Cervical Spine Myelopathy from Metalloma Association with Chronic Retention of a Bullet

A Civilian gunshot wound associated with metallosis in the cervical spine region was an extremely rare case; hence, the clinician had difficulty with diagnosis and surgical treatment. A 57–year-old gentleman had a history of a gunshot wound injury going back 30 years. He presented with neck pain, progress of paresthesia of upper extremities and progressively difficult ambulation for 3 months. Radiographic and pathological diagnosis from tissue of the 7th paravertebral of the cervical spine showed foreign bodies consistent with metallosis. The patient showed improvement of symptoms after posterior cervical spine fixation and decompression. He had full recovery at 1 year follow up. Metallosis can occur in cases of chronic exposure to lead and metals. The results of this chronic process of metallosis will develop to metalloma, which then compresses the spinal cord and develops into myelopathy. The patient had a bullet, or piece of metal at the cervical spine, so surgical removal was performed to prevent further compression of the spinal cord from metalloma.

TRANSPEDICULAR FREE-HAND FIXATION IN THE SUBAXIAL CERVICAL SPINE

Objective. To analyze the results of surgical treatment of patients with injuries and diseases of the cervical spine operated on using transpedicular fixation with free-hand technique.Matherial and Methods. A total of 97 patients with unstable injuries, congenital and acquired deformities, as well as with tumorous lesions of the cervical spine were examined. All patients were evaluated for the stability and reliability of transpedicular fixation in the long-term period, with the analysis of mistakes and complications that arose during treatment.Results. Positive results were obtained in 94.8 % of cases, and signs of fixation instability were absent in all patients. Despite 125 cases of pedicle wall perforation, only four patients required revision surgeries. A low rate of complications was noted, including no damage to the vertebral artery. The pain syndrome in patients decreased.Conclusion. The obtained results prove high efficiency and sufficient safety of the free-hand technique for the cervical spine fixation. At the same time, the technique requires careful preoperative preparation and examination of patients, thorough knowledge of anatomy of the operated area, and experience and qualification of the surgeon.

Neurological outcome and postoperative stability after anterior cervical spine fixation by the use of cervical spine locking plate

Background: The fractures of cervical spine are divided into upper cervical spine (C1-C2) and lower cervical spine (C3-C7) also called sub axial cervical spine. Sub axial cervical injuries are common, ranging in severity from minor ligamentous strain or spinous process fracture to complete fracture dislocation with bone and ligament disruption, resulting in severe spinal cord injury. The objective of this study was to determine the neurological outcome and postoperative stability after anterior cervical spine fixation by the use of cervical spine locking plate (CSLP) attached with cancellous screws.Methods: This descriptive study was carried out in the Department of Neurosurgery, Nishtar Hospital, Multan, Pakistan. One hundred and fifteen patients fulfilled the inclusion criteria were selected. Patient of either gender more than 15 years of age and less than 60 years of age having unstable lower cervical spine injuries from C-3 to C 7 on X-ray underwent anterior cervical fixation.Results: Age range from 15 to 60 years with mean 32.34±standard deviation (SD) =12.06. The mean Frankel grading of the patients was 3.26±standard deviation (SD) =1.33. There were 97 (84.3%) male patients and 18 (15.7%) female patients. The neurological outcome was good in 107(89.6%) patients and poor in 12 (10.4%). The postoperative stability was YES in 109 (94.8%) patients and NO in 06 (5.2%). In the mode of injury there were 65 (56.5%) patients having road traffic accident, 41 (35.7%) patients having fall from tree/roof/stairs, 6 (65.2%) patients having fall of brick on the patient, 1 (0.9%) patient having Buffalo hit/animal contact, 2 (1.7%) patient having contact of head at floor of swimming pool after jumped in.Conclusions: It is concluded from this study that good results were achieved with the use of the CSLP. The use of anterior approach in treatment of the injured lower spine is safe and effective.

Occipital condyle to cervical spine fixation in the pediatric population

Fixation at the craniovertebral junction (CVJ) is necessary in a variety of pediatric clinical scenarios. Traditionally an occipital bone to cervical fusion is preformed, which requires a large amount of hardware to be placed on the occiput of a child. If a patient has previously undergone a posterior fossa decompression or requires a decompression at the time of the fusion procedure, it can be difficult to anchor a plate to the occipital bone. The authors propose a technique that can be used when faced with this difficult challenge by using the occipital condyle as a point of fixation for the construct. Adult cadaveric and a limited number of case studies have been published using occipital condyle (C-0) fixation. This work was adapted for the pediatric population. Between 2009 and 2012, 4 children underwent occipital condyle to axial or subaxial spine fixation. One patient had previously undergone posterior fossa surgery for tumor resection, and 1 required decompression at the time of operation. Two patients underwent preoperative deformity reduction using traction. One child had a Chiari malformation Type I. Each procedure was performed using polyaxial screw-rod constructs with intraoperative neuronavigation supplemented by a custom navigational drill guide. Smooth-shanked 3.5-mm polyaxial screws, ranging in length from 26 to 32 mm, were placed into the occipital condyles. All patients successfully underwent occipital condyle to cervical spine fixation. In 3 patients the construct extended from C-0 to C-2, and in 1 from C-0 to T-2. Patients with preoperative halo stabilization were placed in a cervical collar postoperatively. There were no new postoperative neurological deficits or vascular injuries. Each patient underwent postoperative CT, demonstrating excellent screw placement and evidence of solid fusion. Occipital condyle fixation is an effective option in pediatric patients requiring occipitocervical fusion for treatment of deformity and/or instability at the CVJ. The use of intraoperative neuronavigation allows for safe placement of screws into C-0, especially when faced with a challenging patient in whom fixation to the occipital bone is not possible or is less than ideal.