusion: Transforaminal Epidural Steroid Injection is a simple, safe, and effective nonsurgical procedure. Patients with shorter duration of symptoms, and minimal degree of nerve root compressions shows better improvement. (2013ESJ036)