Search

Anterior cervical discectomy has been performed for almost 50 years. Initially, bone grafts were used routinely, but soon their necessity was questioned. It remains disputed to this day. The aim was to establish whether there are grounds for basing choice of technique on individual patient data. The cervical spine radiographs of 148 patients who had undergone grafted or ungrafted anterior cervical discectomy were reviewed and changes in geometry at the operated level were measured. These data were then examined for any correlation between preoperative geometry, choice of operative technique and adverse clinical outcome. Disturbances to spinal geometry after ungrafted discectomy are minimal at disc heights below 4  mm. At and above 4  mm significant settlement and angulation occur. Complications in our series were fewer where small disc spaces were left ungrafted and larger ones grafted. Disc spaces below 4  mm should not be grafted, but spaces of 4  mm or more should. [ABSTRACT FROM AUTHOR]

Until recently, idiopathic anterior spinal cord herniation was thought to be vanishingly rare. It is an increasingly recognized, readily treatable, condition causing progressive thoracic myelopathy. We have operated on five cases and know of two other patients locally who are as yet undecided on surgery. We are aware of several other unpublished cases in the UK. The syndrome presents typically in middle age with a history of stepwise slowly progressive mid-thoracic anterior hemicord dysfunction characterized by hemianalgesia below the affected segment followed by asymmetric lower limb hypertonia, with initial sparing of posterior column sensation, that progresses through paraparesis to complete paraplegia. The radiological findings, although subtle, are equally typical and surgical repair is easily effected. With increasing clinical and radiological awareness, we believe the apparent incidence of this condition will increase. Idiopathic anterior spinal cord hernia is more common than currently appreciated, and should be positively considered and excluded in every case of progressive thoracic cord dysfunction. [ABSTRACT FROM AUTHOR]

This article presents a case report of skull fractures. A 40-year-old man presented with crush injury to his head and was fully conscious on admission but had an areflexic, marginally weak right upper limb with diminished sensation. CT revealed fractures of the left mastoid complex and left occipital condyle. Fractures of the skull base are commonly observed in head injury. Vascular injury is less common. If the base of skull fractures are anywhere near the vascular pathways, then there should be a very low threshold to perform a cerebral angiogram.

Bungee jumping has been exploited commercially for 13 years and proprietors claim a good safety record. However, published case reports document a wide variety of possible injuries. To this list, we add a report of a subdural haematoma sustained during a variant of the sport, the 'reverse' bungee jump. [ABSTRACT FROM AUTHOR]

'Safe Neurosurgery' a document setting out standards of practice in British neurosurgery was published in 1993. Three years later we have looked at how much of an impact this extremely important document has made. We have been disappointed to discover that overall there has been little change for the better. The paper illustrates the changes seen over the 3 years.

On 8 January 1989 at 20:25 h, a British Midland Boeing 737/400 on approach to East Midlands Airport crashed across the M1 motorway with the immediate loss of 39 lives from the 126 people on board. In the aftermath of the accident a clinical review was commenced to determine the mechanisms of injury in the 87 initial survivors and hopefully provide data to improve commercial aircraft safety in the future. Seventy-seven survivors sustained head and facial trauma in the crash, 45 of whom had periods of amnesia surrounding the event. Twenty-one received injuries from behind, including five of the six severely head-injured adults. Loss of consciousness and duration of amnesia were directly related to the degree of superficial head trauma. Adoption of the fully flexed brace position for crash-landing offered significant protection from head injury and concussion, and possibly reduced injuries from behind. Suggestions are made for potentially improving the survivability of aircraft accidents.