Submandibular tracheal intubation is a simple and effective technique for upper airway management in some maxillofacial surgical patients when both oral and nasal tracheal intubations are not convenient.

Background: The optimum target in surgery for Parkinson’s disease (PD) is still controversial, especially in patients with tremor-dominant PD. We aim to compare results in tremor-dominant patients undergoing pallidotomy vs. those undergoing simultaneous posteroventral pallidotomy (PVP) and ventral intermediate nucleus (VIM) thalamotomy. Methods: Twenty-four patients with tremor-dominant PD were included in this study. Twelve patients received unilateral PVP contralateral to the most affected side. The other 12 patients received simultaneous unilateral PVP and VIM thalamotomy contralateral to the most affected side. Assessment of results in both groups was achieved using both UPDRS “off” motor scores and UPDRS rest tremor subscores. Results: The mean UPDRS off motor score improved in the pallidotomy group from 61.3 preoperatively to 36.8 at 12 months. In the combined group, it improved from 59.6 to 35.2 at 12 months, with no statistically significant difference between both groups. On the other hand, while the mean tremor subscore in the pallidotomy group improved from a mean of 2.3–0.8, the tremors were abolished in all of the patients in the combined group except for 1 patient who showed slight infrequent tremors at 12 months. Conclusion: Patients with tremor-dominant PD achieve more improvement in tremor control after combined PVP and VIM thalamotomy.

Background Data: The management of unstable traumatic thoracolumbar fractures has shifted from more conservative treatment to more operative treatment modalities. Different surgical options have been reported in the literature. Purpose: To review two surgical techniques, anterolateral and posterior approaches, in management of thoracolumbar fractures and present a brief literature review. Study Design: A retrospective case series with review of the literature. Patients and Methods: Thirty patients were managed in the period from October 2012 to November 2016 for thoracolumbar burst fractures. Two patients' groups were identified: Group I underwent anterolateral fixation and included 15 patients, whereas Group II underwent posterior fixation and included 15 patients. Follow-up was done at 3 months, 6 months, and one year postoperative using VAS for pain assessment and ASIA scale for neurological status evaluation. Radiological outcome involved the vertebral height restoration, spinal canal compromise, and kyphus deformity correction. Operative time, operative blood loss, and perioperative complications were all reported for both groups. Results: The most common spinal level affected in our study was L1 vertebra in 10 patients. Operative time and blood loss were found to be significantly less in the posterior approach. A significant improvement of VAS has been reported in both study groups with more improvement in the posterior group compared with the anterolateral one. 93.3% of anterior group patients within the showed either improved or fixed neurological status according to ASIA scale where, in posterior group, all patients showed either improved or fixed neurological status. The mean canal compromise percentage decreased in Group I from 69.3% preoperatively to 15.62% postoperative, whereas in Group II it decreased from 66.2% preoperative to 18.8%. Kyphotic angle has been corrected in posterior group from 13.42° preoperative to 11° at 6 months and 12.5° at one year, whereas in anterolateral group it has been corrected from 19.42° to 17.57° and 20.9°, respectively, with a statistically significant difference between both groups (P<0.01).

Introduction: Lumbar degenerative diseases (LDD) is considered a common disease. Lumbar pedicular screw fixation and interbody fusion is one of the commonly used and effective surgical method in management of single-level lumbar degenerative diseases. Although bilateral pedicular screw (PS) fixation after lumbar interbody fusion is accepted as a standard surgical procedure providing rigid fixation with a great biomechanical stability and clinical benefits, the rigidity of bilateral (PS) fixation can cause device-related osteoporosis of the vertebrae which makes the adjacent segment prone to load and motion-induced degeneration. Therefore, the concept of using less rigid systems of fixation has been advocated. Aim of study: To evaluate effectiveness of unilateral pedicular screws fixation and interbody fusion in unilateral degenerative spine pathology. Patients and methods: This study included 34 patients with single level degenerative lumbar spine disease who were subjected to transforaminal interbody lumbar fusion (TILF) and unilateral transpedicular screws fixation between July 2017 and March 2019 in Ain Shams University hospitals. Results: The study was conducted on 34 patients with age ranging between 32-56 years (mean 45.12±7.80 years). There were 17 male and 17 female in this study. When comparing VAS back pain preoperatively and at postoperative intervals of 1,6 and 12 months, it showed highly significant improvement (P-value 0.000). Also when comparing VAS of leg pain preoperatively and at postoperative intervals of 1,6 and 12 months duration, it showed highly significant improvement (P-value 0.000). ODI preoperatively and at postoperative intervals of 1,6 and 12 months showed also highly significant improvement (P-value 0.000). Regarding the fusion rate, at 6 months postoperative 61.8% (21) of the patients had fusion grade 1,26.5% (9) of the patients had fusion grade 2 and 11.8% (4) of the patients had fusion grade 3. While at 12 months postoperative the percent of grade 1 fusion increased to become 85.3% (29 patients) and the rest were grade 2 fusions (14.7%) with no patients with grade 3 fusion. Conclusion: Unilateral pedicular screws and interbody fusion is a good modality of treatment for unilateral degenerative spine pathology.

Background Data: Anterior cervical discectomy and fusion (ACDF) has been standard procedure in treatment of degenerative cervical disc disease. In order to reduce risks associated with traditional methods of anterior cervical discectomy with fusion a new zero profile cage with screws has been introduced and widely used.Purpose: To compare the clinical and radiological outcomes of two levels ACDF using stand-alone peek cage and zero profile anchored cage with screws.Study Design: Two groups of patients were enrolled in this study; Group A involving 30 consecutive patients that underwent two levels ACDF using standalone peek cages, and Group B including 30 patients that underwent two levels ACDF with zero-profile anchored cage with screws.Patients and Methods: Both surgical groups were assessed clinically involving neck and arm pain Visual Analogue Score (VAS), neck disability index and Nurick score. Radiological evaluation involved the changes in vertebral heights (VH), both segmental (Cobb-s) and global (Cobb-c) Cobb angle and fusion rates via plain X-ray cervical spine that was done pre-operative, immediate post-operative and at 24 months post-operative. Results:The neck disability index and the Nurick score together with both VAS for neck and arm pain were significantly improved after surgery with no statistical difference between both groups. All patients in both groups showed satisfactory fusion rates except two patients in Group A. Both groups showed early marked increase in the VH followed later by cage subsidence that was significantly higher in Group A patients. In both groups; Cobb-c, and Cobb-s angles were significantly increased in the immediate postoperative compared to the preoperative measures. Terminal measures for both Cobb-c and Cobb-s, at 24 months follow up images, in both groups worsened but to a statistically significant lesser extent in Group B compared to Group A.