World Neurosurg
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This finite element analysis aimed to investigate the effects of surgical procedures for cervical spine injury. ⋯ Cervical stabilization was preserved by the APF model. Regarding range of motion, the PF model had an advantage compared with the AF model except for flexion. An understanding of biomechanics provides useful information for the clinician.
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Case Reports
Technique of C2 nerve root preservation in the presence of anomalous vertebral artery in Atlantoaxial operations.
While accessing the C1-C2 joint during posterior atlantoaxial fixation, the C2 nerve root along with its perineural venous plexus remains an obstacle for a panoramic visualization of the entry point of the C1 lateral mass and joint preparation. Therefore, many surgeons frequently advocate its intentional sectioning during this approach, with no related major complications.1,2 However, this sectioning has at times been associated with symptoms such as hypoesthesia, numbness, dysesthesia, and neuropathic ulcers.3 Thus C2 nerve root preservation during posterior approach for atlantoaxial dislocation (AAD) could potentially avoid such consequences.4 Its preservation has been described for AAD cases with relatively normal C1-C2 joint anatomy with no osseovascular abnormalities.2 In contrast, attempt at C2 nerve root preservation in patients with congenital AAD harboring bony and vascular anomalies poses a greater challenge owing to a restricted operative space and the potential for perineural venous bleeding during dissection. This is more so for young neurosurgeons in the initial part of their learning curve. ⋯ The salient operative steps involve gentle teasing and dissection of perineural soft tissues above and below the nerve root; the key to minimize venous bleeding is to dissect, coagulate, and divide them sequentially. A thorough release of the perineural soft tissues allows adequate nerve root mobilization, which in turn provides clear visualization of the C1-C2 joint space, preventing an undue nerve stretching during the C1-lateral mass screw insertion. The anomalous VA usually lies anterior to the C2 nerve root, and careful imaging evaluation allows its anticipation.3 We do not prefer the easy alternative of C2 nerve root sacrifice because of its inherent complications we noticed in our earlier clinical practice.3.
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We investigated the long-term effects of bone cement-augmented instrumentation in multilevel lumbar fusions in a retrospective cohort study. The use of cement-augmented screws is one of the techniques used to reduce early mechanical failure in treating multilevel lumbar fusion, especially in the elderly. However, little information is available regarding the long-term effects. ⋯ Although bone cement-augmented screw implantation can prevent kyphotic deformation at the proximal junction of upper instrumented vertebra in the early postoperative stages of multilevel lumbar fusion, a careful selection of patients is required because of possibly accelerated degeneration of adjacent segments.
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To assess the early outcomes of the following 2 types of proton therapy: passive scattering proton therapy (PSPT) and pencil beam proton therapy (PBPT). ⋯ The PBPT group showed comparable outcome to the PSPT group. The degree of resection was more important than the modality of proton therapy. Further follow-up and cases are necessary to evaluate the benefit of PBPT.
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Bibliometrics assessing academic productivity plays a significant role in neurosurgeons' career advancement. This study aimed to evaluate the influence of multiple author profiles on Scopus on neurosurgeon author-level metrics (h-index, document number, citation number). ⋯ U.S. academic neurosurgeons with multiple existing profiles on Scopus experience a 17.3% loss in h-index, a 16.2% loss in document number, and a 14.1% loss in citations, heavily undercounting their perceived academic productivity.