Neurosurgery
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Comparative Study Clinical Trial
Salvage technique of posterior iliac bolt placement in long-segment spinal constructs with a previous posterior iliac crest harvest: technical note.
Fusion between the lumbar spine and sacrum has been used to treat deformity, degenerative disease, trauma, and tumor. These constructs have a higher failure rate when a long construct is designed, in patients with poor bone quality, and in patients with previous irradiation or with significant osteoporosis. ⋯ The purpose of this technical note is to describe our salvage technique of iliac bolt placement as an adjunct to lumbar-sacral fusions in a previously harvested iliac crest.
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Comparative Study
Outcome of surgical clipping of unruptured aneurysms as it compares with a 10-year nonclipping survival period.
Recent studies on the natural history of unruptured intracranial aneurysms dictate that we reevaluate the risks and benefits of surgical intervention as it compares with the natural course. We analyzed the outcome of surgical clipping of a patient cohort with unruptured aneurysms as it compares with a 10 year nonclipping survival period on the basis of two previously published studies (International Study on Unruptured Intracranial Aneurysms and a study by Juvela et al. [36] from Helsinki). ⋯ Studies on natural history of unruptured intracranial aneurysms suggest 10 year cumulative bleeding-related mortality and severe morbidity of no less than 7.5%. In our study, surgical clipping resulted in an 0.8% rate of mortality and 3.4% permanent morbidity. This suggests that surgical clipping has the potential of a superior outcome to the natural history of patients who have an estimated life expectancy of no less than 10 years.
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Comparative Study
Examining concussion rates and return to play in high school football players wearing newer helmet technology: a three-year prospective cohort study.
The purpose of this study was to compare concussion rates and recovery times for athletes wearing newer helmet technology compared to traditional helmet design. ⋯ Recent sophisticated laboratory research has better elucidated injury biomechanics associated with concussion in professional football players. This data has led to changes in helmet design and new helmet technology, which appears to have beneficial effects in reducing the incidence of cerebral concussion in high school football players.
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Comparative Study
Current treatment strategies and outcomes in the management of symptomatic vertebral hemangiomas.
We analyzed the outcome of patients with symptomatic vertebral hemangiomas treated at University of California, San Francisco, over a 20 year period. Treatment included transarterial embolization, embolization followed by surgical decompression or vertebral reconstruction with arthrodesis, and percutaneous vertebroplasty alone. ⋯ Transarterial embolization followed by laminectomy is a safe and effective procedure for the treatment of cord compression by vertebral hemangioma causing stenosis without instability or deformity. Vertebrectomy preceded by embolization and followed by reconstruction can be used to treat cord compression from extraosseous tumor extension. Transarterial embolization without decompression is an effective treatment for painful intraosseous hemangiomas. Vertebroplasty is useful for improving pain symptoms, especially when vertebral body compression fracture has occurred in patients without neurological deficit, but is less effective in providing long-term pain relief.
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Comparative Study Clinical Trial
Use of a tubular retractor system as a minimally invasive technique for epidural plate electrode placement under local anesthesia for spinal cord stimulation: technical note.
To improve the technique of placement of large plate electrodes for spinal cord stimulation with a minimally invasive approach using the METRx tubular retractor system (Medtronic Sofamor Danek, Minneapolis, MN). This dilating system splits the paravertebral musculature, avoiding the need to strip these muscles from the spine. The technique described makes it possible to perform the procedure (currently, it is most frequently performed using general anesthesia) with local anesthesia and sedation, allowing test stimulation, and with little intraoperative or postoperative discomfort for the patient. ⋯ Using a tubular retractor system, implantation of plate electrodes for spinal cord stimulation can be performed under local anesthesia with acceptable discomfort for the patient, making the approach of the spinal canal minimally invasive. This method allows test stimulation to assess the correct electrode position and results in less local postoperative discomfort because of the small-muscle splitting approach.