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  • ISSN: 2578-3181
    Early Online
    Volume 3, Issue 1
    Case Report
    Chengde Pham* and Jin W. Tee
    Cauda equina syndrome is a neurosurgical emergency that can be a diagnostic challenge as no single history or examination feature has been found to be pathognomonic. We present the case of a twenty-seven-year-old male presenting only with erectile dysfunction and found to have critical cauda equina compression from a large disc prolapse. Whilst sexual dysfunction is a recognized complication of spinal cord injury, the prevalence of erectile dysfunction as a presenting symptom of cauda equina compression is not known. Sexual histories are often poorly taken by clinicians and this case highlights that erectile dysfunction alone can signify cauda equina syndrome.
    Review Article
    Yukawa Y*, Nakashima H, Morita D, Matsumoto T, Ito K, Machino M, and Kato F
    Introduction: Surgical outcomes and complications in the patients, who underwent posterior spinal fusion with pedicle screws for unstable cervical spinal injuries, were investigated comparing plate systems and rod systems. The relative merits of plate systems (non-constrained type) and rod systems (constrained type) were discussed.
    Summary of Background Data: Cervical pedicle screw fixation is an effective procedure for stabilizing an unstable motion segments, however it has not widely been used because it has generally been considered too risky due to the potential risk for injury neurovascular structures, such as vertebral arteries, spinal cord or nerve roots. The authors reported a study to introduce the imaging technique in which pedicle axis views were obtained using fluoroscope to show the screw entry point matched with trajectory angle.
    Materials and Methods: A total of 200 consecutive patients (172 male and 28 female) who underwent pedicle screw fixation with pedicle axis view technique by fluoroscopy, were included in this study. The mean age of the patients at the time of surgery was 47±20 years (range 14-90). A hundred patients were treated with plate systems, and the other 100 with rod systems. Surgical outcomes such as operative time, blood loss, the number of fixed vertebra and the number of using pedicle screws were investigated. Screw malposition was classified either as Grade 0; intact, Grade I; screw exposure (<50% of the screw diameter outside the pedicle) or Grade II; pedicle perforation (>50% of the screw diameter outside the pedicle). Peri- and postoperative complications were also studied.
    Result: The mean operative time was 111(plate; 98, rod; 125) min and mean blood loss was 184(plate; 220, rod; 147) ml. of the 883 screws, 107 screws showed malposition (12% in total, 14% in plate system and 10% in rod system). And 71(8.0%) were in Grade I and 36 (4.1%) were in Grade II. There were 3 surgery-related complications: two penetrations into the vertebral artery by probe and one radiculopathy. There were 11 postoperative complications: 4 cases of instrumentation failure associated with loss of correction (three cases in plate systems and one case in rod systems), 4 cases with loss of correction (>10 degrees) and 3 deep wound infections.Pre- and postoperative tracheotomy was required in 27 patients (13.5%). However, the tracheotomies were easily performed, because those patients underwent posterior surgery alone without postoperative external fixation.
    Discussion and Conclusion: Cervical pedicle screw fixation using a fluoroscopy assisted pedicle axis view technique provided good clinical result in both plate and rod systems. Although 107 of 883 screws demonstrated screw malposition, the incidence of complications associated with instrumentation was relatively low. There were less surgery-related complications in rod systems, comparing plate systems.
    Putu Eka Mardhika, Made Bhuwana Putra, and Tjokorda GB Mahadewa*
    Background: Cervical spondylosis is a degenerative diseaseresulted from multi factorial degenerative changes. It can manifest as neck pain, radiculopathy and/ or myelopathy. Cervical laminoplasty is considered as one of the safest technique to treat cervical spondylosis. However, this technique also has several complications following the surgery. It is important for neurosurgeon to know the complications of this technique.
    Objectives: To determine the prevalence of complications following cervical unilateral open-door laminoplasty in cervical spondylosis patients through systematic review and meta-analysis. Methods: This review includes all full-text articles that examine cervical unilateral open-door laminoplasty in cervical spondylosis patients. PubMed Central, BioMed Central, and Public Library of Science database were searched using keyword “cervical laminoplasty”. Included article was assessed for risk of bias.
    Results: The prevalence of axial pain was 21%, C5 palsy was 6%, CSF leakage was 3%, hematoma was 2%, infection was 3%, Dural tear was 3%, and kyphosis was 10%. There was high heterogeneity between studies.
    Conclusions: The complication with highest prevalence was axial pain with 21% while hematoma was the lowest prevalence with 2%.
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