European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Case Reports
Major neurological deficit following anterior cervical decompression and fusion: what is the next step?
Major neurological deficit following anterior cervical decompression and fusion (ACDF) is a rare event, with incidences of up to 0.2 % now reported. Post-operative MRI is mandatory to assess for ongoing compression of the cord. In the past, the deficit has often been attributed to oedema or overzealous intra-operative manipulation of the cord. Reperfusion injury is a more recent concept. We describe a case of acute cervical disc prolapse with progressive neurology, and the difficult decision making one is faced with when the neurological deficit continues to deteriorate post ACDF. ⋯ The management of patients in whom a neurological deficit has increased post-operatively is difficult. Urgent MRI scan is mandatory to assess for epidural haematoma which may need further decompression. Cord reperfusion injury is a diagnosis of exclusion. The difficulty the clinician faces is in interpreting the MRI for 'acceptable' decompression, and therefore excluding the need for further surgery.
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Determine the effects of dynamic injurious axial compression applied at various lateral eccentricities (lateral distance to the centre of the spine) on mechanical flexibilities and structural injury patterns of the cervical spine. ⋯ Dynamic axial compression loading of the cervical spine with high lateral eccentricities produced primarily soft tissue injuries resulting in more post-injury spinal flexibility in lateral bending and axial rotation than that associated with the bony fractures resulting from low eccentricity impacts.
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Management of C1-C2 instability is very challenging, especially when tumoral lesions are involved. ⋯ Literature is sparse on the treatment of major C1-C2 instability, especially when a secondary lesion is involved, the current case shows a successful treatment strategy with an original technique that was never described before in the literature. The patient was pain free at 1 year follow-up with a stable construct.
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The aim of this study was to investigate how the severity of operative invasion to the posterior muscular-ligament complex impacts postoperative cervical sagittal balance. ⋯ Open-door laminoplasty significantly affected postoperative cervical sagittal balance, with the cervical vertebra appearing to tilt forward. As the severity of surgical invasion to the posterior muscular-ligament complex increased, the loss of cervical sagittal balance also increased.
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Neuroblastoma is the most common extra-cranial solid tumour in children. Metastasis in children to the upper cervical spine are quite rare. ⋯ This is the first report of the use of a trans-oral approach to address a neuroblastoma lesion in the axial spine. This approach was used effectively to achieve local tumour clearance confirmed at 1-year follow-up. Pertinent information to the spinal surgeon on neuroblastoma and the use of the trans-oral approach to the axial spine are discussed.