Treatment of cervical disc disease using Cloward's technique. Part V. The effect of reoperations.

Among 1,106 patients with cervical disc disease in whom Cloward's operation had been performed over a fifteen-year period, 145 patients were reoperated upon with a new Cloward procedure. In the 1st year after the first operation 3/4 of the patients were operated upon on the previous level, whereas reoperations performed later mainly were done on new levels. The effect of the reoperation was poorer than the effect of the 1st operation. Early reoperations--which were due to: an initially unsatisfactory clinical course, postoperative complications or graft problems--had a poor result, but late reoperations--which were caused by relapses--showed a result corresponding to the first operation. The frequency of relapses leading to a 2nd Cloward operation was 8.8% in the first year falling to 0.2% in the following years of observation.

Treatment of cervical disc disease using Cloward's technique. The prognostic value of clinical preoperative data in 1,106 patients.

During a fifteen-year period 1,106 patients underwent Cloward's operation due to cervical disc disease. An analysis of the clinical features showed that the diseases had a very complex pattern of symptoms and signs. In young patients a syndrome of herniated disc predominated whereas a clinical picture of "cervical spondylosis" was found more often in the elderly. It was demonstrated that best results were obtained in young patients, patients with slight symptoms and patients with monoradicular symptoms. A short duration of symptoms is essential for a good outcome, and, on the basis of the data presented, operation is recommended 3 months after the onset of symptoms of cervical disc disease, if previous conservative treatment has failed.

Treatment of cervical disc disease using Cloward's technique. III. Evaluation of cervical spondylotic myelopathy in 138 cases.

Among 1,106 patients with cervical disc disease treated with Cloward's operation over a fifteen-year period, 138 patients had symptoms and signs of spinal cord involvement. The median symptom duration was one year. Nearly all had gait disturbances, 63% had spasticity of the lower extremities and 11% had various degrees of tetraplegia. Three months after surgery 78% of the patients were found to have some symptoms, but only 5% had no symptoms at all. At the time of the questionnaire (average 7.7 years postoperatively) 46% of the patients stated they were still affected by the operation. The duration of preoperative symptoms was of significance to the outcome, but age, sex, and severity of myelopathy were not. It was demonstrated that patients with medullary involvement had a higher annual mortality rate than patients with radicular symptoms, and that this rate depended on the severity of the spinal cord symptoms.

Treatment of cervical disc disease using Cloward's technique. I. General results, effect of different operative methods and complications in 1,106 patients.

During the period from April, 1965, to October, 1979, 1,106 patients with symptoms or signs of cervical disc disease were operated on using Cloward's technique. 94% of the patients alive filled in a questionnaire forwarded on October, 1980. The study revealed that 81% experienced an immediate effect of the operation, and 63% were in a better condition than preoperatively at the time of the questionnaire. It appeared that the effect of the operation 1 year postoperatively was independent of age and observation time, but the functional result and postoperative working capacity were very significantly better in young patients, but still independent of observation time. The result was independent of the number of primarily inserted grafts, cutting of the posterior spinal ligament or the finding of a free herniated disc. Use of calf bone grafts resulted in more reoperations. Primary complications were registered in 13% of the patients, reduced to 5% after 3 months. 3 patients developed a severe tetraplegia, and 6 patients died within 3 months of the operation.

Primary brain stem tumours.

The material consisted of 31 patients with primary brain stem tumours who were investigated retrospectively. Twenty patients were younger than 16 years of age (range: 1 1/2-65 years). The mean age was 11 years. The female/male sex ratio was 19/12. Histological diagnoses were available for 18 patients. All of the verified tumours were gliomas. The diagnoses in 12 cases were made by section or biopsy; in 15 by standard clinical and radiological examinations and in 4 by exploratory operations. Headaches, mental changes, speech and gait disturbances were the most common symptoms at the onset of the illness and at the time of diagnosis. The mean latency period between the emergence of symptom(s) until diagnosis was 4 months (range: 1/2-48 months). Amongst the dominant objective findings were failure of the V, VI and VII cranial nerves, pyramidal tract symptoms, ataxia and nystagmus, occurring singly or in combination. Pneumoencephalograms disclosed characteristic changes in 25 patients (83%). Fourteen patients (45%) received radiation treatment, from which 5 (36%) obtained a temporary remission in their symptoms. The postdiagnostic mean survival period for the patients was 15 months (range: 0-92 months). The survival time was found to depend on the number of damaged cranial nerve nuclei at the time of diagnosis and on the degree of severity and duration of the accompanying hydrocephalus. The prognosis was unfavourable, as the percentage of patients who survived for 2 years was only 6%, and a total duration of illness longer than 2 years occurred in only 7 patients. None of the patients were still surviving at the conclusion of this investigation.