Acta neurochirurgica
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Acta neurochirurgica · Dec 2013
Surgical strategy in grade II astrocytoma: a population-based analysis of survival and morbidity with a strategy of early resection as compared to watchful waiting.
We recently demonstrated a survival benefit of early resection in unselected diffuse low-grade gliomas (LGG). However, heterogeneity within the LGG entity warrants investigation in a homogenous subgroup. Astrocytoma represents the largest subgroup of LGG, and is characterized by diffuse growth and inferior prognosis. We aimed to study the effects of early resection compared to biopsy and watchful waiting in this subgroup. ⋯ Early 3D ultrasound guided resections improve survival, apparently without increased morbidity, compared to biopsy and watchful waiting in patients with diffuse World Health Organization (WHO) grade II astrocytomas.
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Acta neurochirurgica · Dec 2013
Spinal magnetic resonance imaging with reduced specific absorption rate in patients harbouring a spinal cord stimulation device - A single-centre prospective study analysing safety, tolerability and image quality.
Spinal cord stimulation (SCS) is an accepted treatment in patients with failed back surgery (FBS), complex regional pain syndrome (CRPS) and persistent radicular pain following surgery. In order to avoid patient hazards or device malfunction manufacturers advise to abstain from magnetic resonance imaging (MRI) in patients with implanted electrodes or pulse generators. ⋯ Using a protocol with a reduced specific energy absorption rate, spinal MRI examinations in patients with SCS can be considered safe. The current view that neurostimulators are a general contraindication to MR examinations has to be reconsidered in patients with new or progressive spinal symptoms.
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Acta neurochirurgica · Dec 2013
Usefulness of minimum clinically important difference for assessing patients with subaxial degenerative cervical spine disease: statistical versus substantial clinical benefit.
The measurement of the therapeutic outcome of cervical spine surgeries commonly relies on four main patient reported outcomes (PROs): Neck Disability Index (NDI), Visual Analog Scale (VAS) for pain, and Short Form-36 (SF-36) Physical (PCS) and Mental (MCS) Component Summary. However, the clinical impact of such scores and how they could effectively measure therapeutic efficacy remains unclear. In this context, the concept of minimum clinically important difference (MCID) is developing into the standard by which to evaluate treatments, patient satisfaction and cost-effectiveness. ⋯ The MDC (minimum detectable change) approach together with the SR anchor appears to be the most appropriate MCID method. It offers the greatest area under the ROC curve (threshold above the 95 % CI), and the choice of the anchor did not significantly affect this result. MCID values for this dataset were 5.6 for PCS, 5.12 for MCS and 2.41 for NDI.
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Acta neurochirurgica · Dec 2013
Long-term outcome of the Cloward procedure for single-level cervical degenerative spondylosis. Clinical and radiological assessment after a 22-year mean follow-up.
To evaluate the long-term outcomes of the classical Cloward procedure in single-level cervical spondylosis. ⋯ The Cloward technique provided excellent long-term clinical outcome in the treatment of single-level cervical degenerative spondylosis. There were no major alterations of the cervical sagittal balance, and the development of adjacent segment disease (ASD) was not specifically associated with the previous surgery.
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Acta neurochirurgica · Dec 2013
Comparative StudyPercutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures: is it effective?: comparative study with open short-segment pedicle screw fixation with posterolateral fusion.
Since introduction of the pedicle screw-rod system, short-segment pedicle screw fixation has been widely adopted for thoracolumbar burst fractures (TLBF). Recently, the percutaneous pedicle screw fixation (PPSF) systems have been introduced in spinal surgery; and it has become a popularly used method for the treatment of degenerative spinal disease. However, there are few clinical reports concerning the efficacy of PPSF without fusion in treatment of TLBF. The purpose of this study was to determine the efficacy and safety of short-segment PPSF without fusion in comparison to open short-segment pedicle screw fixation with bony fusion in treatment of TLBF. ⋯ Both open and percutaneous short-segment pedicle fixation were safe and effective for treatment of TLBF. Although both groups showed favorable clinical and radiologic outcomes at the final follow-up, PPSF without bone graft provided earlier pain relief and functional improvement, compared with open TPSF with posterolateral bony fusion. Despite several shortcomings in this study, the result suggests that ongoing use of PPSF is recommended for the treatment of TLBF.