Study Design:This was a retrospective cohort study.Objective:To report our 10-year experience of closed reduction using Crutchfield traction followed by anterior cervical discectomy and fusion within 12 h from injury for C-type subaxial cervical fractures (according to the AOSpine classification system).Methods:Clinical records and neuroimaging were retrospectively reviewed. Surgical details were provided.Results:A total of 22 patients were included in the study. The cervical fracture was diagnosed after whole-body computed tomography scan on admission in all cases. Crutchfield traction was applied within 1–5 h from the diagnosis. Surgery consisting of anterior microdiscectomy and fusion with interbody cage and plating was performed 6–12 h after traction positioning. Most patients (19, 86%) had spinal cord injury: 7 were Frankel A (31%), 3 Frankel B (14%), 6 Frankel C (27%), 3 Frankel D (14%), and 3 Frankel E (14%). No neurologic deterioration was observed after the treatment. In 10 cases (45%), neurological symptoms improved 1 year after the trauma. Two patients (10%) died for complication related to spinal cord transition or other organ damage.Conclusions:Early reduction gives the best chance of recovery for patients affected by C-type subaxial cervical fracture. Rapid traction is more often successful and safer than manipulation under anesthesia. After close reduction achieving, anterior microdiscectomy, cage, and plating implant seem to be safe and effective with a low rate of complications.

Objective: To report a rare case of cavernous angioma of the cauda equina with signs of intratumoral and subarachnoid hemorrhage in a patient affected by multiple brain cavernomatosis, and to discuss the clinicoradiological and surgical features of these uncommon lesions using the data available in the literature. Summary of Background Data:Cavernous angiomas of the cauda equina are extremely rare lesions, accounting for only 5% to 12% of all vascular lesions of the spine, and rarely cause spinal subarachnoid hemorrhage. Including the present, only 27 cases are reported in literature. Methods:A case report and review of the literature.Results: A 50 year-old female with history of multiple brain cavernomatosis, presented with low back pain, paraparesis and lower limb hypoesthesia from six months. MRI scans showed a well defined intradural extramedullary mass in the cauda equine at L2 level, with signs of subarachnoid hemorrhage in L5-S1. An "en-bloc" removal of the lesion was performed. The patient was discharged with no neurological deficit. MRI scan 6 months after surgery showed total excision of the lesion with no recurrence. Conclusion:Cavernous angiomas of the cauda equine associated with multiple cerebral cavernous angiomas are extremely rare lesions. They may present low back pain, sciatica, neurologic deficit and subarachnoid hemorrhage. They can be successfully surgically removed in order to prevent bleeding and dangerous enlargement of the lesion.

Primary Central Nervous System Lymphoma (PCNSL) are malignant tumors extremely rare in immunocompetent patients. They represent 2-3% of all cerebral tumors.They are frequently located in the supra-tentorial space and in 60-70% of cases they consist in single lesions. The most common presenting symptoms are hemi paresis, ache, epileptic crises and ataxia. In this article we present the case of a 76 year-old woman admitted for seizures attack and progressive coma state. A preoperative CT scan with contrast enhancement showed a left frontal nodular lesion of 29x16mm, with irregulars enhancement and surrounded by peripheral edema. No alteration of haematological exams was noticed. The patient underwent surgery for with total excision of the lesion. Histological examination was suggestive of non-Hodgkin B cells lymphoma (CD20+, CD 30-). Patient improved after surgery and she was discharged ten days after surgery, with the indication to perform hematologic consult. No recurrences were noticed at 20months follow-up. Although surgery is not routinely recommended for the treatment of PCNSL, we report a case of B-cells lymphoma in which surgical resection, followed by chemotherapy and radiation therapy, resulted in a successful treatment. A critical review of the role of the surgery in consideration of technical advances in neurosurgery was done.

Introduction In the last few years, several interspinous prostheses have been used for the treatment of several degenerative disk diseases involving the lumbosacral region; among them stenosis of the spinal canal or degenerative discopathy. Such devices share the same characteristics such as they require minimally invasive procedures and are implanted in the stenosis of lumbosacral joint or in the degenerative discopathy with the aim to increase canal diameters or upload the task of the intervertebral disk. In this paper, we present our experience in the implant of some interspinous devices (Viking and In-Space) in lumbosacral degenerative disk disease and lumbar spinal stenosis on a single to double level. AIMS The aim of this study is to verify the clinical results on pain and quality of life measured by the application of VAS scale and ODI index with a follow-up of 12 and 36 months. Also, to evaluate the tolerability of the prosthesis material. Materials and Methods From 2007 to 2010, 150 patients have undergone surgery concerning the interspinous dynamic decompression with Viking and In-Space on a single to double level. Viking is a interspinous prosthesis device made by Peek showing the following features: interspinous dynamic spacer able to absorb axial, flexional and torsional stresses applied on the movement segment involved by its implantation as well as, in the meanwhile, to preserve the degrees of freedom of the segment itself. In-Space is an interspinous prosthesis device made by Peek, intended to stop the segmental extension and to distract the interspinous space at a symptomatic level between L1 to L5. In-Space acts as a space-holder and protects mainly the posterior elements by maintaining the foraminal height, opening up the area of the spinal canal, reducing stress on the facet joints and relieving pressure on the posterior annulus. Treatment with Viking and In-Space was indicated in case of LDDD and LLS (assessed by clinical and radiological examinations) linked or not to osteochondrosis, measured by X-ray or NMR. Flexion/extension X-ray views are strongly recommended. The clinical situation was characterized by chronic lumbar back pain with episodic and irregular pain irradiation to inferior limb measured by using VAS scale and ODI index. Among 150 patients, 62 were men and 88 women, ranging from 32 to 77 years old (mean age 53.81). The site of the surgery has been distributed as shown: single level 130 patients ( L4-L5 67, L5-S1 49, L3-L4 10, L2-L3 3, D12-L1 1); double level 20 patients ( L3-L4 and L4-L5 7, L4-L5 and L5-S1 12, L1-L2 and L2-L3 1 ). Results Follow-up period ranged from 12 to 36 months. One patient did not show any clinical benefit and had, subsequently, a new surgery to stabilize L5-S1 area with peduncular screws in another hospital. After stabilization surgery in L5-S1 area, three patients had a radicular leg pain due to disk hernia; the interspinous device has been removed and a microdiscectomy has been performed. The patients achieved the complete pain resolution. In the...