Cervical interbody xenograft with plate fixation: evaluation of fusion after 7 years of use in post-traumatic discoligamentous instability.

STUDY DESIGN: This retrospective study analyzed clinical and radiologic follow-up evaluations of cervical arthrodesis where interbody xenograft combined with internal fixation was used for management of post-traumatic discoligamentous instability. OBJECTIVES: To report results of use of xenograft to avoid the various disadvantages linked to the use of autologous or allogenous bone graft. SUMMARY OF BACKGROUND DATA: Ligamentous instability of the cervical spine is unlikely to heal in a high proportion of cases, and surgical arthrodesis is usually indicated. Anterior arthrodesis has proved to be a safe procedure, but many problems are associated with the use of autograft or allograft. Given the great number of xenograft procedures, there are relatively few reports in the literature. METHODS: A retrospective study analyzed a consecutive series of 52 patients presenting with post-traumatic discoligamentous instability of the cervical spine in which cervical interbody xenografts with plate fixations were done. Follow-up clinical evaluation for neck pain and radiologic evaluation for arthrodesis stability and xenograft fusion at various points in time were done. RESULTS: The long-term results in 41 patients were satisfactory: no infectious complications, extrusion, fracture, loss of height, or resorption of the graft. Seventy-five percent fusion was seen before 9 months after surgery, and 100% fusion was seen 3-18 months after surgery (average, 7.4 months). CONCLUSIONS: Interbody xenograft combined with a rigid plate fixation avoids the problems linked to autologous or allogenous bone graft and gives a safe and solid interbody fusion when arthrodesis is required in ligamentous instability of the cervical spine.

Pneumocephalus after thoracotomy.

BACKGROUND: Pneumocephalus is a well-known phenomenon in which a fistula between the thoracic cavity and the subarachnoid space is one of its rare etiologies. METHODS: We report a new case of pneumocephalus after thoracotomy and review eight similar cases in the literature. RESULTS: In all cases, an operation was carried out for an intrathoracic neoplasm located at the apex with chest wall invasion. In the presence of symptoms, the diagnosis of pneumocephalus and identification of the subarachnoid pleural fistula were differently supplied by radiographic and isotopic exams. In the follow-up, one patient was affected by meningitis and two patients died. CONCLUSIONS: The occurrence of pneumocephalus must be considered when neurologic problems emerge after thoracotomy. It appears that if conservative treatment fails, surgical closure of the fistula via thoracic or neurosurgical approach is indicated.

[Tuberculous spondylodiscitis. Diagnostic elements and value of MRI. Apropos of a cervical localization]. / Spondylodiscite tuberculeuse. Eléments du diagnostic et intérêt de l'IRM. A propos d'une localisation cervicale.

The authors report a case of tuberculous spondylodiscitis with an intracanalar ant retropharyngeal involvement. This pathology is recently increasing like the immunodeficiency syndromes. Cervical tissue compression and neurological signs are the main clinical findings. Among the radiological explorations of disco-vertebral infections, the value of MRI study is now admitted. Using of T1 and T2 weighted sequences and Gadolinium injection provides the positive diagnosis, and well visualizes the extent: low signal of vertebral body, decrease and low signal of discal space, prevertebral and retrovertebral enlargement with a low signal intensity of the abscess in T1 weighted sequence and enhancement following Gd-DTPA administration; high signal intensity of vertebral body, prevertebral and epidural masses and abscess in T2 weighted sequence. The authors describe the evolutive features of Pott's disease and the value of MRI in the post-therapeutic course: T1-signal increases while enhancement following Gd-DTPA administration decreases and T2-signal decreases. The differential diagnosis with chordomas, metastasis, and pyogenic spondylodiscitis is well assessed by MRI.

[Secondary localizations of cerebral glioblastoma. Pathogenic and anatomoclinical focus apropos of a case of multiple bone metastases disclosed by vertebral involvement]. / Les localisations secondaires du glioblastome cérébral. Mise au point pathogénique et anatomo-clinique. A propos d'un cas de métastases osseuses multiples révélé par une atteinte vertébrale.

This report describes a case of a cerebral glioblastoma with multiple metastases appeared two years after craniotomy and revealed by a diffuse vertebral involvement with a lumbo-sciatic pain. The experimental and clinical data from the literature about distant localizations of glioblastoma give the arguments for the rarity and the pathogenic modes of the natural course. The distant localizations of cerebral glioblastoma, identified by immunohistochemical staining for glial fibrillary acidic protein, occurred in young patients, late in the follow-up which the duration is longer than those of classical glioblastomas; their occurrence hasten the disease course. Two distinct oncological entities might be identified: metastases, using blood or lymphatic pathways, commonly from a supra-tentorial primary tumor, are facilitated by surgical treatment; their exclusive extraneural sites are usually symptomatic; grafts, by seeding via cerebrospinal fluid pathways, are spontaneous or facilitated by tumoral removal and are disseminated along the neuraxis; they occur frequently and are usually asymptomatic; when shunts induce them, it gives rise to symptomatic peritoneal seeding; they seem to concern poor invading primary glioblastomas. The extraneural (metastasis) or neuraxial (graft) sites and the ways of occurrence (spontaneous, or facilitated by craniotomy or induced by surgical shunts) allow to classify the distant localizations of glioblastoma in six pathogenic types.

[Chondrosarcoma of the skull base. Apropos of sphenotemporal localization and review of the literature]. / Chondrosarcome de la base du crâne. A propos d'une localisation sphéno-temporale et revue de la littérature.

The authors report a case of chondrosarcoma of the skull base with a myxoïd histology, developed from the right sphenotemporal junction. Twenty six months after enlarged tumour removal, there are no clinical or neuroradiological signs of recurrence. A review of the 180 published cases emphasizes the rarity of this tumour originating of the skull base synchondrosis and occurring in young patients. MRI forms the basis of the topographic work-up but does not formally distinguish it from chordoma. Diagnosis is confirmed by histology which establishes a prognostic scale. Immunohistochemistry eliminates chondroïd chordoma by demonstrating a mesenchymatous phenotype. Only enlarged tumour removal can prolong survival even though improvements have been made in high energy radiation therapy and radiosurgery. Cases of recurrence or rare metastasis are probably due to incomplete exeresis and in most cases linked to high grade histology tumours.

[An unusual cervical tumor: meningioma. Apropos of a case of petrous origin. Review of the literature of meningioma presenting as cervical mass]. / Une tumeur cervicale inhabituelle: le méningiome. A propos d'un cas d'origine pétreuse. Revue de la littérature du méningiome se présentant comme une masse cervicale.

Primary ectopic meningiomas are uncommon. The authors report a case of a 12-year-old boy with a meningioma presenting as a neck mass. The conclusion of the initial biopsy was chemodectoma, but on surgical resection, the tumour was found to have invaded the petrous bone. Post-operative follow-up was uneventful but magnetic resonance imagery revealed extension to the cerebello-pontine angle, the cavernous sinus, the tentorium and the falx. The authors discuss the main pathogenic hypotheses and the classification of ectopic meningiomas. Based on 62 similar cases reported in the literature, primary ectopic meningiomas are found most often in young subjects, with no female predominance, neurofibromatosis is often observed and angioblastic or malignant features are frequent. These tumours can be divided into 6 localizations (jugulo-carotid space, lymph nodes, parotid gland, thyroid gland, soft paravertebral tissues, skin) and into 3 pathogenic groups (solitary ectopic tumour of the neck, tumour of the neck connected to a cranial or spinal meningioma, metastasis). Meningioma of the jugulo-carotid space with connection to the skull base is the most frequent entity. Solitary ectopic meningiomas of the neck occur in only 1 out of 5 cases. In 2 out of 3 cases, the neck localization involves a connection to a cranial or spinal meningioma. In a few cases the neck mass is a metastasis. These findings suggest that a complete neuroradiological work-up is required. Prognosis depends on the completeness of the surgical resection and the histologic aggressiveness frequently encountered.

Crowned dens syndrome: a manifestation of hydroxy-apatite rheumatism.

Crowned dens syndrome is defined as an association of acute cervical pain and calcifications in the peri-odontoid space. The authors report one case of this rare localization of hydroxy-apatite rheumatism and review 12 similar cases in the literature. This disease affects only adult females. Patients present with inflammatory signs, can be treated with non-steroid anti-inflammatory drugs and recover without sequela. Calcium pyrophosphate dihydrate deposition can also lead to this syndrome. Other perioodontoid calcifications and ossifications, usually asymptomatic, appear only as a radiologically crowned dens.