bluuebunny/crossref_metadata_2025 huggingface dataset:
Corpectomy: a direct approach to perimedullary arteriovenous fistulas of the anterior cervical spinal cord
Authors: Hida Kazutoshi , Iwasaki Yoshinobu , Ushikoshi Satoshi , Fujimoto Shin , Seki Toshitaka , Miyasaka Kazuo
Published: May 2009

Object. In this report, the authors describe five consecutive patients with cervical perimedullary arteriovenous fistulas (AVFs) that were successfully treated using a corpectomy performed via an anterior approach.

Methods. Five patients with cervical perimedullary AVF underwent corpectomy via an anterior approach. There were four women and one man who ranged in age from 34 to 62 years (median 55 years). Four patients presented with subarachnoid hemorrhage and one with intramedullary hemorrhage. All five AVFs were located on the anterior surface of the cervical spinal cord and fed by the anterior spinal artery. All patients underwent an anterior approach with 1.5- or two-level corpectomy, opening of the dura mater, and coagulation of the fistula. After dural closure, an iliac bone graft was inserted.

Four patients were treated by surgery alone and one patient by embolization and surgery. Postoperative angiography revealed complete disappearance of the AVF in all patients. Neurological status improved in two cases and stabilized in the other three. There were no surgery-related complications.

Conclusions. Safe and effective interruption of cervical AVFs can be accomplished by an anterior-approach corpectomy.
Spinal dural arteriovenous fistulas: experience with endovascular and surgical therapy
Authors: Eskandar Emad N. , Borges Lawrence F. , Budzik Ronald F. , Putman Christopher M. , Ogilvy Christopher S.
Published: May 2009

Object. Although the pathophysiology of spinal dural arteriovenous fistulas (AVFs) has recently been elucidated, the optimal treatment strategy for these lesions has yet to be defined. Current management techniques include endovascular embolization or microsurgical obliteration.

Methods. The authors reviewed the records and angiograms of all patients with spinal dural AVFs treated at Massachusetts General Hospital over a 6-year period (1992–1998). During this period, it was intended initially to treat all patients with embolization and to reserve surgery for those in whom endovascular treatment failed or in cases in which pretreatment evaluation suggested that endovascular therapy would be ineffective or unsafe.

A total of 26 patients with spinal dural AVFs were treated: there were 22 men and 4 women with a mean age of 65 years (range 39–79 years). Lesions were located in the following areas: five in foramen magnum/cervical, 13 in thoracic, five in lumbar, and three in sacral. Twenty-three (88%) of 26 patients underwent embolization and three (12%) of 23 patients underwent surgery as the primary mode of treatment. Of the 23 patients in whom embolization was performed or attempted, nine (39%) ultimately required surgery. All patients were stabilized or improved following definitive treatment, as assessed by the Aminoff—Logue scores. There was one death secondary to a myocardial infarction.

Conclusions. These data demonstrate that endovascular therapy can be successful as an initial treatment for the majority of patients; however, there is a 39% failure rate, which is not observed following surgical therapy. Once a definitive therapy has been achieved using either technique virtually all patients are either stabilized or improved.
Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up
Authors: Iwasaki Motoki , Kawaguchi Yoshiharu , Kimura Tomoatsu , Yonenobu Kazuo
Published: May 2009

Object. The authors report the long-term (more than 10-year) results of cervical laminoplasty for ossification of the posterior longitudinal ligament (OPLL) of the cervical spine as well as the factors affecting long-term postoperative course.

Methods. The authors reviewed data obtained in 92 patients who underwent cervical laminoplasty between 1982 and 1990. Three patients were lost to follow up, 25 patients died within 10 years of surgery, and 64 patients were followed for more than 10 years. Results were assessed using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. The recovery rate was calculated using the Hirabayashi method. The mean neurological recovery rate during the first 10 years after surgery was 64%, which declined to 60% at the last follow-up examination (mean follow up 12.2 years). Late neurological deterioration occurred in eight patients (14%) from 5 to 15 years after surgery. The most frequent causes of late deterioration were degenerative lumbar disease (three patients), thoracic myelopathy secondary to ossification of the ligamentum flavum (two patients), or postoperative progression of OPLL at the operated level (two patients). Postoperative progression of the ossified lesion was noted in 70% of the patients, but only two patients (3%) were found to have related neurological deterioration. Additional cervical surgery was required in one patient (2%) because of neurological deterioration secondary to progression of the ossified ligament. The authors performed a multivariate stepwise analysis, and found that factors related to better clinical results were younger age at operation and less severe preexisting myelopathy. Younger age at operation, as well as mixed and continuous types of OPLL, was highly predictive of progression of OPLL. Postoperative progression of kyphotic deformity was observed in 8% of the patients, although it did not cause neurological deterioration.

Conclusions. When the incidence of surgery-related complications and the strong possibility of postoperative growth of OPLL are taken into consideration, the authors recommend expansive and extensive laminoplasty for OPLL.
Peripheral nerve grafts promoting central nervous system regeneration after spinal cord injury in the primate
Authors: Levi Allan D. O. , Dancausse Hector , Li Xiuming , Duncan Suzanne , Horkey Laura , Oliviera Maria
Published: May 2009

Object. Partial restoration of hindlimb function in adult rats following spinal cord injury (SCI) has been demonstrated using a variety of transplantation techniques. The purpose of the present study was twofold: 1) to determine whether strategies designed to promote regeneration in the rat can yield similar results in the primate; and 2) to establish whether central nervous system (CNS) regeneration will influence voluntary grasping and locomotor function in the nonhuman primate.

Methods. Ten cynomologus monkeys underwent T-11 laminectomy and resection of a 1-cm length of hemispinal cord. Five monkeys received six intercostal nerve autografts and fibrin glue containing acidic fibroblast growth factor (2.1 µg/ml) whereas controls underwent the identical laminectomy procedure but did not receive the nerve grafts. At 4 months postgrafting, the spinal cord—graft site was sectioned and immunostained for peripheral myelin proteins, biotinylated dextran amine, and tyrosine hydroxylase, whereas the midpoint of the graft was analyzed histologically for the total number of myelinated axons within and around the grafts. The animals underwent pre- and postoperative testing for changes in voluntary hindlimb grasping and gait.

Conclusions. 1) A reproducible model of SCI in the primate was developed. 2) Spontaneous recovery of the ipsilateral hindlimb function occurred in both graft- and nongraft—treated monkeys over time without evidence of recovering the ability for voluntary tasks. 3) Regeneration of the CNS from proximal spinal axons into the peripheral nerve grafts was observed; however, the grafts did not promote regeneration beyond the lesion site. 4) The grafts significantly enhanced (p < 0.0001) the regeneration of myelinated axons into the region of the hemisected spinal cord compared with the nongrafted animals.
Successful management of spinal dural arteriovenous fistulas undetected by arteriography
Authors: Oldfield Edward H. , Bennett Andrew , Chen Michael Y. , Doppman John L.
Published: May 2009

✓ Spinal dural arteriovenous fistulas (AVFs) frequently cause progressive myelopathy. When they are localized by imaging studies, surgery can be safely performed by simply interrupting the vein draining the fistula intradurally, and the results will be excellent and lasting. In some patients with clinical features of a spinal dural AVF and in whom magnetic resonance imaging and/or myelography findings are consistent with a diagnosis of a spinal dural AVF, however, spinal arteriography demonstrates no such results. The authors used a simple strategy based on knowledge of the epidemiology, pathophysiology, and anatomy of spinal dural AVFs to manage these cases successfully. In two patients, atherosclerotic occlusion was the primary cause for the failure of arteriography to visualize the dural AVF. The presence of an aortic aneurysm was an additional contributing factor preventing arteriographic visualization in one of these patients. In a third patient, massive obesity, and aortic atheroslerosis and tortuosity contributed to the absence of findings on three spinal arteriograms before surgical exploration lead to a more focused arteriographic examination that was successful.
Cerebrospinal fluid leaks following spinal surgery: use of fat grafts for prevention and repair
Authors: Black Perry
Published: May 2009

✓ Cerebrospinal fluid (CSF) leaks are relatively common following spinal surgery. A midline dural tear in the spine is readily repaired by direct application of sutures; however, far-lateral or ventral dural tears are problematic. Fat is an ideal sealant because it is impermeable to water. In this paper the author reports his experience with using fat grafts for the prevention or repair of CSF leaks and proposes a technique in which a large sheet of fat, harvested from the patient's subcutaneous layer, is used to cover not only the dural tear(s) but all of the exposed dura and is tucked into the lateral recess. This procedure prevents CSF from seeping around the fat, which may be tacked to the dura with a few sutures. Fibrin glue is spread on the surface of the fat and is further covered with Surgicel or Gelfoam. For ventral dural tears (associated with procedures in which disc material is excised), fat is packed into the disc space to seal off the ventral dural leak. Dural suture lines following spinal intradural exploration are prophylatically protected from CSF leakage in the same manner. With one exception, 27 dural tears noted during 1650 spinal procedures were successfully repaired using this technique. There was one case of postoperative CSF leakage in 140 cases in which intradural exploration for tumor or other lesions was undertaken. Both postoperative CSF leaks were controlled by applying additional skin sutures. The use of a fat graft is recommended as a rapid, effective means of prevention and repair of CSF leaks following spinal surgery.
Complications associated with the prophylactic use of methylprednisolone during surgical stabilization after spinal cord injury
Authors: Molano Maria Del Rosario , Broton James G. , Bean Judy A. , Calancie Blair
Published: May 2009

Object. The authors attempted to determine if there is a significant relationship between the incidence of medical complications and the prophylactic use of methylprednisolone (MP) during spine surgery in patients with acute spinal cord injury (SCI) who had already received MP on hospital admission (typically in the setting of an Emergency Room/Trauma Center).

Methods. The authors studied 73 patients with acute SCI who were admitted to the hospital for at least 7 days postinjury. All patients 1) received a 24-hour regimen of MP in the acute period of hospitalization; and 2) underwent surgery to stabilize the spine and/or decompress the spinal cord. Patients were separated into two groups on the basis of whether they received additional MP therapy during spine surgery. A chart review was conducted retrospectively to determine the incidence of complications up to 6 weeks postinjury. Muscle strength and American Spinal Injury Association grades were determined prospectively throughout the follow-up period.

In patients who received two courses of MP following acute SCI (one at initial hospitalization and one during surgery), a significantly increased probability of complications was demonstrated compared with those who received no MP therapy during surgery. This was particularly evident when the incidences of serious complications were compared.

Conclusions. Prophylactic use of MP as a neuroprotective agent during spine surgery in patients with acute SCI should be avoided in those in whom MP was administered on admission to the hospital.
Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography
Authors: Doi Kazuteru , Otsuka Ken , Okamoto Yukinori , Fujii Hiroshi , Hattori Yasunori , Baliarsing Amresh S.
Published: May 2009

Object. The authors describe a new magnetic resonance (MR) imaging technique to demonstrate the status of the cervical nerve roots involved in brachial plexus injury. They discuss the accuracy and reproducibility of a MR imaging—derived classification for diagnosis of nerve root avulsion compared with those of myelography combined with computerized tomography (CT) myelography.

Methods. The overlapping coronal—oblique slice MR imaging procedure was performed in 35 patients with traumatic brachial plexus injury and 10 healthy individuals. The results were retrospectively evaluated and classified into four major categories (normal rootlet, rootlet injuries, avulsion, and meningocele) after confirming the diagnosis by surgical exploration with or without spinal evoked potential (EP) measurements and by referring to myelography and CT myelography findings. The reliability and reproducibility of the MR imaging—based classification was prospectively assessed by eight independent observers, and its diagnostic accuracy was compared with that of traditional myelography/CT myelography classification, correlated with surgical and spinal EP findings in another 50 cervical roots in 10 patients with traumatic brachial plexus injury.

Conclusions. In the retrospective study in which MR imaging and myelography/CT myelography findings involving 175 cervical roots in 35 patients were compared, the sensitivity of detection of the cervical nerve root avulsion was the same (92.9%) with both modalities. In the prospective study, interobserver reliability and intraobserver reproducibility showed that there was no statistically significant difference between MR imaging and myelography/CT myelography and that their accuracy for detecting cervical root avulsion was the same as that in the retrospective study.

The overlapping coronal—oblique slice MR imaging technique is a reliable and reproducible method for detecting nerve root avulsion. The information provided by this modality enabled the authors to assess the roots of the brachial plexus and provided valuable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction, or other imaging modalities.
Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics
Authors: Holly Langston T. , Kelly Daniel F. , Counelis George J. , Blinman Thane , McArthur David L. , Cryer H. Gill
Published: May 2009

Object. Diagnosing and managing cervical spine trauma in head-injured patients is problematic due to an altered level of consciousness in such individuals. The reported incidence of cervical spine trauma in head-injured patients has generally ranged from 4 to 8%. In this retrospective study the authors sought to define the incidence of cervical injury in association with moderate or severe brain injury, emphasizing the identification of high-risk patients.

Methods. The study included 447 consecutive moderately (209 cases) or severely (238 cases) head injured patients who underwent evaluation at two Level 1 trauma centers over a 40-month period. Of the 447 patients, 24 (5.4%) suffered a cervical spine injury (17 men and seven women; mean age 39 years; median Glasgow Coma Scale [GCS] score of 6, range 3–14). Of these 24 patients, 14 (58.3%) sustained spinal cord injuries (SCIs), 14 sustained injuries in the occiput—C3 region, and 10 underwent a stabilization procedure. Of the 14 patients with SCIs, nine experienced an early hypotensive and/or hypoxic insult. Regarding the mechanism of injury, cervical injuries occurred in 21 (8.2%) of 256 patients involved in motor vehicle accidents (MVAs), either as passengers or pedestrians, compared with three (1.6%) of 191 patients with non-MVA-associated trauma (p < 0.01). In the subset of 131 MVA passengers, 13 (9.9%) sustained cervical injuries. Patients with an initial GCS score less than or equal to 8 were more likely to sustain a cervical injury than those with a score higher than 8 (odds ratio [OR] 2.77, 95% confidence interval [CI] = 1.11–7.73) and were more likely to sustain a cervical SCI (OR 5.5, 95% CI 1.22–24.85). At 6 months or more postinjury, functional neurological recovery had occurred in nine patients (37.5%) and eight (33.3%) had died.

Conclusions. Head-injured patients sustaining MVA-related trauma and those with an initial GCS score less than or equal to 8 are at highest risk for concomitant cervical spine injury. A disproportionate number of these patients sustain high cervical injuries, the majority of which are mechanically unstable and involve an SCI. The development of safer and more rapid means of determining cervical spine integrity should remain a high priority in the care of head-injured patients.
Surgical treatment of lumbar stenosis in achondroplasia
Authors: Thomeer Ralph T. W. M. , van Dijk J. Marc C.
Published: May 2009

Object. The authors conducted a study to evaluate the results of a unique surgical procedure for treating primary lumbar stenosis in patients with achondroplasia, based on its distorted anatomical dimensions.

Methods. A consecutive single-center series of 36 achondroplastic dwarfs with symptomatic lumbar stenosis underwent dynamic lumbar myelography to determine the most stenotic lumbar segment. This level was surgically decompressed by selective widening of the lumbar interapophyseolaminar diameter; laminectomy was not performed.

The L2–3 level was decompressed in 97% of the cases and the L1–2 and L3–4 levels in 58 and 61%, respectively. Lower lumbar levels were rarely affected by stenosis. Stenosis typically did not occur at the level of the lamina, where the pseudoscalloping of the vertebral body compensates for the spinal narrowing, obviating the need for laminectomy. Complete relief of symptoms was demonstrated in 25 (71.4%) of 35 patients. Tolerable disease remained in eight patients (22.9%) postoperatively. In two cases (5.7%) surgery resulted in no benefit. One case was lost to follow up. The presence of a lumbar epidural hematoma complicated one procedure.

Conclusions. In this series the interapophyseolaminar decompression was demonstrated to be an effective and safe procedure for the treatment of symptomatic stenosis in achondroplasia. The upper lumbar segments, particularly the L2–3 level, were most frequently involved. Dynamic lumbar myelography proved mandatory in demonstrating the symptomatic level.
Traumatic thoracic spinal fracture dislocation with minimal or no cord injury
Authors: Shapiro Scott , Abel Todd , Rodgers Richard B.
Published: May 2009

Object. Thoracic fracture dislocations reportedly lead to complete paraplegia in 80% of cases. It is rare for these dislocations not to cause neurological deficits, as evidenced by the mere 11 well-documented neurologically intact cases in the English-language literature.

Methods. The authors report four cases of thoracic fracture dislocation that remained neurologically intact and discuss 11 other previously published well-documented cases.

Overall there were 10 men and five women with a mean age of 34 years (range 17–66 years). Mechanisms of injury included car crash in six, motorcycle crash in seven, plane crash in one, and fall from a horse in one. On admission, neurological deficits were absent in 11 patients, intercostal neuralgia was present in two, and mild lower-extremity weakness/numbness was demonstrated in two. All suffered significant thoracic pain, with 14 patients having sustained rib fractures and eight a hemothorax. The levels of dislocation were T3–4 in two, T5–6 in four, T6–7 in four, T7–8 in two, T8–9 in one, and T9–10 in two. All suffered some degree of lateral translation (mean 12 mm, range 3–27 mm). There were six cases of well-documented anterior subluxation in addition to translation (mean 12 mm, range 4–23 mm), and all involved some degree of fracture imploding of one vertebral body (VB) into an adjacent VB. There were six cases of burst fracture with translation (mean kyphotic angle 38°, range 28–50°). Bilateral pedicle shear fractures were present in all 15 cases at the site of subluxation, thus separating the anterior from the posterior elements and preserving the spinal canal. Only two of the 15 patients suffered complete spondylolisthesis. Five patients underwent successful nonoperative management with prolonged bed rest; at follow-up examination, neurological status remained normal in all five, lesions were radiographically unchanged in three, and there was less subluxation but not anatomical alignment in two. Ten patients underwent successful internal fixation via anterior approaches (two cases), posterior approaches (five cases), and combined approaches (three cases). Neurological status either improved to normal or remained normal except in one case with persistent intercostal neuralgia. Surgery resulted in no change in alignment in three, improved but not anatomical alignment in 11, and normal alignment in one patient. All patients ambulated unassisted by 6 months.

Conclusions. In cases in which bilateral pedicle fractures occur at the site of significant thoracic subluxation and/or translation, preservation of the spinal canal and spinal cord neurological function can rarely occur when both the lamina and spinal cord do not dislocate along with the anterior VBs. In these instances, perfect anatomical reduction may require forces that unnecessarily put neurological function at risk and the results appear to justify internal fixation with some or no reduction of deformity.
Avulsion transverse ligament injuries in children: successful treatment with nonoperative management
Authors: Lo Patrick A. , Drake James M. , Hedden Douglas , Narotam Pradeep , Dirks Peter B.
Published: May 2009

✓ Neck injuries in children most commonly affect the upper cervical spine. Injuries of the transverse ligament and its attachments may result in C1–2 instability, but the optimum form of treatment is unknown.

Three patients, who ranged in age from 5 to 11 years, sustained transverse atlantal ligament injuries with unilateral avulsion fracture of the osseous tubercle of C-1. One child was injured in a fall and two were involved in motor vehicle accidents. Although all patients presented with neck pain, none exhibited neurological deficits. Plain radiography demonstrated no evidence of osseous injury, but an increased predental interval was noted in each case. Computerized tomography (CT) scanning demonstrated the avulsion fractures, and magnetic resonance imaging revealed evidence of soft-tissue injuries in the occipital—C2 ligamentous complex. All children were managed with external immobilization (halo vest in two and a Sterno-Occipito-Mandibular Immobilizer brace in one), for 6 to 12 weeks. Follow-up CT scanning demonstrated reattachment of the avulsed osseous tubercle, and dynamic cervical spine radiographs revealed the absence of C1–2 instability.

The results of these cases suggest a role for external immobilization in the treatment of osseous avulsion injuries of the transverse atlantal ligament in children.
Spontaneous intracranial hypotension due to thoracic disc herniation
Authors: Winter Stuart C. A. , Maartens Nicholas F. , Anslow Philip , Teddy Peter J.
Published: May 2009

✓ Spontaneous intracranial hypotension is frequently idiopathic. The authors report on a patient presenting with symptomatic intracranial hypotension caused by a transdural calcified thoracic disc herniation. Cranial magnetic resonance (MR) imaging revealed classic signs of intracranial hypotension, and a combination of spinal MR and computerized tomography myelography confirmed a mid-thoracic transdural calcified herniated disc as the cause. The patient was treated with an epidural blood patch and burr hole drainage of the subdural effusion on two occasions. Postoperatively the headache resolved and there was no neurological deficit.

Thoracic disc herniation may be a cause of spontaneous intracranial hypotension.
Dual-strap augmentation of a halo orthosis in the treatment of atlantooccipital dislocation in infants and young children
Authors: Steinmetz Michael P. , Verrees Meg , Anderson James S. , Lechner Roseanna M.
Published: May 2009

✓ Two children who were 13 months and 3 years old and who had suffered traumatic atlantooccipital dislocation were each treated by being placed in a halo orthosis for 10 weeks. Because of a continued loss of reduction due to the poor fit of the halo vest, a dual-strap augmentation was developed. This strap augmentation allowed consistent reduction to be maintained. Both children were therefore successfully treated nonsurgically with a halo vest. One child remained neurologically intact and the other had improvement in motor strength. There were no complications from the use of strap augmentation for halo vest fixation.
History of spinal disorders and Cerrahiyetül Haniye (Imperial Surgery)
Authors: Naderi Sait , Acar Feridun , Arda M. Nuri
Published: May 2009

✓ The history of spinal surgery represents an important aspect of spine-related sciences. The development of the treatment strategies of spine-related disorders has predominantly been recorded in the Western literature. In this paper, a Turkish physician, Şerefeddin Sabuncuoğlu (1385–1468), and his treatise, Cerrahiyetül Haniye (Imperial Surgery), are presented. Three sections of this book regarding spinal disorders (spinal dislocations, sciatica, and back pain) are reviewed. The techniques described were used by Sabuncuoğlu in the 1400s. In conclusion, the language and illustrations of this treatise are unique. Compared with current approaches, there are no major differences in the principles of treating spinal traumas despite the passage of almost 500 years.
Atraumatic bloodless removal of intramedullary hemangioblastomas of the spinal cord
Authors: Malis Leonard I.
Published: May 2009

Object. The goal of this study was to summarize the author's personal experience in the surgical treatment of 19 patients with intramedullary spinal cord hemangioblastomas.

Methods. All cases were from the author's private practice and were treated between 1967 and 1990. In all cases the intramedullary hemangioblastomas were totally removed by using a unique microsurgical technique of bipolar coagulation, which is fully described in this paper. A bipolar forceps was used to shrink each tumor and detach it from its feeding and draining vessels. Tumor resection was successfully accomplished in all patients. Blood loss was minimal, averaging less than 100 ml, and what little bleeding occurred did so during laminotomy or laminectomy. No bleeding occurred during tumor removal, and no transfusions were given. All patients were symptomatic preoperatively, and all recovered or improved following surgery.

Conclusions. The technique described in this paper makes tumor removal safe, effective, and relatively easy.
Combined anterior—posterior fusion for cervical spondylotic myelopathy in patients with athetoid cerebral palsy
Authors: Onari Katsuhiro , Kondo Soichi , Mihara Hisanori , Iwamura Yuichi
Published: May 2009

Object. Cervical spondylotic myelopathy (CSM) or myeloradiculopathy, frequent in adults with athetoid cerebral palsy, is a serious secondary disability in patients with an existing congenital handicap. Although several surgical procedures have been described for CSM in adults with athetoid cerebral palsy, none has had satisfying long-term results. The object of this study was to evaluate the effectiveness and safety of combined anterior—posterior fusion with wave-shaped rods and its influence on the stability of other spinal segments.

Methods. Twenty-three patients with CSM and athetoid cerebral palsy underwent posterior fusion with wave-shaped rods combined with anterior interbody fusion with internal fixation; 20 patients, 17 men and three women, were followed for more than 5 years. This procedure yielded good results. The mean follow-up period was 8.7 years (range 5–17 years). At 1-year follow-up examination, ambulation had improved in 12 patients. Upper-extremity pain, deltoid muscle weakness, and ability to self-feed improved in almost all patients. Myelopathy recurred in one patient 8.5 years after surgery. The mean motion angle at the adjacent level to the fixed segment did not change postoperatively, but the mean motion between C-1 and C-2 increased and slight atlantoaxial subluxation occurred postoperatively in five patients.

Conclusions. Combined anterior—posterior fusion can effectively improve neurological function in patients with CSM and athetoid cerebral palsy, even in those with severe involuntary movements. Postoperative rigid external fixation is not required.
Traumatic central cord syndrome: results of surgical management
Authors: Guest James , Eleraky Mohammed A. , Apostolides Paul J. , Dickman Curtis A. , Sonntag Volker K. H.
Published: May 2009

Object. The authors compare clinical outcomes demonstrated in patients with traumatic central cord syndrome (CCS) who underwent early (< 24 hours after injury) or late (> 24 hours after injury) surgery.

Methods. The clinical characteristics, radiographic findings, surgery-related results, length of hospital stay (LOS), and clinical outcomes obtained in 50 patients with surgically treated traumatic CCS were reviewed retrospectively. Shorter intensive care unit (ICU) stay and LOS were observed in all patients who underwent early surgery compared with those who underwent late surgery. In patients with CCS secondary to acute disc herniation or fracture/dislocation who underwent early surgery significantly greater overall motor improvement was observed than in those who underwent late surgery (p = 0.04). Overall motor outcome in patients with CCS secondary to spinal stenosis or spondylosis who underwent early surgery was not significantly different from that in those who underwent late surgery (p = 0.51). Worse motor outcomes were found in patients who were older than 60 years of age and in whom initial bladder dysfunction was present (p = 0.03 and 0.02, respectively) compared with younger patients without bladder dysfunction.

Conclusions. Early surgery is safe and more cost effective than late surgery for the treatment of traumatic CCS, based on ICU stay and LOS and improved overall motor recovery, in patients whose CCS was related to acute disc herniation or fracture. In the setting of spinal stenosis or spondylosis, early surgery was safe but did not improve motor outcome compared with late surgery.
Ultrastructural scoring of graded acute spinal cord injury in the rat
Authors: Kaptanoglu Erkan , Palaoglu Selcuk , Surucu H. Selcuk , Hayran Mutlu , Beskonakli Etem
Published: May 2009

Object. There is a need for an accurate quantitative histological technique that also provides information on neurons, axons, vascular endothelium, and subcellular organelles after spinal cord injury (SCI). In this paper the authors describe an objective, quantifiable technique for determining the severity of SCI. The usefulness of ultrastructural scoring of acute SCI was assessed in a rat model of contusion injury.

Methods. Spinal cords underwent acute contusion injury by using varying weights to produce graded SCI. Adult Wistar rats were divided into five groups. In the first group control animals underwent laminectomy only, after which nontraumatized spinal cord samples were obtained 8 hours postsurgery. The weight-drop technique was used to produce 10-, 25-, 50-, and 100-g/cm injuries. Spinal cord samples were also obtained in the different trauma groups 8 hours after injury. Behavioral assessment and ultrastructural evaluation were performed in all groups.

When the intensity of the traumatic injury was increased, behavioral responses showed a decreasing trend. A similar significant negative correlation was observed between trauma-related intensity and ultrastructural scores.

Conclusions. In the present study the authors characterize quantitative ultrastructural scoring of SCI in the acute, early postinjury period. Analysis of these results suggests that this method is useful in evaluating the degree of trauma and the effectiveness of pharmacotherapy in neuroprotection studies.
Functional recovery after complete contusion injury to the spinal cord and transplantation of human neuroteratocarcinoma neurons in rats
Authors: Saporta Samuel , Makoui A. Shahram , Willing Alison E. , Daadi Marcel , Cahill David W. , Sanberg Paul R.
Published: May 2009

Object. Human neuroteratocarcinoma (hNT)—derived neurons are differentiated postmitotic neurons derived from a human teratocarcinoma cell line following treatment with retinoic acid. In preclinical transplantation studies investigators have demonstrated both their safety as a source of neurons for transplantation and efficacy in treating stroke-related behavioral deficits. The objective of this study was to examine whether hNT neurons transplanted in an area of complete spinal cord contusion would improve electrophysiological measures of spinal cord function.

Methods. Complete spinal cord contusion injury, defined as the complete loss of motor evoked potentials (MEPs), was produced in 30 rats at T-8. Ten rats with contused spinal cords underwent transplantation with hNT neurons within the site of contusion immediately after injury (immediate transplant group). Ten rats underwent hNT neuron transplantation following a 2-week evaluation for loss of MEPs (delayed transplant group). Ten other rats with contusion injury served as a spinal cord injury control group, and 10 rats underwent only a T-8 laminectomy and served as noninjured controls. All rats survived 8 weeks after transplantation. In the delayed transplant group significant functional recovery was observed, as demonstrated by return of MEPs and a modest improvement of motor function. Immunohistochemical analysis showed the survival, integration, and long fiber outgrowth of the grafted hNT neurons.

Conclusions. These findings suggest that the transplantation of the hNT neurons may be an effective means of reestablishing electrical connectivity of the injured spinal cord.
Unusual case of extradural choroid plexus papilloma of the sacral canal
Authors: Kurtkaya-Yapicier Özlem , Scheithauer Bernd W. , Van Peteghem Karl Peter , Sawicki John E.
Published: May 2009

✓ An unusual case of a sacral, extradural choroid plexus papilloma involving the S1–3 level is described. This 50-year-old woman presented with a 4-month history of pain involving her right buttock, perineum, and leg. Contrast-enhanced magnetic resonance (MR) imaging of the spine revealed a well-defined, mildly enhancing sacral canal mass at the S1–3 level; its appearance was consistent with that of a benign tumor. Intraoperatively, the lesion was found to be extradural in location and was entwined among nerve roots in the sacral canal. Microscopic examination of the gross totally resected tumor revealed typical features of a choroid plexus papilloma. Despite performing a thorough neuroimaging workup (craniospinal contrast-enhanced MR imaging) for an intracranial or spinal primary mass, none was found. The choroid plexus appeared entirely normal; however, both a cavum septum pellucidum and a cavum vergae were noted. Extraneural choroid plexus papilloma, specifically intrasacral, extradural choroid plexus papilloma has not been previously reported. The present example is thought to have arisen either from ectopic choroid plexus tissue or perhaps by metaplasia from ependymal rests.
Delayed intracranial migration of cervical sublaminar and interspinous wires and subsequent cerebellar abscess
Authors: Stevenson Kevin L. , Wetzel Matthew , Pollack Ian F.
Published: May 2009

✓ Delayed complications associated with sublaminar and interspinous wiring in the pediatric cervical spine are rare. The authors present a case of delayed complication in which a cervical fusion wire migrated into the cerebellum, causing subsequent cerebellar abscess 2 years after posterior cervical arthrodesis. A craniotomy was required to remove the wire and drain the abscess. Despite their history of safety and successful fusion, procedures involving sublaminar and interspinous wiring carry a risk of neurological injury secondary to wire migration. A thorough neuroimaging evaluation is required in patients who have undergone fusion and who have neurological complaints to detect late instrumentation-related sequelae.
Initial stability of cervical spine fixation: predictive value of a finite element model
Authors: Pitzen Tobias R. , Matthis Dieter , Barbier Dragos D. , Steudel Wolf-Ingo
Published: May 2009

✓ The purpose of this study was to generate a validated finite element (FE) model of the human cervical spine to be used to analyze new implants. Digitized data obtained from computerized tomography scanning of a human cervical spine were used to generate a three-dimensional, anisotropic, linear C5–6 FE model by using a software package (ANSYS 5.4). Based on the intact model (FE/Intact), a second was generated by simulating an anterior cervical fusion and plate (ACFP) C5–6 model in which monocortical screws (FE/ACFP) were used. Loading of each FE model was simulated using pure moments of ± 2.5 Nm in flexion/extension, axial left/right rotation, and left/right lateral bending. For validation of the models, their predicted C5–6 range of motion (ROM) was compared with the results of an earlier, corresponding in vitro study of six human spines, which were tested in the intact state and surgically altered at C5–6 with the same implants. The validated model was used to analyze the stabilizing effect of a new disc spacer, Cenius (Aesculap AG, Tuttlingen, Germany), as a stand-alone implant (FE/Cenius) and in combination with an anterior plate (FE/Cenius+ACFP). In addition, compression loads at the upper surface of the spacer were investigated using both models.

As calculated by FE/Intact and FE/ACFP models, the ROM was within 1 standard deviation of the mean value of the corresponding in vitro measurements for each loading case. The FE/Cenius model predicted C5–6 ROM values of 5.5° in flexion/extension, 3.1° in axial rotation (left and right), and 2.9° in lateral bending (left and right). Addition of an anterior plate resulted in a further decrease of ROM in each loading case. The FE/Cenius model predicted an increase of compression load in flexion and a decrease in extension, whereas in the FE/Cenius+ACFP model an increase of graft compression in extension and unloading of the graft in flexion were predicted.

The current FE model predicted ROM values comparable with those obtained in vitro in the intact state as well as after simulation of an ACFP model. It predicted a stabilizing potential for a new cage, alone and in combination with an anterior plate system, and predicted the influence of both loading modality and additional instrumentation on the behavior of the interbody graft.
A simple and reliable behavioral analysis of locomotor function after spinal cord injury in mice
Authors: Mikami Yuji , Toda Masahiro , Watanabe Masahiko , Nakamura Masaya , Toyama Yoshiaki , Kawakami Yutaka
Published: May 2009

✓ To establish a simple and reliable method to assess the behavioral function after spinal cord injury (SCI) in mice, the authors used an automated animal movement analysis system, SCANET.

Two different SCI lesions were created in adult female BALB/c and C57BL/6 mice by transecting both the posterior columns and the left lateral and anterior funiculi or only the left lateral and anterior funiculi at T-8. Control mice underwent laminectomy only. The SCANET system consists of a cage equipped with two crossing sensor frames arranged at different heights, by which small (M1) and large (M2) horizontal movements and the vertical movement involved in rearing (RG) can be monitored. The authors assessed locomotor function by determining the M1, M2, and RG scores; to this end, they used the SCANET system and a previously established behavior test, the 21-point open-field Basso-Beattie-Bresnahan (BBB) Locomotor Rating Scale. The results indicated that the RG scores were significantly and consistently different between the spinal cord—injured and control mice, irrespective of the mouse strain or injury model, but that M1 and M2 scores were not. Moreover, there was a statistically positive correlation between the RG score and the BBB Scale score.

For the assessment of locomotor function after SCI, use of the SCANET sytem in behavioral analysis is simple and the method is highly reproducible. The analysis of vertical movement is useful for assessing the recovery of limb function in mice following thoracic hemisection.
Slitlike syrinx cavities: a persistent central canal
Authors: Holly Langston T. , Batzdorf Ulrich
Published: May 2009

Object. The authors review their experience in the diagnosis and management of 32 patients with slitlike syrinx cavities.

Methods. There were 18 men and 14 women with a mean age of 40 years. Presenting symptoms that prompted magnetic resonance (MR) imaging evaluation were mechanical spinal pain (13 patients), radicular pain (seven patients), paresthesia (six patients), numbness (five patients), and muscle spasm (one patient). In 12 patients neurological examination demonstrated normal status, and in the remainder only minimal sensory or motor abnormalities were found. The mean diameter of the syrinx cavity was 2 mm (range 1–5 mm), and on average it covered three vertebral levels. The cavities were limited to the cervical region in 16 patients, the thoracic in 12, and both regions in four patients.

The mean follow-up time for changes in clinical condition and repeated MR imaging features were 38 and 32 months, respectively. Thirty-one patients were treated nonoperatively, and one was treated surgically. During the follow-up period clinical improvement was documented in six patients, worsened status in seven, and no change was demonstrated in the clinical status of 19 patients. None of the syrinx cavities changed in size. In 16 patients medical workup revealed alternative diagnoses that were determined to be the true causes of each patient's symptoms.

Conclusions. Slitlike cavities likely do not represent true syringomyelia but rather remnants of the central canal detected in a small percentage of adults. Review of the authors' experience indicates that these cavities are asymptomatic and are unlikely to change in size. They can be considered an incidental finding, and in many of these patients another condition explaining the patient's symptoms may be found.
Trauma-induced myelopathy in patients with ossification of the posterior longitudinal ligament
Authors: Matsunaga Shunji , Sakou Takashi , Hayashi Kyoji , Ishidou Yasuhiro , Hirotsu Masataka , Komiya Setsuro
Published: May 2009

Object. In these prospective and retrospective studies the authors evaluated trauma-induced myelopathy in patients with ossification of the posterior longitudinal ligament (OPLL) to determine the effectiveness of preventive surgery for this disease.

Methods. The authors studied 552 patients with cervical OPLL, including 184 with myelopathy at the time of initial consultation and 368 patients without myelopathy at that time. In the former group of 184 patients retrospective analysis was performed using an interview survey to ascertain the relationship between onset of myelopathy and trauma. In the latter group of 368 patients prospective examination was conducted by assessing radiographic findings and noting changes in clinical symptoms apparent during regular physical examination. The follow-up period ranged from 10 to 32 years (mean 19.6 years).

In the retrospective investigation, 24 patients (13%) identified cervical trauma as the trigger of their myelopathy. In the prospective investigation, 70% of patients did not develop myelopathy over a follow-up period greater than 20 years (determined using the Kaplan—Meier method). Of the 368 patients without myelopathy at the time of initial consultation, only six patients (2%) subsequently developed trauma-induced myelopathy. Types of ossification in patients who developed trauma-induced myelopathy were primarily a mixed type. All patients in whom stenosis affected 60% or greater of the spinal canal developed myelopathy regardless of a history of trauma.

Conclusions. Preventive surgery prior to onset of myelopathy is unnecessary in most patients with OPLL.
Validity and reliability of the Short Form—36 in cervical spondylotic myelopathy
Authors: King Joseph T. , Roberts Mark S.
Published: May 2009

Object. Validity (the extent to which a test measures what it is intended to measure) and reliability (the stability and reproducibility of measures of the same concept over time or across methods of gathering data) are important characteristics of any outcomes instrument. Generic outcomes instruments are designed for use in any population; however, their validity and reliability in particular diseases should be verified to ensure their appropriateness for use in that disease. In this study the authors assessed the validity and reliability of the Medical Outcomes Study Short Form—36 (SF-36), a generic outcomes instrument, in a population of patients with cervical spondylotic myelopathy (CSM).

Methods. The SF-36 was administered to a cohort of patients with CSM on an outpatient basis. Symptom-related data derived from a structured interview and physical examination findings were used to classify cases according to the myelopathy scales of Nurick, Cooper, Harsh, and a Western modification of the Japanese Orthopaedic Association (JOA). Construct validity was assessed by determining whether SF-36 scores varied in accordance with predefined hypotheses relating to the myelopathy scores by using the Cuzick nonparametric test for trend. The reliability of the SF-36 scores was assessed using Cronbach alpha.

Eighty-eight patients with CSM completed the SF-36 and interview. Construct validity was demonstrated by confirming the hypothesized relationship between SF-36 scales and the myelopathy scales of Nurick (p ≤ 0.003), Cooper leg subscale (p ≤ 0.012, except the general health perceptions domain [p = 0.091]), Harsh (p ≤ 0.016), and the motor component of the modified JOA (p ≤ 0.006). Reliability was demonstrated for all eight SF-36 domain scales and the physical component and mental component summary scales, in which Cronbach alpha satisfied the Nunnally criterion of 0.7.

Conclusions. The SF-36 provides valid and reliable data on patients with CSM.