World Neurosurg
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In Taiwan (my country), the proportion of people 65 years or older was over 14% in 2018, which is known as entering "aged society." More and more thoracolumbar burst fractures in the setting of osteoporosis happen nowadays. In this study, a finite element model on thoracolumbar burst fracture was established and 4 types of posterior short-segment fixations were tested under normal bone quality and osteoporotic conditions. ⋯ The S-I-C provided the strongest construct even in osteoporosis status. But osteoporosis would result in weakness for spinal construct, which might lead to implant failure.
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Patients with mucopolysaccharidosis type I (MPS I) have a good life expectancy due to early therapeutic options, such as stem cell therapy. Stem cell therapy can prevent the progression of some skeletal malformations. In contrast, the progression of thoracolumbar kyphoscoliosis, genua vara, and hip dysplasia cannot be influenced. We present 3 cases of children with MPS I with thoracolumbar kyphosis/kyphoscoliosis treated with a growing rod system. ⋯ If conservative treatment fails and surgery is necessary, an individual approach is needed. Dorsal stabilization with pedicle screws using a growing rod technique is an option for the correction of thoracolumbar/lumbar kyphosis in children with MPS I. However, fusion should be prevented initially or should be kept as short as possible. We achieved acceptable correction of the spinal deformity using the growing rod technique. Finally, surgery with correction and fusion is necessary after exhausted correction potential.
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Incidence of chronic subdural hematoma (CSH) associated with metastases of extraneural malignancies is rare. We report a rare case of CSH wherein most of the CSH cavity was occupied with metastatic cancer cells; in addition, we review the literature. ⋯ To the best of our knowledge, this is the first report of a CSH accompanied by tumor metastasis in most of the CSH cavity. Although rare, if a patient with cancer has CSH, the CSH should be treated considering the possibility of metastasis.
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Brucellosis is an endemic disease. Brucellar spondylitis is mainly manifested as a unifocal lesion, but noncontiguous multifocal brucellar spondylitis is more rare. ⋯ Clinicians should raise awareness of noncontiguous multifocal brucellar spondylitis. The Wright agglutination test and whole spine MRI are the key methods to reduce misdiagnosis and missed diagnosis of noncontiguous multifocal brucellar spondylitis. Drug therapy for brucellar spondylitis is the basis, and surgical treatment is complementary therapy. The use of alternative chemotherapy and surgery for noncontiguous multifocal brucellar spondylitis is also safe and effective.
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The superficial temporal artery to middle cerebral artery (MCA) end-to-side anastomosis is the most commonly used direct extracranial-intracranial bypasses type for Moyamoya disease (MMD). In progressive MMD without suitable scalp arteries, other bypass constructs may need to be considered to augment blood flow. ⋯ This case illustrates the need for creative bypass constructs in progressive MMD patients with multiple prior surgeries. Two surgical goals are paramount: flow augmentation with preservation of the existing collateral network to avoid complications and new deficits.