Rheumatoid atlantoaxial instability treated by anterior transarticular C1-C2 fixation. Case report.

The authors present a case that demonstrates the usefulness of anterior transarticular screw fixation in the treatment of instability due to rheumatoid arthritis. The surgical technique of this infrequently used procedure is presented. A 35-year-old female patient with medical history significant for rheumatoid arthritis complained of persistent headache and upper neck pain. Examination revealed a decreased range of cervical rotational motion. Magnetic resonance imaging of the cervical spine revealed anterior displacement of C1, destruction of the left lateral atlantoaxial articulation and bony erosion of the C2 vertebral body below the base of the odontoid. Dynamic radiographs showed increased C1-C2 mobility. The authors used a right anterolateral approach to the cervical spine to perform fixation of lateral atlantoaxial articulations by means of titanium cannulated compressive screws. On 4-month follow-up examination, successful C1-C2 stabilization was documented. Despite restriction of neck rotation, the patient reported satisfactory improvement and re-turned to work.

[Direct fixation of odontoid process base fractures]. / Bezposrednie zespolenie zlaman podstawy zeba kregu obrotowego.

Fractures of the base of odontoid process are serious spinal injuries. Their treatment still remains controversial. External rigid immobilisation is the way of conservative healing. Operations by posterior approach: posterior atlantoaxial fixation, atlantoaxial transarticular screw fixation or even occipitocervical fixation limit range of head motion. Direct odontoid screw fixation preserves normal motion of C1-C2 junction. Success of this method depends on proper patients selection. The authors present description of surgical technique based on literature review and their own experience. The authors perform odontoid fixation by means of single cannulated cancellous screw guided by K-wire. This wire provides stability of broken odontoid process during procedure of screw insertion. Old fracture--1 case in author's experience--has been curetted before fixation. The authors reviewed clinical efficacity and results of direct odontoid screw fixation published in current literature.

[Percutaneous vertebral surgery. Indications, technics and possibilities]. / Przezskórna plastyka kregów. Wskazania, technika i mozliwosci.

UNLABELLED: The authors report their own experience with percutaneous vertebroplasty, one of the so called--minimally invasive methods, used to treat a certain group of spinal lesions affecting the vertebral bodies. The paper contains a brief review of the current literature, basic problems, indications and operative technique. The authors remark, that insertion of the needle into the vertebral body gives an access for biopsy before cement injection. This procedure was realised in the case of diagnostic uncertainty. Technical details of transpedicular biopsy are described. The authors present 2 representative cases. FIRST CASE: a female with pathologic fracture of the Th7 vertebral body of osteoporotic origin. TREATMENT: combination of biopsy and vertebroplasty by percutaneous transpedicular approach. Second case: a female with cancer metastasis in L1 vertebral body, vertebroplasty was performed to support the anterior spinal column. Needle insertion was controlled either by radiofluoroscopy or by CT. The authors confirm pain relief related to vertebroplasty.

[Anterior interbody fusion of cervical spine with case-plate PCB]. / Przednia stabilizacja miedzytrzonowa kregoslupa szyjnego implantem typu cage-plytka PCB--prezentacja przypadków.

Two cases with cervical discopathy and radiculopathy are presented. Discectomy and anterior interbody fusion with cage-plate PCB manufactured by French company Scient'x was performed. Authors present the shape of the implant and technical details of implantation. The paper discusses the advantages of the PCB which simplifies and shortens the operation procedure, minimizes the risk of traditional bone graft harvesting and provides immediate stabilization of the operated segment.

Effect of ochratoxin A (OTA) on the activity of some enzymes in developing eggs ofAscaris suum.

The studies focused on the effect of 1-ppm ochratoxin A solution on the activity of some enzymes during successive embryogenesis stages ofAscaris suum. As a result of OTA-affected incubation ofA suum eggs, inhibition of AcP reactions was observed throughout the embryonic development, reduction in of SDH and LDH activity during cleavage and gastrulation, and enhancement of the SDH and LDH activity was found in larvae. Moreover, inhibition of the processes of cleavage, gastrulation and organogenesis was recorded. The observed morphological and metabolic embryo disorders demonstrated teratogenic properties of the studied mycotoxin, and the presence of granules of various sizes in the developing eggs may indicate that OTA penetrated into the eggs.

[Intradural spinal cysticercosis provoking radicular symptoms]. / Przypadek wewnatrzoponowej cysticerkozy ogona konskiego z objawami korzeniowymi.

The authors describe a case of spinal intracanal cysticercosis. The cysts were situated intradurally, provoking radicular symptoms: pain, paresis. CT investigations showed herniation of discs L4/L5 and L5/S1 interpreted as the cause of the mentioned symptoms. Surgical treatment included discectomy L4/L5 and L5/S1. Recurrence of symptoms was investigated by means of MRI showing the presence of cysts situated among cauda equina roots. Intraoperative finding--cysticercosis was confirmed by pathologic investigation.

[The case of severe craniocervical dislocation due to rheumatoid arthritis]. / Przypadek powaznej dyslokacji pogranicza czaszkowo-kregoslupowego na tle reumatoidalnego zapalenia stawów.

UNLABELLED: The authors describe a case of craniocervical dislocation secondary to rheumatoid arthritis producing important canal narrowing: ventrally by migrated odontoid and dorsally by posterior arch of C-1 with medullary compression. Symptoms of hyperreflexia, spasticity and left hemiparesis with Babinski sign were present. SURGICAL PROCEDURE: transoral odontoidectomy was performed followed by suboccipital approach, C-1 laminectomy and occipitocervical fixation (Olerud device and bone graft). Outcome with neurologic improvement. CONCLUSIONS: Transoral odontoidectomy combined with occipitocervical decompression and fixation is effective approach for treatment of severe craniocerebral dislocation. Its advantages: ventral and dorsal decompression combined with immediate stabilisation.

[Posttraumatic ectopic calcification as an additional pathologic factor of brachial plexus palsy]. / Pourazowe wapnienie ektopowe jako dodatkowy czynnik patologiczny porazenia splotu ramiennego.

The authors describe a case of a 54-year-old male, who was attacked with a broken bottle and wounded in left supraclavicular region. No neurologic deficit was observed immediately after injury. Some days later signs of upper trunk brachial plexus palsy were detected. Gradually symptoms of the Erb syndrome have developed. He was operated on 5 months after injury. During surgery no discontinuity of the brachial plexus was found. Unexpectedly there were an inner scar and free bony fragment compressing the upper trunk and the suprascapular nerve. Both the scar and bony fragment were carefully dissected and removed. Result of surgery: pain relief, restoration of normal sensation and partial restoration of biceps function.

Mechanical properties of the human brachial plexus.

This study shows measurements of force and elongation during experimental traction of human brachial plexus. Experiments were realised on fresh cadaveric specimens, mechanism of traction injury of brachial plexus was simulated. Predominant lesion provoked by direct lateral traction of isolated brachial plexus was avulsion of the roots. Epineural mechanical failure as first lesion occurred at anterior margin of avulsed roots in the proximity of intervertebral foramen. The force leading to rupture of brachial plexus ranged between 217.7N-546.3N, stress value between 1.3 N/mm2-3.5 N/mm2. Elongation until rupture was 19.6%-58.8% of initial length.

Conception of the cervico-brachial protector for motorcycle drivers.

The increasing popularity of motorcycles increases the role of motorcycle accidents as a main cause of brachial plexus injuries. In view of the high social cost of treatment of the victims it seemed desirable to devise some kind of protective clothing for motorcyclists. The protective clothing devised by teams from Department of Neurosurgery, TRICOTEXTIL--and Aeronautics and Applied Mechanics Institute, consists of the following parts: cervical collar--acting against force causing lateral bending and extension of cervical spine, shock-absorptive shoulder pads--acting against the impact energy partially absorbing it and partially transmitting to the dorsal stiff bar, dorsal stiff bar and sacroiliac belt--partially immobilizes the thoracic and lumbar spine, acts against its compression, transmits the impact energy to the iliac crests and hips. The expected biomechanical effects of the cervico-brachial protector are as follows: In brachial region it should diminish the impact energy by its partial absorption and partial transmission along dorsal stiff bar to sacroiliac belt. It should act against excessive cervical spine motion--mainly against lateral bending and extension. It should act against excessive depression of the shoulder. The protective system built in the jacket should co-operate with the helmet of motorcycle driver. It should be comfortable for the driver and conform to security standards. Prototype of the protector underwent kinetic sledge tests in Industrial Motorization Institute (PIMOT), Warsaw, with the use of Hybrid Dummy II.

[Fixating techniques of craniocervical junction: selection criteria]. / Metody stabilizacji pogranicza czaszkowo-kregoslupowego--kryteria doboru.

Adequate choice of fixation technique at craniocervical junction depends on many factors: anatomical conditions at fusion site (e.g. anterior dislocations of the odontoid and rupture of the transverse ligament are contraindications for direct odontoid screw fixation. Sublaminar wiring and interlaminar clamps are useless in case of deficiency of posterior bony elements of C1 and C2 whether a result of laminectomy or destruction), bone quality (osteopenic bone is contraindication for screw techniques either transarticular or transpedicular). Enclosing of occipital bone into instrumentation may be difficult in wire and clamping techniques. In contrast screw techniques allow for easy grip the occipital bone. Screw techniques seem ideal in cases requiring enclosing of the occipital bone. The fusion rate at C1/C2 level seems independent of fixation techniques. When supplemented with external immobilization even biomechanically inferior wiring or interlaminar clamping provide nearly 100 rate of fusion. Screw techniques are technically demanding but they seem the method of choice when occipital bone is to be enclosed in instrumentation.

[The application of intervertebral implant for spine stabilization]. / Zastosowanie wszczepu miedzytrzonowego do stabilizacji kregoslupa.

UNLABELLED: The purpose of this study is determination of efficacy of the SOCON posterior device combined with PROSPACE PLIF interbody fusion system in the treatment of lumbar spondylolisthesis. Both devices are fabricated by Aesculap AG. Lumbar interbody fusion is a surgical technique used to create local spinal stability. Recently there is a wide group of interbody implants made of different osteoconductive materials. The authors present brief classification of lumbar interbody fusion implants. The 1 case of spondylolisthesis L5/S1 is analyzed including operative technique and outcome. CONCLUSION: PROSPACE is effective as interbody support and fusion element.