Journal of neurosurgery
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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.
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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
Kyphoplasty for vertebral compression fractures: 1-year clinical outcomes from a prospective study.
Over the past 15 years, vertebroplasty has emerged as a treatment for vertebral compression fractures. This technique, however, does not restore vertebral height and is associated with a high rate of cement leakage. Recently, kyphoplasty was developed in an effort to circumvent this problem. Although its immediate results have been reported, it is unclear whether the benefits endure. ⋯ Kyphoplasty is an effective treatment for vertebral compression fractures. The benefits presented in the early postoperative period and persisted at 1 year posttreatment.
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Journal of neurosurgery · Jul 2003
Case Reports Comparative StudyFocal fractionated radiotherapy for intramedullary spinal arteriovenous malformations: 10-year experience.
Radiosurgical treatment of spinal arteriovenous malformations (AVMs) is becoming a practical therapeutic option as methodology improves, but no comparative study has yet been published on focal fractionated radiotherapy. The authors report their experience with conventional and hypofractionated radiotherapy for spinal AVM. ⋯ Because no patient experienced adverse effects, the maximum tolerable radiation dose for the spinal cord associated with an AVM could not be identified, although it presumably is higher than those administered. The lack of rebleeding in patients in whom complete angiographic occlusion was absent suggests that the natural history of spinal AVMs may be less aggressive than previously reported.
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Journal of neurosurgery · Jul 2003
Case ReportsSpinal cord edema: unusual magnetic resonance imaging findings in cervical spondylosis.
Spinal cord edema is a rare radiological finding in chronic degenerative disorders of the spine. Between 1997 and 2001, the authors treated six patients with cervical spondylotic myelopathy in whom postoperative spinal cord edema was demonstrated. The authors describe the radiological and clinical features of this unusual condition. ⋯ The radiological characterization of spinal cord edema was based on the reversible white matter lesion most likely caused by disturbed local venous circulation induced by chronic spinal cord compression. Such unusual MR findings in cervical spondylotic myelopathy should be differentiated from intramedullary spinal cord tumors, demyelinating disorders, or inflammatory processes.