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Anterior cervical discectomy and fusion is one of the most widely used surgical treatments for patients with degenerative cervical spine disease. It has been performed with various techniques and devices for many years. This is a retrospective study included 20 patients suffering from degenerative cervical disc disease. All these patients had an anterior approach for cervical discectomy in which the interbody fusion of 1 to 3 motion segments from C3 to C7 was done. The clinical and radiological data obtained were analyzed. All patients were regularly assessed through the follow up period of two years post surgical intervention. This study included 20 patients (14 males and 6 females). Patients' age ranged from 26 to 82 years with a mean of 45 years. Seventeen patients had a single level discectomy, two patients had two levels discectomy and one patient had 3 levels discectomy. The C5-6 being the most commonly affected level seen in 12 (60 %) patients. The mean operative time was 120±15 minutes. The changes in the visual analogue score, Japanese orthopedic association score and Nurick score were statistically significant in post operative. All patients had an evidence of fusion by the ninth month post operatively. Interbody fusion cages appear safe and effective, and their use helps to avoid some of the inherent problems in performing current anterior cervical fusion techniques. However, this outcome needs to be validated through more controlled trials with longer follow up. [ABSTRACT FROM AUTHOR]

Surgery of the degenerative cervical spine disease could be punctuated by certain complications (infectious, mechanical, neurological and esotracheal or CSF fistulas). We report a case of rejection of an interbody cage by the oral route during a coughing effort in a patient operated for cervical herniated disc. A 58-year-old man with no significant medical history. Clinically, he presented a cervical spinal cord compression syndrome (Nurick grade 4). Neuroimaging (CT and cervical MRI) found cervical arthrosis with myelopathy on herniated disc up to C3C4. An anterior approach was performed with C3-C4 discectomy and placement of an interbody cage. The immediate post-operative follow-up was simple with good recovery on the motor level apart from a difficulty in swallowing. After a year of evolution, the patient reported the expulsion of a foreign body (the interbody cage) during a coughing effort. An X-ray of the cervical spine confirms the absence of the cage. The esophageal fistulography returned without abnormalities. The classic complications in cervical spine fusion surgery with an interbody cage are the anterior secondary displacements with risk of esotracheal involvement or posterior with risk of radiculo-medullary involvement. These movements could be linked to a technical problem (malposition of the cage, unsuitable dimensions) causing the absence of body fusion. The rejection could also be linked to an intolerance of the patient's immune system to the foreign interbody cage. Rejection of the interbody cage by the oral route is an extremely rare and unusual complication. Its occurrence has not been previously reported as a complication of cervical spine surgery. It seems to us that this is the first case described in the literature. [ABSTRACT FROM AUTHOR]

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice. Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P -value < 0.05 was considered to be statistically significant. Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship ( P = 0.023, Phi = 0.26), lack of access to journals ( P = 0.002, Phi = 0.332), and limited access to conferences ( P = 0.019, Phi = 0.369) were associated with the country income category. Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Kanmounye, Robertson, Thango, Doe, Bankole, Ginette, Ondoma, Balogun, Opoku, Jokonya, Mbaye, Shabhay, Ashour, Silva, Cheserem, Karekezi, Hassani, Mentri, Laeke, Aklilu, Sanoussi, Musara, Ntalaja, Ssenyonga, Bakhti, El Abbadi, Mahmud, El-Ghandour, Al-Habib, Kolias, Servadei, Fieggen, Qureshi, Esene, CAANS Young Neurosurgeons Committee and WFNS Young Neurosurgeons Committee.)

Background: Providing a comprehensive and effective neurosurgical service requires adequate numbers of well-trained, resourced, and motivated neurosurgeons. The survey aims to better understand 1) the demographics of young neurosurgeons worldwide; 2) the challenges in training and resources that they face; 3) perceived barriers; and 4) needs for development., Methods: This was a cross-sectional study in which a widely disseminated online survey (April 2018-November 2019) was used to procure a nonprobabilistic sample from current neurosurgical trainees and those within 10 years of training. Data were grouped by World Bank income classifications and analyzed using χ 2 tests because of its categorical nature., Results: There were 1294 respondents, with 953 completed responses included in the analysis. Of respondents, 45.2% were from high-income countries (HICs), 23.2% from upper-middle-income countries, 26.8% lower-middle-income countries, and 4.1% from low-income countries. Most respondents (79.8%) were male, a figure more pronounced in lower-income groups. Neuro-oncology was the most popular in HICs and spinal surgery in all other groups. Although access to computed tomography scanning was near universal (98.64%), magnetic resonance imaging access decreased to 66.67% in low-income countries, compared with 98.61% in HICs. Similar patterns were noted with access to operating microscopes, image guidance systems, and high-speed drills. Of respondents, 71.4% had dedicated time for neurosurgical education., Conclusions: These data confirm and quantify disparities in the equipment and training opportunities among young neurosurgeons practicing in different income groups. We hope that this study will act as a guide to further understand these differences and target resources to remedy them., (© 2020 The Author(s).)

Background: Strengthening health systems requires attention to workforce, training needs, and barriers to service delivery. The World Federation of Neurosurgical Societies Young Neurosurgeons Committee survey sought to identify challenges for residents, fellows, and consultants within 10 years of training., Methods: An online survey was distributed to various neurosurgical societies, personal contacts, and social media platforms (April-November 2018). Responses were grouped by World Bank income classification into high-income countries (HICs), upper middle-income countries (UMICs), low-middle-income countries (LMICs), and low-income countries (LICs). Descriptive statistical analysis was performed., Results: In total, 953 individuals completed the survey. For service delivery, the limited number of trained neurosurgeons was seen as a barrier for 12.5%, 29.8%, 69.2%, and 23.9% of respondents from HICs, UMICs, LMICs, and LICs, respectively ( P < 0.0001). The most reported personal challenge was the lack of opportunities for research (HICs, 34.6%; UMICs, 57.5%; LMICs, 61.6%; and LICs, 61.5%; P  = 0.03). Other differences by income class included limited access to advice from experienced/senior colleagues ( P < 0.001), neurosurgical journals ( P < 0.0001), and textbooks ( P  = 0.02). Assessing how the World Federation of Neurosurgical Societies could best help young neurosurgeons, the most frequent requests ( n  = 953; 1673 requests) were research ( n  = 384), education ( n  = 296), and subspecialty/fellowship training ( n  = 232). Skills courses and access to cadaver dissection laboratories were also heavily requested., Conclusions: Young neurosurgeons perceived that additional neurosurgeons are needed globally, especially in LICs and LMICs, and primarily requested additional resources for research and subspecialty training., (© 2020 The Author(s).)