bluuebunny/crossref_metadata_2025 huggingface dataset:
Pedicle subtraction osteotomy in the treatment of chronic, posttraumatic kyphotic deformity
Authors: Heary Robert F. , Bono Christopher M.
Published: January 2008

Object

Thoracolumbar fractures, treated operatively or nonoperatively, may cause painful kyphotic deformities over time. A pedicle subtraction osteotomy (PSO) is a single-stage posterior procedure designed to correct sagittal plane deformity. Although it was initially used to treat nontraumatic conditions, a PSO can be highly effective in chronic, posttraumatic fractures of the lumbar spine. In this report the authors review details obtained in the treatment of three patients with severe, posttraumatic spinal deformities. They describe the surgical technique used to correct the sagittal malalignments.

Methods

All three patients were middle aged, and good bone mineral density had been demonstrated in each case preoperatively. After PSO, a mean 51° improvement in sagittal alignment was achieved and maintained until a solid arthrodesis was documented in each case. Substantial improvements in pain relief and functional outcome were observed. A detailed, procedure-specific literature review was undertaken.

Conclusions

A PSO is a valuable tool to add to the armamentarium of neurosurgeons who treat patients suffering from painful posttraumatic deformity following fractures of the upper lumbar spine.
The effect of mitomycin C in reducing epidural fibrosis after lumbar laminectomy in rats
Authors: Lee Jin-Yul , Stenzel Werner , Impekoven Peter , Theisohn Martin , Stützer Hartmut , Löhr Mario , Reithmeier Thomas , Ernestus Ralf-Ingo , Ebel Heinrich , Klug Norfrid
Published: January 2008

Object

xtensive epidural fibrosis after lumbar spine surgery might be an important underlying cause of failed-back syndrome. Based on previously obtained data, the effect of mitomycin C (MMC) in a concentration of 0.1 mg/ml on spinal epidural fibrosis in a rat laminectomy model was investigated in a large series.

Methods

ighty adult Wistar rats underwent lumbar laminectomy. In 40 rats, MMC in a concentration of 0.1 mg/ml was locally applied to the laminectomy sites. No similar treatment was performed in the other 40 rats. At intervals from one to 12 weeks after laminectomy, both macroscopic and histological evaluations were performed. For radiological investigation, 10 rats underwent magnetic resonance (MR) imaging at 6 weeks postoperatively. Furthermore, the concentration of MMC in cerebrospinal fluid (CSF) and serum was determined 12 hours postoperatively in seven rats.

Due to ease of absorption, high levels of MMC were rapidly detectable in serum, whereas the values obtained from the CSF were markedly lower. In the majority of MMC-treated laminectomy sites, epidural scarring was significantly reduced and dural adhesions were absent, in comparison with control sites (p < 0.001), as confirmed by MR images. Accordingly, the macroscopic dissection of epidural fibrous tissue to reexpose the dura mater was performed more easily and without severe bleeding in these rats. The healing of skin and the lumbar fascia was not affected, and dural leakage was not observed. All control sites showed dense epidural fibrosis with marked dural adherence.

Conclusions

n this experimental model, it was shown that locally applied MMC in a concentration of 0.1 mg/ml effectively reduces epidural fibrosis and dural adherence without side effects in rats that underwent lumbar laminectomy.
Pleomorphic xanthoastrocytoma of the spinal cord
Authors: Nakamura Masaya , Chiba Kazuhiro , Matsumoto Morio , Ikeda Eiji , Toyama Yoshiaki
Published: January 2008

✓ The authors present clinical, radiological, and pathological features in a patient with a pleomorphic xanthoastrocytoma (PXA) of the spinal cord. To their knowledge, this is only the second report of a spinal cord PXA. In addition they perform a review of the literature on these tumors.
Posterior cervical spinal cord infarction complicating the treatment of an intracranial dural arteriovenous fistula embolization
Authors: Blanc Raphaël , Hosseini Hassan , Le Guerinel Caroline , Brugières Pierre , Gaston André
Published: January 2008

✓ Acute ischemic infarction of the posterolateral bulbomedullary junction occurred in a 28-year-old man who underwent arterial embolization for the treatment of an intracranial dural arteriovenous malformation. The migration of the embolic agent in the posterior spinal artery via a peripheral anastomosis between the middle meningeal artery and the posterior meningeal artery was responsible for this complication. The cast of glue in the radiculopial system at the upper cervical level was visible on computed tomography scanning, and magnetic resonance imaging demonstrated circumscribed signal changes and restricted diffusion in the arterial territory of the bulbomedullary junction. The authors discuss the anatomical, clinical, and technical issues of this rare complication.
A review of factors predictive of surgical outcome for ossification of the ligamentum flavum of the thoracic spine
Authors: Inamasu Joji , Guiot Bernard H.
Published: January 2008

Object

Ossification of the ligamentum flavum (OLF) is a pathological condition that affects the ligament and causes slowly progressive myeloradiculopathy in adults. Although OLF has been regarded as endemic to East Asian countries, studies from outside these areas have increasingly been reported. Because of long-standing compression of the spinal cord by OLF, a patient’s functional prognosis may not always be favorable, and attempts have been made in recent studies to identify clinical factors that are predictive of the surgical outcome of patients with thoracic OLF.

Methods

The authors conducted a review of the literature published in the English, Japanese, and Korean languages. They examined studies in which correlation between clinical factors and outcome was statistically evaluated. The clinical factors included sex, age, level of the ossified ligamentum flavum, number of segments affected by OLF, coexisting ossification of the posterior longitudinal ligament (OPLL) or other spinal disorders, preoperative duration of symptoms, preoperative neurological score, computed tomography (CT)–based classification, and the presence of intramedullary high signal intensity on T2-weighted magnetic resonance images.

Conclusions

The clinical factors that are unlikely to be predictive of outcome include sex, age, level of the ossified lesion, number of OLF-affected segments, coexisting OPLL, CT classification, and the presence of high signal intensity. It is unclear whether the preoperative duration of symptoms or neurological score is predictive of outcome because the results have been inconsistent among the studies. Analysis of the more recent literature, however, suggests that these two factors are predictive of outcome. The use of a neurological score should be standardized so that compilation and comparison of data can be facilitated.
Regression of an atlantoaxial degenerative articular cyst associated with subluxation during conservative treatment
Authors: Sagiuchi Takao , Shimizu Satoru , Tanaka Ryusui , Tachibana Shigekuni , Fujii Kiyotaka
Published: January 2008

✓ The presence of an atlantoaxial degenerative articular cyst is rare; when present this lesion extends posteriorly to the dens, causing cervicomedullary compressive myelopathy. The authors describe a symptomatic case of this lesion associated with atlantoaxial subluxation in a 76-year-old man. The patient’s neurological symptoms resolved and corresponded to a reduction in the size of the cyst. After 8 months of continued conservative treatment, in which the patient wore a Philadelphia collar, the cyst spontaneously regressed. Subsequently, a C1–2 posterior fusion was performed to treat the atlantoaxial subluxation.
Revision surgery of the lumbar spine: anterior lumbar interbody fusion followed by percutaneous pedicle screw fixation
Authors: Lee Sang-Ho , Kang Byung-Uk , Jeon Sang Hyeop , Park Jong Dae , Maeng Dae Hyeon , Choi Young-Geun , Choi Won-Chul
Published: January 2008

Object

The aim of this study was to evaluate the efficacy of anterior lumbar interbody fusion (ALIF) augmented by percutaneous pedicle screw fixation (PSF) for revision surgery in the lumbar spine and to determine the prognostic factors affecting surgical outcomes.

Methods

The population included 54 consecutively treated patients in whom revision surgery involving ALIF with PSF was performed between 2001 and 2004. There were 22 men and 32 women, whose mean age was 59.5 years (range 25–78 years). The diagnoses prior to revision ALIF were as follows: degenerative disc disease in 25 patients, instability/spondylolisthesis in 15, recurrent disc herniation in seven, and pseudarthrosis in seven. The mean follow-up period was 24 months (range 12–52 months). The mean visual analog scale score for back and leg pain decreased, respectively, from 7.8 to 2.3 and 8.0 to 2.3 (p < 0.001). The mean Oswestry Disability Index score improved from 70 to 25% (p < 0.001). Radiological evidence of fusion was noted in 52 of 54 patients. The mean preoperative segmental lordosis, whole lumbar lordosis, and sacral tilt were 15.2, 35.5, and 28.3°, respectively; these values were significantly increased to 20.4, 40.7, and 31.4°, respectively, after revision surgery (p < 0.001). The increase in sacral tilt was positively correlated with improvement in back pain (p = 0.028) and functional status (p = 0.025).

Conclusions

The results demonstrate that ALIF followed by PSF can be an effective alternative in revision surgery of the lumbosacral spine in selected cases. Not only can solid fusion be achieved, sagittal alignment can also be restored in the majority of patients.
Delayed postoperative spinal epidural hematoma causing tetraplegia
Authors: Neo Masashi , Sakamoto Takeshi , Fujibayashi Shunsuke , Nakamura Takashi
Published: January 2008

✓The authors describe a case of postoperative spinal epidural hematoma (PSEH) that developed in a patient 9 days after he underwent laminoplasty. A PSEH is a rare but critical complication of spinal surgery that usually occurs within a few days of the procedure. The authors draw attention to the possibility of delayed PSEH and its triggering mechanism. In this case, a 59-year-old man with no history of bleeding disorder underwent cervical laminoplasty for mild myelopathy. On the 7th postoperative day computed tomography demonstrated no abnormal findings in the operative field. On the 9th postoperative day, while straining to defecate, the patient suddenly felt neck and shoulder pain, and tetraplegia rapidly developed. Magnetic resonance imaging demonstrated a huge epidural hematoma. The clot was evacuated during emergency revision surgery, during which the arterial bleeding from a split muscle wall was confirmed. The postoperative course after the revision surgery was uneventful and the patient had none of the previous symptoms 1 year later.

A PSEH causing paralysis can occur even more than a week after surgery. The possibility of a delayed-onset PSEH should be kept in mind, and prompt diagnosis should be made when a patient presents with paresis or paralysis after an operation. The authors recommend advising patients that for a while after surgery they avoid strenuous activity.
Clinical follow up after instrumentation-augmented lumbar spinal surgery in patients with unsatisfactory outcomes
Authors: Hsu Chien-Jen , Chou Wen-Ying , Chang Wei-Ning , Wong Chi-Yin
Published: January 2008

Object.

The authors investigated the causes of unsatisfactory outcomes in patients who had undergone instrumentation-assisted lumbar surgery and followed the clinical and imaging results of the revision surgery.

Methods.

Myelography and postmyelography computed tomography (CT) scanning were successfully conducted in 103 patients. In nearly 80% of these patients, the main symptom was back pain, with or without leg pain. Additional electromyography and nerve conduction velocity studies were also conducted in 22 patients in whom CT myelography could not help to establish the definitive cause of surgical failure. There were 26 cases of spinal stenosis, 13 of adjacent-segment instability, 15 of pseudarthrosis, 11 of screw misplacement, four of epidural fibrosis, five of arachnoiditis, seven of disc disruption, and 22 miscellaneous. When conservative treatment failed to relieve symptoms, surgery was suggested whenever an operable lesion was found. Revision surgery was performed in 48 patients, and these cases form the basis of this retrospective cohort study. All patients underwent clinical and imaging follow up for a minimum of 2 years. Two-year clinical outcomes were assessed using the 36-Item Short Form Health Survey questionnaire and compared with earlier scores using the Student t-test. Fusion status was evaluated by two orthopedic surgeons, who examined flexion–extension x-ray films or CT studies.

The greatest improvement after revision surgery was documented in patients with symptoms related to spinal stenosis or disc disruption. Little improvement was observed in patients with misplaced pedicle screws causing nerve injury and those with epidural fibrosis or arachnoiditis.

Conclusions.

Adequate decompression at the initial operation and prevention of restenosis or accelerated adjacent-segment degeneration yielded the most favorable prognosis in the present cases. Successful posterolateral arthrodesis combined with supplemental interbody fusion improved the surgical outcomes in cases involving disc disruption or degeneration.
Technical description, phantom accuracy, and clinical feasibility for fiducial-free frameless real-time image-guided spinal radiosurgery
Authors: Muacevic Alexander , Staehler Michael , Drexler Christian , Wowra Berndt , Reiser Maximilian , Tonn Joerg-Christian
Published: January 2008

Object

The authors describe the technical application of the Xsight Spine Tracking System, data pertaining to accuracy obtained during phantom testing, and the initial clinical feasibility of using this fiducial-free alignment system with the CyberKnife in spinal radiosurgery.

Methods

The Xsight integrates with the CyberKnife radiosurgery system to eliminate the need for implantation of radiographic markers or fiducials prior to spinal radiosurgery. It locates and tracks spinal lesions relative to spinal osseous landmarks. The authors performed 10 end-to-end tests of accuracy using an anthropomorphic head and cervical spine phantom. Xsight was also used in the treatment of 50 spinal lesions in 42 patients. Dose planning was based on 1.5-mm-thick computed tomography slices in which an inverse treatment planning technique was used.

All lesions could be treated using the fiducial-free tracking procedure. Phantom tests produced an overall mean targeting error of 0.52 ± 0.22 mm. The setup time for patient alignment averaged 6 minutes (range 2–45 minutes). The treatment doses varied from 12 to 25 Gy to the median prescription isodose of 65% (40 to 70%). The tumor volume ranged between 1.3 and 152.8 cm3The mean spinal cord volume receiving greater than 8 Gy was 0.69 ± 0.35 cm3No short-term adverse events were noted during the 1- to 7-month follow-up period. Axial and radicular pain was relieved in 14 of 15 patients treated for pain.

Conclusions

Fiducial-free tracking is a feasible, accurate, and reliable tool for radiosurgery of the entire spine. By eliminating the need for fiducial implantation, the Xsight system offers patients noninvasive radiosurgical intervention for intra- and paraspinal tumors.
Tapered cages in anterior lumbar interbody fusion: biomechanics of segmental reactions
Authors: Moore Jason , Yoganandan Narayan , Pintar Frank A. , Lifshutz Jason , Maiman Dennis J.
Published: January 2008

Object

The aim of this study was to determine the in vitro biomechanical responses of lumbar spinal segments after implantation of tapered cages.

Methods

Range of motion (ROM)– and stiffness-related data were determined in 10 human cadaveric T12–S1 columns subjected to flexion, extension, and lateral bending modes before and after anterior lumbar interbody fusion in which stand-alone LT-CAGE devices were used. The overall column showed no significant changes in ROM or stiffness. At the instrumented level, stiffness increased significantly (p < 0.05) in flexion and lateral bending modes. Indications of instability in extension were present, but these values were not statistically significant. There was no evidence of adjacent-level instability at any level in any mode, except for the segment superior to the fixation level in flexion; here there was a significant increase in ROM (p < 0.05) and a decrease in stiffness.

Conclusions

The anatomical conformity and bilateral placement of cages provide ample stability and rigidity at the treated level, comparable to that of other cage systems. Because hypermobility is traditionally related to early degenerative changes, the present results appear to suggest that cages do not significantly contribute to such alterations.
Symptomatic air trapped in the spine after lumbar epidural corticosteroid injection
Authors: Ammirati Mario , Perino Florence
Published: January 2008

✓ The authors report the first case involving trapped epidural air in the spine that mimicked a mass lesion and caused neurological symptoms after epidural corticosteroid injection in the lumbar region. New neurological symptoms developed immediately after injection, and magnetic resonance (MR) imaging demonstrated trapped air displacing the dural sac. After the patient underwent conservative treatment, the new symptoms resolved, and follow-up MR imaging and computed tomography demonstrated resorption of the epidural air in the lumbar region. To limit this problem, the clinician should decrease the amount of air injected in the epidural space or substitute nitrous oxide for air when injecting steroid agents epidurally.
A pioneer from the Islamic Golden Age: Haly Abbas and spinal traumas in his principal work, The Royal Book
Authors: Belen Deniz , Aciduman Ahmet
Published: January 2008

✓ Spinal diseases have attracted medical scientists throughout the history of medicine, probably because they are relatively easy to diagnose and fairly simple to treat. Physicians who made great progress in medicine during the glorious Islamic civilizations also enthusiastically dealt with spine-related problems. More than a thousand years ago Persia was a cradle of medical learning, and Islamic medicine and other sciences spread westward from that center. A leading figure during this period was Haly Abbas, who created an excellent and compact medical encyclopedia, The Royal Book. Sadly, this book has rarely been cited in the literature. The subject of the present vignette is Abbas’ work regarding spinal trauma.
Effect on bone induction of using contrast media to reconstitute recombinant human bone morphogenetic protein-2 in an ectopic model in rats
Authors: Zanella John M. , Oliver Colleen , Peckham Steve M. , McKay Bill , Toth Jeffrey M. , Boden Scott D.
Published: January 2008

Object

In this study the authors tested the osteoinductive potential of recombinant human bone morphogenetic protein–2 (rhBMP-2) when combined with each of three commercially available contrast media (Conray, Omniscan, and Optiray).

Methods

Initial in vitro and cadaver tests verified the feasibility of using contrast media to visualize absorbable collagen sponge implants containing rhBMP-2 on fluoroscopic radiographic images. For the feasibility studies, lyophilized rhBMP-2 was prepared for injection by reconstitution with contrast media instead of sterile water. For the in vivo study, samples of an rhBMP-2 stock solution were diluted to 0.1 mg/ml by using three contrast media. In each sample, the final solution consisted of 97% contrast medium by volume. Recombinant human bone morphogenetic protein–2 diluted with sterile water for injection was used as a positive control. The rhBMP-2 solutions were applied to 0.5-cm3 collagen sponges and implanted subcutaneously on the thoracic cavity of athymic rats. At 4 weeks, the rats were killed, and the implants were removed. The explants were graded for degree of bone formation by using manual palpation and radiographic and histological assessments.

Conclusions

By all methods of evaluation used, rhBMP-2 diluted with Omniscan was equivalent to rhBMP-2 diluted with sterile water in inducing bone formation. Both Conray and Optiray were shown to inhibit the osteoinductive potential of rhBMP-2.
Comparison of polyetheretherketone cages with femoral cortical bone allograft as a single-piece interbody spacer in transforaminal lumbar interbody fusion
Authors: Cutler Aaron R. , Siddiqui Saquib , Avinash L. Mohan , Hillard Virany H. , Cerabona Franco , Das Kaushik
Published: January 2008

Object

Transforaminal lumbar interbody fusion (TLIF) is an accepted alternative to circumferential fusion of the lumbar spine in the treatment of degenerative disc disease, spondylolisthesis, and recurrent disc herniation. To maintain disc height while arthrodesis takes place, the technique requires the use of an interbody spacer. Although titanium cages are used in this capacity, the two most common spacers are polyetheretherketone (PEEK) cages and femoral cortical allografts (FCAs). The authors compared the clinical and radiographic outcomes of patients who underwent TLIF with pedicle screw fixation, in whom either a PEEK cage or an FCA was placed as an interbody spacer.

Methods

The charts and x-ray films obtained in 39 patients (age range 33–68 years, mean 44.7 years) who underwent single-level TLIF between October 2001 and April 2004 and in whom either a PEEK cage (18 patients) or FCA (21 patients) was placed as an interbody spacer were evaluated in a retrospective study. Radiological outcome was based on fusion rate and a comparison of the initial postoperative lordotic angle on standing lateral radiographs with that at long-term follow up (mean follow up 15.1 months, minimum 12 months). To control for variations in radiographic magnification, the authors used lordotic angle as an indirect measure of disc space height. Clinical outcome was assessed using the Oswestry Disability Index (ODI).

There were no major complications in either group. Radiographically documented fusion occurred in all patients in the PEEK group and 95.2% of those in the FCA group. Pseudarthrosis developed in one patient in the FCA group, and this patient underwent additional surgery. In both groups, the mean lordotic angle changed by less than 2.20° during the postoperative period, and the mean postoperative ODI score was more than 40 points lower than the mean preoperative score. There was no significant difference between the two groups in mean change in lordotic angle (p = 0.415) and mean change in ODI score (p = 0.491).

Conclusions

Both PEEK cages and FCAs are highly effective in promoting interbody fusion, maintaining postoperative disc space height, and achieving desirable clinical outcomes in patients who undergo TLIF with pedicle screw fixation. The advantages of PEEK cages include a lower incidence of subsidence and their radiolucency, which permits easier visualization of bone growth.
An unusual transverse sacral fracture treated with early decompression
Authors: Robles Luis A. , Plantillas Edgar
Published: January 2008

✓The authors describe the case of a patient who sustained a transverse sacral fracture (TSF) associated with a depressed laminar fracture in a personal watercraft accident. The patient underwent early surgery, which allowed a quick recovery. To the best of the authors’ knowledge, the mechanism of injury and type of fracture have not been previously described or classified in cases of TSF.
Gene transfer of insulin-like growth factor–I providing neuroprotection after spinal cord injury in rats
Authors: Hung Kuo-Sheng , Tsai Shin-Han , Lee Tao-Chen , Lin Jia-Wei , Chang Cheng-Kuei , Chiu Wen-Ta
Published: January 2008

Object

Insulin-like growth factor–I (IGF-I) has been shown to be a potent neurotrophic factor that promotes the growth of projection neurons, dendritic arborization, and synaptogenesis. Its neuroprotective roles may be coordinated by activation of Akt, inhibition of glycogen synthase kinase–3β (GSK-3β), and thus inhibition of tau phos-phorylation. The authors investigated the role and mechanism of IGF-I gene transfer after spinal cord injury (SCI).

Methods

Studies were performed in 40 male Sprague–Dawley rats after spinal cord hemisection. The authors conducted hydrodynamics-based gene transfection in which an IGF-I plasmid was rapidly injected into the rat’s tail vein 30 minutes after SCI. The animals were randomly divided into four groups: Group I, sham operated; Group II, SCI treated with pCMV–IGF-I gene; Group III, SCI treated with vehicle pCMV–LacZ gene; and Group IV, SCI only. The results showed that IGF-I gene transfer promoted motor recovery, antiinflammatory responses, and anti-apoptotic effects after SCI. Using techniques of Western blotting and immunohistochemistry, the authors assessed the mechanism of IGF-I gene transfer after SCI in terms of activation of Akt, inhibition of GSK-3β, attenuation of p35, and inhibition of tau phosphorylation. Moreover, they found that IGF-I gene transfer could block caspase-9 cleavage, increase Bcl-2 formation, and thus inhibit apoptosis after SCI.

Conclusions

The intravenous administration of IGF-I after SCI activated Akt, attenuated GSK-3β, inhibited p35 activation, diminished tau hyperphosphorylation, ended microglia and astrocyte activation, inhibited neuron loss, and significantly improved neurological dysfunction. Furthermore, IGF-I attenuated caspase-9 cleavage, increased Bcl2, and thus inhibited apoptosis after SCI.
Upper cervical myelopathy due to arachnoiditis and spinal cord tethering from adjacent C-2 osteomyelitis
Authors: Rajpal Sharad , Chanbusarakum Krisada , Deshmukh Praveen R.
Published: January 2008

✓Myelopathy caused by a spinal cord infection is typically related to an adjacent compressive lesion such as an epidural abscess. The authors report a case of progressive high cervical myelopathy from spinal cord tethering caused by arachnoiditis related to an adjacent C-2 osteomyelitis.

This 70-year-old woman initially presented with a methicillin-sensitiveStaphylococcus aureusosteomyelitis involving the C-2 odontoid process. She was treated with appropriate antibiotic therapy but, over the course of 4 weeks, she developed progressive quadriparesis. A magnetic resonance image revealed near-complete resolution of the C-2 osteomyelitis, but new ventral tethering of the cord was observed at the level of the odontoid tip. She subsequently underwent open surgical decompression and cord detethering. Postoperatively she experienced improvement in her symptoms and deficits, which continued to improve 1 year after her surgery.

To the authors’ knowledge, this is the first reported case of progressive upper cervical myelopathy due to arachnoiditis and cord tethering from an adjacent methicillin-sensitiveS. aureusC-2 osteomyelitis.
Calcific retropharyngeal tendinitis: a frequently missed diagnosis
Authors: Jiménez Sara , Millán José M.
Published: January 2008

✓Neck pain is a common presentation in emergency departments that requires the exclusion of serious underlying pathological entities. Acute calcific retropharyngeal tendinitis is a rare and underrecognized cause of atraumatic neck pain and stiffness.

Although this entity has been reported previously, it is often poorly recognized and is often confused with other more serious lesions, such as infectious, traumatic, and neoplastic conditions. Clinically, it can be very difficult to distinguish from these three disorders, and a definitive diagnosis can only be established using imaging studies.

A knowledge of the characteristic clinical spectrum and, most importantly, its imaging features is crucial for making the correct diagnosis of this uncommon cause of neck pain. The authors present their experience with one case to highlight the characteristic findings of this disorder on plain radiography, computed tomography, and magnetic resonance imaging.
Application of a novel headrest system for odontoid screw fixation
Authors: Hott Jonathan S. , Deshmukh Vivek R. , Papadopoulos Stephen M. , Spetzler Robert F.
Published: January 2008

✓The authors describe a unique headholder device adapted to facilitate the placement of anterior odontoid screws. The patient’s head is affixed in the headholder equipped with an articulating arm that can be placed in a paramedian fashion. This configuration rigidly fixates the head and provides an unencumbered open-mouth view of the odontoid using radiographic images, thus making screw placement easier.
Influence of cross-linked hyaluronic acid hydrogels on neurite outgrowth and recovery from spinal cord injury
Authors: Horn Eric M. , Beaumont Michael , Shu Xiao Zheng , Harvey Adrian , Prestwich Glenn D. , Horn Kris M. , Gibson Alan R. , Preul Mark C. , Panitch Alyssa
Published: January 2008

Object

Therapies that use bioactive materials as replacement extracellular matrices may hold the potential to mitigate the inhibition of regeneration observed after central nervous system trauma. Hyaluronic acid (HA), a nonsulfated glycosaminoglycan ubiquitous in all tissues, was investigated as a potential neural tissue engineering matrix.

Methods

Chick dorsal root ganglia were cultured in 3D hydrogel matrices composed of cross-linked thiol-modified HA or fibrin. Samples were cultured and images were acquired at 48-, 60-, and 192-hour time points. Images of all samples were analyzed at 48 hours of incubation to quantify the extent of neurite growth. Cultures in cross-linked thiolated HA exhibited more than a 50% increase in neurite length compared with fibrin samples. Furthermore, cross-linked thiolated HA supported neurites for the entire duration of the culture period, whereas fibrin cultures exhibited collapsed and degenerating extensions beyond 60 hours.

Two concentrations of the thiolated HA (0.5 and 1%) were then placed at the site of a complete thoracic spinal cord transection in rats. The ability of the polymer to promote regeneration was tested using motor evoked potentials, retrograde axonal labeling, and behavioral assessments. There were no differences in any of the parameters between rats treated with the polymer and controls.

Conclusions

The use of a cross-linked HA scaffold promoted robust neurite outgrowth. Although there was no benefit from the polymer in a rodent spinal cord injury model, the findings in this study represent an early step in the development of semisynthetic extracellular matrice scaffolds for the treatment of neuronal injury.
Reverse transformation of Modic Type 2 changes to Modic Type 1 changes during sustained chronic low-back pain severity
Authors: Marshman Laurence A. G. , Trewhella Matthew , Friesem Tai , Bhatia Chandra K. , Krishna Manoj
Published: January 2008

✓Modic Type 2 (MT2) neuroimaging changes are considered stable or invariant over time and relatively quiescent, whereas Modic Type 1 (MT1) changes are considered unstable and more symptomatic. The authors report two cases in which MT2 changes were symptomatic and evidently unstable, and in which chronic low-back pain severity remained unaltered despite a MT2–MT1 reverse transformation. Two women (41 and 48 years old) both presented with chronic low-back pain. Magnetic resonance (MR) images demonstrated degenerating discs at L5–S1 associated with well-established MT2 changes in adjacent vertebrae. Repeated MR imaging in these two patients after 11 months and 7 years, respectively, revealed reverse transformation of the MT2 changes into more florid MT1 changes, despite unaltered chronic low-back pain severity. Following anterior discectomy and disc arthroplasty, immediate abolition of chronic low-back pain was achieved in both patients and sustained at 3-year follow up. Modic Type 2 changes are therefore neither as stable nor as quiescent as originally believed. Each type can change, with equal symptom-generating capacity. More representative imaging–pathological correlates are required to determine the precise nature of MT changes.
Return of normal urological and neurological function after revision surgery for spondyloptosis
Authors: Jones-Quaidoo Sean M. , Hunt Travis , Shaffrey Christopher I. , Arlet Vincent
Published: January 2008

✓ The authors report on the return of neurological and urological function in an adolescent after revision surgery for spondyloptosis 5 years after the index procedure for high-grade spondylolisthesis. This 16-year-old girl with Grade 3 spondylolisthesis was initially treated with a posterolateral reduction and fusion. Following surgery, cauda equina syndrome symptoms developed and did not resolve despite subsequent surgical decompression. Five years later, because of worsening radicular pain, an inability to walk for significant distances, and no resolution of persistent bladder dysfunction, the patient presented with spondyloptosis.

Posterior decompression, sacral dome osteotomy, and posterior reduction were performed and followed 3 days later with the placement of an anterior fibula autograft. Her bladder function recovered within 6 months, and at the 18-month follow up the patient reported a normal ability to ambulate.
Malignant transformation of spinal meningeal melanocytoma
Authors: Wang Fulin , Li Xianghong , Chen Linghong , Pu Xiaolu
Published: January 2008

✓Meningeal melanocytomas are rare tumors and malignant transformation of these lesions is even rarer. The authors report on a case of a 57-year-old man who presented with a melanocytoma located at the L5–S1 level. After gross-total resection of the tumor, it recurred 1 year later as a malignant melanoma. In addition, multiple subcutaneous metastases were found at that time. The patient was treated with radiation therapy (5000 cGy). Five months later metastases in the liver and the left ninth rib were discovered. The pertinent literature is reviewed and disease criteria are presented to distinguish meningeal melanocytoma from malignant melanoma and from meningiomas or schwannomas containing melanotic pigment. Patients and investigators should be cautioned that a meningeal melanocytoma may recur and transform into a malignant melanoma.
Castleman disease of the spine mimicking a nerve sheath tumor
Authors: Finn Michael A. , Schmidt Meic H.
Published: January 2008

✓ Castleman disease is a rare lymphoproliferative disease of unknown cause. In most cases, afflicted patients present with a mediastinal mass although the disease may manifest in numerous other sites, including intracranially and rarely intraspinally. The authors report on the case of a 19-year-old woman who presented with a large paraspinal mass emanating from the T7–8 neural foramen. The morphological and signal characteristics revealed on magnetic resonance imaging were similar to those of nerve sheath tumors. The patient underwent open biopsy sampling of the lesion, and results of a pathological evaluation revealed hyaline-vascular type Castleman disease. She underwent radiotherapy and remains symptom-free with a radiographically stable lesion 1 year later. Although the disease has been reported to mimic a meningioma when encountered in intracranial locations, to the authors' knowledge, this is the first case of the disorder mimicking a nerve sheath tumor. When the diagnosis of Castleman disease is made, good results can be obtained with partial resection and radiotherapy.
Selective treatment of an anterior spinal artery aneurysm with endosaccular coil therapy
Authors: Lavoie Pascale , Raymond Jean , Roy Daniel , Guilbert François , Weill Alain
Published: January 2008

✓The authors report the case of a 12-year-old boy with spinal cord arteriovenous malformation (AVM) and an associated anterior spinal artery (ASA) aneurysm treated with selective coil placement in the context of subarachnoid hemorrhage (SAH).

The patient presented with headache. Head computed tomography scanning revealed no abnormal findings. The cerebrospinal fluid was sampled and analyzed and a diagnosis of SAH was established. Investigation, including magnetic resonance imaging of the cord as well as cerebral and spinal angiography, revealed a conus medullaris AVM and a saccular aneurysm located on the ASA at the T-11 level. The aneurysm was thought to be responsible for the bleeding.

Superselective ASA angiography showed that the aneurysm was at the bifurcation between a large coronal artery supplying the AVM and the ASA. The relation of the aneurysm's neck to the main spinal axis and the aneurysm's morphological features indicated that the lesion was suited for endosaccular coil therapy. The aneurysm was selectively occluded, using electrodetachable bare platinum coils. Follow-up angiography immediately after surgery and at 6 months thereafter demonstrated complete occlusion of the aneurysm and a perfectly patent anterior spinal axis. On clinical follow-up examination, the patient remained neurologically intact.

When the morphological features of a spinal aneurysm and its relation with the anterior spinal axis are favorable, selective endosaccular coil placement can successfully be achieved.
Diathermy testing: a novel method with electric knife stimulation to avoid nerve injuries during lumbar pedicle screw placement
Authors: Yamazaki Takashi , Matsudaira Ko
Published: January 2008

✓ The purpose of this retrospective study was to demonstrate the utility of diathermy in avoiding nerve injuries due to misplacement of lumbar pedicle screws (PSs).

The authors used diathermy to assess whether a screw deviated from the pedicle by observing synchronous leg movements caused by intermittently touching an electric knife to the pedicular instrument. Diathermy was performed in 259 cases in which 1301 PSs had been placed. Leg movements were observed in 36 cases, and the sensitivity of diathermy was 85.7%, with a specificity of 99.5%. No neurological complications associated with the placement of PSs were observed after adding diathermy testing to conventional methods.

Diathermy testing may be a way to avoid nerve injuries during lumbar PS placement.
Unilateral multilevel interlaminar fenestration instead of laminectomy or hemilaminectomy: an alternative surgical approach to intraspinal space-occupying lesions
Authors: Koch-Wiewrodt Dorothee , Wagner Wolfgang , Perneczky Axel
Published: January 2008

✓Laminectomy is the most conventional dorsal approach to intraspinal space-occupying lesions and may result in gradually increasing instability or deformity of the vertebral column. Less invasive procedures such as hemilaminectomy and osteoplastic laminotomy have been described by other authors, but an approach that interferes with spinal stability to an even lesser extent seems desirable.

In an attempt to further reduce the need for bone removal, the authors used interlaminar fenestration (mostly unilateral) at one or more spinal levels to remove intramedullary, extramedullary, or extradural lesions, and even some lesions that extended over several spine segments. The authors present their experiences with this surgical approach in 78 patients harboring different intraspinal lesions. Up to 16 segments were fenestrated in one patient. Complete removal of the lesion was possible in most patients, and no postoperative spinal instabilities were observed in up to 8 years of follow up. Multilevel interlaminar fenestration, also called “multiple spinal keyhole surgery,” is a feasible, safe, and effective approach to intraspinal lesions.
Accepting Father Rhine? Technological Fixes, Vigilance, and Transnational Lobbies as 'European' Strategies of Dutch Municipal Water Supplies 1900-1975
Authors: Disco Cornelis
Published: January 2008

Downstream users of river water (e.g. municipal waterworks) always face the problem of controlling the behaviour of upstream polluters. In the case of an international river like the Rhine this is exacerbated when there are no international arrangements constraining upstream polluters. This demands flexibility and creativity from downstream waterworks. In this article I describe the repertoires developed by the municipal waterworks of two large Dutch cities, Amsterdam and Rotterdam. Two main repertoires are visible: 1) 'coping' by means of technical fixes and vigilance and 2) 'transnational technopolitics' aimed at institutionalising regulatory regimes to curb pollution. Rotterdam, totally dependent on Rhine water, emphasised 'coping' on a day to day basis, placing its trust on technologies of purification and vigilance. Amsterdam, using dune and lake water though envisioning future use of Rhine water, pursued a long-term strategy aimed at improving the purity of the Rhine's waters - including extensive longitudinal pollution measurements and transnational technopolitics. During the 1950s, the Amsterdam waterworks played a major role in forging international links among waterworks along the Rhine culminating in a sectoral organisation of Rhine Waterworks. This was one of the foundation stones on which the riparian nations were gradually able to build an effective regime for pollution control.
Empire, Environment and Religion: God and the Natural World in Nineteenth-Century New Zealand
Authors: Beattie James , Stenhouse John
Published: January 2008

This article, using colonial New Zealand as a case-study, and integrating environment, empire and religion into a single analytic framework, contends that Christian and environmental discourses interpenetrated and interacted in irreducibly complex ways during the long nineteenth century. Many of the colony's mostly Protestant settlers interpreted the book of Genesis as giving them responsibility to 'subdue and replenish' the natural world; dominion theology played an important role in legitimising the improvement projects integral to settler capitalism whose consequences have aroused ambivalence from many modern scholars. Yet some, perhaps many, colonists also believed that they had a duty to take care of the land and its creatures even while transforming it. A commitment to large-scale environmental change could and often did co-exist with interest in and respect for nature. When the unexpected and unwanted consequences of environmental transformation became apparent, as they did shortly after the beginning of organised settlement, concerned Protestant community leaders deployed Christian discourse, biblical images and Protestant ethics along with utilitarian and scientific arguments to mobilise environmental concern and a conservationist conscience.
Most, the Town that Moved: Coal, Communists and the 'Gypsy Question' in Post-War Czechoslovakia
Authors: Glassheim Eagle
Published: January 2008

As Czechoslovakia's communist planners continually increased norms for power and coal production in the 1950s through 1970s, the sprawling surface mines of the north Bohemian brown coal basin expanded voraciously, swallowing 116 villages and parts of several larger cities by 1980. Infamously, the entire historic centre of Most was obliterated in order to expose over 85 million tons of coal. Planners envisioned a new city of Most as a model of socialist modernity. Deriding Most's old town as a decaying capitalist relic, officials lauded New Most's spacious and efficient prefabricated high-rises. Adding to the contrast, the majority of Old Most's remaining inhabitants by 1970 were Roma (Gypsies). For communists, the Roma evoked an old order of segregation, class oppression and bad hygiene. By relocating Roma to modern housing, they could 'liquidate once and for all the Gypsy problem'. This article examines the rhetorics of modernity employed as communists sought to 'solve' intertwined coal, gypsy and housing 'problems' in the city of Most. At the crossroads of several related modernising projects in the twentieth century, Most provides insight into connections between ethnic cleansing, social and environmental engineering and urban planning.
Science, Environment and Empire History: Comparative Perspectives from Forests in Colonial India
Authors: Sivaramakrishnan K.
Published: January 2008

Books reviewed in this essay: Arun Agrawal Environmentality: Technologies of Government and the Making of Subjects. (New Ecologies for the Twenty-first Century) Durham, NC: Duke University Press. 2005. $22.95. xvi + 325pp. Peder Anker Imperial Ecology: Environmental Order in the British Empire, 1895-1945 Cambridge, MA: Harvard University Press. 2001. $67.00. vii + 343pp. David Arnold The Tropics and the Traveling Gaze: India, Landscape and Science, 1800-1856. (Culture, Place, and Nature) Seattle: University of Washington Press. 2006. $50.00. xiv + 298pp. Gregory A. Barton Empire Forestry and the Origins of Environmentalism (Cambridge Studies in Historical Geography, 34) Cambridge: Cambridge University Press. 2002. $65.00. xiii + 192pp. Richard Drayton Nature's Government: Science, Imperial Britain, and the 'Improvement' of the World New Haven: Yale University Press. 2000. $50.00. xxi + 346pp. S. Ravi Rajan Modernizing Nature: Forestry and Imperial Eco-Development, 1800-1950 (Oxford Historical Monographs) Oxford: Oxford University Press. 2006. $105.00. xv + 286pp.
Joined Against Pain and Gathered in Hope: The Role of Hokies United
Authors: Schneiter Steven R. , MacEachran Brianne
Published: January 2008

After April 16, 2007, Hokies United needed to heal itself and the Virginia Tech community. About Campus editorial assistant Brianne MacEachran interviewed Steve Schneiter, a faculty co-creator of the campus group that has organized responses to tragedies since the events of September 11, 2001, about managing suffering, this time their own.
Urbanism Without Density
Authors: Segal Rafi , Verbakel Els
Published: January 2008

The predominance of sprawling, low‐density urban environments throughout the world begs the question: What constitutes a city? Such environments also require us to rethink public space, traditionally at the core of city centres. Rafi Segal and Els Verbakel outline the challenges and opportunities that cities of dispersal raise. Copyright © 2008 John Wiley & Sons, Ltd.
The Public and the V2
Authors: Robbins Bruce
Published: January 2008

The London Blitz has come to epitomise the golden age of urban togetherness and bonhomie when the public was bound by a common enemy threat. Through his reading of Thomas Pynchon's Gravity's Rainbow, literary critic Bruce Robbins questions the archetypal view of the Second World War as a watershed after which the ideal intact city and its community were ultimately destroyed. Copyright © 2008 John Wiley & Sons, Ltd.
Peripheral Landscapes, El Caracol, Mexico City
Authors: Castillo Jose
Published: January 2008

In Mexico City, unplanned illegal development exists cheek by jowl with developer‐driven housing. Jose Castillo of arquitectura 911sc explains how the practice's project for New Caracol provides leisure facilities and open space that afford opportunities for social and cultural exchange between the two different communities. Copyright © 2008 John Wiley & Sons, Ltd.
User‐Focused Public Space(M)UTOPIA in Denmark
Authors: Cornea Serban
Published: January 2008

The Danish practice MUTOPIA brings to public space a strong sense of delight and playfulness, while demonstrating an overriding concern with the end user. As Serban Cornea of MUTOPIA explains, a temporary plaza for the extensive development of Orestad Nord in Copenhagen aims ‘to speed up the process of creating the area's own identity’, while the practice's housing for Lyngby‐Taarb'k, Hovedstaden, audaciously puts the ‘garden’ back into the ‘garden suburb’ by relocating the transport infrastructure to the rooftops. Copyright © 2008 John Wiley & Sons, Ltd.
Mur Island, Graz, Austria
Authors: Acconci Vito
Published: January 2008

The New York artist Vito Acconci has chosen to work through architecture, seeing the potential of it as a medium to engage ‘the public with the world around them’. He explains why he believes the location of his highly successful cultural centre for Mur Island, Graz, in Austria missed the opportunity to rejuvenate areas of the city beyond the historic core. Copyright © 2008 John Wiley & Sons, Ltd.