Journal of neurosurgery
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Journal of neurosurgery · Oct 2003
Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis. Technical note.
The purpose of this study was to determine the efficacy and feasibility of posterolateral percutaneous endoscopic lumbar foraminotomy (PELF) for foraminal or lateral exit zone stenosis of the L5-S1 level in the awake patient. Twelve consecutive patients with L5-S1 foraminal stenosis and associated leg pain underwent PELF between May 2001 and July 2002. Under fluoroscopic guidance, posterolateral endoscopic foraminal decompression was performed using a bone reamer, endoscopic forceps, and a laser. ⋯ There was no complication. The PELF procedure provides a simple alternative for treating lumbar foraminal or lateral exit zone stenosis in selected cases. The authors found that the posterolateral endoscopic approach to the L5-S1 foramen was usually possible and that using a bone reamer to undercut the superior facet was effective.
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The purpose of this paper was to analyze outcomes in patients at the Louisiana State University Health Sciences Center (LSUHSC) who presented with contusion-stretch injuries to the axillary nerve. These injuries resulted from shoulder injury either with or without fracture/dislocation. Although recovery of deltoid function can occur spontaneously, this was not always the case. ⋯ Operative exploration of axillary contusion-stretch lesions is worthwhile in carefully selected cases. If indicated by inspection and intraoperative electrical studies, nerve repair can lead to useful function.
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Journal of neurosurgery · Oct 2003
Sympathetic mechanisms in cerebral blood flow alterations induced by spinal cord stimulation.
Cervical spinal cord stimulation (SCS) has been found to augment cerebral blood flow (CBF) in a number of animal models, although the mechanisms underlying the cerebrovascular effects of SCS are poorly described. In this study, the authors examined the role of sympathetic tone in CBF alterations induced by SCS in rats. ⋯ Sympathetic tone plays a major role in SCS-induced increases in CBF. This effect seems to be mediated primarily by alpha1-adrenergic receptors. Systemic hypotension alone cannot explain the effects of sympathetic blockade on the SCS response. Clinical use of SCS in the treatment of cerebral ischemia should take alpha1-adrenergic receptor sympathetic tone into account.
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Journal of neurosurgery · Oct 2003
Spinal blood flow in 24-hour megadose glucocorticoid treatment in awake pigs.
Because of the controversy regarding the benefits of 24-hour administration of methylprednisolone in patients with spinal cord injury (SCI), it is important to investigate its mechanism of action and side effects. This study was conducted to determine if high-dose methylprednisolone modulates neural and vertebral blood flow in an awake large-sized animal model without SCI. ⋯ In the awake pig model, 24-hour methylprednisolone treatment does not modulate cerebral or SCBF, nor does it increase the risk for vertebral osteonecrosis by producing vertebral ischemia.
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Journal of neurosurgery · Oct 2003
Mechanism of the spinal cord injury and the cervical spondylotic myelopathy: new approach based on the mechanical features of the spinal cord white and gray matter.
The authors have previously investigated the mechanical properties of the white and gray matter in the bovine cervical spinal cord, demonstrating that the gray matter is more rigid, although more fragile, than the white matter. In the present study they conducted additional tensile tests on the bovine cervical spinal cord by changing strain levels and strain rates applied to the white and gray matter. ⋯ These differences in mechanical properties between the white and gray matter constitute different mechanisms contributing to the development of tissue damage and clinical symptoms.