Journal of neurosurgery
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Journal of neurosurgery · Jan 2001
Case ReportsResults and risk factors for anterior cervicothoracic junction surgery.
Stabilization of the cervicothoracic junction (CTJ) requires special attention to the operative approach and biomechanical requirements of the fixation construct. In this study the authors assess the morbidity associated with the anterior approach to the CTJ and define risks that may lead to construct failure after anterior CTJ surgery. ⋯ Findings of this study, in the setting of these factors, indicate that anterior reconstruction alone may not meet the biomechanical needs of this spinal region and that supplementary fixation may be considered to augment stabilization for fusion success.
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Journal of neurosurgery · Jan 2001
Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis.
Patients with deep wound infections complicating previously placed internal instrumentation have been successfully treated by debridement and prolonged postoperative antibiotic therapy, which avoided removal of the hardware. Comparatively fewer patients with pyogenic discitis and vertebral osteomyelitis (PDVO) have undergone single-stage debridement, arthrodesis, and internal fixation. The purpose of this study was to determine the efficacy of combining debridement, arthrodesis in which iliac autograft is used, and segmental internal fixation in a single-stage procedure for patients in whom nonoperative management of PDVO has failed. ⋯ The authors conclude that single-stage debridement, arthrodesis, and internal fixation can be effective in the treatment of PDVO. A 6-week course of postoperative intravenous antibiotics may be sufficient in patients with few risk factors. The harvesting of iliac autograft through the same operative exposure may not increase the risk of secondary infection.
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Journal of neurosurgery · Jan 2001
The effects of dexamethasone on bone fusion in an experimental model of posterolateral lumbar spinal arthrodesis.
The use of corticosteroid agents during the healing phase after spinal arthrodesis remains controversial. Although anecdotal opinion suggests that corticosteroids may inhibit bone fusion, such an effect has not been substantiated in clinical trials or laboratory investigations. This study was undertaken to delineate the effect of exogenous corticosteroid administration on bone graft incorporation in an experimental model of posterolateral lumbar fusion. ⋯ The corticosteroid agent dexamethasone inhibited bone graft incorporation in a rabbit model of single-level posterolateral lumbar spinal fusion, inducing a significantly higher rate of nonunion, compared with that in saline-treated control animals.
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Journal of neurosurgery · Jan 2001
Randomized Controlled Trial Multicenter Study Clinical TrialA multicenter prospective randomized controlled trial of the efficacy of mild hypothermia for severely head injured patients with low intracranial pressure. Mild Hypothermia Study Group in Japan.
The criteria for the use of mild hypothermia (34 degrees C) in severely head injured patients have not been standardized. A prospective randomized controlled trial was conducted to determine whether mild hypothermia is essential in the treatment of severely head injured patients with low intracranial pressure (ICP). ⋯ Mild hypothermia should not be used for the treatment of severely head injured patients with low ICP because this therapy conveys no advantage over normothermia in such patients.