Early Clinical Improvement of the Axial Pain after Sagittal Curve Restoration in Patients Who Underwent a Multiple Level Microdiscectomy with Fusion of the Cervical Spine Using Zero Profile Cages

A common pathology that causes axial and/or radicular pain is cervical degenerative spine. It has the potential to cause myelopathy. The majority of cases necessitate surgical decompression and sagittal balance correction;surgery may be performed at multiple levels of the cervical spine. Typically, during decompression, the degenerated discs are replaced and the spine is fused, and it has been recommended to restore the lordotic curve during the procedure to avoid any axial pain post-operatively. We followed our patients who had multiple level cervical spine decompression with fusion and monitored their axial pain after correction or in the absence of correction of the normal lordosis in the early post-operative period. When various levels of degenerative cervical spine are treated, it appears that axial pain does not improve in the immediate or early postoperative term.

Lumbar Disc Prolapse in Adolescent Patients

Objective: To discusses the surgical treatment of prolapsed lumber intervertebral disc in adolescents and its long-term results (PLID). Background: PLID is very rare in adolescence. Heavy lifting and trauma are the main causes;back pain and radicular pain are the most common clinical presentations, and surgical treatment gives satisfactory outcome after failure of conservative treatment. Methods: During period from January 2014-January 2019 twenty patients between 14 - 20 years old underwent for lumbar disc surgery in Neurosurgery department, Hadramawt University, Yemen, 18 patients were males while 2 were females. Results: Twenty patients 18 males (80%) while 2 females (20%) all patients have low back pain (100%), unilateral sciatica in (90%), bilateral sciatica in (10%) and sphincter disturbance in (10%). The most common affected level is L4/5 represent (80%) while L5/S1 (20%), partial lumbar laminectomy in (40%) and microdiscectomy and fenestration in (60%). Complication rate was (15%) and recurrence only (5%). Conclusion: PLID in adolescence is very rare;back pain and sciatica were the main clinical presentation. Meticulous surgical procedures give satisfactory outcome and excellent result.

Should the Surgical Instrument Parts That Are Broken and Remain in the Distance of the Disc Be Removed? Should It Be Quit? A Case Report

Background and Aim: Lumbar posterior open microdiscectomy is a procedure that is widely used to treat lumbar disc diseases. These operations have a low risk of complications. It is unusual for the tool to break and remain in the intervertebral space during surgery. In this situation, we wanted to provide a set of suggestions based on our research of the literature on pituitary forceps blade fractures and the procedure for removing the fractured portion from the disc space during lumbar posterior open microdiscectomy surgery. Case Presentation: 10 days ago, a 37-year-old female patient presented to our clinic complaining of low back pain, left leg pain, and left foot weakness. A diagnosis of lumbar disc herniation necessitating surgery was obtained following neurological and radiographic examinations. The patient was advised to have surgery. The patient had standard lumbar microdiscectomy surgery. However, the tip of the pituitary forceps was broken during disc removal and remained in the L5-S1 disc space. The scope confirmed that the alien object was in space. After the evaluation, it was decided to remove the piece of instrument that was broken and remained in the disc space. The broken surgical handpiece was removed and documented under fluoroscopy. Additionally, it was forwarded to the technical unit for examination. Conclusion: A few case reports in the literature describe a surgical tool piece fracture that remained in the disc distance of the lumbar microdiscectomy. Complication management may be time-consuming and risky. Such a complication should be addressed and resolved appropriately because this situation might have detrimental terms on surgical risks and the legal procedure.