Journal of neurosurgery
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Journal of neurosurgery · Jan 2004
Anterior correction of cervical kyphotic deformity: effects on myelopathy, neck pain, and sagittal alignment.
Cervical myelopathy may develop as a result of spinal cord compression with or without deformity. The effect of persistent kyphotic deformity on the ability of the cervical cord to recover following decompressive surgery is not known. ⋯ The correction of sagittal alignment may promote recovery in spinal cord function in patients with kyphotic deformity.
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Journal of neurosurgery · Jan 2004
Case ReportsGiant cell ependymoma of the spinal cord. Case report and review of the literature.
Several rare histological variants of ependymoma have been described. The authors report on a patient in whom cervical spinal cord astrocytoma was originally diagnosed after evaluation of a limited biopsy specimen. More abundant tissue obtained during gross-total resection included areas of well-differentiated ependymoma. ⋯ Only two cases of terminal filum and two of supratentorial giant cell variant of ependymoma have been reported. To the authors' knowledge, this represents the first case of giant cell ependymoma of the spinal cord. The clinical significance is the potential for misdiagnosis with anaplastic (gemistocytic) astrocytoma, especially in cases in whom limited biopsy samples have been obtained.
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Journal of neurosurgery · Jan 2004
Microsurgical interlaminary vertebro- and kyphoplasty for severe osteoporotic fractures.
Percutaneous vertebro- and kyphoplasty have become established methods for the treatment of uncomplicated osteoporotic vertebral fractures. In the setting of severe fractures involving fragmentation of the posterior wall and neural compromise, however, decompressive surgery cannot be performed and epidural cement leakage is poorly controlled. A microsurgical interlaminary approach for vertebro- and kyphoplasty was developed to allow spinal decompression and control of the spinal canal during augmentation. ⋯ The present microsurgical interlaminary approach for vertebro- and kyphoplasty enables treatment of severe osteoporotic fractures involving fragmentation of the posterior wall and neural compromise. Decompressive surgery is possible and the risk of epidural cement leakage is controlled intraoperatively. This technique can be regarded as a procedure on the treatment continuum between percutaneous augmentation and conventional open reconstruction.
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Journal of neurosurgery · Jan 2004
Case ReportsTransvertebral interbody cage and pedicle screw fixation for high-grade spondylolisthesis. Case report.
Surgical stabilization of high-grade lumbosacral spondylolisthesis is clinically challenging, and the success of deformity reduction and fusion varies. The authors describe a patient with Grade III spondylolisthesis at L5-S1. Partial reduction was achieved and fusion involved pedicle screw fixation and a posterior transvertebral interbody cage. ⋯ Clinical and early radiographic results were excellent. Transsacral cage fixation can be considered a viable option to buttress the region in which high-grade L5-S1 spondylolisthesis has been reduced. The cage provides substrate for interbody arthrodesis and acts as a biomechanical stabilizer that helps prevent pedicle screw failure.
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Journal of neurosurgery · Jan 2004
Experience in the surgical management of spontaneous spinal epidural hematoma.
Spontaneous spinal epidural hematoma (SSEH) is a rare disease entity. Although many cases have been reported in the literature, controversy persists as to its origin, diagnosis, and timing of treatment. The authors conducted a study in patients treated in their hospital and report the results. ⋯ Surgery is a safe and effective procedure to treat SSEH. The disease-related mortality rate was 5.7%, the surgery-related complication rate was 2.9%, and there were no operation-related deaths. Neurological outcome after surgery is positively correlated with preoperative neurological deficits (88.9% complete recovery in patients with incomplete neurological deficits compared with 37.5% in those with complete deficits [p < 0.001]). In patients in whom the time interval from initial ictus was shorter (< 48 hours) and in whom the duration of complete neurological symptoms was also briefer (< 12 hours), there is a positive correlation with better neurological and functional recovery (p < 0.05).