Journal of neurosurgery
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Journal of neurosurgery · Oct 2003
Randomized Controlled Trial Clinical TrialFactors associated with the development of vasospasm after planned surgical treatment of aneurysmal subarachnoid hemorrhage.
The goal of this study was to determine factors associated with the development of symptomatic vasospasm among patients with aneurysmal subarachnoid hemorrhage (SAH) who participated in the randomized, double-blind, placebo-controlled trials of tirilazad between 1991 and 1997. ⋯ Symptomatic vasospasm was associated with the amount of SAH on the CT scan, the presence of IVH, and the patient's neurological grade. The association with patient age may reflect alterations in vessel reactivity associated with age. A history of hypertension may render the brain more susceptible to symptoms from vasospasm. The explanation for the relationships with aneurysm size, use of prophylactic induced hypertension, and the particular study is unclear.
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Journal of neurosurgery · Oct 2003
Multicenter Study Clinical TrialClinical and radiological evaluation of the Codman semiconstrained load-sharing anterior cervical plate: prospective multicenter trial and independent blinded evaluation of outcome.
Semiconstrained load-sharing implants for spinal fixation accommodate change in the screw-plate interface as bone grafts shrink. The authors evaluated the clinical and radiological outcome in patients after placement of the Codman anterior cervical plate (ACP) system, which allows change in the screw-plate angle. ⋯ Based on an independent blinded evaluation, the Codman ACP provides effective fixation with load sharing and is effective in achieving fusion with a 94% success rate. Direct comparison with rigidly locked devices is required to establish definitively the optimal method for anterior cervical fixation.
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Journal of neurosurgery · Oct 2003
Randomized Controlled Trial Clinical TrialLow-dose radiotherapy for the inhibition of peridural fibrosis after reexploratory nerve root decompression for postlaminectomy syndrome.
The authors of clinical studies have demonstrated a significant association between the presence of extensive post-lumbar discectomy peridural scar formation and the recurrence of low-back and radicular pain. Low-dose perioperative radiotherapy has been demonstrated to inhibit peridural fibrosis after laminectomy in animal models. The present study was designed to evaluate the clinical efficacy of preoperative irradiation in patients with failed-back surgery syndrome due to peridural fibrosis who underwent reexploration and nerve root decompression. ⋯ Preoperative low-dose external-beam irradiation improved clinical outcomes after reexploration and decompression of nerve roots affected by postlaminectomy peridural fibrosis causing radicular pain. The addition of preoperative irradiation may improve outcome in patients who undergo reoperation for recurrent radicular pain associated with a significant amount of peridural fibrosis, particularly now that no antiadhesion product is available for clinical use.
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Journal of neurosurgery · Oct 2003
Comparative Study Clinical TrialImproved accuracy of computer-assisted cervical pedicle screw insertion.
The authors introduce a unique computer-assisted cervical pedicle screw (CPS) insertion technique used in conjunction with specially modified original pedicle screw insertion instruments. The accuracy of screw placement as well as surgery-related outcome and complication rates were compared between two groups of patients: those in whom a computer-assisted and those in whom a conventional manual insertion technique was used. ⋯ In contrast to the previously reported computer-assisted technique, our CPS insertion technique provides real-time three-dimensional instrument/screw tip information. This serves as a powerful tool for safe and accurate pedicle screw placement in the cervical spine.
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Journal of neurosurgery · Oct 2003
Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine.
Factors related to long-term surgical outcome of thoracic myelopathy caused by ossification of the ligamentum flavum (OLF) have not been fully investigated. To evaluate these factors, the authors reviewed medical records obtained in patients who had undergone decompressive surgery for thoracic OLF. ⋯ Duration of preoperative symptoms represents the most important predictor of long-term surgery-related outcome in patients treated for thoracic OLF. The type of ossified ligamentum flavum, dural adhesion, and simultaneous surgery for coexistent cervical or lumbar lesions do not appear to influence the long-term postoperative prognosis.