Spontaneous resolution of discal cyst around L5 nerve root: case report and review of literature.

The treatment of discal cysts is controversial, with different surgical options described in the literature. We present an interesting case of spontaneous resolution of a symptomatic discal cyst. Based on our case report, we recommend non-operative management in the first instance and an up-to-date MRI scan before contemplating surgery.

Anterior cervical corpectomy: review and comparison of results using titanium mesh cages and carbon fibre reinforced polymer cages.

Different types of cages have recently become available for reconstruction following anterior cervical corpectomy. We review the results using titanium mesh cages (TMC) and stackable CFRP (carbon fibre reinforced polymer) cages. Forty-two patients who underwent anterior cervical corpectomy between November 2001 and September 2008 were retrospectively reviewed. Pathologies included cervical spondylotic myelopathy (CSM), cervical radiculopathy, OPLL (ossified posterior longitudinal ligament), metastasis/primary bone tumour, rheumatoid arthritis and deformity correction. All patients were evaluated clinically and radiologically. Outcome was assessed on the basis of the Odom's criteria, neck disability index (NDI) and myelopathy disability index (MDI). Mean age was 60 years and mean follow-up was 1½ years. Majority of the patients had single-level corpectomy. Twenty-three patients had TMC cages while 19 patients had CFRP cages. The mean subsidence noted with TMC cage was 1.91 mm, while with the stackable CFRP cage it was 0.5 mm. This difference was statistically significant (p < 0.05). However, there was no statistically significant correlation noted between subsidence and clinical outcome (p > 0.05) or between subsidence and post-operative sagittal alignment (p > 0.05) in either of the groups. Three patients had significant subsidence (> 3 mm), one of whom was symptomatic. There were no hardware-related complications. On the basis of the Odom's criterion, 9 patients (21.4%) had an excellent outcome, 14 patients (33.3%) had a good outcome, 9 patients (21.4%) had a fair outcome and 5 patients (11.9%) had a poor outcome, i.e. symptoms and signs unchanged or exacerbated. Mean post-operative NDI was 26.27% and mean post-operative MDI was 19.31%. Fusion was noted in all 42 cases. Both TMC and stackable CFRP cages provide solid anterior column reconstruction with good outcome following anterior cervical corpectomy. However, more subsidence is noted with TMC cages though this might not significantly alter the clinical outcome unless the subsidence is significant (>3 mm).

Lumbar interspinous spacers: a systematic review of clinical and biomechanical evidence.

STUDY DESIGN: Systematic review. OBJECTIVE: To evaluate the current biomechanical and clinical evidence available on the use and effectiveness of lumbar interspinous devices and to recommend indications for their use. SUMMARY OF BACKGROUND DATA: Lumbar interspinous spacers (ISPs) have recently become popular as an alternative treatment for lumbar degenerative disease. Several spacers are currently available in the market and there have been various proposed indications. The relevant biomechanical and clinical papers are analyzed. METHODS: A systematic review of clinical and biomechanical studies was done using the following key words: interspinous implants, interspinous devices, interspinous spacers, dynamic stabilization, X-STOP, Coflex, Wallis, DIAM. The database inclusions were MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PubMed. The main outcome measure was clinical outcome assessment based on validated patient-related questionnaires. Biomechanical studies were analyzed to evaluate the effects of ISPs on the kinematics of the spine. The methodology of the clinical studies was also analyzed. RESULTS: Largest number of studies has been with the X-STOP device. The biomechanical studies with all the devices showed that ISPs have a beneficial effect on the kinematics of the degenerative spine. Apart from 2 randomized controlled trials, the other studies with the X-STOP device were not of high methodologic quality. Nevertheless, analysis of these studies showed that X-STOP may improve outcome when compared to nonoperative treatment in select group of patients aged 50 or over, with radiologically confirmed lumbar canal stenosis and neurogenic claudication, who have improvement of their symptoms in flexion. Studies on the other devices show satisfactory outcome to varying degrees. However, due to small number and poor design of the studies, it is difficult to clearly define indications for their use in lumbar degenerative disease. CONCLUSION: Lumbar ISPs may have a potential beneficial effect in select group of patients with degenerative disease of the lumbar spine. However, further good quality trials are needed to clearly outline the indications for their use.