Background Data: Spinal cord ependymomas can arise in different locations throughout the spinal cord, with the most frequent location being the cervical spine. Ependymomas usually grow slowly, compressing rather than infiltrating spinal tumors. Among different prognostic and predictor factors, the extent of resection has been the strongest predictor of outcomes. Multimodal intraoperative neurophysiological monitoring (IONM) helps maximize the extent of resection with minimal postoperative neurological complications. Purpose: To assess the impact of IONM on the extent of surgical resection and outcomes of spinal cord ependymomas. Study Design: A retrospective cohort study. Patients and Methods: Twenty-five patients who underwent spinal cord ependymoma resection in 4 centers between March 2014 and February 2018 were eligible for the inclusion criteria of this study. Patients were divided into two groups: the IONM group and the non-IONM group. IONM consisted of electromyography (EMG), transcranial motor evoked potentials (tcMEP), and somatosensory evoked potentials (SSEP). All patients were submitted for full neurological examination and MRI of the spine both preoperatively and at the postoperative routine follow-up. Postoperative radiotherapy was conducted routinely by our radiotherapists. The secondary outcomes were the correlation between the warning criteria of IONM and postoperative neurological outcomes and their impact on the extent of tumor resection. Also, a recurrence rate during the follow-up period was reported.
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Background Data: Chiari malformation type-I (CM-I) is a challenging subject to wrap our hands around table. Chiari symptoms often range from, unexplained, and/or occipital Valsalva type headache, chronic fatigue syndrome, to lower cranial nerve abnormalities, or brain stem compression, till severe neurological insult which augmented by syringomyelia, or syringobulbia. Exact diagnostic and prognostic tools carry a great controversy which ranged from simple MRI study to MR imaging-based CSF velocity measurements, morphological, dynamic craniocervical junction assessments, subarachnoid pressure recordings, and compliance calculations were compared before and after surgical treatment.
Background Data: Anterior cervical discectomy and fusion (ACDF) is a gold-standard option for treating cervical degenerative disc diseases (DDD). Anterior plating enhances stabilization with improved outcomes and reduced risk of pseudarthrosis yet with annoying morbidities. Fusion with stand-alone cages avoids such complications, although its use in multilevel disc arthrodesis is still controversial. Study Design: Retrospective multicenter comparative cohort study. Purpose: To evaluate clinical and radiological long-term outcomes after ACDF with stand-alone polyetheretherketone (PEEK) cages versus ACDF with cages and plating. Patients and Methods: Patients who underwent four-level stand-alone ACDF (Group 1) or ACDF with plating (Group 2) between July 2012 and May 2016 and followed up for at least two years were recruited for this study. In this study, the reported outcome parameters included operative time, operative blood loss, fusion rate, cervical curve, neck disability index (NDI), Visual Analogue Score (VAS) of neck pain, patient satisfaction, and perioperative morbidity. Results: Forty-seven patients, including 25 males and 22 females, were reported. The mean age was 50.8 and 50.1 years in Groups 1 and 2, respectively. Twenty-four patients underwent stand-alone ACDF and 23 underwent ACDF with plating. The baseline characteristics data of both groups were homogeneous between groups. The outcome parameters (NDI, cervical curve VAS scores, fusion rate, complications, reoperation rate, and patient satisfaction) showed no significant difference between the two groups at different time points of follow up. Pre-and postoperative NDI and VAS showed significant improvement in both groups. Dysphagia was reported more frequently in Group 2. Conclusion: Four-level ACDF with stand-alone PEEK cage is equally effective as ACDF with anterior plating in patients treated for four-level cervical DDD with less incidence of dysphagia. (2021ESJ233)
BACKGROUND:Cubital tunnel syndrome is one of the most frequent upper extremity entrapment neuropathies. The best surgical therapy for cubital tunnel syndrome remains controversial and a topic of discussion.
OBJECTIVE:Our goal is to compare the results of two different surgical approaches for cubital tunnel syndrome and to correlate the preoperative findings guided by electrodiagnostic studies with the intraoperative findings regarding the accurate sites of ulnar nerve compression at the cubital tunnel in both surgical approaches, as well as to assess the long-term clinical outcome of surgical management.
PATIENTS AND METHODS:From 2012 to 2018, we retrospectively reviewed the data of 79 patients who had cubital tunnel syndrome and were managed by two different surgical procedures. To confirm the diagnosis and locate locations of ulnar nerve entrapment in the cubital tunnel, preoperative electrodiagnostic tests were done. Preoperative clinical symptoms were identified using Dellon's staging approach, and postoperative clinical outcome was assessed using a modified Bishop rating system in all patients.
RESULTS:The outcomes were graded excellent in 61 patients, good in 15 patients, and fair in three patients. Regarding the in situ group, excellent improvement was obtained in 30 patients (78.9%), good improvement in 6 patients (15.8%) and fair improvement in 2 patients (5.3%). Regarding the transposition group, excellent improvement was achieved in 31 patients (75.6%), whereas good improvement and fair improvement were observed in 9 patients (21.9%) and 1 (2.4%) patient, respectively. Electrodiagnostic studies were not accurate in detecting the actual sites of ulnar nerve entrapment, while intraoperative results were more accurate.
CONCLUSION:In situ decompression is as beneficial as anterior transposition in the treatment of cubital tunnel syndrome, according to our findings. When compared to intraoperative results, electrodiagnostic investigations perform poorly in diagnosing the precise locations of ulnar nerve compression.
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