Journal of neurosurgery
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Journal of neurosurgery · Jul 2003
Review Case ReportsSurgical management of lumbosacral nerve root hemangioblastomas in von Hippel-Lindau syndrome.
Hemangioblastomas in the lumbosacral region are rare, and the authors of prior reports have not defined the surgical management, histopathological features, or outcome in a group of patients after resection of these tumors. To identify features that will help guide the operative and clinical management of these lesions, the authors reviewed data obtained in a series of patients with von Hippel-Lindau syndrome who underwent resection of lumbosacral nerve root hemangioblastomas. ⋯ Lumbosacral nerve root hemangioblastomas can be safely removed in most patients with von Hippel-Lindau syndrome. Generally, hemangioblastomas of the lumbosacral nerve roots should be resected when they become symptomatic. Because these neoplasms appear to originate from the nerve root, it is necessary to sacrifice the nerve root from which the hemangioblastoma originates to achieve complete resection.
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Journal of neurosurgery · Jul 2003
Comparative StudyBiomechanical analysis of multilevel cervical corpectomy and plate constructs.
The authors compared the biomechanical stability of two multilevel cervical constructs involving the placement of equal size anterior cervical plates (ACPs) after decompressive surgery: the first is placed after three-level corpectomy with strut graft and the second after two-level corpectomy and aggressive discectomy with strut graft. In addition, both constructs were evaluated with and without the application of a screw attaching the ACP to the strut graft to determine whether the additional screw enhanced stability in any mode of loading. ⋯ The construct associated with the two-level corpectomy/discectomy provided better immediate postoperative stability than that associated with the three-level corpectomy. The addition of a screw to the strut graft conferred stability on the three-level construct but not the two-level construct.
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Journal of neurosurgery · Jul 2003
Case ReportsVertebroplasty in focal Paget disease of the spine. Case report.
Paget disease is an idiopathic metabolic disease of bone that may involve the axial and appendicular skeleton. In up to one third of patients there may be pagetoid involvement of the spine, which can cause back pain and vertebral collapse, with instability or myeloradiculopathy. ⋯ The authors report on a case of localized Paget disease of the spine treated successfully by performing percutaneous vertebroplasty. They propose this procedure as a useful intervention that can be undertaken safely in patients with spinal Paget disease, in whom acquisition of a transpedicular biopsy sample is required as part of diagnosis.
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Journal of neurosurgery · Jul 2003
One-stage three-dimensional correction and fusion: a multilevel posterior lumbar interbody fusion procedure for degenerative lumbar kyphoscoliosis. Technical note.
Surgery for degenerative lumbar kyphoscoliosis (DLKS) is very challenging because the curve has become rigid due to circumferential osteoarthritic changes. Therefore, a standard procedure involving correction and fusion after decompression of the nerves has not yet been established. The authors have been searching for an effective procedure that provides adequate decompression and three-dimensional (3D) correction for symptomatic DLKS. ⋯ They analyze the results obtained in the first 23 cases and discuss the advantages and disadvantages of the procedure. The correction effect was excellent, and compared with other instrumentation-assisted procedures, this surgery is not remarkably invasive. Although the procedure is limited in achieving normal sagittal alignment and the acceleration rate of adjacent-disc degeneration remains relatively high, it is an option for the rigid deformity characterized by DLKS.
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Journal of neurosurgery · Jul 2003
Transarticular screw fixation in the middle and lower cervical spine. Technical note.
Although atlantoaxial transarticular screw fixation is technically demanding and there is a significant risk of vertebral artery (VA) injury, transarticular screw insertion in the middle and lower cervical spine is simple and can be performed safely with the aid of lateral fluoroscopic guidance. The authors describe the surgical techniques and outcome of transarticular screw fixation in the middle and lower cervical spine. Transarticular screw insertion into C2-3 or caudal cervical joints was performed from the articular pillar, directing the screw anterocaudally to penetrate the facet joint and the anterior cortex of the articular pillar, parallel to the sagittal plane. ⋯ No instance of screw backout or loosening was identified radiographically; fusion was achieved in all patients. Biomechanical strength is maintained by penetrating four cortical layers. When performed appropriately, this method is safe and reliable and deserves more widespread use.