Journal of neurosurgery
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Journal of neurosurgery · Jan 2004
ReviewSurgical innovation or surgical evolution: an ethical and practical guide to handling novel neurosurgical procedures.
Surgical innovation is an important driver of improvements in technique and technology, which ultimately translates into improvements in patients' outcomes. Nevertheless, patients may face new risks of morbidity and mortality when surgical innovation is used, and well-intentioned surgical "experimentation" on patients must be regulated and monitored. In this paper the authors examine the challenges of defining surgical innovation and briefly review the literature on this challenging subject. ⋯ The authors propose guidelines for determining the need for regulation of innovation. The potential role of institutional review boards in this process is highlighted.
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Journal of neurosurgery · Jan 2004
Tracheostomy placement in patients with complete cervical spinal cord injuries: American Spinal Injury Association Grade A.
The authors sought to identify variables that predispose patients with acute American Spinal Injury Association (ASIA) Grade A cervical spinal cord injury (SCI) to require tracheostomies for ventilator support or airway protection. ⋯ Several risk factors were identified that corresponded to the frequent tracheostomy placement in the acute injury phase after complete cervical SCI. Early tracheostomy may be considered in patients with multiple risk factors to reduce duration of stay in the intensive care unit and facilitate ventilatory weaning.
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Journal of neurosurgery · Jan 2004
Accelerated spondylotic changes adjacent to the fused segment following central cervical corpectomy: magnetic resonance imaging study evidence.
The authors studied whether cervical spine motion segments adjacent to a fused segment exhibit accelerated degenerative changes on short-term follow-up magnetic resonance (MR) imaging. ⋯ On short-term follow-up MR imaging, levels adjacent to the fused segment exhibited more pronounced degenerative changes (compared with remote levels) in 75% of patients who had undergone one- or two-level central corpectomy.
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Journal of neurosurgery · Jan 2004
Comparative StudyLaminoplasty for cervical myelopathy caused by subaxial lesions in rheumatoid arthritis.
Although controversy exists regarding surgical treatment for rheumatoid subaxial lesions, no detailed studies have been conducted to examine the efficacy of laminoplasty in such cases. To discuss indications for laminoplasty in rheumatoid subaxial lesions, the authors retrospectively investigated clinical and radiological outcomes in patients who underwent laminoplasty for subaxial lesions. ⋯ Patients with nonmutilating-type RA can benefit from laminoplasty for myelopathy due to subaxial lesions.
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Journal of neurosurgery · Jan 2004
Case ReportsImproved repair of cervical esophageal fistula complicating anterior spinal fusion: free omental flap compared with pectoralis major flap. Report of four cases.
Esophageal injury is a serious complication of anterior cervical fusion. A team approach to the management of these cases is described. The authors performed spinal assessment, control of the fistula, and interposition of a vascularized flap between the spine and the esophagus. They compared the overall efficacy of the pectoralis major flap (pedicled; two cases) and omental flap (free; two cases).