bluuebunny/crossref_metadata_2025 huggingface dataset:
Frequency of unexpected and important histopathological findings in routine intervertebral disc surgery
Authors: Hasselblatt Martin , Maintz David , Goll Thomas , Wildförster Uwe , Schul Christoph , Paulus Werner
Published: January 2008

Object

The value of routine histopathological examination of intervertebral disc tissue has been questioned, but sufficient numbers of studies have yet to be conducted to provide a definitive sense of its importance. The aim of this study was to investigate the nature and frequency of unexpected histopathological findings in intervertebral disc surgery.

Methods

The authors conducted a retrospective examination of consecutive surgical specimens obtained in patients with benign indication for discectomy at four neurosurgical centers.

Surgical specimens obtained during 2102 operations (2177 intervertebral discs) in 2017 patients were evaluated. In addition to one case of cavernous malformation, two specimens (obtained in 0.1% of patients) revealed unexpected pathological diagnoses of malignancy (metastasized prostate carcinoma and diffuse large B-cell lymphoma).

Conclusions

The results of this retrospective study suggest that routine histopathological examination of specimens obtained during intervertebral disc procedures is both justified and cost effective.
Decompression of idiopathic lumbar epidural lipomatosis: diagnostic magnetic resonance imaging evaluation and review of the literature
Authors: Ishikawa Yoshinori , Shimada Yoichi , Miyakoshi Naohisa , Suzuki Tetsuya , Hongo Michio , Kasukawa Yuji , Okada Kyoji , Itoi Eiji
Published: January 2008

Object

Idiopathic symptomatic spinal epidural lipomatosis (SEL) is a rare condition, and few reports have discussed diagnostic imaging criteria. To evaluate factors relating to its clinical symptoms, correlations between clinical features and the presence of spinal epidural fat were investigated, and the literature concerning idiopathic SEL was reviewed.

Methods

Morphological gradings of epidural fat were evaluated in seven patients with idiopathic SEL by using magnetic resonance (MR) imaging. In addition, body mass index (BMI), the number of involved vertebral levels, grade, and preoperative Japanese Orthopaedic Association (JOA) score were analyzed. Surgery resulted in symptomatic relief, with a mean JOA score recovery rate of 67.4%. Grading of epidural fat tended to display a slight negative correlation with preoperative JOA score, whereas a strong significant positive correlation was found between the number of involved vertebral levels and BMI.

Conclusions

The number of involved vertebral levels and obesity are strongly correlated, whereas severity of dural compression is not always significantly associated with neurological complications. These results indicate that epidural fat of the lumbar spine contributes to neurological deficits. In addition, weight-reduction therapy appears to decrease the number of vertebral levels involved. Magnetic resonance imaging–based grading is helpful for the diagnosis and evaluation of idiopathic lumbar SEL. Moreover, symptoms and neurological findings are important for determining the surgical approach.
Simultaneous end-to-side coaptations of two severed nerves to a single healthy nerve in rats
Authors: Özbek Serhat , Kurt M. Ayberk
Published: January 2008

Object

This experimental study was designed to evaluate functional and sensory outcomes and morphological features observed after simultaneous end-to-side coaptations of distal stumps of two nerves to a single neighboring nerve. Studies were performed using both parallel and end-to-side coaptation (PEC) and serial end-to-side coaptation (SEC) methods in a rat model.

Methods

In the PEC group, distal stumps of the sural and common fibular nerves were coapted to the intact tibial nerve 1 cm apart from each other in an end-to-side fashion. In the SEC group, identical surgical procedures apart from the coaptation method were conducted. For the coaptation method in this group, the distal stump of the common fibular nerve was first coapted to the side of the intact tibial nerve, and then the distal stump of the sural nerve was coapted to the side of the common fibular nerve 1 cm apart from the first coaptation site.

Nonoperated contralateral sides were used as controls. Nerve regeneration in both groups was evaluated functionally, electrophysiologically, and histomorphometrically.

Conclusions

When there is a need for two end-to-side coaptations of two severed nerves, PEC is the recommended method of choice to obtain better axonal regeneration into both nerves.
Evaluation of DuraGen in preventing peridural fibrosis in rabbits
Authors: Tatsui Claudio E. , Martinez Gonzalo , Li Xiuming , Pattany Pradip , Levi Allan D.
Published: January 2008

Object

Peridural fibrosis is the scar tissue formed over the dura mater after a laminectomy. It has been implicated as a cause of persistence of pain after spinal surgery and associated with increased risk of complications during revision surgery. The application of a mechanical barrier to cover the peridural space to block the migration of inflammatory cells from superficial layers to the epidural space can potentially prevent or decrease scar formation. The authors evaluated the use of DuraGen for this purpose.

Methods

Seventeen New Zealand White rabbits underwent bilateral L-4 and L-7 laminectomies. Each space was randomly assigned to either receive DuraGen, fat graft, or no (sham) treatment. At a mean 18 ± 4 weeks after surgery, the animals underwent magnetic resonance (MR) imaging with and without Gd enhancement, and the area of the scar tissue overlying the middle of the laminectomy was measured. The rabbits were killed and the spinal cords with an intact dural covering were harvested. The midsection of each treated level was evaluated histologically and the scar area was measured.

In rabbits in which a fat graft was placed, MR imaging of the epidural space demonstrated a significant (p < 0.05) increase in the mean area (0.9713 mm2) of scar tissue compared with those in which DuraGen was used (0.687 mm2) or those receiving sham treatment (0.6661 mm2). The same correlation was observed when the histological sections were measured at the middle of the laminectomy site where the mean areas of both DuraGen (1008 mm2) and control (2249 mm2) groups were significantly lower than that in the fat graft group (6007 mm2) (p < 0.01 and 0.05, respectively). No significant differences between the DuraGen and control groups were observed.

Conclusions

The authors demonstrated that peridural scarring formed in all groups. The mean area of scar deposition was significantly higher in the fat graft group than in the DuraGen or control group both on MR imaging and histological analysis. DuraGen was more effective than a fat graft in preventing epidural fibrosis but not significantly different from that occurring in control animals.
Recurrent sciatica due to periligamentous trapped epidural gas after spinal sequestrectomy
Authors: Capelle Hans-Holger , Krauss Joachim K.
Published: January 2008

✓The authors describe the unusual case of a 50-year-old woman who suffered from sciatic pain due to periligamentous trapped epidural gas after lumbar sequestrectomy. The patient underwent removal of free herniated disc material via a translaminar approach through the L-5 lamina without discectomy. Four days later she suffered from recurrent pain, and neuroimaging studies revealed an epidural gas formation at the site of the sequestrectomy. After evacuation of the gas, her pain resolved. Postoperative intraspinal gas may be symptomatic in the rare case.
Thoracic ossified meningioma and osteoporotic burst fracture: treatment with combined vertebroplasty and laminectomy without instrumentation
Authors: Liu Chun-Lin , Lai Po-Liang , Jung Shih-Ming , Liao Cheng-Chih
Published: January 2008

✓ Although spinal meningioma is a common benign neoplasm, the ossified variant is rare. No more than 20 sporadic cases were reported in the literature between 1977 and January 2005. Recently, the authors treated a patient with a symptomatic ossified meningioma located in the posterior aspect of T-11 and an associated osteoporotic T-11 burst fracture. The tumor was completely removed by T10–11 laminectomy and transpedicular vertebroplasty was performed. The kyphotic deformity of the T-11 burst fracture was partially reduced and maintained for at least 2 months after vertebroplasty and laminectomy. The clinical presentation and management of this case are reported.
Benign fibrous histiocytoma of the thoracic spine
Authors: Kuruvath Sarin , O’Donovan Dominic G. , Aspoas A. Robert , David Karoly M.
Published: January 2008

✓ Benign fibrous histiocytoma (BFH) is a rare skeletal tumor, accounting for approximately 1% of all surgically managed benign bone tumors. Spinal location is very rare, and its management can be challenging, involving excision of tumor and spinal reconstruction and stabilization. The prognosis is good after treatment. The authors present the case of BFH involving the thoracic spine and a review of the literature concerning BFH of the spine.
Regional instability following cervicothoracic junction surgery
Authors: Steinmetz Michael P. , Miller Jared , Warbel Ann , Krishnaney Ajit A. , Bingaman William , Benzel Edward C.
Published: January 2008

Object

The cervicothoracic junction (CTJ) is the transitional region between the cervical and thoracic sections of the spinal axis. Because it is a transitional zone between the mobile lordotic cervical and rigid kyphotic thoracic spines, the CTJ is a region of potential instability. This potential for instability may be exaggerated by surgical intervention.

Methods

A retrospective review of all patients who underwent surgery involving the CTJ in the Department of Neurosurgery at the Cleveland Clinic Foundation during a 5-year period was performed. The CTJ was strictly defined as encompassing the C-7 vertebra and C7–T1 disc interspace. Patients were examined after surgery to determine if treatment had failed. Failure was defined as construct failure, deformity (progression or de novo), or instability. Variables possibly associated with treatment failure were analyzed. Statistical comparisons were performed using the Fisher exact test.

Between January 1998 and November 2003, 593 CTJ operations were performed. Treatment failed in 14 patients. Of all variables studied, failure was statistically associated with laminectomy and multilevel ventral corpectomies with fusion across the CTJ. Other factors statistically associated with treatment failure included histories of cervical surgery, tobacco use, and surgery for the correction of deformity.

Conclusions

The CTJ is a vulnerable region, and this vulnerability is exacerbated by surgery. Results of the present study indicate that laminectomy across the CTJ should be supplemented with instrumentation (and fusion). Multilevel ventral corpectomies across the CTJ should also be supplemented with dorsal instrumentation. Supplemental instrumentation should be considered for patients who have undergone prior cervical surgery, have a history of tobacco use, or are undergoing surgery for deformity correction.
Prevention of percutaneous electrode migration in spinal cord stimulation by a modification of the standard implantation technique
Authors: Renard Violette M. , North Richard B.
Published: January 2008

Object

Percutaneous spinal cord stimulation (SCS) electrodes are prone to migration even after scar tissue encapsulation. The authors devised a simple technique to eliminate longitudinal migration.

Methods

In 99 patients who received implanted percutaneous electrodes, less than 0.1 cm3 of silicone elastomer adhesive was injected between the anchoring sleeve and the electrode. As a result, no patient required revision surgery due to longitudinal electrode migration over a mean follow-up period of 20.2 ± 12.3 months (range 1.8–39.7 months). Postimplant SCS-related surgical procedures were required in 15 patients (15%) for the following indications: infection in three patients, expanded area of pain in four patients, lateral migration after the sutures eroded through the supraspinous ligament in one patient, postural changes in stimulation in one patient, receiver-site pain in two patients, technical failure in three patients, and inadequate pain relief in one patient.

Conclusions

With modification of the standard technique for implantation of percutaneous SCS electrodes, no longitudinal migration of electrodes was noted in this series of 99 patients.
Treatment of neurogenic claudication by interspinous decompression: application of the X STOP device in patients with lumbar degenerative spondylolisthesis
Authors: Anderson Paul A. , Tribus Cliff B. , Kitchel Scott H.
Published: January 2008

Object

Interspinous process decompression (IPD) theoretically relieves narrowing of the spinal canal and neural foramen in extension and thus reduces the symptoms of neurogenic intermittent claudication (NIC). The purpose of this study was to compare the efficacy of IPD with nonoperative treatment in patients with NIC secondary to degenerative spondylolisthesis.

Methods

The authors conducted a randomized controlled study in patients with NIC; they compared the results obtained in patients treated with the X STOP IPD device with those acquired in patients treated nonoperatively. The X STOP implant is a titanium alloy device that is placed between the spinous processes to reduce the canal and foraminal narrowing that occurs in extension. In a cohort of 75 patients with degenerative spondylolisthesis, 42 underwent surgical treatment in which the X STOP IPD device was placed and 33 control individuals were treated nonoperatively. Patients underwent serial follow-up evaluations. The Zurich Claudication Questionnaire (ZCQ), 36-Item Short Form Health Survey (SF-36), and radiographic assessment were used to determine outcomes. Two-year follow-up data were obtained in 70 of 75 patients.

Statistically significant improvement in ZCQ and SF-36 scores was seen in X STOP device–treated patients but not in the nonoperative control patients at all postoperative intervals. Overall clinical success occurred in 63.4% of X STOP device–treated patients and only 12.9% of controls. Spondylolisthesis and kyphosis were unaltered.

Conclusions

The X STOP device was more effective than nonoperative treatment in the management of NIC secondary to degenerative lumbar spondylolisthesis.
Metachronous double spinal dural arteriovenous fistulas
Authors: Rizvi Tanvir , Garg Ajay , Mishra Nalini K. , Gaikwad Shailesh B. , Gupta Vipul
Published: January 2008

✓ Spinal dural arteriovenous fistulas (DAVFs), the most common of spinal vascular malformations, are AVFs in the dura mater of the nerve root and/or adjacent spinal dura. These fistulas are most often solitary and are fed by a single radicular artery that primarily supplies the dura mater. Multiple spinal DAVFs are rarely reported in the literature. Those that have been documented have been synchronous in their presentation in that they were found during the same examination or were present at the initial examination but missed and only recognized at the second examination. The authors report the case of a patient with two spinal DAVFs occurring at different spinal levels at different points in time (metachronous).
Preoperative imaging of cervical spine hemangioblastomas using three-dimensional fusion digital subtraction angiography
Authors: Sciubba Daniel M. , Mavinkurve Gaurav G. , Gailloud Philippe , Garonzik Ira M. , Recinos Pablo F. , McGirt Matthew J. , Woodworth Graeme F. , Witham Timothy , Khavkin Yevgeniv , Gokaslan Ziya L. , Wolinsky Jean-Paul
Published: January 2008

✓ Angiography is often performed to identify the vascular supply of hemangioblastomas prior to resection. Conventional two-dimensional (2D) digital subtraction (DS) angiography and three-dimensional (3D) DS angiography provides high-resolution images of the vascular structures associated with these lesions. However, such 3D DS angiography often does not provide reliable anatomical information about nearby osseous structures, or when it does, resolution of vascular anatomy in the immediate vicinity of bone is sacrificed. A novel angiographic reconstruction algorithm was recently developed at The Johns Hopkins University to overcome these inadequacies. By combining two separate sequences of images of bone and blood vessels in a single 3D representation, 3D fusion DS (FDS) angiography provides precise topographic information about vascular lesions in relation to the osseous environment, without a loss of resolution.

In this paper, the authors present the cases of two patients with cervical spine hemangioblastomas who underwent preoperative evaluation with FDS angiography and then successful gross-total resection of their tumors. In both cases, FDS angiography provided high-resolution 3D images of the hemangioblastoma anatomy, including each tumor’s topographic relationship with adjacent osseous structures and the location and size of feeding arteries and draining veins. These cases provide evidence that FDS angiography represents a useful adjunct to magnetic resonance imaging and 2D DS angiography in the preoperative evaluation and surgical planning of patients with vascular lesions in an osseous environment, such as hemangioblastomas in the spinal cord.
Microsurgical posterior foraminotomy with laminoplasty for cervical spondylotic radiculomyelopathy including cervical spondylotic amyotrophy
Authors: Sasai Kunihiko , Umeda Masayuki , Saito Takanori , Ohnari Hiroyuki , Wakabayashi Ei , Iida Hirokazu
Published: January 2008

Object

The authors retrospectively investigated the surgical outcomes and radiographically documented changes after microsurgical posterior foraminotomy with en bloc laminoplasty in patients with cervical spondylotic radiculo-myelopathy (CSRM), including cervical spondylotic amyotrophy (CSA), during a period greater than 2 years.

Methods

Thirty-four consecutive patients (24 men and 10 women) were included in this study. Twenty patients had preoperative radicular pain, and CSA was diagnosed in 14 patients. The mean age at the time of surgery was 61 years (range 43–77 years). The follow-up period ranged from 2 to 6.5 years (mean 3.4 years). Foraminotomy was performed at 49 sites. Neurological improvement was evaluated using the Japanese Orthopaedic Association (JOA) scoring system; radicular pain and deltoid muscle strength were also evaluated clinically. Cervical lordosis, flexion–extension angles, range of motion (ROM), and the angulation and the extent of vertebral slippage at the affected nerve root levels were measured preoperatively and at last follow-up examination.

The mean rate of JOA score improvement was 67.2% (range 22.2–100%). In all 20 patients, preoperative radicular pain completely resolved after surgery. In all 14 patients with CSA, deltoid muscle strength improved; in approximately 80% of these patients, there was either no muscle weakness or only slight weakness. The flexion angles and ROM significantly decreased at the time of the last follow-up examination (p = 0.0402 and 0.0196, respectively). No other items changed significantly.

Conclusions

The aforementioned surgical procedure was safely completed and the surgical outcomes were satisfactory for CSRM including CSA. The instability (the angulation and the vertebral slippage) did not significantly change after surgery. This procedure yielded outstanding results and should be considered an option for cervical laminoplasty in the future.
Remarkable reduction or disappearance of retroodontoid pseudotumors after occipitocervical fusion
Authors: Yamaguchi Ikuko , Shibuya Sei , Arima Nobuo , Oka Shiro , Kanda Yoshiaki , Yamamoto Tetsuji
Published: January 2008

✓ Retroodontoid or periodontoid pseudotumor unassociated with rheumatoid arthritis or hemodialysis is clinically rare. The authors report three cases of retroodontoid pseudotumor that they treated surgically. All patients exhibited myelopathy of the upper cervical spinal cord. Plain radiography depicted atlantoaxial instability in two of the three patients. Spinal cord compression caused by a mass lesion in all patients was clearly demonstrated on magnetic resonance images. In two patients, the mass lesion was not limited to the retroodontoid region and expanded continuously to the cranial base. Posterior laminectomy of the atlas and occipitocervical fusion were performed. After surgery, the pseudotumor disappeared in two cases and was clearly reduced in one case, and neurological symptoms also improved. Retroodontoid pseudotumor is a lesion for which symptomatic improvement can be expected with posterior decompression and fusion, even without direct tumor excision.
Cost–utility analysis of routine neurosurgical spinal surgery
Authors: Räsänen Pirjo , Öhman Juha , Sintonen Harri , Ryynänen Olli-Pekka , Koivisto Anna-Maija , Blom Marja , Roine Risto P.
Published: January 2008

Object

Cost–utility analysis is currently the preferred method with which to compare the cost-effectiveness of various interventions. The authors conducted a study to establish the cost–utility results of routine neurosurgery-based spinal interventions by examining patient-derived values.

Methods

Two hundred seventy patients undergoing surgery for cervical or lumbar radicular pain filled in the 15-dimensional health-related quality of life (HRQOL) questionnaire before and 3 months after surgery. Quality-adjusted life years (QALYs) were calculated using the utility data and the expected remaining life years of the patients. The mean HRQOL score (scale, 0–1) increased after cervical surgery (169 patients, mean age 52 years, 40% women) from 0.81 ± 0.11 preoperatively, to 0.85 ± 0.11 at 3 months, and after lumbar surgery (101 patients, mean age 54 years, 59% women) from 0.79 ± 0.10 preoperatively, to 0.85 ± 0.12 at 3 months (p < 0.001). Of the 15 dimensions of health, improvement in the following was documented in both groups: sleeping, usual activities, discomfort and symptoms, depression, distress, vitality, and sexual activity (p < 0.05). The cost per QALY gained was €2774 and 1738 for cervical and lumbar operations, respectively. In cases in which surgery was delayed the cost per QALY was doubled.

Conclusions

Spinal surgery led to a statistically significant and clinically important improvement in HRQOL. The cost per QALY gained was reasonable, less than half of that observed, for example, for hip replacement surgery or angioplasty treatment of coronary artery disease; however, a prolonged delay in surgical intervention led to an approximate doubling of the cost per QALY gained by the treatment.
Spinal epidural arteriovenous fistula with perimedullary drainage
Authors: Krings Timo , Mull Michael , Bostroem Azize , Otto Juergen , Hans Franz J. , Thron Armin
Published: January 2008

✓ The classic angiographically demonstrated features of spinal dural arteriovenous fistulas are shunts of radiculomeningeal branches with radicular veins draining exclusively in the direction of perimedullary veins and thereby causing venous congestion. These shunts are located at the point where the radicular vein passes the dura mater. Spinal epidural arteriovenous shunts, however, normally do not drain into the perimedullary veins and are, therefore, asymptomatic, presumably because of a postulated reflux-impeding mechanism between the dural sleeves. The authors report on a patient in whom an epidural arteriovenous shunt showed delayed retrograde drainage into perimedullary veins, leading to the classic clinical (and magnetic resonance imaging–based) findings of venous congestion. Intraoperatively the angiographically established diagnosis was confirmed. Coagulation of both the epidural shunt zone and the radicular vein resulted in complete obliteration of the fistula, as confirmed on repeated angiography.

This rare type of fistula should stimulate considerations on the role of valvelike mechanisms normally impeding retrograde flow from the epidural plexus to perimedullary veins and suggest that, in certain pathological circumstances, epidural fistulas can drain retrogradely into perimedullary veins as an infrequent variant of spinal arteriovenous shunts.
Facet cyst in the lumbar spine: radiological and histopathological findings and possible pathogenesis
Authors: Kusakabe Takashi , Kasama Fumio , Aizawa Toshimi , Sato Tetsuro , Kokubun Shoichi
Published: January 2008

Object

The authors define facet cyst as a cyst located beside the facet joint and exhibiting a communication with the joint, as demonstrated on arthrography and subsequent computed tomography (CT) of the joint space. The purpose of this study was to determine the pathogenesis of facet cysts based on their radiological and histological features.

Methods

Forty-six juxtafacet cysts in 45 patients (26 men and 19 women, age range 41–82 years) were surgically treated after evaluation by arthrography and subsequent CT scanning. A communication channel between the cyst and the joint was confirmed in all cases and thus the lesions were designated facet cysts. In almost all patients the involved facet joint showed moderate to severe degeneration. After a thorough preoperative radiological evaluation, these cysts were excised en bloc by medial facetectomy with the entire ligamentum flavum. The specimens were cut axially at the maximum diameter and were histologically investigated.

Morphologically, the cysts exhibited three shapes, appearing as: 1) a small protrusion, 2) a semicircular cyst, or 3) a round cyst. The cyst walls consisted of elastic and collagen fibers undergoing fibrinoid degeneration, but no synovial lining cells were detected. The cystic cavities were regularly filled with fibrinoids, and myxoid degeneration was found particularly in the larger cysts.

Conclusions

Facet cysts are closely related to the degeneration of the neighboring facet joint. Analysis of the findings in this histological study suggests that there are several shapes of facet cysts. The authors propose that the shape could depend on the stage of the cyst’s development.
Regression of retroodontoid pseudotumors following C-1 laminoplasty
Authors: Suetsuna Futoshi , Narita Hozumi , Ono Atsushi , Ohishi Hirotaka
Published: January 2008

✓The authors report a new technique for C-1 laminoplasty without fusion in the treatment of cervical myelopathy associated with a retroodontoid pseudotumor (also known as a phantom tumor).

The authors review the cases of three patients who underwent C-1 laminoplasty in which hydroxyapatite was used and fusion was not performed. All patients suffered from severe progressive myelopathy before surgery. Magnetic resonance imaging revealed a retroodontoid pseudotumor compressing the spinal cord at the C-1 level in all cases. Computed tomography was performed to examine the extent of bone erosion at the atlantoaxial joint and dens. Clinical parameters included neurological function, measured using the Japanese Orthopaedic Association score, and neck pain. Imaging parameters included pre- and postoperative atlas–dens intervals; the space available for the spinal cord; instability of the atlantoaxial joints; osteoarthritic changes of the atlantoaxial joint; postoperative changes in T2 high-intensity signal; and postoperative alteration in the size of the pseudotumor.

Magnetic resonance imaging demonstrated complete disappearance of the pseudotumor in two cases and partial reduction in one case. In all three cases sufficient neurological recovery was observed. The mean recovery rate was 87.0%.

This new technique is less invasive than standard procedures, preserves the cervical range of motion, and avoids the morbidity of obtaining a bone graft and placing instrumentation. The authors conclude that C-1 laminoplasty without fusion is an option in the surgical management of cervical myelopathy associated with a retroodontoid pseudotumor, either without C1–2 instability or with slight, but reducible, C1–2 instability.
Cervical pedicle screw fixation in 100 cases of unstable cervical injuries: pedicle axis views obtained using fluoroscopy
Authors: Yukawa Yasutsugu , Kato Fumihiko , Yoshihara Hisatake , Yanase Makoto , Ito Keigo
Published: January 2008

Object

The authors conducted a study to introduce the imaging technique in which pedicle axis views are obtained using fluoroscopy to match the screw entry point with pedicle orientation and to report the clinical results and safety of cervical pedicle screw fixation (PSF) in patients treated for unstable cervical injuries.

Methods

One hundred consecutive patients with unstable cervical injuries underwent PSF in which the authors used fluoroscopic imaging to acquire pedicle axis views. There were 87 men and 13 women whose mean age was 42.5 years. The accuracy of PS placement was examined postoperatively using axial computed tomography (CT) and oblique radiography. Screw malpositioning was classified either as screw exposure (< 50% of the screw outside the pedicle) or pedicle perforation (> 50% of the screw outside the pedicle boundaries).

The mean operative time was 97.6 minutes, and the mean estimated blood loss was 221 ml. Local vertebral alignment around the injured segment measured 6.0° of kyphosis preoperatively and 6.7° of lordosis postoperatively. Solid posterior bone fusion was achieved in all but three patients who died shortly after surgery. There was no secondary dislodgment of instrumentation in 95% of these 97 cases. Of the 419 cervical PSs, 43 (10.3%) were of the screw-exposure type and 17 (4.0%) of the pedicle-perforation type. There were two surgery-related complications: one penetration of a probe into the vertebral artery and one radiculopathy. There were six postoperative complications: two cases of instrumentation failure associated with loss of correction, three cases of correction loss (> 10°), and one case of deep wound infection.

Conclusions

Solid posterior fusion without secondary dislodgment of hardware was demonstrated in 95% of the cases. The incidence of complications associated with cervical PSF was not high. Postoperative CT scanning showed that 17 (4.0%) of 419 screws perforated the pedicle. It appears that fluoroscopy performed using pedicle axis views improves the accuracy and safety of cervical PS insertion.
Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population
Authors: Aizawa Toshimi , Sato Tetsuro , Sasaki Hirotoshi , Kusakabe Takashi , Morozumi Naoki , Kokubun Shoichi
Published: January 2008

Object

Data obtained in patients with thoracic myelopathy caused by ossification of the ligamentum flavum (OLF) were retrospectively reviewed to clarify clinical features and surgical outcomes in the Japanese population.

Methods

Seventy-two patients who underwent surgery for OLF-induced myelopathy in the Miyagi Prefecture, Japan, between 1988 and 2002 were observed for at least 2 years. Clinical data were collected from medical and operative records. The patients were evaluated pre- and postoperatively using the modified Japanese Orthopaedic Association (JOA) scale (maximum score 11). The relationships among various factors (age, sex, and preoperative duration of symptoms) affecting the preoperative severity of myelopathy and postoperative improvement were also examined.

Conclusions

In this series the surgical outcome was relatively good and depended on the severity of myelopathy; thus early and correct diagnosis is required to avoid poorer results. The male/female ratio was 3.2 and the mean patient age at surgery was 61 years for men and 68 for women. The patients commonly noticed numbness or pain in their lower legs or gait disturbances. In a total of 104 decompressed intervertebral disc levels, more than 80% of the ossified ligaments were at the T9–10 level or lower. The mean preoperative JOA score of 5.1 improved to 7.9 after an average of 46 months. The postoperative results statistically depended on the preoperative severity of myelopathy. Among studies of patients with OLF-related myelopathy, the present study had the largest sample size, which should help clarify the clinical features of OLF myelopathy.
Accuracy and safety of pedicle screw fixation in thoracic spine trauma
Authors: Fisher Charles G. , Sahajpal Vic , Keynan Ory , Boyd Michael , Graeb Douglas , Bailey Christopher , Panagiotopoulos Kostas , Dvorak Marcel F.
Published: January 2008

Object

The authors evaluated the accuracy of placement and safety of pedicle screws in the treatment of unstable thoracic spine fractures.

Methods

Patients with unstable fractures between T-1 and T-10, which had been treated with pedicle screw (PS) placement by one of five spine surgeons at a referral center were included in a prospective cohort study. Postoperative computed tomography scans were obtained using 3-mm axial cuts with sagittal reconstructions. Three independent reviewers (C.B., V.S., and D.G.) assessed PS position using a validated grading scale. Comparison of failure rates among cases grouped by selected baseline variables were performed using Pearson chi-square tests. Independent peri- and postoperative surveillance for local and general complications was performed to assess safety.

Twenty-three patients with unstable thoracic fractures treated with 201 thoracic PSs were analyzed. Only PSs located between T-1 and T-12 were studied, with the majority of screws placed between T-5 and T-10. Of the 201 thoracic PSs, 133 (66.2%) were fully contained within the pedicle wall. The remaining 68 screws (33.8%) violated the pedicle wall. Of these, 36 (52.9%) were lateral, 27 (39.7%) were medial, and five (7.4%) were anterior perforations. No superior, inferior, anteromedial, or anterolateral perforations were found. When local anatomy and the clinical safety of screws were considered, 98.5% (198 of 201) of the screws were probably in an acceptable position. No baseline variables influenced the incidence of perforations. There were no adverse neurological, vascular, or visceral injuries detected intraoperatively or postoperatively.

Conclusions

In the vast majority of cases, PSs can be placed in an acceptable and safe position by fellowship-trained spine surgeons when treating unstable thoracic spine fractures. However, an unacceptable screw position can occur.
Deep vein thrombosis due to migrated graft bone after posterior lumbosacral interbody fusion
Authors: Yoshimoto Hisashi , Sato Shigenobu , Nakagawa Izumi , Hyakumachi Takahiko , Yanagibashi Yasushi , Nitta Fumihito , Masuda Takeshi
Published: January 2008

✓The authors report the case of an 83-year-old woman with refractory sciatica attributable to isthmic spondylolisthesis at L-5. Her symptoms were successfully improved after posterior lumbar interbody fusion (PLIF) at L5–S1; however, notable swelling in her left leg suddenly developed 2 days postoperatively. Anterior migration of a fragment of bone graft was demonstrated on computed tomography scanning, and there was obvious occlusion of the left common iliac vein (CIV) on magnetic resonance venography. Ultrasonography revealed a thrombus in the left CIV at the site of compression. To prevent a pulmonary embolism during manipulation of the affected vein, an inferior vena cava filter was placed just before excision of the migrated bone fragment. The swelling in the patient’s leg subsided quickly after the surgery, and she was treated with heparin and warfarin to prevent recurrent deep vein thrombosis (DVT). Six months after the second surgery, complete restoration of blood flow to the left CIV and no recurrence of DVT were demonstrated on magnetic resonance venography. Especially in elderly patients with degenerative disc disease, excessive curettage and impaction of disc materials during the PLIF procedure may cause migration of bone graft fragments. Surgeons should be aware of the possible vascular complications of PLIF.
Uterus-like mass of müllerian origin in the lumbosacral region causing cord tethering
Authors: Sharma Mehar Chand , Sarkar Chitra , Jain Deepali , Suri Vaishali , Garg Ajay , Vaishya Sandeep
Published: January 2008

✓The presence of müllerian-origin tissue in the lumbosacral region is extremely uncommon. The authors report two cases of müllerian-origin tissue in that region. In the first case a 33-year-old woman harbored a conus medullaris mass lesion. Spinal dysraphism, tethered cord syndrome (TCS), and diastematomyelia were also present. In the second case a 24-year-old woman presented with low-back pain and a conus medullaris lesion, which was a cause of the TCS. Pathological examination in both cases revealed a uterus-like structure with evidence of fresh and old hemorrhage. The rarity of this lesion and its association with diastematomyelia requires documentation.
Tethered cord due to spina bifida occulta presenting in adulthood: a tricenter review of 61 patients
Authors: Rajpal Sharad , Tubbs R. Shane , George Timothy , Oakes W. Jerry , Fuchs Herbert E. , Hadley Mark N. , Iskandar Bermans J.
Published: January 2008

Object

Children with spina bifida occulta require early surgery to prevent neurological deficits. The treatment of patients with a congenitally tethered cord who present in adulthood remains controversial.

Methods

The authors studied the medical records of 61 adult patients who underwent surgical untethering for spina bifida occulta at three institutions between 1994 and 2003. Patients who had undergone prior myelomeningocele repair or tethered cord release surgery were excluded.

The most common intraoperative findings were lipomyelomeningocele (41%) and a tight terminal filum (36%). The follow-up duration ranged from 10.8 to 149.5 months. Of the 34 patients with back pain, status improved in 65%, worsened in 3%, remained unchanged in 18%, and improved and later recurred in 15%. Lower-extremity pain improved in 16 patients (53%), remained unchanged in 23%, improved and then recurred in 17%, and worsened in 7%. Lower-extremity weakness improved in 47%, remained unchanged in 47%, and improved and then recurred in 5%. Finally, of the 17 patients with lower-extremity sensory changes, status improved in 35%, remained unchanged in 35%, and the information on five patients was unavailable. Surgical complications included three wound infections, one cerebrospinal fluid leak, and two pseudomeningoceles requiring surgical revision. One patient developed acute respiratory distress syndrome and sepsis postoperatively and died several days later.

Conclusions

Adult-age presentation of a congenital tethered cord is unusual. Despite a slight increase in postoperative neurological injury in adults, surgery has relatively low risk and offers good potential for neurological improvement or stabilization. As they do in children, the authors recommend early surgery in adults with this disorder. The decision to undertake surgery, however, should be modulated by other factors such as a patient's general medical condition and risk posed by anesthesia.
Surgical outcomes in adult patients with syringomyelia associated with Chiari malformation Type I: the relationship between scoliosis and neurological findings
Authors: Ono Atsushi , Suetsuna Futoshi , Ueyama Kazumasa , Yokoyama Toru , Aburakawa Shuichi , Numasawa Takuya , Wada Kanichiro , Toh Satoshi
Published: January 2008

Object

The clinical characteristics of pediatric scoliosis associated with syringomyelia have been reported in previous studies, but scoliosis associated with syringomyelia in adults is rarely treated, and there is a paucity of detailed studies. In the present study of adult syringomyelia associated with Chiari malformation Type I, the authors investigated the relationships among the syrinx, scoliosis, and neurological data.

Methods

The population was composed of 27 patients (≥ 20 years of age) who underwent foramen magnum decompression for the treatment of syringomyelia. The patients were divided into two groups: those with scoliosis of 10° or more (Group A) and those without scoliosis (Group B). The authors assessed the length of the syrinx, duration of morbidity, and clinical status before and after surgery based on the Japanese Orthopaedic Association (JOA) Scale.

There were 15 cases in Group A and 12 in Group B. The mean length of the syrinx was 12.8 vertebral bodies (VBs) in Group A and 7.2 VBs in Group B. The mean duration of morbidity was 14.2 years in Group A and 6.8 years in Group B. The mean preoperative JOA score was 10.1 in Group A and 14.4 in Group B, whereas the mean postoperative JOA scores were 11.9 and 15.8, respectively. There were significant differences between Groups A and B in length of the syrinx, duration of morbidity, and pre- and postoperative JOA scores.

Conclusions

In patients with syringomyelia and scoliosis the syringes spanned a greater number of VBs, the duration of morbidity was greater, neurological dysfunction was more severe, and surgical results were poorer. Scoliosis could be a predicting factor of the prognosis in patients with syringomyelia and Chiari malformation Type I.
Medical management of Pott disease in the thoracic and lumbar spine: a prospective clinical study
Authors: Kotil Kadir , Alan M. Servet , Bilge Turgay
Published: January 2008

Object

The aim of this study was to evaluate conservative medical management of 44 patients with Pott disease. The prognostic significance of various clinical, radiological, and long-term follow-up findings in these patients was also evaluated.

Methods

Between January 1990 and January 2005 data were collected prospectively at the authors' clinic in 44 patients with Pott disease in the thoracic or lumbar spine. These patients had no major neurological deficits or severe spinal deformities. The study population consisted of 21 male (48%) and 23 female (52%) patients, with a mean age of 42.1 years (range 10–70 years). The most common region of Pott disease was the thoracolumbar junction (18 cases; 41%), followed by the thoracic (16 cases; 36%) and lumbar (10 cases; 23%) regions. All patients presented with abscesses. With the exception of two cases, all had kyphotic angles smaller than 30°. At presentation, 20 patients had neurological signs of spinal cord compression during clinical examination. Both clinical and biopsy findings were used in all cases for diagnosis. A diagnosis was confirmed by a positive biopsy specimen culture in 19 (43.2%) of 44 cases, and histopathological findings were compatible with the results of these cultures in all cases. All patients were treated with antituberculous chemotherapy, and the diseases in only two (4.5%) was resistant to the regimen. An independent observer assessed the clinical and imaging findings after a mean follow-up duration of 40 months.

Forty-two (95.4%) of the 44 patients were successfully treated with conservative medical management and attained acceptable spinal deformity angles, and none of these patients had any residual instability, radiculopathy, or neurological compromise. Only 4.5% of the patients experienced residual spine deformity (as much as a 30° kyphotic angle), which was clinically obvious but biomechanically stable.

Conclusions

Patients with Pott disease in the lumbar or thoracic region, without neurological deficits or kyphosis, can be treated conservatively in the vast majority of cases. Indications for surgery need to be redefined given these new data.
Sacral epidural noncommunicating arachnoid cyst
Authors: Sakellaridis Nikolaos , Panagopoulos Demetrius , Mahera Helen
Published: January 2008

✓ The authors examine the natural history of a spinal epidural arachnoid cyst and present their experience with its treatment in a 25-year-old man who presented with progressive cauda equina syndrome. Neuroimaging revealed two neighboring sacral epidural cysts. The cysts were completely removed via a sacral S1–4 laminectomy; no communication with the subarachnoid space could be found. The patient's postoperative course was uneventful. He experienced progressive improvement and, finally, complete resolution of symptoms and no recurrence of the cyst. Nabors Type I sacral epidural arachnoid cysts are rare; in some cases their origins and the mechanism by which they cause deterioration in the patients' clinical condition are debatable. Findings in the present case support the idea that some of these cysts are noncommunicating but progressive in their clinical presentation. This lesion type is also known to occur intracranially. A brief review of the literature is provided.
Evidence of blood–brain barrier dysfunction and CSF immunoglobulin synthesis in Down Syndrome Regression Disorder
Authors: Santoro Jonathan D. , Eduthan Neetha Paul , Khoshnood Mellad M. , Jafarpour Saba , Boyd Natalie K. , Vogel Benjamin N. , Nguyen Lina , Kazerooni Lilia , Britton Eleanor , Lyford Hannah R. , Galbraith Matthew D. , Rachubinski Angela L. , Espinosa Joaquin M.
Published: February 2025

Objectives

This study sought to evaluate proteomic, metabolomic, and immune signatures in the cerebrospinal fluid of individuals with Down Syndrome Regression Disorder (DSRD).

Methods

A prospective case–control study comparing proteomic, metabolomic, and immune profiles in individuals with DSRD was performed. Samples were obtained from a biorepository of affected individuals and compared to clinically available data and previously obtained neurodiagnostic studies. Individuals with DSRD were compared to individuals with established neuroinflammatory conditions (e.g., multiple sclerosis), and neurotypical controls undergoing a lumbar puncture for headaches. Samples underwent high‐throughput proteomic, metabolomic, and immune marker profiling. Data was compared across groups and clinical phenotypes. Gene set enrichment analysis and pathway analyses were utilized to analyze the data.

Results

In total, 34 individuals with DSRD, 22 neuroinflammatory controls, and 27 neurotypical controls were enrolled in the study. We observed a highly significant concordance in dysregulated proteomics signatures in DSRD and neuroinflammatory controls versus healthy controls, most prominently upregulation of many immunoglobulin sequences. In addition, individuals with DSRD displayed strong upregulation of liver‐derived plasma proteins and erythrocyte proteins in the CSF, indicating poor blood–brain barrier integrity. The immune marker profile of DSRD is clearly similar to other neuroimmunological conditions, including strong elevation of MIP3‐α, eotaxin, and IFN‐γ.

Interpretation

Individuals with DSRD have unique CSF proteomic and metabolomic signatures consistent with neuroinflammation and increased blood–brain barrier permeability. The CSF of individuals with DSRD was more comparable to individuals with neuroinflammatory disorders than neurotypical controls, indicating the potential for an immune etiology of disease.
Inducing Cuproptosis with Copper Ion‐Loaded Aloe Emodin Self‐Assembled Nanoparticles for Enhanced Tumor Photodynamic Immunotherapy
Authors: Yu Zhen , Cao Lei , Shen Yue , Chen Jieqi , Li Huizhen , Li Chengmin , Yin Ji‐Ye , Li Yueqin , Meng Yingcai , Li Xiangping
Published: February 2025

Immunotherapy has fundamentally transformed the clinical treatment landscape for non‐small cell lung cancer (NSCLC). While its effectiveness is ultimately limited by patient heterogeneity and immunosuppressive tumor microenvironment. Photodynamic therapy (PDT), as an emerging antitumor immunotherapy, has shown its unique therapeutic advantages. However, previous studies often overlooked the potential toxicity of photosensitizers (PS), making the discovery of safe and effective PS a pressing clinical need. In this study, Aloe Emodin (AE), a medicinal plant natural compound, was loaded with copper ions (Cu), and self‐assembled into nanoparticles (NPs) under the modification of PEG2k‐DSPE‐FA. NPs can target, accumulate, and reside within tumor sites, responsively releasing copper ions and AE, thus dual‐functioning by inducing tumor cell death via cuproptosis and enhancing PDT effects. The LLC tumor‐bearing mouse model demonstrated that NPs induce the maturation of dendritic cells (DCs) in vivo, promote lymphocyte infiltration, transform “cold tumors” into “hot tumors” and significantly enhance the efficacy of immune checkpoint blockade (ICB). This study provides experimental evidence of AE as a clinically promising PDT agent and offers a novel perspective for the synergistic treatment of clinical NSCLC.