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Background: Type II odontoid fractures are mostly encountered in the elderly. Due to a high risk of non-union fractures in the case of conservative treatment, surgical fixation is widely recommended. Anterior odontoid screw fixation (AOSF) is a method that allows for a wide range of cervical mobility, and it is a relatively safe procedure that is recommended as the method of choice, although rare complications can be fatal when it leads to life-threatening oesophageal perforation., Purpose: The aim of this study is to present potential risk factors which lead to these rare complications, and possible methods of treatment., Methods: This article presents the case of a patient hospitalised in the Neurosurgery Department of St Lukas Hosital in Tarnów in 2016. A literature review was performed using PubMed; search criteria included the phrases 'odontoid fracture perforation' and 'anterior cervical spine perforation'. The search returned 235 articles, of which 55 publications were in line with the subject of this paper, with only 12 deemed appropriate for consideration., Result: The authors present the case of an elderly patient with a history of odontoid fracture. Ten weeks after primary AOSF, the patient came to the Neurosurgery Department due to expectorating screws. This implied the need for further examination and even oesophageal reconstructive surgery or another spinal surgery. In laryngological examination and in gastroscopy there were no signs of fistula. In this case conservative treatment was proceeded. Due to odontoid fracture, non-union cervical posterior stabilisation was necessary., Conclusion: Patients with oesophageal perforation should be treated with special care.

Background: Surgical treatment of odontoid fractures with posterior C1/C2 fusion always leads to severe limitations in mobility of the cervical spine and head., Purpose: To assess the mobility of the cervical spine in patients treated with various surgical methods after an axis body fracture., Material and Methods: A group of 61 subjects receiving surgical treatment in a group of 214 subjects treated for odontoid fractures at one ward of neurosurgery at a regional hospital. Studies also included odontoid peg and Hangman fractures. The range of motion of the head was compared to standards by the International Standard Orthopedic Measurements (ISOM) and to head mobility in a control group of 80 healthy subjects without any pathologies or complaints associated with the cervical spine. Ranges of motion were measured with the CROM goniometre with regard to flexion, extension, right and left lateral flexion and right and left rotation. The functional status was evaluated with Neck Disability Index (NDI) standard questionnaires indicated for patients with cervical spine pain., Results: Except for flexion and extension, patients after odontoid fractures had a statistically significantly smaller range of motion of the cervical spine in all planes compared to the control group and ISOM standards., Conclusions: Odontoid fractures lead to limitations in mobility of the cervical spine even after treatment with methods that in theory should preserve the C1/C2 mobility., (Copyright © 2017. Published by Elsevier Sp. z o.o.)

Background and Purpose: To analyze the changes in spino-pelvic parameters after surgical treatment of lumbar isthmic spondylolisthesis., Materials and Methods: Sixty patients recruited from a group of consecutive series of 128 cases with isthmic spondylolisthesis operated on between 2002 and 2012 in the Department of Neurosurgery, Tarnow, Poland. All patients were operated on by the same surgeon (the first author). Spino-pelvic parameters: PI, SS, PT, LSA, and LL were measured manually on standing lateral view radiograms. Patients were divided according to Spinal Deformity Study Group classification which we modified for means of analysis: (A) low-grade group: subgroups with balanced pelvis and unbalanced pelvis (instead of normal and high PI subgroups), (B) high-grade group: subgroups with balanced and unbalanced pelvis., Results: Twenty-nine patients had unbalanced pelvis before the operation. In 10 of them (34%), the procedure resulted in full correction of pelvis position meaning that they achieved balanced pelvis after the surgery. There were 6 patients with low-grade slip who had balanced pelvis preoperatively but showed unbalanced pelvis after the surgery but this loss of balanced pelvis did not affect the clinical outcome which overall was good among them. Patients with unbalanced pelvis presented changes towards restoration of spino-sacro-pelvic anatomy postoperatively: PT decreased while SS increased, although these changes were not statistically significant., Conclusion: Further studies are needed to confirm whether surgical correction of spino-pelvic parameters results in better clinical outcome in patients with isthmic spondylolisthesis., (Copyright © 2014 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

The authors present their experience in the minimally invasive posterior keyhole lumbar corpectomy with transpedicular stabilization. This technique involves the removal of the posterior part of the affected vertebral body with the pedicle screw fixation through four 2-3 cm long skin incisions on the back. Two cephalad skin incisions provide an approach for corpectomy and instrumentation of the upper pedicles of the construct. Two caudal skin incisions provide an approach for instrumentation of the lower pedicles of the construct. The minimum armamentarium requirement includes classic micro lumbar discectomy retractor set and intraoperative fluoroscopy. According to the authors' best knowledge this is the first minimally invasive posterior keyhole lumbar corpectomy ever reported in the literature (2002). This is also the first minimally invasive transpedicular fixation ever performed in Poland (2002). This technique was presented during EANS Congress (Lisbon, September 2003). Some reports have recently appeared in the literature on percutaneous pedicle screw fixation of the lumbar spine in non traumatic cases. A special instrumentarium system (Sextant by Medtronic) has been developed and used in this type of minimally invasive stabilization. Although this system has not been dedicated for spine fractures it is feasible in trauma cases. We have one case of L2 burst fracture fixed percutaneously with Sextant.

Developmental abnormalities or inflammatory disorders provoke deformations and instability of the craniocervical junction. The most dangerous results of these lesions are: sudden brainstem compression or cervical myelopathy. The authors propose the guidelines for surgical management of non-traumatic deformities caused by: a) rheumatoid arthritis of the spine, b) congenital anatomic changes of the occipit and odontoid. Main goals of surgical treatment are decompression and stabilization. The choice of surgical approach and method depends on pathology. It is very important to estimate individual anatomic changes and mobility--possibility of reduction. The authors discuss surgical methods actually used for fusion and decompression of the occipitocervical junction.