Stab wounds to the cervical spine are less common than injuries from road accidents, sports injuries, and falls. The presence of vital, vascular, neural, respiratory, and digestive structures in the neck region mean that this kind of spinal injury is generally critical, and its management is a challenge. We report a unique case of a previously healthy 17-year-old adolescent admitted for quadriplegia secondary to a stab wound to the cervical spine at the C4C5 level. There was no surgical indication. The patient underwent physiotherapy. He showed spontaneous neurological improvement two weeks later and was able to sit on his own and to walk about three months of physical rehabilitation.

COVID-19 pandemic touch all part of world to the date more than fifteen millions of patients are infected by virus including about 1,388,926 deaths (European Centre for Disease Prevention and Control an agency of the European Union). Morocco has put in place strict containment measures to control the disease and prevent the saturation of health systems. One of the great difficulties is to quickly identify asymptomatic and paucisymptomatic cases which function as an important vector of contagion. Anosmia and fever are one of revealed mode for the young patient but is not all the case. We report one case in the sense. A 40-year-old man without medical history was admitted in the hospital after complaining 3 days ago clinical symptoms of fever, cough, headache and anosmia. Immediately, the patient benefits of COVID-19 protocol, measure of fever, nasal swab and polymerase chain reaction (PCR) test. Despite the negativity of PCR test of COVID-19, the patient was placed in isolation. Two days later, he presented a generalized seizures, then we performed a cerebral computed tomography scan (CT scan) which showed a bilateral frontal oedema. The cerebral magnetic resonance imaging (MRI) revealed the presence of 4x4x4 cm well enhanced meningeal extra axial mass of the anterior skull base with peri-tumoral oedema corresponding to an olfactory groove meningioma. The tumour was totally resected through a left fronto-lateral approach. The postoperative courses were uneventful with the persistence of totally anosmia.

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Spinal meningiomas are usually intra dural tumors, the purely extra dural localization is exceptional, they are easily mistaken for malignant tumor resulting in inadequate management. Only 77 cases have been reported in the literature. Less than 28 cases have been confirmed after durotomy since 1898. We report a new observation followed by an analytical review of the literature with a study of the socio-epidemiological, radiological parameters and of the neurosurgical and progressive management of extra dural spinal meningiomas. Observation: a 57-year-old, female patient with no medical history was admitted to our training for slow dorsal spinal cord compression progression since 06 months. Neurological examination found FRANKEL stage C paraplegia, higher level D7 hypoaesthesia without sphincter disorders. The medullary MRI objectified an intraspinal process of 1.5x2x1cm, well limited, of the right posterolateral of D8-D9 causing compression of the dorsal cord with an intramedullary hyper signal in T2. The D8-D9 laminectomy was performed. Surgical exploration found an extra dural lesion without intra dural extension. The excision was macroscopically complete. Histological examination was in favor of a benign meninigothelial. The post-operative course was marked by a partial and progressive recovery of the neurological deficit and no recurrence. Discussion: the retrospective analysis of literature about 49 publications was founded that, the incidence in 1933 by Elsberg was 5.5%, Haft in 1963 found 3.5%. In 2020 our study found 3.46% of all spine meningioma. The mean age is 44.19 years [8 years -85 years] with a female predominance of 2/1. The mode of revelation is in 11.53% of fortuitous discovery, in 59.93% by the high state of spinal cord compression stage C of FRANKEL. The topography is dorsal = 51.31%, cervical = 44.76%. MRI scan has been use since 1996 at 67.60%. Laminectomy was performed in 71.79% with durotomy in 11%. The excision is complete with SIMPSON I in 70% and SYMPSON III in 27%. The predominant histological is a grade 1 of meningioma = 73.41%, grade 2 = 6.32%, grade 3 = 1.26% in 19 % meningioma was not specified by the authors. Conclusion: The prognosis of extra dural spinal meningiomas according to our study is good overall with only 3 cases of recurrence of spinal meningioma in 36 patients, or 8.33% after a mean follow-up of 31.59 months [1 -168 months] with P=0,012.

Background: The surgery outcome of cervical spondylotic myelopathy (CSM) for some authors depend to the clinical signs (obesity, smoking, sex, age, patient’s activity, and the surgery delays). Nevertheless, for others authors it’s depending to the chirurgical approach (anterior or posterior or the levels number of decompression in the cervical spine). There is no consensus although some arguments prevail over to others in the literature. Our study purpose was to determine the important clinical factors predictors of surgical outcome in patients with CSM. It’s a retrospective study of 107 patients admitted to the Mohamed V hospital in Rabat over 06 years from January 2013 to December 2018 for cervical spondylotic myelopathy (CSM) operated and were followed up for 1year. Their neurological status pre and postoperative was assessed using the Japan Orthopedic Association (JOA) score and others prognostics factors such as sex, age, duration of symptoms, Cobbs angle, number of discs compressed, MODIC class signal and, (P<0.05) was statistically significant. Patients were classified into 02 groups, youngers patients in group 1 = G1 (<60 years of age; n = 70) and an elderly patients group = G2 (>/=60 years of age; n = 37). The mean age = 52.72 years [42.27-63.16], male 64.5% against 35.5% of women, a sex ratio = 2/1 in favor of men. In G1, mean age X1= 45.6 years. In G 2, mean age X2 = 61.85 years. The average delays for surgery = 11.28 months [6-18.19]. In G1 it was 10.30 months and 16.34 months in G2. The pre operatory JOA score (JOA PREO) = 9.87 +/- 2.033. JOA PREO score was 11 and 7 respectively in G1 and G2. The prevalence of MODIC (MC) = 52.23% and type 2 of MC was predominant in both groups, with p> 0.05. G1 patients underwent an ACDF in 82% and laminectomy in 18%. In G 2 laminectomy was performed in 50% and the anterior discectomy in 21.73%, corporectomy in 28.27%. After surgery, JOA score passed to severe to moderate 13.48 and 13.27 after 1year of follow-up in G1 and G2. In conclusion those factors such as sex, number of discs involved, and Cobbs angle on prognosis were not statistically significant (P>0.05) but patient’s age and duration of symptoms < 1 year predict to have more neurologic improvement (P<0.05) according to the JOA score.