Surgical treatment of craniocervical instability: comparison of two constructs regarding clinical and radiological outcomes of 100 patients.

PURPOSE: There is an increased demand for surgical solutions to treat craniocervical instability. This retrospective study demonstrates the clinical and radiological outcomes of unstable craniocervical junction treated with occipitocervical fusion. MATERIAL AND METHODS: The mean age of 52 females and 48 males was 56.89 years. The clinical and radiological outcomes were assessed, including NDI, VAS, ASIA score, imaging, complications and bony fusion in two used constructs: a modern occipital plate-rod-screw system (n = 59) and previous bilateral contoured titanium reconstruction plates-screws (n = 41). RESULTS: Clinically and on imaging, patients presented with neck pain, myelopathy, radiculopathy, vascular symptoms and craniocervical instability. The mean follow-up was 6.47 years. A solid bony fusion was achieved in 93.81% of the patients. The NDI and the VAS improved significantly from 28.3 and 7.67 at the presentation to 16.2 and 3.47 at the final follow-up. The anterior and posterior atlantodental interval (AADI and PADI), the clivus canal angle (CCA), the occipitoaxial angle (OC2A) and the posterior occipitocervical angle (POCA) improved significantly. Six patients required early revision. CONCLUSION: Occipitocervical fusion can yield excellent results regarding clinical improvement and long-term stability with a high fusion rate. Simple reconstruction plates, though more demanding surgically, achieve similar results. Preserving a neutral patient's position for fixation avoids postoperative dysphagia and may help prevent adjacent segment disease development.

Infraclavicular arterio-arterial prosthetic loop is a safe and effective vascular access technique for haemodialysis in frail patients: a prospective observational study.

Vascular access failure causes significant morbidity among end stage renal failure patients. With the increased life expectancy and frailty of those patients, maintaining vascular access became a great challenge. In this study, we assess the short and midterm outcomes of infraclavicular arterio-arterial prosthetic loop (IAAPL) as vascular access for haemodialysis in frail patients who have exhausted conventional vascular access methods. A prospective observational study of 43 patients undergoing IAAPL was conducted in a single centre between May 2017 and March 2020. Primary, assisted primary and secondary patency rates were recorded in addition to complications and patient compliance with access. The achieved primary, assisted primary and secondary patency rates at 6 months are 87.5%, 95%, 97.5% respectively, at one year, corresponding rates were 75%, 83.3%, 94.4% and at 18 months they were 68.6%, 77.1%, 85.7% respectively. There was no procedure related mortality and life-threatening complications during the study period. So we can assume that infraclavicular AAPL is a safe and effective method of obtaining alternative vascular access for hemodialysis in frail patients for whom the conventional vascular access for hemodialysis is not suitable or contraindicated.