Intraoperative Measurement of Endotracheal Tube Cuff Pressure and Its Change During Surgery in Correlation With Recurrent Laryngeal Nerve Palsies, Hoarseness, and Dysphagia After Anterior Cervical Discectomy and Fusion: A Prospective Randomized Controlled Trial.

STUDY DESIGN: Prospective randomized controlled trial. OBJECTIVES: Adjustment of endotracheal tube cuff pressure (ETCP) in anterior cervical discectomy and fusion (ACDF) may influence the incidence of complications such as recurrent laryngeal nerve palsy (RLNP), hoarseness, and dysphagia. METHODS: The prospective randomized controlled trial was designed to investigate the influence of ETCP on the incidence of postoperative complications. All eligible patients underwent vocal cord examination before and after ACDF and were randomized into a control group (CG) and intervention group (IG). Endotracheal tube cuff pressure was passively monitored in CG, and in IG, it was maintained at 20 mmHg. Outcomes were evaluated during hospitalization and during follow-up. RESULTS: A total of 98 patients were randomized, each group consisted of 49 patients. Statistical analysis showed that gender and age did not influence the incidence of complications. In CG, duration of retractor placement and extent of approach significantly impacted the occurrence of complications. The incidence of postoperative RLNP was 8.2% in IG and 12.2% in CG, hoarseness and dysphonia were present in 18.4% in IG and in 37.5% in CG, and dysphagia in 20.8% in IG and in 22.5% in CG. Hoarseness was significantly present more in CG (P = .018). Only one patient from CG presented with RLNP after 1 year, the remaining nine patients spontaneously recovered. CONCLUSIONS: Unregulated ETCP can lead to a significantly higher incidence of hoarseness; however, its improvement rate is 100%. The early postoperative complication rate was higher in CG, and after one year, 1 patient had RLNP and 1 patient had dysphagia.

Utility of Hounsfield units in predicting fusion rates of patients undergoing anterior odontoid screw fixation following Anderson d'Alonzo type II and shallow type III fractures.

BACKGROUND: Main objective of this study was to determine whether Hounsfield units (HU) measured in three areas of the axis correlate with successful fusion in patients with type II and shallow type III C2 fractures undergoing anterior odontoid screw osteosynthesis (AOSF). METHODS: Forty-five patients with C2 fractures treated via AOSF were analyzed. Only bony fusion with bone trabeculations across the fracture line was considered a successful result. Preoperative HU values were measured in three zones- corpus, watershed and dens. Statistical analysis was performed to determine significant differences between HU of fused and unfused patients in all three zones of a complete and adjusted patient cohort. RESULTS: Statistically significant differences of HU values were found between fused (corpus- 363.7, watershed- 327.9) and unfused (corpus- 279.5, watershed- 194.2) of the complete cohort and the adjusted cohort. Cut-off HU values in the watershed zone were calculated for the complete (250 and 300) and adjusted cohort (240 and 260), dividing patients into three groups of bone quality. Patients with high watershed bone quality (HU>300) achieved successful fusion in 84.62%, patients with low bone quality (HU<250) in 3.85% and patients with medium bone quality (HU 250-300) in 50%. CONCLUSIONS: Preoperative measurement of HU can be used to predict the probability of successful fusion in patients undergoing AOSF for type II and shallow type III C2 fractures. AOSF is a highly effective treatment modality in patients with watershed HU>300, whereas alternatives should be considered in patients with watershed HU<250.

Acute Progressive Pediatric Post-Traumatic Kyphotic Deformity.

Cervical kyphosis is a rare entity with challenging management due to the limitations of pediatric age, along with a growing spine. The pathogenesis is made up of a large group of congenital, syndromic and acquired deformities after posterior element deterioration or as a result of previous trauma or surgery. In rare progressive cases, kyphotic deformities may result in severe "chin-on-chest" deformities with severe limitations. The pathogenesis of progression to severe kyphotic deformity after minor hyperflexion trauma is not clear without an obvious MR pathology; it is most likely multifactorial. The authors present the case of a six-month progression of a pediatric cervical kyphotic deformity caused by a cervical spine hyperflexion injury, and an MR evaluation without the pathology of disc or major ligaments. Surgical therapy with a posterior fixation and fusion, together with the preservation of the anterior growing zones of the cervical spine, are potentially beneficial strategies to achieve an excellent curve correction and an optimal long-term clinical outcome in this age group.