No abstract

The authors describe the surgical technique of anterior cervical fusion using bone grafts obtained from cervical vertebral bodies. This series consisted of 90 patients with cervical intervertebral disc disease suffering from cervical spondylotic myelopathy. Thirty-five patients were operated on at one level, 33 at two levels, and 22 at three levels. Postoperative x-ray films showed solid bone fusion in all patients at a mean follow-up time of 24 months (range 1 year to 3 years 6 months). Anterior angulation was found in four (4.4%) of the 90 patients. This surgical procedure has two major advantages: 1) there are no complications related to the iliac donor site, allowing early patient mobilization; and 2) the extensive posterior spur can be removed safely and easily under a wide operative field without damaging the spinal cord and nerve roots.

Lateral position of the ECA is not extremely rare in patients undergoing CEA for atherosclerosis and may be a congenital variation, although this is still controversial. CEA can be performed safely if the arteries from the CCA to the ICA are rotated, and the ICA is moved to the shallow surgical field under wider longitudinal exposure. Although no postoperative cerebral infarcts were detected, the risk of artery-to-artery embolism resulting from artery repositioning prior to plaque removal should be taken into consideration.

The facial electromyographic response was monitored intraoperatively in 40 patients with hemifacial spasm who were operated on by microvascular decompression of the facial nerve. All 40 patients showed an abnormal facial electromyographic response (lateral spread response) with a latency of about 10 msec after stimulation. The abnormal response resolved before decompression in 22, resolved immediately with decompression in 16, and failed to resolve in two. Of the 38 patients in whom the abnormal response disappeared during surgery, 36 were postoperatively free from hemifacial spasm and two had mild hemifacial spasm. The two patients in whom the lateral spread response did not disappear during surgery showed persistent hemifacial spasm. In conclusion. Disappearance of the lateral spread response during surgery correlated with the absence of hemifacial spasm in the early postoperative period. The prognosis of hemifacial spasm was good in cases in whom the lateral spread response disappeared. Therefore, the authors think that intra-operative facial electromyography is very useful in assessing the efficacy of microvascular decompression and in predicting the prognosis of hemifacial spasm.