Jarle Sundseth

Immediate (0–6 h), early (6–72 h) and late (>72 h) complications after anterior cervical discectomy with fusion for cervical disc degeneration; discharge six hours after operation is feasible

SummaryObjectives. The introduction of minimally invasive techniques and total intravenous anaesthesia has led to reports of the performance of anterior cervical discectomy and fusion as an outpatient. The safety of this approach, requires information about the complications presenting within this period. The aim of this study was to assess the rates and types of immediate (0–6 h), early (6–72 h) and late (>72 h) complications after anterior cervical discectomy with fusion.Methods. We prospectively studied complications after anterior cervical discectomy with fusion in patients with degenerative cervical disc disease. There were 390 consecutive operations: 278 fused with autologous iliac crest bone graft and 112 with a PEEK (Polyetheretherketone) graft.Results. No patient died. Thirty seven patients (9%) experienced one or more complications that could be related to the operation. These presented in the immediate, early and late periods in 17, 1 and 19 patients, respectively. Thus, 18/37 complications were detected before discharge from the neurosurgical department 48–72 h after operation and of these 17 (4.2%) were detected within the first 6 h after surgery. Each of the five potentially life-threatening neck hematomas was detected within 6 h (immediate).Conclusions. After anterior cervical discectomy and fusion, a 6 h postoperative observation period followed by discharge from the neurosurgical unit is likely to be as safe as observation as an inpatient for a longer period.

Surgical mortality and complications leading to reoperation in 318 consecutive posterior decompressions for cervical spondylotic myelopathy.

Halvorsen CM, Lied B, Harr ME, Rønning P, Sundseth J, Kolstad F, Helseth E. Surgical mortality and complications leading to reoperation in 318 consecutive posterior decompressions for cervical spondylotic myelopathy.
Acta Neurol Scand: 2011: 123: 358–365.
© 2010 John Wiley & Sons A/S.

prefabricated patient-Matched cranial Implants for Reconstruction of Large skull Defects

Cranial defects can be caused by injury, infection, or tumor invasion. Large defects should be reconstructed to protect the brain and normalize the cerebral hemodynamics. The conventional method is to cover the defect with bone cement. Custom-made implants designed for the individual patient are now available. We report our experience with one such product in patients with large cranial defects (>7.6 cm in diameter). A CT scan with 2 mm slices and a three-dimensional reconstruction were obtained from the patient. This information was dispatched to the company and used as a template to form the implant. The cranial implant was received within four weeks. From 2005 to 2010, custom-made cranial implants were used in 13 patients with large cranial defects. In 10 of the 13 patients, secondary deep infection was the cause of the cranial defect. All the implants fitted well or very well to the defect. No infections were seen after implantation; however, one patient was reoperated on for an epidural hematoma. A custom-made cranial implant is considerably more expensive than an implant made of bone cement, but ensures that the defect is optimally covered. The use of custom-made implants is straightforward and timesaving, and they provide an excellent medical and cosmetic result.

Idiopathic Ventral Spinal Cord Herniation: An Increasingly Recognized Cause of Thoracic Myelopathy

Idiopathic spinal cord herniation (ISCH), where a segment of the spinal cord has herniated through a ventral defect in the dura, is a rarely encountered cause of thoracic myelopathy. The purpose of our study was to increase the clinical awareness of this condition by presenting our experience with seven consecutive cases treated in our department since 2005. All the patients developed pronounced spastic paraparesis or Brown-Séquard syndrome for several years (mean, 4.7 years) prior to diagnosis. MRI was consistent with a transdural spinal cord herniation in the mid-thoracic region in all the cases. The patients underwent surgical reduction of the herniated spinal cord and closure of the dural defect using an artificial dural patch. At follow-up, three patients experienced considerable clinical improvement, one had slight improvement, one had transient improvement, and two were unchanged. Two of the four patients with sphincter dysfunction regained sphincter control. MRI showed realignment of the spinal cord in all the patients. ISCH is probably a more common cause of thoracic myelopathy than previously recognized. The patients usually develop progressive myelopathy for several years before the correct diagnosis is made. Early diagnosis is important in order to treat the patients before the myelopathy has become advanced.

Magnetic resonance imaging evaluation after implantation of a titanium cervical disc prosthesis: a comparison of 1.5 and 3 Tesla magnet strength.

PurposeCervical disc prostheses induce significant amount of artifact in magnetic resonance imaging which may complicate radiologic follow-up after surgery. The purpose of this study was to investigate as to what extent the artifact, induced by the frequently used Discover® cervical disc prosthesis, impedes interpretation of the MR images at operated and adjacent levels in 1.5 and 3 Tesla MR.MethodsTen subsequent patients were investigated in both 1.5 and 3 Tesla MR with standard image sequences one year following anterior cervical discectomy with arthroplasty.Outcome measuresTwo neuroradiologists evaluated the images by consensus. Emphasis was made on signal changes in medulla at all levels and visualization of root canals at operated and adjacent levels. A “blur artifact ratio” was calculated and defined as the height of the artifact on T1 sagittal images related to the operated level.ResultsThe artifacts induced in 1.5 and 3 Tesla MR were of entirely different character and evaluation of the spinal cord at operated level was impossible in both magnets. Artifacts also made the root canals difficult to assess at operated level and more pronounced in the 3 Tesla MR. At the adjacent levels however, the spinal cord and root canals were completely visualized in all patients. The “blur artifact” induced at operated level was also more pronounced in the 3 Tesla MR.ConclusionsThe artifact induced by the Discover® titanium disc prosthesis in both 1.5 and 3 Tesla MR, makes interpretation of the spinal cord impossible and visualization of the root canals difficult at operated level. Adjusting the MR sequences to produce the least amount of artifact is important.

Predictors of early in-hospital death after decompressive craniectomy in swollen middle cerebral artery infarction

BackgroundSwollen middle cerebral artery infarction is a life-threatening disease and decompressive craniectomy is improving survival significantly. Despite decompressive surgery, however, many patients are not discharged from the hospital alive. We therefore wanted to search for predictors of early in-hospital death after craniectomy in swollen middle cerebral artery infarction.MethodsAll patients operated with decompressive craniectomy due to swollen middle cerebral artery infarction at the Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Oslo, Norway, between May 1998 and October 2010, were included. Binary logistic regression analyses were performed and candidate variables were age, sex, time from stroke onset to decompressive craniectomy, NIHSS on admission, infarction territory, pineal gland displacement, reduction of pineal gland displacement after surgery, and craniectomy size.ResultsFourteen out of 45 patients (31%) died during the primary hospitalization (range, 3–44 days). In the multivariate logistic regression model, middle cerebral artery infarction with additional anterior and/or posterior cerebral artery territory involvement was found as the only significant predictor of early in-hospital death (OR, 12.7; 95% CI, 0.01–0.77; p = 0.029).ConclusionsThe present study identified additional territory infarction as a significant predictor of early in-hospital death. The relatively small sample size precludes firm conclusions.