No abstract

Prospective case series studies have shown that plasma disc decompression (PDD) using the COBLATION SpineWand device (ArthroCare Corporation, Austin, TX) is effective for decompressing the disc nucleus in symptomatic contained cervical disc herniations. This prospective, randomized controlled clinical trial was conducted to evaluate the clinical outcomes of percutaneous PDD as compared to conservative care (CC) through 1 year. Patients (n = 115) had neck/arm pain [50 on the visual analog scale (VAS) pain scale and had failed at least 30 days of failed CC. Patients were randomly assigned to receive either PDD (n = 62) or CC (n = 58). Clinical outcome was determined by VAS pain score, neck disability index (NDI) score, and SF-36 health survey, collected at 6 weeks, 3 months, 6 months, and 1 year. The PDD group had significantly lower VAS pain scores at all follow-up time points (PDD vs. CC: 6 weeks, -46.87 ± 2.71 vs. -15.26 ± 1.97; 3 months, -53.16 ± 2.74 vs. -30.45 ± 2.59; 6 months, -56.22 ± 2.63 vs. -40.26 ± 2.56; 1 year, -65.73 ± 2.24 vs. -36.45 ± 2.86; GEE, P \ 0.0001). PDD patients also had significant NDI score improvement over baseline when compared to CC patients at the 6 weeks (PDD vs. CC: -9.15 ± 1.06 vs. -4.61 ± 0.53, P \ 0.0001) and 1 year (PDD vs. CC: -16.70 ± 0.29 vs. -12.40 ± 1.26, P = 0.005) follow-ups. PDD patients showed statistically significant improvement over baseline in SF-36 physical component summary scores when compared to CC patients at 6 weeks and 1 year (PDD vs. CC: 8.86 ? 8.04 vs. 4.24 ± 3.79, P = 0.0004; 17.64 ± 10.37 vs. 10.50 ± 10.6, P = 0.0003, respectively). In patients who had neck/arm pain due to a contained cervical disc herniation, PDD was associated with significantly better clinical outcomes than a CC regimen. At 1 year, CC patients appeared to suffer a ''relapse, showing signs of decline in most measurements, whereas PDD patients showed continued stable improvement.

The literature on spinal neurinomas (N) and meningiomas (M) in children is reviewed, and five personal cases of N are added (one in the context of Recklinghausen's disease). The cases of N totalled 151, and of M 69, accounting respectively for 10.9% and 4.3% of childhood spinal tumours and 2.6% and 1.3% of spinal N and M of all ages. Sixty-one cases of N (16 in the context of Recklinghausen's disease) and 26 cases of M (5 in the context of Recklinghausen's disease) are analyzed in detail. N occurs chiefly between ages 9 and 15 years, the sex ratio is 3 : 2, all levels of the spinal canal are equally affected, and extradural N or conditions with an extradural component (48%) are more frequent than in adults (26.9%). M occurs chiefly between 12 and 15 years, the sex ratio is 3 : 2, the prevalence of the thoracic segment (47.8%) is less marked than in adults (81%), and the frequency of the extradural site (10.6%) is close to the sum of the extradural and dumb-bell lesions in adults (11.1%). In children vertebral signs, i.e., spinal rigidity and tenderness, and spasm of paravertebral muscles, are more intense, earlier, and more frequent than in adults, and the clinical history is shorter. The chances of recovery from neurological deficits are greater, as are those of malignant degeneration.

We report a case of V ventricular cystic dilatation, presenting with specific neurological symptoms including low back pain, bilateral sciatica, weakness of dorsiflexion, and urinary retention. MRI showed a large cystic dilatation of the ventriculus terminalis. Surgical fenestration of the cyst allowed complete relief from symptoms and remission of the neurological deficit.

Conventional treatment for cervical disc herniations often defaults to open cervical discectomy, potentially supplemented by intervertebral fusion. Newer treatment strategies focus on percutaneous, minimally invasive procedures which are capable of resolving herniation pathology while offering decreased morbidity and convalescence time when compared to fusion. In cases where patients complain of radicular and neck pain symptoms related to a contained herniated disc, plasma disc decompression may be used as a minimally invasive treatment option on the cervical intervertebral discs.Three hundred and forty-nine patients who presented with a contained herniated cervical disc or focal protrusion causing pain associated with cervical nerve root compression were treated between January 2003 and May 2007. This case series study was conducted to evaluate clinical results through 1 year postoperatively.