We describe our experience of 600 patients with progressive post-traumatic myelopathy, predominantly of the cystic type. The aetiology, clinical and radiological features and treatment are described and discussed.

Oesophageal perforations associated with cervical fractures occur from a variety of injuries. Fractures of the cervical spine, blunt trauma and penetrating injuries such as gunshot wounds, knives and missiles, perforate the cervical oesophagus. This retrospective study consists of 24 patients with an oesophageal perforation and cervical fracture. Motor vehicle accidents were responsible for 54% of the oesophageal perforations. The other oesophageal injuries were related to ante rior spine surgery, gunshot wounds and sports-related activities. The clinical features related to these injuries included the obvious signs of an oesophageal perforation as well as fever of unknown origin, leukocytosis and unexplained persistent tachycardia. A variety of techniques was used to establish the diagnosis. All the patients had treatment for the cervical fracture and 20 patients required surgical repair of the oesophagus. The most common oesophageal complications were stricture of the oesophagus (54%) and oesophageal diver ticulum (10%). The other complications were atelectasis, pneumonia, tracheo bronchitis, pulmonary embolism, cervical osteomyelitis, cervical abscess, medias tinitis, septicemia and cervical fistulae. These patients have a serious life threatening illness that may be difficult to diagnose and treat.

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A new surgical method, myelocyst-peritoneal shunt, has been performed on a small series of patients with congenital and acquired spinal cord cysts. In all cases, the progressive deterioration of neurological function ceased and all patients had slight to significant objective and/or subjective improvement in neurological function. The technical method is described along with individual case reports. Due to the short length of follow-up, the small number of operations, and the tendency for spinal cord cysts to spontaneously improve, the author discussed only potential advantages and disadvantages of this procedure as compared to prior spinal cord cyst operations. The creation of an in vitro human module spinal cord cyst by means of this operation has made it possible for the author to perform more basic ongoing investigation into the pathophysiology of spinal cord cysts and other similar disorders.