Purpose: The purpose of this work was to compare outcome after simple posterior fusion with that after double anterior and posterior fusion for the treatment of scoliosis in cerebral palsy children.

Material and methods: We reviewed the files of 33 cerebral palsy children (mean age 16 years). Twenty-one children had a posterior fusion and twelve a double anterior-posterior fusion. The classical causes of cerebral palsy were represented. Simple posterior fusion was used for more moderate scoliosis (Cobb angle 50–80°), 31% could be reduced during the bending test. Double fusion was used for more severe cases (Cobb > 80°), 18% reducible. Classical procedures were used: CD instrumentation posteriorly, simple release or Colorado rod anteriorly. Thoracophreno-laparotomy (n=6) or thoracoscopy (n=3) was used for anterior fusion. For the double fusions, the posterior procedure was performed the same day in 11/12 patients.

Results: Operative time for double fusion was twice that for posterior fusions. There was no significant difference in blood loss between the two techniques. Complications were more frequent for double fusion but there were no deaths (one death due to respiratory failure after posterior fusion). All the double fusion patients remained in the intensive care unit for 2.5 – 21 days (mean 6.5 days). There was no significant difference between hospital stay (mean 18 days). Gain was better for double fusion (62% versus 52%).

Discussion: Double fusion for cerebral palsy scoliosis treated late is a major operation with significant but tolerable morbidity, particularly for major scoliosis > 80°. The double procedure enables good reduction and quality fusion. Considering the current reduction and fixation options, isolated posterior fusion can still be indicated in younger children with a reducible curvature.

Purpose: Since 1990, we have used specific material, presented to us by T. Tajima (Japan) during his visit in 1989 for percutaneous surgical cervical discectomy. French material was developed in 1992. The purpose of this work is to present our experience with this technique over the last ten years.

Material and methods: Indications were cervicobrachial neuralgia unresponsive to medical care and secondary to MRI or CT documented cervical disc herniation. We used the right anterolateral approach guided with the image amplifier for patients under local anaesthesia and neuroleptanalgesia ou general anaesthesia. A guide wire was positioned in the centre of the anterior aspect of the disc to insert a 2.5 mm working tube in the middle of the disc. A special trephin with an inverted inside thread induced an aspiration effect when turned into the disc, in line with the posterior wall of the vertebra. This enabled removal of several “carrots” measuring 1 to 2 cm long of discal or even disco-osteophytic material. The removal of the posterior third of the disc and the herniation was completed with a fine disc forceps.

Results: There were 85 procedures in 82 patients, mean age 42 years (35 women, 47 men): 57 at one level, mainly C5C6, 27 at two levels simultaneously, and one at three levels during the same operation. Mean follow-up for the 80 results known was 15 months (3–90 months). There were nine failures (two required conventional surgical fusion), 14 fair results, and 57 good results, giving a total of 88.75% good and fair results. Unlike percutaneous surgical lumbar discectomy, where good results at three months may deteriorate at two years, good results at three months after percutaneous cervical discectomy remained good at two years.

Discussion: This technique provides results as good as chemonucleolysis. An advantage of the technique that allergy or disco-osteophytic protrusions are not contraindications. We did not have any infection or injury to neighbouring tissue.

Conclusion: When rigorous operative procedures are used in this area with potential risk, percutaneous surgical cervical discectomy can be a useful routine therapeutic tool.