Anterior cervical discectomy and interbody fusion using titanium cage: report of early results

The aim of this study was to evaluate the early results of treatment of cervical disc diseases by anterior interbody fusion using titanium cage and allograft. The study included 22 patients with cervical disc disease. Some of them had more than one level operated, so, 26 disc level have been operated on. These patients had an anterior interbody fusion through an extrapharyngeal anterolateral approach. The fusion was augmented by titanium cage and milled allograft. The period of follow-up ranged from 6 months to 2 years. Patients were assessed using Odom's criteria. Post-operative assessment revealed excellent outcome in 2 patients [9.1%], good in 11 [50%], satisfactory in 8 [36.4%] and one patient with poor outcome. Post-operative complication included, one patient with superficial wound infection, change of voice in another patient, completely reversible dysphagia in two patients. Pseudoarthrosis occurs in one patient only, while one patient developed post-operative quadriplegia. It has been concluded that anterior decompression and interbody fusion is a promising option for cervical disc diseases, whether herniated disc or degenerative spondylosis. The chances for a sound fusion are better with the use of titanium cage and the post-operative morbidity is remarkably less with the use of allograft

Synovectomy of the knee. A comparative study between two post-operative regimens

The aim of this study was to compare the results of knee synovectomy with the use of two different post-operative regimens; cast immobilization then manipulation, and immediate continuous passive motion. It included 40 patients with rheumatoid knee synovitis. In all of them, open knee synovectomy was done through a midline skin incision. Post-operatively, patients were randomized into two groups; the first group [Cast group] included 20 patients who had a long leg cast applied for two weeks. After that, the cast was removed and the knee manipulated gently under general anaesthesia. In the second group [CPM group], continuous passive motion started immediately post-operatively, using CPM machine for three hours, three times daily, seven days a week. Knee swelling was assessed by measuring the mid-patellar circumference. The quadriceps muscle bulk was determined by measuring the mid-thigh circumference. The patients were followed-up at 3 months, 6 months and one year. At the final follow-up, the range of knee flexion was significantly better in patients of CPM group compared to those of immobilization group [93.6° and 91.5° respectively]. The knee joint swelling was less in CPM group [44.5 cm] than in cast group [45.2 cm], the difference was statistically significant. Quadriceps wasting was no significant between the two groups; 50.2 cm in the cast group, and 53.5 cm in CPM group. Wound gapping occurred in 3 patients in immobilization group and one patient in the CPM group. It was concluded that the use of continuous passive motion in the early post-operative period following open knee synovectomy is a reasonable choice

Early post-operative pulmonary function changes and complications after anterior spinal fusion and instrumentation for severe adolescent idiopathic thoracic scoliosis

The present study has concentrated only on the early changes in pulmonary functions and the incidence and types of postoperative pulmonary complications after anterior spinal procedures for patients with severe adolescent idiopathic scoliosis [AIS] to assess the course of recovery and safety of such procedures in this group of patients. Eighteen patients, all of them had severe AIS, with a mean age of 14.3 +/- 3.1 years and a mean Cobb angle of 64 +/- 14 degrees were included in this study. All the monitored pulmonary functions showed a statistically significant decrease one-week after the operation. In the one-month follow up, these functions showed some improvement, but still significantly lower than the preoperative values. It was concluded that the correction of the spine deformity in patients with severe adolescent idiopathic scoliosis by the anterior procedure is safe as regards the course of recovery and the early postoperative pulmonary complications