Introduction: Objective of study is to provide a quantitative description of the amount of RLN irritation during ACDF and to correlate the amount of irritation with operative parameters.

Methods: In a series of 98 patients undergoing ACDF continuous IEMG monitoring of the vocal cords was performed with a specially designed, commercially available Endotracheal Tube. The amount of irritation was described as irritation score (IS) by use of our proposed formula IS=log( ∑ (AxD)/B ), where A is the amplitude of irritation, D the duration of irritation and B the baseline irritation

Results: The amount of RLN irritation as described by our formula was statistically higher in patients that had undergone previous surgery compared to de novo cases (p= 0.024), and in cases where self retained retractors were used compared to handheld retractors (p= 0.020). Although results were not statistically significant, the irritation score was higher in patients presented with postoperative hoarseness.

Conclusions: The use of our proposed scale may be a useful adjunct in the prevention of RLN injury in patients undergoing ACD with or without fusion.

Objective: The purpose of this communication was to evaluate the long-term outcome of patients with type II odontoid fractures treated with anterior screw fixation.

Material and Methods: In our prospective clinical study 34 patients, 21 males and 13 females (with mean age 35.4 + 0.8 years) with type II odontoid fractures of traumatic etiology, underwent anterior cannulated screw fixation, during a period of 36 months. All patients had radiologicaly confirmed intact transverse ligament and a reducible odontoid fracture. All patients were immobilized in a Miami J cervical collar for 4 weeks postoperatively. Radiological examination of the cervical spine with plain X rays and cervical spine CT was performed at 6 weeks and two, six and 12 and 24 months postoperatively. Follow-up time ranged between 36 and 80 months (mean follow-up 54.3+ months).

Results: 32 patients had an uneventful postoperative course, while one patient developed pulmonary atelectasis, which resolved without any significant sequelae and another one developed a superficial wound infection, which resolved without removing the implanted hardware. Radiographic evaluation showed satisfactory bony fusion and no evidence of abnormal movement at the fracture site in 31 patients (91.1%). In two patients (5.8%), the radiographic studies showed pseudo-arthrosis and instability while in one patient (2.9%) the implanted cannulated screw was broken but there was no instability shown.

Conclusions: In our series anterior odontoid screw fixation constituted a safe therapeutic modality with high stability and low mechanical failure rates in short and long term follow-up period.

Purpose: To present our experience in the treatment of sub-acromial impingement by the method of arthroscopic acromioplasty.

Material – Method: This study includes 41 patients (17 males and 24 females) with average age 53.07 years (range 22 – 69). All patients were suffering from intense pain in the shoulder joint and presented movement limitation. The patients were evaluated clinically and with plain Xrays and MRI of the region. Prior to the intervention all the patients had followed a variety of adequate conservative treatment including immobilization, anti-inflammatory therapy, physical therapy, local infiltration with corticoids and xylocain. The results proved unsatisfactory.

The surgical technique consisted of triple portal arthhroscopic intervention (anterior, posterior, lateral) and the use of a shaver for the completion of the acromio – plasty. The surgical time was 40 minutes (30 – 55)

The post – operative protocol, which included passive and active physiotherapy, was identical for all patients.

Results: The required average hospitalization was 36 hours (14 – 48). The average time needed for satisfactory rehabilitation amounted to 27 days (20 – 45). We followed closely our patients for an average of 11 months. (4 – 16). The painful symptoms disappeared thoroughly in 92.7% of our cases (38). Moderate pain persisted in 7.3% (3). Shoulder movements were fully restored in 95.1% (39). We observed no peri-operative or post – operative complications.

Conclusions: The arthroscopic airomioplasty is the surgical treatment of choice in the cases of sub-aromial impingement. The method presents no great technical difficulties. The operative time is considered short, and the results in their great majority are excellent. The hospitalization needed is minimal, the rehabilitation is rapid, and the economic cost is not significant.

We firmly believe that the arthroscopic acromio – plasty is the treatment of choice in the case of failed conservative treatment.