[Our experience with the use of Active-C cervical prosthesis]. / Az Active-C nyaki porckorong-protézis használatával szerzett tapasztalataink.

BACKGROUND AND PURPOSE: The most widely used surgical procedure in the treatment of cervical spine disc hernias have been the anterior cervical discectomy and fusion for decades. The usage of cervical disc prostheses enabled us to preserve the movements of the affected segments, hereby reducing the overexertion of the adjacent vertebrae and discs. Our goal is to follow our patients operated with Active-C prosthesis (which is used in the Institute since 2010) to gather information about the change of their complaints and about the functioning and unwanted negative effects of the prostheses. Question - Is the usage of Active-C prosthesis an efficient procedure? METHODS: Between 2010 and 2013, performing the survey of neurological conditions and functional X-ray examinations. We measured the complaints of the patients using the Visual Analogue Scale, Neck Disability Index and Cervical Spine Outcomes Questionnaire. The control group consisted of patients who were operated in one segment using the fusion technique. RESULTS: In the study group according to the Neck Disability Index scale after 18 months, seven patients had no complaints, while twelve persons reported mild and the remaining six moderate complaints. In the control group, moderate complaints were present in four patients, while twelve patients reported mild complaints. The other eight persons showed no complaints. According to the results of the Visual Analogue Scale in the group of prosthesis, the degree of referred pain decreased from 8.6 to 1.84 one and a half years after the surgery. A decrease was observable in the case of axial pain too, from 6.6 down to 1.92 (p<0.01). In case of three from the twenty-five patients there was no sign of movement in the level of the prosthesis. CONCLUSION: According to the present short- and mediumterm studies, the usage of the cervical disc prosthesis can be considered as an efficient procedure, but at the same time the advantages can only be determined in the long run, therefore further following and studies are required.

Role of modified open-door laminoplasty in the treatment of multilevel cervical spinal stenosis: a retrospective analysis of 43 cases.

BACKGROUND AND PURPOSE: Symptomatic degenerative multilevel cervical spinal stenosis--beside other methods--is often treated using the open-door laminoplasty. This procedure aims to decompress the spinal cord and preserve the stability of the cervical spine. The efficiency and safety of the method was proved by numerous Japanese and American studies, also the technique related complications are well known. We treated 43 patients with symptomatic multilevel cervical spine stenosis using the open-door laminoplasty as a surgical procedure of choice in the National Institute of Clinical Neurosciences between 2009 and 2012. In this article we analyse our results and the related literature is discussed. METHODS: Symptomatic patients with a minimum of three-segment cervical spine stenosis and radiologically proved myelopathy or with electrophisiologically verified subclinical myelopathy were selected for laminoplasty. Patients in whom cervical kyphosis was present were operated on using laminectomy and posterior fusion. Postoperative control CT, MRI and/or X-ray images were made after the surgery and at six weeks, three, six and 12 months after the operation and in the same time neurological evaluation was performed. The modified Japanase Orthopaedic Association (mJOA) scale value was assigned to patients preoperatively, six weeks, three, six and 12 months after the operation. The statistical difference between the groups of data was tested by chi square test. RESULTS: The average follow-up time was 27 months (minimum seven, maximum 42). According to the mJOA scale, 26 patient's condition (61%) improved, in 13 cases (30%) remained unchanged, and in one case (2%) we detected neurological deterioration. We lost three patients during the follow up period. The median of mJOA preoperatively was 12 (minimum eight, maximum 18), while six week postoperative mJOA was 14 (minimum 10, maximum 17). Three, six and 12 months mean value of mJOA was 14 which shows that the improvement in patients' condition remained stable at one year after surgery. The difference was statistically significant (p < 0.05). The canal's average anteroposterior diameter on CT was 8.29 ± 0.92 mm at the level of C III, while after the operation we measured 15.16 ± 1.02 mm; 7.54 ± 0.62 mm at the level of C IV before, and 15.29 ± 0.2 mm after; 9.05 ± 0.48 mm at the level of C V before and 17.23 ± 0.4 mm after the surgery. The differences proved to be significant (p = 0.0001). CONCLUSION: According to our experiences the modified open-door laminoplasty is an efficient and safe method for the treatment of symptomatic multilevel cervical spinal stenosis.

Biportal endoscopic technique in the treatment of spinal stenosis: early clinical experiences and results.

OBJECTIVE: Minimally invasive procedures in spine surgery have undergone significant development in recent times. A demand emerged from both surgeons and patients to develop and perform these types of surgeries in order to prevent biomechanical and surgical complications. Our study aimed to present early clinical results of a biportal endoscopy technique in the treatment of degenerative spinal stenosis. METHOD: We created a retrospective database of patients who underwent biportal spinal endoscopic decompression at the National Institute of Clinical Neuroscience, Department of Neurosurgery, Semmelweis University, Budapest, Hungary, in 2019. The surgical steps of technique is discussed in details. RESULTS: Retrospectively, we identified and collected 21 patients in our retrospective analysis. The early results after endoscopic decompression were excellent, 17 patients (81%) mentioned good general comfort which coincided with small incisions and the preservation of posterior spinal muscles. Three patients (14%) mentioned good condition and minor postoperative pain which could be controlled with analgesics. One patients (5%) mentioned postoperative discomfort. The patients were controlled at 3, 6 and 9 months. The mean follow-up time was 7 months. DISCUSSION: Biportal endoscopic technique was developed to fulfil the requirements of minimally invasive techniques. Our results indicate this method may be highly effective for the treatment of lumbar spinal stenosis and an alternative to conventional microsurgical decompression; however, our study limited by its retrospective manner and small population size.

Management Strategy of Osteoblastomas Localized in the Occipitocervical Junction.

OBJECTIVE: The aim of this article was to analyze extracted patient data from the literature and highlight the best treatment options and survival outcomes for osteoblastomas in the occipitocervical region. METHODS: A systematic literature search method was used to select articles containing information about the demographic features, tumor location, treatment characteristics, adjuvant therapies, and follow-up time. RESULTS: From 25 articles, 31 cases of osteoblastoma in the occipitocervical junction were selected for analysis. Average patient age was 17 years (range, 5-57 years); there were 21 male (67%) and 10 female (33%) patients. All patients had cervical pain as the presenting symptom. Other symptoms included torticollis (0.13%) and sensory or motor neurologic deficits (0.16%). The average follow-up time was 41 months, and the local recurrence rate was 0.125%. Recommendations of each article are categorized and discussed in detail. CONCLUSIONS: Osteoblastoma is a rare entity in the occipitocervical region, so treatment experiences are limited and mostly based on case reports. To determine the best treatment for these lesions, osteoblastomas should be staged using the Enneking staging system; different methods may be recommended for different stages, and the feasibility of fusion depends on the remaining amount of bony structures and joints. Additional adjuvant therapies may be recommended only in special cases.

Para-split laminotomy: a rescue technique for split laminotomy approach in exploring intramedullary midline located pathologies.

OBJECTIVE: Conventional posterior approaches, which may involve multilevel laminectomies and facetectomies, may lead to spinal deformities, instability, and subluxation. We developed the multilevel spinous process splitting and distraction laminotomy technique, which is an option for approaching midline intramedullary spinal pathologies with preservation of mechanically relevant bone and muscle structures. In some cases, midline splitting is not feasible or convenient because of anatomical differences of spinous processes and laminas. Our objective was to develop a minimally invasive rescue approach technique that makes it possible to remove intramedullary lesions but does not increase the risk of damage to the crucial posterior stabilizers of the spine. METHODS: We used the para-split laminotomy technique for opening the spinal canal not in the midline but rather in the parasagittal plane. The technique can be combined with the basic split laminotomy technique. This novel technique was used in five adult patients with midline intramedullary pathologies of the cervical and cervicothoracic spine. RESULTS: The operating field under the microscope was sufficient for tumor removal according to the keyhole concept. The approach used did not affect the extent of resection or neurologic outcome. The average number of split laminae was 6 (range: 3-10). Average follow-up was 18 months (range: 13-36 months). Histologic results were as follows: two ependymomas, two astrocytomas, and one primitive neuroectodermal tumor (PNET). To confirm the extension of resection, all patients underwent postoperative magnetic resonance imaging evaluations. The resections were complete in the cases of two ependymomas, subtotal in one astrocytoma, and partial in the other astrocytoma case and the PNET case. Computed tomography scans showed the extension of para-split approaches and the moderately disturbed bony structures. Instability was detected in none of the patients on the flexion-extension lateral radiographs during the follow-up period. CONCLUSION: The minimally invasive multilevel para-split laminotomy approach as a rescue technique for split laminotomy is a safe and effective surgical procedure, suitable for exploring different intramedullary pathologies located in the midline of the spinal canal. This modified surgical approach fulfills the requirements of other minimally invasive techniques and lowers the risk of damage to the crucial posterior stabilizers of the spine; furthermore, disintegration of the vertebral arches and facet joints is reduced.