Journal of neurosurgery. Spine
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Case Reports
Postoperative retroperitoneal hematoma following transforaminal percutaneous endoscopic lumbar discectomy.
The purpose of this study was to demonstrate the clinical characteristics of postoperative retroperitoneal hematoma (RPH) following transforaminal percutaneous endoscopic lumbar discectomy (PELD) and to discuss how to prevent the complication of unintended hemorrhage. ⋯ Although transforaminal PELD is a minimally invasive and safe procedure, the possibility of RPH should be kept in mind. Adequate technical and anatomical considerations are important to avoid this unusual hemorrhagic complication, especially in the patient with underlying medical problems or previous operative scarring. A high index of suspicion and early detection is also important to avoid the progression of the hematoma.
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Spontaneous spinal epidural hematoma (SSEH) is rare. Its etiology remains controversial; however, spinal venous wall susceptibility to intravenous pressure change and the resultant venous rupture seem to be involved. ⋯ This neurological false localizing sign seems to have resulted from counterforce by preexisting asymptomatic cervical intervertebral disc herniation at the C6-7 levels inducing direct pressure on the anterior spinal cord. This case is the first reported instance of posterior cervical SSEH manifesting acute anterior spinal cord syndrome as its false localizing sign.
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Case Reports Clinical Trial
Surgery in the cervicothoracic junction with an anterior low suprasternal approach alone or combined with manubriotomy and sternotomy: an approach selection method based on the cervicothoracic angle.
The authors propose an easy MR imaging method to measure and categorize individual anatomical variations within the cervicothoracic junction (CTJ). Furthermore, they propose guidelines for selection of the appropriate approach based on this new categorization system. ⋯ Imaging of the thoracic manubrium should be routinely included on MR imaging studies obtained in the CTJ. It is important for the surgeon to understand the pertinent anatomy of the individual patients and to determine the feasible surgical approaches after evaluating the CTA and vascular factors preoperatively. An anterior low suprasternal approach, or this approach combined with manubriotomy, is applicable in most of the cases in the CTJ. It should be cautioned that preoperatively unrecognized variations of the left BCV above the SSN might result in potential intraoperative trauma during an anterior approach.
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The aim of this study was to describe a novel technique for laminoplasty in which translaminar screws are used in the thoracic and lumbar spine. ⋯ The authors found that the laminoplasty and translaminar screw technique is feasible in the thoracic and lumbar regions, but further studies are needed to analyze the biomechanical effects and long-term outcomes in a large number of patients.
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The goal in this study was to develop a convenient, less-invasive animal model to monitor progression of intervertebral disc (IVD) degeneration for future testing of new treatments for disc degeneration. ⋯ After introducing an 18- or 21-gauge needle into the NP area of discs in the rat tail, the stabbed disc showed signs of degeneration in terms of MR imaging and histological outcome measurements. Changes in BMPRII expression in this animal model provide an insight for the effectiveness of delivering BMPs into the region responsible for chondrogenesis for disc repair. This convenient, less-invasive, reproducible, and cost-effective model may be a useful choice for testing novel treatments for disc degeneration.