Spine
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The authors studied the vascular anatomy of the thoracic and lumbar spine in cadavers related to the clinical use of total en bloc spondylectomy in malignant vertebral tumors. ⋯ Total en bloc spondylectomy conducted posteriorly is less likely to damage the thoracic aorta from T1 to T4 but, distal to T5, the aorta must be carefully retracted anteriorly before manipulation of the affected vertebra(e). For a malignant tumor involving L1 or L2, the medial and, occasionally, the intermediate crura of the diaphragm and the first two lumbar arteries must be treated carefully before spondylectomy. Malignant tumors involving the L3 and L4 vertebral bodies can be approached with a total en bloc spondylectomy technique only when the inferior vena cava has been safely retracted anteriorly.
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This study retrospectively analyzed the outcome of unilateral vertebral artery ligation during cervical spine surgery. ⋯ A vertebral artery could be ligated uneventfully when the diameter of the vertebral artery was not larger than the one not involved. Where vertebral artery ligation could not be avoided, it should be confirmed by preoperative angiogram that the other vertebral artery is large enough and that simultaneous occlusion testing of the involved vertebral artery is uneventful.
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Review Case Reports
Bilateral vertebral artery lesion after dislocating cervical spine trauma. A case report.
This case report illustrates the problems associated with diagnosis and management of vertebral artery injuries resulting from dislocating cervical spine trauma. ⋯ The possibility of the complication of a vertebral artery lesion should be kept in mind when examining patients with cervical spine trauma, especially in patients with fracture-dislocation. Immediate identification by vertebral angiography, magnetic resonance imaging, or thin-slice computed tomography scan is necessary for optimal management of this injury.
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Clinical Trial
Prospective outcome evaluation of spinal cord stimulation in patients with intractable leg pain.
The results of spinal cord stimulation were prospectively evaluated using both subjective patient self-report measures and objective physical functional testing. ⋯ Spinal cord stimulation implantation can result in improved physical function and decreased pain in patients who are carefully screened and in whom the implantation is performed with the patient awake to help ensure optimal pain-relieving lead placement.