World Neurosurg
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Review Case Reports
Motion preservation at all cost? Multilevel hinge non-union, plate breakage, and intra-dural plate migration following cervical laminoplasty: a case report and literature review.
Cervical laminoplasty is a motion-preserving procedure that addresses spinal cord compression and avoids postlaminectomy kyphosis associated with cervical laminectomy. The most common complications include C5 nerve palsy, axial neck pain, hinge nonunion, and premature closure. Plating is a relatively newer method of laminoplasty fixation that may provide greater stabilization postoperatively and reduce the risk of laminoplasty closure compared with less rigid (e.g., suture) fixation techniques. Although prior studies have reported low rates of laminar/lateral mass screw back out, plate breakage and migration have not been previously described in the literature. The purpose of this paper is to present a case of multilevel hinge nonunion, plate breakage, and plate fragment migration. Although rare, plate failure may result in a dural tear and spinal cord injury/compression. ⋯ We provide recommendations for preventing hinge nonunion because resultant micromotion likely contributed to the plate breakages observed in this patient.
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Review Comparative Study
Thrombectomy-related emboli: Direct aspiration vs. stent retriever thrombectomy for acute ischemic stroke; our experience and literature review.
Thrombectomy-related emboli (TRE) represent a potentially dangerous complication of thrombectomy procedures for acute ischemic stroke. The aim of this study was to compare the rate of TRE in aspiration thrombectomy (ASP) and stent retriever thrombectomy techniques. ⋯ The applied thrombectomy technique (ASP vs. SRT) is not an independent predictor of TRE rates. Operative time tends to affect the rates of uTRE and successful recanalization. The ASP technique offers higher rates of successful recanalization in less operative time.
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Meta Analysis
How Center of Rotation Changes and What Affects These After Cervical Arthroplasty: A Systematic Review and Meta-analysis.
To determine how center of rotation (COR) changes and what affects changes in COR after cervical arthroplasty. ⋯ Prosthesis design affects changes in COR after cervical arthroplasty. If a constrained or semiconstrained prosthesis is chosen (2-piece implant, ball-and-socket, or ball-in-trough design), the COR location tends to shift anteriorly and/or superiorly, whereas if a nonconstrained prosthesis is chosen (3-piece implant, mobile nucleus design), the COR tends to keep the same location as preoperation. In addition, the position of the prosthesis in the intervertebral space also can affect changes in COR after cervical arthroplasty.
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Just like Raymond M. Peardon Donaghy and Gazi Yasargil changed modern neurosurgery by introducing the surgical microscope into the operating room, so did Leonardo Gigli by developing and using for the first time a tool that allowed faster, easier, and safer opening of the skull. ⋯ Gigli (1863-1908) was an Italian surgeon and obstetrician remembered among others for describing his operation-the lateralized version of Severin Pineau's pubiotomy for safe delivery in cases of maternal pelvic deformity-and for designing the Gigli saw, a simple yet brilliant wire saw, versatile enough to be used as both a tool of war and a surgical instrument in the fields of gynecology, orthopedics, surgery, and neurosurgery. The authors pay tribute to Gigli and his contribution at 125 years since the first written mention of his innovative instrument.
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Instability of the craniovertebral junction (CVJ) following odontoidectomy is relatively common. Traditionally, separate stage posterior atlantoaxial ± occipitocervical fusion is used for treatment. A transmucosal approach using a clean-contaminated route is associated with hypothetical risks of infectious complications. ⋯ Five (1.16%) patients required removal of their anterior fixation device, 4 (0.93%) related to SSI. ORs comparing our results with Medvedev et al's retrospective National Surgical Quality Improvement Program study assessing the risk associated with posterior cervical fixation showed no statistical difference between postoperative infection rates (OR = 0.72, P = 0.36). An extensive review of the literature found no evidence to suggest placement of spinal hardware via transmucosal corridor is associated with an increased risk of SSI.