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Objective: Open-door laminoplasty is an effective surgical technique in the treatment of multi-level cervical spondylotic myelopathy. In the present study, we reviewed the safety and short-term neurological outcome after expansiIe cervical laminoplasty in the treatment of traumatic cervical cord injury without overt fracture or instability. Method: We retrospectively reviewed our database over a 3-year period (January 2005-December 2007) and identified 18 surgically treated cervical spinal cord injuries without overt fracture or instability. All of these patients underwent laminoplasty. We collected data on the preoperative and the immediate postoperative and 2-month neurological examinations. Neurological function was assessed using the Asia Spinal Injury Association (ASIA) grading system. We also reviewed the occurrence of complications and short-term radiological stability after the index procedure. Results: The median age was 57 years old. All patients had hyperextension injuries with underlying cervical spondylosis, stenosis and OPLL in the absence of overt fracture or instability. The average delay from injury to surgery was 1 day. The preoperative ASIA grade scale was grade A : 9 patients(50%), grade C : 3 patients(17%), and grade D : 6 patients(33%). There were no case of immediate postoperative deterioration or at 2 months follow-up. Neurological outcome: ASIA grade of 13 patients(72.2%) improved ASIA grade when examined 2 months after operation. We have no case of complication and radiological instability. Conclusion: Surgical intervention consisting of laminoplasty can be safely applied in the subset of patients with cervical cord injury without overt fracture or instability who have significant cervical spondylosis/stenosis. Laminoplasty is a safe, low-morbidity, decompressive procedure, and in our patients did not produce neurological deterioration.
Introduction : The increased use of oral anticoagulant (OA) and antiplatelet (AP) drug comes at risk of severe complications. There is evidence that these therapeutic strategies result in a higher incidence of chronic subdural hematoma(CSDH) associated with the increasing age of population. The use of anticoagulation or anti-thrombotic therapy as a causative agent in the development of CSDH was investigated. Materials and methods : In this retrospective study we collected the medical records of all 190 patients with CSDH admitted to our hospital over a 10-year period, from 1998 to 2007. We examined these medical records to obtain specific details , such as the past history, the physical examination, Glasgow Coma Scale(GCS), investigation performed, treatment modality, number of recurrence and Glasgow Outcome Score(GOS). Results : Regarding the use of OA and AP drug, aspirin and its derivatives were used by 23 (12.1%) patients, warfarin by 15 (7.9%) and the remaining 152 (80%) were not using OA or AP drug. A interesting finding was that the recurrence rate in chronic subdural hematoma appeared to be slightly higher in those patients who were on aspirin, but this finding did not show statistical significance. Conclusion : We found that anticoagulant or anti-thrombotic therapy was used by a significant percentage of CSDH patients and the recurrence rate in chronic subdural hematoma appeared to be slightly higher in those patients who were on aspirin, but this finding did not show statistical significance. The results of this study may be useful in the clinical management of this subgroup of CSDH patients.