✓ The authors report a further 3-year follow-up review of a series of 59 patients suffering with intractable pain due to lumbar spondylosis and treated by multiple-level bilateral laminectomies and facetectomies. Routine postoperative x-ray examination revealed that six of 59 patients had developed spondylolisthesis. Two of the six were symptomatic and required a secondary fusion procedure. Analysis of the patients who had developed vertebral slippage revealed that 6% of the patients with only two levels (L-4 and L-5) removed developed spondylolisthesis, but in those with three or more levels removed 15% showed slipped vertebrae. After an average follow-up period of 6 years, 87% of patients still had a worthwhile result as contrasted with 91% of the same series who had had a good result after a follow-up period averaging 3 years.

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The authors report the case of a patient with subarachnoid hemorrhage in whom an intracranial dural arteriovenous malformation coexisted with a spinal arteriovenous malformation. The latter was considered to be the source of the hemorrhage by clinical and radiographic criteria. It is concluded that patients with subarachnoid hemorrhage who show no suitable intracranial source for their bleed in some instances should be investigated for a spinal origin of hemorrhage.

A technique of shunting the lateral ventricle to the superior sagittal sinus is described. It has been used in 36 adult patients; infection occured in 2 patients (5.6%), and 2 patients required shunt revision (5.6%). The outcome of 18 patients with high pressure hydrocephalus could be validly evaluated, and successful control was achieved in 15 (83%). One of the 3 failures could have been avoided because shunting was undertaken before the ventricular fluid had cleared of blood. Four patients with normal or low pressure hydrocephalus were treated; only 1 had a successful result. This technique is suitable for patients with high pressure hydrocephalus and is of particular value in very ill or debilitated patients because of the rapidity with which it can be performed under local analgesia. Its use in normal or low pressure hydrocephalus must still be evaluated. In any event, the sagittal sinus is certainly a feasible alternate receptor site for ventricular shunting.

The authors discuss routine removal of inferior articular processes and their facets during laminectomy, with wide visualization of the lumbar nerve roots, which has proven to be most successful in relief of the symptoms of lumbar spondylosis. No instance of postoperative vertebral instability has been found. In a consecutive series of 70 patients averaging 58.3 years of age, 91% of patients adequately followed did well. Of six patients who did poorly, three had apparent explanations and, presumably, such errors are avoidable. Despite the generally advanced age of this series (12 patients aged over 70 years) there was no mortality or undue morbidity. Patients previously operated on for disc herniation, as a group, were somewhat younger and the spondylosis tended to be more localized (to the area of previous surgery) than in patients operated on for the first time.