Background Data: Atlantoaxial rotatory fixation is a relatively uncommon condition. It remains a poorly understood entity despite many reports in the literature. There is no consensus about the best imaging modality for the diagnosis and the best therapeutic modality the patients benefit from. Purpose: This study was conducted to determine the efficacy of imaging modality and treatment measures and to determine risk factors for recurrence in consideration of the cause, management, and outcome. Study Design: This is a retrospective clinical case study and a literature review. Patients and Methods: Our hospital records were reviewed between January 1995 and December 2011. We were able to track 12 children with atlantoaxial rotatory fixation treated by posterior fixation. The mean age was 8.6+2.4 years. Seven were boys and 5 were girls. Sports injury was reported in 4 cases, falls in 3 cases, unknown injury in 3 cases, and road traffic accident in 2 cases. All children had neck pain with torticollis and decreased cervical motion. The mean duration of symptoms before diagnosis was 21.3 days. All children were neurologically intact. All underwent plain cervical radiographs and computed tomography to document atlantoaxial rotation. All children were submitted to closed reduction with cervical traction followed by posterior surgical fixation and fusion after failure of conservative treatment. Results: All procedures went uneventfully with no added neurologic deficits and a stable repair over at least 12 months follow-up period. Easiness of reduction was affected by the duration of symptoms prior to traction. All had radiographic documentation of stability and fusion. One girl had recurrent rotation two years after modified Gallie fixation after minor head trauma. She was repaired using Harms' technique. Conclusion: The optimal therapy of atlantoaxial rotatory fixation entails early diagnosis with computed tomography. Reduction with cervical skull tongue traction followed by posterior fixation and fusion accomplished reduction and was curative to all patients. There was no correlation between recurrence and age, sex of the child or the cause of rotation. (2012ESJ011)

Background Data: Shallow-water diving injuries have devastating consequences for patients and their families in terms of requiring intensive use of resources in both the acute and rehabilitative phases of injury. With the final clinical outcome often poor, the question is raised as to whether a target group can be identified for whom to implement a preventive program. Purpose: Our aim is to evaluate the demographics, clinical features and outcomes of shallow-water diving injuries in Fayed resort. Study Design: A descriptive analytic cross section prospective study involving 20 patients with diving accidents.

Background Data: Improving the knowledge about the epidemiology of the traumatic brachial plexus injuries (BPI) helps in providing an appropriate assessment and management of these cases. This issue is important especially in those injuries that have much burden on the individual and national income. Purpose: To evaluate the epidemiological, clinical, and outcome of traumatic brachial plexus injuries in Suez Canal University and Damanhur Medical National Institute Hospitals over 2 years. Study Design: A retrospective descriptive clinical case study. Patients and Methods: Eighteen patients had traumatic brachial plexus injury were operated by our team from January 2014 to December 2015. Data regarding the age, sex, causes of BPI, patterns of injury, surgical approaches, surgical procedures and recovery outcome were collected. Results: All the patients were males with mean age 31 years, 72% encountered road traffic accidents (RTA), and 90% were because of motorbike accidents. 60% showed upper BPI. Neurolysis, nerve grafting and nerve transfer were the surgical procedures that were followed. Functional recovery had been achieved in about 61% of the study population. Conclusion: Our study gives insight into epidemiological aspects of the BPI in Egypt and the role of our new center in the management of those injuries. Taking into consideration the small number of the study population, our results were more or less similar published literatures. (2016ESJ112)

Background Data: The cervicothoracic spine is a junction area with complex biomechanics. A variety of disorders affect this region, rendering it unstable. Numerous posterior constructs have been evaluated. The clinical efficacy of a screwrod system utilizing tapered (dual-diameter) rods in cervicodorsal stabilization is still not evident. Purpose: Our aim is to evaluate the clinical efficacy of dual diameter rods (5.5-3.5mm taper), connecting 3.5-mm cervical lateral mass screws/pedicle screws and 5.5-mm thoracic pedicle screws used to instrument across the cervicothoracic junction for a variety of pathologies. Study Design: A retrospective descriptive clinical case study. Patients and Methods:The authors retrospectively reviewed their archive between February 2011 and February 2015, and ten patients who were operated upon due to cervicothoracic junction pathologies were included. All patients underwent surgical treatment by posterior instrumentation utilizing tapered rods. The cases were periodically followed up. Results: There were six men and four women included in the study, with a mean age of 40 years (range 21-62 years). There were five cases of trauma, two cases of tuberculosis and three cases of spine metastasis. Seven patients experienced marked improvement of their preoperative weakness according to Frankel grades of paraplegia. All patients showed stable cervicodorsal junction with fusion after one year. Three patients suffered postoperative wound infection. Conclusion: Tapered rods are an excellent and a viable option to connect screws to stabilize cervicothoracic junction. (2015ESJ089)

Background Data: Disc herniations at the L1/2 and L2/3 levels are different from those at lower levels of the lumbar spine with regard to clinical characteristics and surgical outcome. Spinal canals are narrower than those of lower levels, which may compromise multiple spinal nerve roots or conus medullaris. Purpose: The aim of this study to evaluate the clinical features and surgical outcomes of upper lumbar disc herniations. Study Design: A prospective descriptive clinical case study. Patients and Methods: Thirty patients underwent surgeries for single fresh lumbar disc herniation at the L1/L2 or L2/3 levels. They were operated between 2011 and 2014. Participants were evaluated pre-operatively and post-operatively at 3, 6, 9, and 12 month intervals. Pain was scored by a VAS for both lower limb and back pain. The clinical outcomes were compared using the Prolo economic and functional rating scale. Results: The affected levels were L1/2 in 9 patients and L2/3 in 21 patients. The mean age of patients was 52.5 years and (Range=29-67). The mean follow-up period was 13.6 months. Most patients complained of back and buttock pain (27 patients, 90%), and radiating pain in areas such as the anterior or anterolateral aspect of the thigh (23 patients, 77%). Weakness of lower extremities was observed in 12 patients (39%) and sensory disturbance was presented in 15 patients (50%). Only 4 patients (13%) had undergone previous lumbar disc surgery (One patient at L1-2 and the other 3 patients at L4-5 level). Discectomy was performed in all patients. The mean values of preoperative back pain by VAS were 7.7±0.3. The mean values of radicular pain were 8.3±1.4. The mean values of preoperative Prolo Scale were 5.1±0.7. At 1 year follow up the mean back pain on VAS decreased significantly to 2.6±0.4 (P<0.01) and the mean lower limb pain on VAS also decreased significantly to 2.5 ±0.5 (P<0.01). When the outcome was evaluated by the Prolo scale, 23% (7 of 30) of all the patients experienced excellent results, 50% (15 of 30) had good results, 23% (7 of 30) had fair results, and 3% (1 of 30) had poor results. By 12 months follow up period, 73% of the study group expressed clinical success. Conclusion: Clinical features of disc herniations at the L1/2 and L2/3 levels were variable, and localized sensory change or pain was rarely demonstrated. In most cases, the discectomy was performed successfully by conventional posterior laminectomy.

Background Data: Adult Chiari malformation is a heterogeneous group of conditions, with the underlying commonality of disruption of normal CSF flow through the foramen magnum. Some cases are congenital, but others are acquired. The optimal surgical treatment of adult Chiari malformation type-I is unclear. Purpose: To evaluate the operative and postoperative results of extradural and intradural approaches in the treatment of Chiari malformation type-I. Study Design: A descriptive retrospective clinical case study. Patients and Methods: Twenty patients underwent surgery for adult Chiari malformation type-I. They were divided into two groups; posterior fossa decompression group and posterior fossa decompression with duroplasty group. Each group included 10 patients. They were operated between 2008 and 2015. Participants were evaluated pre-operatively and post-operatively every three months. Operative time, hospital stay and complications were assessed. The clinical outcomes were compared between the two groups using The Chicago Chiari Outcome Scale. Results: No statistically significant differences were found between the decompression and duroplasty groups with regard to demographics, preoperative symptoms, radiographic characteristics, and clinical outcomes. Egy Spine J -Volume 20 -October 2016However, the operative time, hospital stay and aseptic meningitis were higher in the duroplasty group. Conclusion: The clinical outcome of posterior fossa decompression is nearly identical to that of posterior fossa decompression with duroplasty in adult patients with Chiari type-I; however, the operative time, hospital stay and complication rate is higher in duroplasty group. (2016ESJ113)

Background Data: Siamese twins are joined by a part of their body at birth and the causes of the merger are often unknown. When the merger is on the spine it is rachipagus. It is an extremely rare and strange condition, and there are only a few documented cases in the literature. We present one additional case of parasite rachipagus on the dorsolumbar level. Purpose: Our aim is to describe a girl with a parasitic twin attached to her lower back, combined with a spina bifida and a lipomyelomeningocele. Study Design: Case report and review of the literature Patient and Method: In September 2014, a female baby from North Sinai was referred to Suez Canal University Hospital. She was 1 month old and had an extra well developed parasitic twin attached to her back. She was surgically treated in the Neurosurgery and Pediatric Surgery Departments. Results: A rare example of rachipagus conjoint parasitic twinning in a newborn girl is described. A lipomatous mass, a rudimentary intestinal loop with an attached atrophic pelvis and hind limb were found adherent to the dorsal vertebral arches of the autosite in the thoracolumbar region. Surgical excision of the parasitic twin, excision of the dorsal lipoma, repair of the cord and wound repair were done Conclusion: Parasitic rachipagus is a rare embryogenic malformation with a good surgical prognosis on the autosite in the absence of associated congenital anomalies. (2016ESJ111)