Purpose

The treatment of C2 fractures with collar, halo or surgery can all be justified depending on the patient. In our unit, primary treatment is with a halo: in a previous study presented at BASS we found an 85% fusion rate. In a follow on study, we wished to assess the outcome in those patients who underwent surgical treatment.

Several human conditions have a tendency to affect one side of the body over the other. Do lumbar disc prolapses have such a tendency? We sought to answer this question by an analysis of operated cases.

Primary lumbar microdiscectomy cases were identified using the coding system. 1286 cases were identified and in 764 the laterality was not recorded. Electronic records were then examined to establish, where possible, the side of the procedure from the clinic letter or discharge summary. 22 cases were eliminated due to miscoding (laminectomy, instrumentation, revision) and in 24 the side of the operation could not be established. In the remaining 1240 cases (96.4%) the laterality was determined.

Patients who underwent primary lumbar microdiscectomy in a single neurosurgical unit over a 5-year period (2002-2007).

Procedures were bilateral, left or right.

126 cases were bilateral. There were 1114 defined lateral cases. 618 (55.5%) were on the left compared to 496 (44.5%) on the right. The ratio of left to right is close to 5:4. The null hypothesis was that the number of left and right sided operations would be equal. The findings of this study were statistically highly significant (p value < 0.001, binomial test) and the null hypothesis could be rejected.

There is a small but definite preponderance of left sided over right sided cases at a ratio of 5:4. This finding may have implications regarding our understanding of both the epidemiology and biomechanics of lumbar disc prolapse.

Purpose of Study: Literature suggests that decompression of Chiari malformation for syrinx may influence the need for surgical correction of scoliosis: we therefore wished to review the clinical presentation, indications for surgery, complications and requirement for scoliosis correction after foramen magnum decompression in patients with syrinx, secondary to Chiari malformation.

Methods: A retrospective review of the available clinical information including clinic letters, case notes and radiology.

Results: 9 patients were identified. (Age range 4–16) 8 patients had progressive curves.

Neurological symptoms: 2 patients significant, 4 insignificant, 3 none.

Of 9 patients, 1 has not had surgery.

8 patients have had foramen magnum decompressions (+/− laminectomy, +/− duroplasty).

Complications: 1 patient required revision surgery for a radiculopathy > 1year post first operation: this patient required prolonged ventilation for MRSA chest sepsis. 1 patient developed a symptomatic pseudomeningocoele requiring lumbar drainage. All patients had improvement of neurological symptoms.

Of 8 patients having a foramen magnum decompression, 5 required scoliosis correction and 3 did not.

Conclusions: Foramen magnum decompression can relieve neurological symptoms in this cohort of patients.3 of 8 (38%) patients avoided scoliosis correction after decompression and decompression may therefore influence curve progression.

Ethics approval: Not applicable

Interest Statement: None