Journal of neurosurgery
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Journal of neurosurgery · Aug 1995
Case ReportsIschemic optic neuropathy following lumbar spine surgery. Case report.
This 48-year-old hypertensive man, a cigarette smoker, awoke in the recovery room with visual loss in the right eye after uncomplicated lumbar spine surgery. His intraoperative blood pressure had been maintained at relatively low levels to reduce bleeding; a loss of 1500 cc of blood was reported. Postoperative hemoglobin was 4.2 g/dl less than the preoperative hemoglobin; however, the patient did not receive a blood transfusion. ⋯ The right optic nerve and retina were initially normal but the patient eventually developed optic nerve atrophy consistent with the clinical diagnosis of ischemic optic neuropathy. Neurosurgeons should be aware that this condition may follow uncomplicated lumbar spine surgery and should obtain prompt ophthalmological consultation when patients develop postoperative visual loss. Aggressive and rapid correction of blood pressure and hematocrit may be helpful in individuals who develop ischemic optic neuropathy after lumbar spine surgery.
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Journal of neurosurgery · Aug 1995
Biomechanical analysis of bone mineral density, insertion technique, screw torque, and holding strength of anterior cervical plate screws.
✓ The bone mineral density (BMD) of 99 cadaveric cervical vertebral bodies (C3-7) was determined using dual x-ray absorptiometry. The vertebral bodies were randomly assigned to receive either a unicortical (51 bodies) or bicortical (48 bodies) Caspar cervical plating screw. The initial insertion torque was measured using a digital electronic torque wrench, and the force required to withdraw the screw from the vertebral body was determined. ⋯ The calculated holding index and resultant pullout force were significantly correlated for both techniques of screw insertion (r = 0.92), and a significant difference in holding index was observed with unicortical versus bicortical screw placement (p = 0.04). The determination of BMD and measurement of insertion torque to create a unique holding index provides an assessment of bone-screw interaction and holding strength of the screw, both of which impact on the resultant stability of cervical instrumentation. As the number of cervical plating systems increases, the determination of a holding index for various screws and insertion techniques may assist in the comparison of cervical instrumentation.
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Journal of neurosurgery · Jul 1995
Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome.
Thirty patients were treated surgically for spinal epidural hematoma (SEH). Twelve of these cases resulted from spinal surgery, seven from epidural catheters, four from vascular lesions, three from anticoagulation medications, two from trauma, and two from spontaneous causes. Pain was the predominant initial symptom, and all patients developed neurological deficits. ⋯ Patients taken to surgery within 12 hours had better neurological outcomes than patients with identical preoperative Frankel grades whose surgery was delayed beyond 12 hours. This large series of SEH demonstrates that rapid diagnosis and emergency surgical treatment maximize neurological recovery. However, patients with complete neurological lesions or long-standing compression can improve substantially with surgery.
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Journal of neurosurgery · Jul 1995
Electrical stimulation of the trigeminal nerve root for the treatment of chronic facial pain.
Between March 1990 and December 1992, 23 patients with chronic intractable facial pain due to various forms of injury to the trigeminal nerve or nerve root underwent implantation of an electrical stimulating system to treat their pain. All patients had failed previous extensive pain treatment efforts. A monopolar platinum-iridium electrode was implanted on the trigeminal nerve root via percutaneous puncture of the foramen ovale. ⋯ Although changes in the patterns of analgesic medication usage were few, six patients (26%) now experience a normal life style. Only one complication was seen, namely a dislocated electrode, which was easily replaced. Chronic electrical stimulation of the trigeminal nerve root appears to be an easy and safe technique for providing relief of chronic facial pain related to injury to the trigeminal nerve in a significant number of patients.