Abstract: Abstract Purpose: To test the reliability of Three-Dimensional Balanced-Fast Field Echo (B-FFE 3D) sequence in low-field MRI scans (Open devices) for grading of lumbar nerve root compromise using clinical and intraoperative findings for final judgment. Material and Methods: Seven hundred lumbar nerve roots in 350 symptomatic patients were evaluated prospectively using lowfield MR system (0.23 T) and B-FFE 3D sequence. MR image-based grading system was correlated with surgical grading of lumbar nerve root compromise due to herniated lumbar disc in 31 patients found indicated for surgery in which 52 roots were operated upon. Results: Fifty two nerve roots were evaluated at surgery, highly significant association between surgical grading and MRI grading was found. Sensitivity of MRI grading of the relation between nerve root and the disc using open MRI devices mentioned was found to be very high after being checked for during surgical exploration of the roots indicated for decompression. Conclusion: Image-based grading using low-field MR system (Open devices) (0.23 T) and B-FFE 3D sequence enabled reliable evaluation and reporting of nerve root compromise.

Abstract: Abstract Background: Cervical spondylosis is the most frequent pathologic condition affecting the adult spine.(1) The etiology of myelopathy is multi-factorial.(2) Laminectomy is relatively a simple operation. The complications associated with dorsal approaches are predictable and preventable.(4, 5) Methods: Between September 2004 and January 2006, 56 patients had laminectomy for cervical spondylotic myelopathy (CSM). These procedures were performed at two centers by the surgeon authors. We had 32 males and 24 female patients. The age ranged from 33 to 72 years with a mean of 60.3±8.6. Strict inclusion and exclusion criteria were followed. Laminectomy was done to three levels in one case, four levels in 18 cases and five levels in 37 cases. The mean number of laminectomized levels was 4.64 levels per patient. Fifty-two of our patients were followed up for at least nine months postoperatively (range of follow up was from nine to 15 months with a mean of 13 months). Preoperative functional assessment, x-ray films both static and dynamic and magnetic resonance imaging (MRI) were done. Patients were followed up at three, six and nine months postoperatively by complete neurological examination and functional scoring by the modified JOA score and by radiography. The cases which showed postoperative deterioration were offered postoperative MRI. Thirty-eight patients (73.1%) showed functional improvement while two patients showed deterioration (3.8 %) and 12 patients (23.1%) remained unchanged. Radiologically, four patients (7.7%) showed abnormal intervertebral movement on flexion-extension films between 1 and 3 mm at single level. Seven patients (13.5%) had static sublaxation on the postoperative lateral x-ray film between 2 and 6 mm, three of these patients had dynamic instability on flexion-extension films on the same level of the static instability. The mean improvement in the JOA functional score was 2.265±2.376 at the final follow up. This was found to be statistically significant. We found no statistically significant correlation between the age, sex, number of levels been laminectomized and postoperative instability to the degrees we had in our series and the degree of functional improvement. So the instabilities to the mild levels that we found in our patients in the post operative period did not affect the functional outcome. Conclusion: We found this method in treatment of CSM to be a safe and effective method on the short term. However, a longer follow-up and larger patient population are needed to further prove the effectiveness and safety.

Abstract: Abstract Objective: Lumbar disc herniation is a common pathology. Foley and Smith developed the technique microendoscopic discectomy (MED) in 1997.(1) We started using MED in June 2002. The purpose of this report is to present the early clinical results and complications. Methods: This is a prospective study. We randomly chose 30 patients indicated for surgery for herniated lumbar disc according to strict criteria, MED was performed on these patients from June 2002 to March 2005 using the METRx endoscope. We had 21 males and nine females. Mean age was 34 (range: 17-54 years) years. In four patient the indicated disc level was L3-L4, in 22 patients L4-L5, in four patients L5-S1. Selection criteria were persistent radiculopathy for at least two months that failed to respond to conservative treatment associated with positive tension signs, sensory or motor deficits and associated with relevent radiological abnormalities. All patients had follow up visits for at least six months postoperatively and we considered six months to be the end of the follow up period. Results: The mean postoperative hospital stay was two days. The mean operative time was 123 minutes. The mean blood loss was 243 mL. All patients began to walk on the same operative day. The mean Japanese Orthopaedic Association score (JOA score)(2) improved from 9.7 ±2.6 preoperatively to 26.5± 2.5 postopertively. The mean return to work time was 21 days. There were two cases of dural tear without consequences, and one case of nerve root injury with worsening of motor power. Conclusion: We found this technique of MED to be useful with very good results on the early postoperative period that are comparable to open and Microscopic discectomy techniques.