The Discover artificial cervical disc replacement offers favorable outcome compared with ACDF for a single-level cervical disk disease at short-term and long-term follow-up.

In our cohort of patients with pituitary tumors who underwent GKRS, 30% developed new hypopituitarism during the follow-up period.

Introduction Anterior cervical discectomy and fusion is still the “gold standard” for surgical treatment of patients with single-level cervical disc disease but in the past decade it has been challenged by total cervical disc replacement which offers several advantages over it. Materials and Methods A total of 100 patients with a single level cervical disc disease who fulfilled the inclusion and exclusion criteria were treated with total cervical disc replacement using Discover artificial cervical disc (DePuy Spine Inc., Raynham, Massachusetts) between May 2008 and September 2010. All patients were evaluated with pre- and postoperative serial radiographic studies (MRI, standard and functional cervical spine X-rays), and clinically. For clinical evaluation we used neck disability index (NDI), visual analog scale (VAS) for neck and arm pain and neurological status at 3, 6, 12, 24, and 48 months. Results The results of our study show that total cervical disc replacement using Discover provides excellent radiological and clinical outcomes in long-term follow-up during minimally 48 months. Patients showed significant improvement in clinical parameters, NDI and VAS (arm and neck) at follow-up visits. None of the patients developed adjacent disc disease. During the follow-up period in 15 of our patients heterotopic ossification occurred with complete loss of range of motion at the treated level (15%). Also we had one patient with the prosthesis migration at the 2-year follow-up visit who was reoperated. There were no other major surgery-related complications. Conclusion Discover total cervical disc replacement is according to our study safe and efficient method for surgical treatment of a single level cervical disc disease in selected patients with excellent outcome at long-term follow-up.

Introduction Lumbosacral schwannomas are predominantly benign tumors arising from nerves within the spinal canal. Being one of the most common intradural extramedullary tumors, spinal schwannomas comprise up to 30% of such lesions. Surgery is the primary treatment modality and after total resection recurrence is rare. We present our experiences and results with patients operated on lumbosacral schwannomas with the use of intraoperative neuromonitoring with evoked potentials (SSEP, MEP, muscle EMG, cauda mapping). Materials and Methods A retrospective review of prospectively collected data from patients with a diagnosis of lumbosacral schwannomas operated at University Hospital Centre Zagreb, Croatia, from January 2009 to May 2014 was performed. We analyzed preoperative and postoperative medical records, pathological findings, radiographic studies, and clinical outcome of patients treated surgically for lumbosacral schwannomas. Surgical outcome was compared with evoked potential changes during surgery for lumbosacral schwannoma that significantly differed from baseline values. Results In the analyzed period, 26 patients were operated on for lumbosacral schwannomas at our institution. Of these were 11 male and 15 female patients. Mean age was 49.8 years. There were 4 giant and 22 nongiant schwannomas. Giant spinal schwannoma was defined as a tumor that extends over two or more vertebral levels, erodes vertebral bodies, and/or extends into the extraspinal space disrupting myofascial planes. Low back pain and radiculopathy were the most common presenting symptoms, rarely associated with urinary incontinence. Nongiant schwannomas were treated using minimal invasive unilateral approach, while giant schwannomas were treated using laminoplasty technique. In all patients, intraoperative neuromonitoring with SSEP, MEP, and spontaneous EMG was performed. Postoperatively, 21 patients fully recovered from preoperative neurological symptoms at 6-month follow-up. In 12 patients, SSEP changes occurred during surgery that differ from baseline values but had no impact on outcome. Four patients had transient neurological worsening which was in concordance with intraoperative SSEP and EMG disturbance findings. Out of 26 tumors excised, 2 were malignant schwannomas. One of the patients with the diagnosis of malignant schwannoma had to be reoperated for recurrence and died 2 years later. One patient with giant schwannoma developed an intracranial epidural hematoma postoperatively. Conclusion Intraoperative multimodality (SSEP, EMG) monitoring properly used and understood is a useful tool in lumbosacral schwannoma surgery. It assists the surgeon through the procedure as a means of intraoperative guidance allowing for completeness and safety of tumor removal and as such can influence the surgical outcome.