[Cervical myelopathy: retrospective analysis of surgical results in 53 cases treated by anterior cervical discectomy and interbody fusion]

PATIENTS AND METHODS

We perform a retrospective analysis of clinical results in 53 consecutive patients surgically treated for cervical myelopathy or myelo-radiculopathy with anterior cervical discectomy and interbody fusion by means of the Cloward procedure.

RESULTS

64.2% of the patients had good outcome as measured by the improvement in one or more grades in the Nurick's scale. No mortality related to the surgical procedure was noted, although 9.4% of the cases suffered neurological deterioration. Correct fusion was achieved in 92.5% of the patients, with a rate of post-surgical kyphosis of 9.4%. Multivariate analysis identified as factors related to the clinical outcome: age (p = 0.008), vascular risk factors (p = 0.031), duration of symptoms (p = 0.002), pre-surgical neurological status (p < 0.001), neuroradiological diagnosis (p = 0.014), intra-medullary high signal intensity changes in T2-weighted images (p = 0.008), prolongation of the central somato-sensory or motor conduction times (p = 0.004) and neurologic complications (p = 0.012)

CONCLUSIONS

Treatment optimisation of the patient suffering cervical spondylotic myelopathy requires individualised evaluation. Prospective randomised studies are needed to answer the questions when and how to operate.

[Anterior cervical diskectomy and interbody arthrodesis using Cloward technique: retrospective study of complications and radiological results of 167 cases]

PATIENTS AND METHODS

We performed a retrospective analysis of complications and radiological results in 167 patients surgically treated, for discal or spondylotic disease of the cervical spine, with Cloward procedure. Using uni and multivariate analysis, we tried to identify risk factors that might be correlated with surgical complications or radiological results.

RESULTS

Surgical treatment was indicated for cervical radiculopathy in 68% of the patients and for myelopathy or radiculomyelopathy in the remaining 32%. The pathologic disease responsible of the symptomatology was soft disk herniation in 59% of the cases and spondylotic changes in 41%. The patients that underwent surgery because of myelopathy were one decade older, had a longer symptomatic period and presented multi-segmentary spondylotic disease with higher frequency than patients affected of radiculopathy. The most common segments operated were CS-C6 (44.3%) and C6-C7 (30.5%). Surgical mortality was 0.6% and morbidity 29.3%. Most of the complications were transient, although 4.8% of the patients developed permanent neurological deterioration.

CONCLUSIONS

Complications were most commonly seen in the group of the patients undergoing surgery because of long-lasting myelopathy with multi-segmentary spondylotic disease, in those with vascular risk factors and in those operated of more than one segment. Surgeon anatomic knowledge and experience are critical for diminishing such complications. Non-union rate was 9.6%, and another 9.6% of the patients developed post-surgical kyphosis. Both factors correlated with the need of re-operation.

Three cases of ruptured intracranial aneurysm in a family

A family is reported in which three members had an aneurysm at the junction of the posterior cerebral artery and the carotid artery. Two patients harbonred symmetrically placed bilateral aneurysm each. The cases suggest a hereditary basis for its causation.

[Epidemiology and course of craniocerebral injuries in children in Cantabria]

We present the epidemiology and the outcome of the patients younger than 15 years-old who were admitted to our hospital during 1986 with the diagnosis of head injury. One hundred and fifty-five met the required inclusion criteria, this offers an incidence of head injury in children of 139/100,000. The boy/girl ratio was 2.1/1. The commonest causes were traffic accidents (45%), mainly those knocked down or on bicycles, and falls (41%). According to the Glasgow Coma Scale 88.5% of the head injuries were slight, only 11.5% being moderate or severe. The outcome was good in 97%. There were two intrahospital deaths, that happened in the 8 patients with severe head injury, giving a mortality rate of 25% for this group; and 5 deaths out of hospital. Thus, the global mortality secondary to head injury for children was 6.3/100,000 and year. These data show: a) the sanitary importance of the head injury in children; b) the necessity of a separate study of the head injury in children since the precipitating causes and the clinical outcome are specific; and c) the shortcomings in the urgent out of hospital medical attention, as indicates an out of hospital mortality rate of 71% which is well above that of other developed countries.