Neurosurgery
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In the surgical management of cervical spondylosis, the application of rigid internal fixation can enhance the immediate stability of the cervical spine. The sophistication of such internal fixation systems and the indications for their use are continuously evolving. A sound understanding of regional anatomy, biomechanics, and kinematics within the cervical spine is essential for the safe and effective application of internal fixation. ⋯ Although lateral mass screws provide excellent fixation within the subaxial cervical spine, the regional anatomy of C2 and C7 often make it difficult to place such screws, and pedicle screws at these levels are advocated. Pedicle screws achieve fixation into both the anterior and posterior column and are arguably the most stable form of rigid internal fixation within the cervical spine. Familiarity with these internal fixation techniques can be an extremely valuable tool for the spine surgeon managing these degenerative disorders of the cervical spine.
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Cervical spondylosis is a result of degenerative changes of the cervical spine. Neurological symptoms of myelopathy result from the narrowing of the spinal canal, causing spinal cord compression. ⋯ Surgical decompression can be addressed from a ventral, dorsal, or combined approach. The authors discuss the technical aspects of the surgical decision making process regarding the decision to approach the spine from a ventral or dorsal orientation.
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Degenerative disease of the cervical spine commonly occurs in the natural process of aging. This can lead to compression of the spinal cord and symptomatic myelopathy. We review the pathophysiological factors that lead to myelopathy and the controversial natural history of untreated myelopathy. Signs and symptoms at presentation, examination findings, differential diagnosis, and diagnostic studies are also discussed.
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To evaluate clinical usefulness of cerebrospinal fluid stroke volume (SV) assessed in the cerebral aqueduct, via cine phase-contrast magnetic resonance imaging, for predicting outcome after shunt surgery in suspected normal pressure hydrocephalus. ⋯ The data from this study show no evidence that cine phase-contrast magnetic resonance imaging measurements of SV in the cerebral aqueduct are useful for selecting patients with normal pressure hydrocephalus symptoms to shunt surgery.
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Comparative Study
Subarachnoid hemorrhage treated with clipping: long-term effects on employment, relationships, personality, and mood.
Only one-third of patients regain functional independence after aneurysmal subarachnoid hemorrhage (SAH). Despite this recovery, many of these patients experience psychosocial problems. We assessed the long-term effects of SAH on employment, relationships, personality, and mood. ⋯ The long-term psychosocial effects of SAH are considerable, even in patients who regain functional independence. Treating physicians should be aware of these long-term effects of SAH when discussing prognosis and reintegration to work after initial recovery with patients and family.