Background: Iatrogenic cervical nerve root injury may occur during cervical spine surgeries, which leads to upper limb palsy. The question of how a permanent iatrogenic upper limb palsy would be managed remains unclear. Recent developments of nerve transfer have led to a considerable interest in its applications. This study outlines a new reconstructive approach forupper limb palsy following cervical spine surgery using nerve transfer.Methods: In an attempt to reconstruct iatrogenic upper limb palsy, we performed nerve transfer in 4 patients with permanently lost functions. Medical Research Council Scale for Muscle Strength was used to assess muscle strength. Electromyography was performed to assess the reinnervation of the target muscles.Results: All patients underwent surgery between 7 and 12 months after primary injury. Spinal accessory nerve to suprascapular nerve transfer with or without transferring the long head of triceps branch of the radial nerve to anterior branch of the axillary nerve was used to reconstruct shoulder abduction in 2 patients. Double fascicular nerve transfer (a fascicle of the ulnar nerve to biceps branch and a fascicle of the median nerve to brachialis branch of the musculocutaneous nerve) was used to reconstruct elbow flexion in 3 patients. One patient had lost both his elbow flexion and shoulder abduction. After a mean of 10 months of follow-up, all patients improved to a muscle strength of M4 without donor deficit .Conclusion: In our view, these results represent an excellent initial step toward the treatment of iatrogenic nerve root injury after spine surgery.Level of Evidence: 4.

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Background: Traumatic brain injury is believed to be a public health disorder with some complications. Post Traumatic Neurocognitive Disorders (PTND) received much attention among these complications because of the high prevalence of mild traumatic brain injuries. On the other hand, advanced neuroimaging is increasingly becoming an exciting modality in the field of traumatic brain injury. Magnetic resonance spectroscopy (MRS) provides a new window to understand the detailed biochemistry alterations following traumatic brain injury. Therefore, some researchers have addressed the relations between MRS data and PTND. Objectives: The research aimed to achieve the biochemistry alterations following TBI and find the relations between these alterations and PTND based on published literature in this field. Materials & Methods: With this mind, a systematic search in MEDLINE and EMBASE databases performed to identify relevant published articles without date limitation. The systematic search keyword-targeted all MRS data relevant to the post traumatic neurocognitive disorders. Results: Of the search results, a total of 22 journal articles were reported relations between MRS data and neurocognitive disorders. A variety of questionnaires and computerized tests has been used to detect neurocognitive outcomes. Most studies focused on N-acetyl aspartate (NAA), Choline (Cho), Creatine (Cr), Myo-inositol (MI), and their ratios. As MRI scanners are becoming stranger detecting extra-metabolites such as glutamate, glutamine and glutathione are more reliable. In this regard a few studies reported significant relations between alterations in these metabolites and PTND. Conclusion: MRS is a powerful tool that can provide important data to detect long-term neurocognitive disorders following TBI.

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Introduction: Odontoid pathologies constitute a special category because they may lead to instability. Instability is defined by abnormal spinal alignment under physiologic conditions (loads) such as standing, walking, bending, or lifting. Since instability poses a risk of cord damage, surgical interventions may be required for durable long-term stabilization. This study demonstrates operative technique and results of endoscopic endonasal approach to the odontoid. Methods: We conducted a retrospective study involving 18 patients who underwent endoscopic endonasal odontoidectomy (EEO) due to Craniovertebral pathologies. Demographic data, clinical features of the patients, risk factors, intraoperative and postoperative complications were reported in this series. Results: Satisfactory outcomes achieved in 16 patients based on comparing modified Rankin scale before and after the surgery (P value= 0.0001). The mean duration for EEO was 232.6 ± 18.8 minutes. The mean blood loss during surgery was 386.67 ± 153.04 ml. The mean duration of hospital stay was seven days. All patients were extubated within a few hours after surgery. Against the backdrop of a successful anterior decompression in the aforementioned cases, intraoperative cerebrospinal fluid (CSF) leakage, postoperative meningitis, and pulmonary thromboembolism have emerged as devastating complications. However, two intraoperative CSF leakages were managed by direct dural repair and fat graft; two patients died due to postoperative meningitis and pulmonary thromboembolism 7 and 4 days after the second surgery. Conclusion: In conclusion, EEO can be effectively used for anterior decompression of the odontoid pathologies, despite the risk of complications.