Introduction: Objective of study is to provide a quantitative description of the amount of RLN irritation during ACDF and to correlate the amount of irritation with operative parameters.

Methods: In a series of 98 patients undergoing ACDF continuous IEMG monitoring of the vocal cords was performed with a specially designed, commercially available Endotracheal Tube. The amount of irritation was described as irritation score (IS) by use of our proposed formula IS=log( ∑ (AxD)/B ), where A is the amplitude of irritation, D the duration of irritation and B the baseline irritation

Results: The amount of RLN irritation as described by our formula was statistically higher in patients that had undergone previous surgery compared to de novo cases (p= 0.024), and in cases where self retained retractors were used compared to handheld retractors (p= 0.020). Although results were not statistically significant, the irritation score was higher in patients presented with postoperative hoarseness.

Conclusions: The use of our proposed scale may be a useful adjunct in the prevention of RLN injury in patients undergoing ACD with or without fusion.

Objective: The purpose of this communication was to evaluate the long-term outcome of patients with type II odontoid fractures treated with anterior screw fixation.

Material and Methods: In our prospective clinical study 34 patients, 21 males and 13 females (with mean age 35.4 + 0.8 years) with type II odontoid fractures of traumatic etiology, underwent anterior cannulated screw fixation, during a period of 36 months. All patients had radiologicaly confirmed intact transverse ligament and a reducible odontoid fracture. All patients were immobilized in a Miami J cervical collar for 4 weeks postoperatively. Radiological examination of the cervical spine with plain X rays and cervical spine CT was performed at 6 weeks and two, six and 12 and 24 months postoperatively. Follow-up time ranged between 36 and 80 months (mean follow-up 54.3+ months).

Results: 32 patients had an uneventful postoperative course, while one patient developed pulmonary atelectasis, which resolved without any significant sequelae and another one developed a superficial wound infection, which resolved without removing the implanted hardware. Radiographic evaluation showed satisfactory bony fusion and no evidence of abnormal movement at the fracture site in 31 patients (91.1%). In two patients (5.8%), the radiographic studies showed pseudo-arthrosis and instability while in one patient (2.9%) the implanted cannulated screw was broken but there was no instability shown.

Conclusions: In our series anterior odontoid screw fixation constituted a safe therapeutic modality with high stability and low mechanical failure rates in short and long term follow-up period.