bluuebunny/crossref_metadata_2025 huggingface dataset:
Subarachnoid—pleural fistula treated with noninvasive positive-pressure ventilation
Authors: Yoshor Daniel , Gentry J. Brett , LeMaire Scott A. , Dickerson John , Saul John , Valadka Alex B. , Robertson Claudia S.
Published: May 2009

✓ The authors describe the case of a 24-year-old man who underwent an L-1 corpectomy for spinal decompression and stabilization following an injury that caused an L-1 burst fracture. Postoperatively, an accumulation of spinal fluid developed in the pleural space, which was refractory to 1 week of thoracostomy tube drainage and lumbar cerebrospinal fluid (CSF) diversion. The authors then initiated a regimen of positive-pressure ventilation in which a bilevel positive airway pressure (PAP) mask was used. After 5 days, the CSF collection in the pleural space resolved. Use of a bilevel PAP mask represents a safe, noninvasive method of reducing the negative intrathoracic pressure that promotes CSF leakage into the pleural cavity and may be a useful adjunct in the treatment of subarachnoid—pleural fistula.
Anomalous vertebral artery—induced cervical cord compression causing severe nape pain
Authors: Watanabe Kei , Hasegawa Kazuhiro , Takano Kou
Published: May 2009

✓ The authors describe a very rare case of cervical cord compression caused by anomalous bilateral vertebral arteries (VAs). A 65-year-old woman had been suffering from intractable nape pain and torticollis. Magnetic resonance imaging revealed a signal void region in which spinal cord compression was present. Angiography demonstrated anomalous bilateral VAs compressing the spinal cord. Microvascular decompressive surgery was successfully performed. Neuroradiological and intraoperative findings are presented.
Anatomical location of T2–3 sympathetic trunk and Kuntz nerve determined by transthoracic endoscopy
Authors: Wang Yeou-Chih , Sun Ming-Hsi , Lin Chi-Wen , Chen Yen-Ju
Published: May 2009

Object. Bilateral subaxillary transthoracic endoscopic sympathectomy (TES) is a popular procedure of upper thoracic sympathectomy. The anatomical locations of the T-2 and T-3 sympathetic trunks, as viewed under the endoscope, are varied in the rib head areas. In this study, the authors investigated the more visible anatomical locations of the T-2 and T-3 sympathetic trunks, the so-called nerves of Kuntz, and intercostal rami by performing transthoracic endoscopy.

Methods. Seventy patients with palmar hyperhidrosis undergoing bilateral TES (140 sides) via the anterior subaxillary approach were included in this study. The operative findings and video images of the T-2 and T-3 sympathetic trunks and ganglia were recorded and analyzed. The anatomical locations of the T-2 and T-3 sympathetic trunks along the horizontal axes of the rib heads were determined using a three-region system constructed by the authors. The area between the rib neck and the medial border of the rib head was equally divided into Region E (external half) and Region M (medial half). The area between the medial border of the rib head and the paravertebral ligament was defined as Region I.

The incidence of the T-2 and T-3 sympathetic trunks found in Regions E, M, and I were 31.4 to 42.9%, 50 to 57.1%, and 7.1 to 11.4%, respectively, on the left side, and 24.3 to 34.3%, 57.1 to 65.7%, and 8.6 to 10%, respectively, on the right side. One right (1.4%) and six left (8.6%) Kuntz nerves originating from the T-3 sympathetic trunk were found in seven patients (10%). The intercostal ramus was found around the T-2 rib neck in 24 patients (34.3%), with 18 cases (25.7%) for each side. The intercostal ramus around the T-3 rib neck was found in 17 patients (24.3%): 12 (17.1%) on the right and nine (12.9%) on the left.

Conclusions. These results indicate that approximately 90% of the T-2 or T-3 sympathetic trunks are located on the rib head. These findings may also be used to assist the surgeon in fluoroscopic guidance for locating the T-2 and T-3 sympathetic trunks during posterior percutaneous sympathectomy.
Anterior cervical fusion with carbon fiber cage containing coralline hydroxyapatite: preliminary observations in 45 consecutive cases of soft-disc herniation
Authors: Agrillo Umberto , Mastronardi Luciano , Puzzilli Fabrizio
Published: May 2009

Object. The purposes of bone substitutes for anterior cervical fusion (ACF) are immediate biomechanical support and osteointegration of the graft. The authors report their preliminary results in performing ACF in which carbon fiber cages (CFCs) containing coralline hydroxyapatite (HA) are used as bone substitute.

Methods. During a 24-month period, anterior microsurgical discectomy was performed in 45 consecutive patients for soft-disc cervical herniation. In all cases ACF was performed using a CFC containing a core of granulated coralline HA. Fifty-seven CFCs were implanted in 33 single-level and 12 two-level procedures.

The mean operative time was 83 minutes for one-level and 97 minutes for two-level procedures. The mean hospital stay was 1.51 days, and there were no permanent complications. At a mean follow up of 22.3 months, the pain had decreased or disappeared in all patients, and the patients' satisfaction rate was very high. Good results were also obtained in patients who smoked cigarettes. Patients underwent radiographic evaluation at Day 1, and 1, 3, 6, and 12 months postoperatively. Implant-related complications were not observed and revision surgeries were not performed. Twelve-month cervical x-ray films demonstrated complete fusion in all cases, without evidence of breakage, collapse, pseudarthrosis, subsidence, angular deformity, or protrusion. Signs of pathological absorption and necrosis were not found in contiguous vertebral bodies, and inflammatory reactions were never seen around cages.

Conclusions. These preliminary results suggest that implants composed of CFC containing granulated coralline HA are promising bone substitutes to be used in ACF, with a good rate of incorporation and no significant complications.
Posterior atlantooccipital membrane for duraplasty
Authors: Tubbs R. Shane , Wellons John C. , Blount Jeffrey P. , Oakes W. Jerry
Published: May 2009

✓ The authors describe the use of autogenetic posterior atlantooccipital (PAO) membrane for duraplasty following after posterior cranial fossa surgery. The PAO membrane is routinely exposed for procedures of the posterior cranial fossa and merely needs to be dissected free of the underlying dura mater. Recently this membrane was obtained in several pediatric patients following procedures of the posterior cranial fossa such as duraplasty in case of Chiari I malformation. No postoperative complications were found at 6-month follow-up examination. The advantages of this intervention include less manipulation of muscle and fascia than that involved in other procedures and, therefore, seemingly less postoperative pain and the negation of issues inherent with foreign-body graft sources. The authors believe this structure to be of use as a dural substitute in small dural openings of the posterior cranial fossa.
Effect of spinal disease on successful arthrodesis in lumbar pedicle screw fixation
Authors: Narayan Prithvi , Haid Regis W. , Subach Brian R. , Comey Christopher H. , Rodts Gerald E.
Published: May 2009

Object. Pedicle screw fixation with transverse process fusion has gained widespread acceptance since its inception. Improved rates of arthrodesis have been demonstrated when this technique is used. The authors present one of the largest series of patients to undergo this procedure at a single center; one of the goals was to correlate construct length and spinal disease with rates of successful arthrodesis by conducting a prospective analysis of lumbar fusion in which pedicle screws were placed.

Methods. During a 7-year period, the senior author performed pedicle screw fixation with posterolateral fusion in 457 patients; the mean follow-up period was 28.4 months. Indications for fusion included metastatic tumor, single-level degenerative disc disease (DDD), trauma, degenerative scoliosis, and translational vertebral instability. Successful fusion was based on the radiographic demonstration of a bilateral contiguous osseous bridge over the transverse processes and absence of movement on dynamic x-ray films.

Fusion rates were lowest in cases of tumors (54%) and highest in cases of trauma (96%). In patients with single-level DDD the rate was 91%, and in those with translational instability it was 89%. Fusion rates, however, declined steeply in relation to each additional motion segment in the translational instability group. In this group a strong linear trend for proportion was demonstrated (p < 0.001). The overall fusion rate in patients with degenerative scoliosis was 70%. The overall fusion rate for the entire group was 86%.

Conclusions. The data in this study can be used as a benchmark with which to compare newer technologies. Although overall pedicle screw—assisted fusion rate in cases of trauma or selected degenerative lesions approached 90%, the arthrodesis rates are not uniform for the different diagnoses. This appears to be related to the underlying spinal disease and the number of segments included in the fusion.
Surgical treatment of superior sulcus tumors with spinal and brachial plexus involvement
Authors: Bilsky Mark H. , Vitaz Todd W. , Boland Patrick J. , Bains Manjit S. , Rajaraman Viswanathan , Rusch Valerie W.
Published: May 2009

Object. Non—small cell lung carcinomas with spinal and brachial plexus involvement have traditionally been considered to be Stage IIIb lesions and therefore unresectable. Advances in spinal surgery, the application of magnetic resonance (MR) imaging, and improvements in neoadjuvant therapy require a reassessment of the potential for complete resection.

Methods. The authors conducted a retrospective review of all procedures involving the resection of superior sulcus tumors with spinal or brachial plexus involvement performed between 1985 and 1999. Assessment or resectability and operative planning were based on an MR imaging classification scheme in which the extent of spinal involvement was considered. Class A tumors involved the periosteum of the vertebral body (VB) (16 patients); Class B, distal neural foramen without epidural compression (eight patients); Class C, proximal neural foramen with epidural compression (four patients); and Class D, bone involvement (VB or posterior elements) with or without epidural involvement (14 patients). Brachial plexus involvement was present in 21 patients, including 17 with T-1 nerve root only and four with C-8 or lower-trunk infiltration.

Complete tumor resection was achieved in 27 patients and incomplete resection in 15. Complications occurred in 14 patients, two of which were related to instrumentation failures. The overall median survival was 1.44 years. The median survival for the complete and incomplete resection groups were 2.84 and 0.79 years, respectively (p = 0.0001). There was no statistical difference in survival among classification groups.

Conclusions. Complete tumor resection of superior sulcus tumors is possible in selected patients in whom involvement of the spinal column and/or brachial plexus is present. Preoperative MR imaging is essential for evaluation of the spine and surgical planning. Survival and cure are dependent on complete resection, regardless of the extent of spinal involvement.
Relationship between alignment of upper and lower cervical spine in asymptomatic individuals
Authors: Nojiri Kenya , Matsumoto Morio , Chiba Kazuhiro , Maruiwa Hirofumi , Nakamura Masaya , Nishizawa Takashi , Toyama Yoshiaki
Published: May 2009

Object

The aim of this study was to establish standard values for the normal alignment of the upper cervical spine and to clarify its relationship with the lower cervical spine in terms of alignment.

Methods

Three hundred thirteen asymptomatic volunteers (155 men and 158 women) participated in this study. Lateral radiographs were obtained with the neck in neutral position, and the angles formed by the occiput (Oc) and the axis, the atlas and the axis, and C-2 to C-7 were measured. The mean Oc—C2 angle was 14.5 ± 8° in men and 16 ± 8.5° in women; the mean C1–2 angle was 26.5 ± 7° and 28.9 ± 6.7°, respectively; and the mean C2–7 angle was 16.2 ± 12.9° and 10.5 ± 10.3°, respectively. Although weak, statistically significant negative correlation was observed between Oc—C2 and C2–7 angles (r = −0.31 in men and −0.37 in women), and between C1–2 and C2–7 angles (r = −0.22 in men and −0.22 in women). The correlation coefficient between the Oc—C2 and C2–7 angles was greater than that between the C1–2 and C2–7 angles.

Conclusions

Such relationships between alignment of the upper and lower cervical spines should be taken into consideration when performing occipitocervical fusion.
Anterior cervical plate fixation: biomechanical effectiveness as a function of posterior element injury
Authors: Pitzen Tobias , Lane Chris , Goertzen Darrell , Dvorak Marcel , Fisher Charles , Barbier Dragos , Steudel Wolf-Ingo , Oxland Thomas
Published: May 2009

Object

The primary goal of this study was to determine if the stabilization provided to the spine by anterior cervical fixation with plating (ACFP) was dependent on the degree of posterior element injury. The secondary goal was to evaluate the effectiveness of additional posterior screw/rod stabilization in these injuries.

Methods

Following ACFP with interbody bone graft and stepwise transection of the posterior ligaments and facets at C5–6, eight fresh-frozen human C4–7 spine segments were loaded using pure moments of ± 1.5 Nm in flexion—extension, axial rotation, and lateral bending in the intact state. Posterior screw/rod fixation was performed after complete ligamentous destruction and complete removal of the facets. Repeated-measures analysis of variance and pairwise Student-Newman-Keuls tests were used to detect changes in the range of motion (ROM) and neutral zone (NZ). Statistical significance was assumed at a 95% level.

Significant increases in ROM occurred in each loading direction after transection of the capsular ligaments (p < 0.001) and again following facetectomy (p < 0.001) compared with the ACFP condition. Additional posterior fixation resulted in a significant decrease in ROM in all loading directions (p < 0.001). There was a significant increase in NZ for complete ligamentous destruction compared with ACFP (p < 0.05) and facetectomy compared with ACFP (p < 0.05) for flexion—extension. In lateral bending, a significant increase in NZ was found for facetectomy compared with ACFP (p < 0.05).

Conclusions

Capsular ligaments and articular facets are important structures in limiting three-dimensional vertebral motion in the presence of an anterior plate. Supplementary posterior fixation does reduce motion for all injury conditions.
Transarticular screw fixation in the middle and lower cervical spine
Authors: Takayasu Masakazu , Hara Masahito , Yamauchi Katsuaki , Yoshida Mitsuhiro , Yoshida Jun
Published: May 2009

✓ Although atlantoaxial transarticular screw fixation is technically demanding and there is a significant risk of vertebral artery (VA) injury, transarticular screw insertion in the middle and lower cervical spine is simple and can be performed safely with the aid of lateral fluoroscopic guidance. The authors describe the surgical techniques and outcome of transarticular screw fixation in the middle and lower cervical spine.

Transarticular screw insertion into C2–3 or caudal cervical joints was performed from the articular pillar, directing the screw anterocaudally to penetrate the facet joint and the anterior cortex of the articular pillar, parallel to the sagittal plane. Because the VA and the nerve roots are anterior to the articular pillar at these levels, the screw can be placed safely with the assistance of lateral fluoroscopic guidance. Twenty-five patients ranging in age from 15 to 84 years underwent transarticular screw fixation, with a total of 81 screws. The transarticular screw was used as an anchor screw in combination with posterior cervical instrumentation in 19 patients and for facet screw fixation itself in six patients. Screw placement was successful and uncomplicated in all cases. The follow-up period ranged from 3 months to 5 years. No instance of screw backout or loosening was identified radiographically; fusion was achieved in all patients. Biomechanical strength is maintained by penetrating four cortical layers. When performed appropriately, this method is safe and reliable and deserves more widespread use.
The impact of minimally invasive cervical spine surgery
Authors: Adamson Tim E.
Published: May 2009

✓ Since 1997, cervical endoscopic laminoforaminotomy (CELF) has been an effective and safe treatment option for unilateral cervical radiculopathy secondary to disc herniation or foraminal stenosis. The development of the surgical technique is reviewed and recent outcomes discussed. Its impact is addressed in relation to the patient and surgeon.
Cervical radiculopathy, entrapment neuropathy, and thoracic outlet syndrome: how to differentiate?
Authors: McGillicuddy John E.
Published: May 2009

✓ The common diagnoses of cervical radiculopathy and upper-extremity entrapment neuropathies can at times be difficult to differentiate. Additionally, thoracic outlet syndrome is often diagnosed when, in fact, the problem is radiculopathy or neuropathy. Another source of confusion, especially in older patients, is neuralgic amyotrophy, brachial plexitis, or the Parsonage—Turner syndrome. The differential diagnosis of unilateral arm pain, weakness, and/or sensory loss includes all of these problems. The clinical and electrodiagnostic features of each are discussed as an aid to distinguishing between these common and similar entities.
Transdural herniation of the thoracic spinal cord: untethering via a posterolateral transpedicular approach
Authors: Gwinn Ryder , Henderson Fraser
Published: May 2009

✓ Anterior spinal cord herniation is a well-documented condition in which the thoracic cord becomes tethered within a defect in the anterior dura mater. Typical procedures have involved a posterior approach with direct manipulation of the thoracic cord to expose and blindly release its point of tethering. The authors report three cases in which a novel approach for the treatment of anterior thoracic cord herniation was performed, cord manipulation and traction are minimized, and direct dural repair of the defect is performed.
Improved repair of cervical esophageal fistula complicating anterior spinal fusion: free omental flap compared with pectoralis major flap
Authors: Reid Russell R. , Dutra José , Conley David B. , Ondra Stephen L. , Dumanian Gregory A.
Published: May 2009

✓ Esophageal injury is a serious complication of anterior cervical fusion. A team approach to the management of these cases is described. The authors performed spinal assessment, control of the fistula, and interposition of a vascularized flap between the spine and the esophagus. They compared the overall efficacy of the pectoralis major flap (pedicled; two cases) and omental flap (free; two cases).
Outcome evaluation of the operative management of lumbar disc herniation causing sciatica
Authors: Fisher Charles , Noonan Vanessa , Bishop Paul , Boyd Michael , Fairholm David , Wing Peter , Dvorak Marcel
Published: May 2009

Object. The authors conducted a study to assess health-related quality of life (HRQOL) and the appropriateness of surgery in patients who have undergone elective lumbar discectomy.

Methods. The study involved a prospective cohort of 82 surgically treated patients with lumbar disc herniation causing lower-extremity radiculopathy. An independent study coordinator recorded demographic data and administered the North American Spine Society (NASS) lumbar spine instrument and the Short Form—36 (SF-36) before treatment, and at 6 months and 1 year after surgery. The HRQOL results were also compared with normative data for the NASS and SF-36. The influence of baseline variables on HRQOL was determined using regression modeling. The InterQual Indicators for Surgery and Procedures (ISP) were used to compare surgeon practice patterns with standardized indications for surgery.

The NASS neurogenic symptom (NSS) and pain/disability scores (PDSs) showed very significant improvement at 6 months and little change between 6 months and 1 year. The SF-36 physical function and bodily pain scale scores were associated with the greatest improvement. Interestingly, the 1-year NASS (NSS and PDS) and SF-36 (only PCS) scores remained lower than those of age-matched normative data. Other than preoperative HRQOL scores, the only other variable that inversely influenced HRQOL was the duration of time between symptom onset and surgery. Ninety-five percent of ISP forms were completed, and 97% of the indications recorded by the surgeon matched the criteria.

Conclusions. The reporting of standardized outcomes in association with indications for surgery is feasible and may help elucidate the ideal rate for discectomy.
Two-year observation of artificial intervertebral disc replacement: results after supplemental ultra—high strength bioresorbable spinal stabilization
Authors: Kotani Yoshihisa , Abumi Kuniyoshi , Shikinami Yasuo , Takahata Masahiko , Kadoya Ken , Kadosawa Tsuyoshi , Minami Akio , Kaneda Kiyoshi
Published: May 2009

Object. This 2-year experimental study was conducted to investigate the efficacy of a bioactive three-dimensional (3D) fabric disc for lumbar intervertebral disc replacement. The authors used a bioresorbable spinal fixation rod consisting of a forged composite of particulate unsintered hydroxyapatite/poly-l-lactide acid (HA/PLLA) for stability augmentation. The biomechanical and histological alterations as well as possible device-related loosening were examined at 2 years postoperatively.

Methods. Two lumbar intervertebral discs (L2–3 and L4–5) were replaced with the 3D fabric discs, which were augmented by two titanium screws and a spanning bioresorbable rod (HA/PLLA). The segmental biomechanics and interface bone ingrowth were investigated at 6, 15, and 24 months postoperatively, and results were compared with the other two surgical groups (3D fabric disc alone; 3D fabric disc with additional anterior instrumentation stabilization). The 3D fabric disc and HA/PLLA—spinal segments demonstrated segmental mobility at 15 and 24 months; however, the range of motion (ROM) in flexion—extension decreased to 49 and 40%, respectively, despite statistically equivalent preserved torsional ROM. Histologically there was excellent osseous fusion at the 3D fabric disc surface—vertebral body interface. At 2 years posttreatment, no adverse tissue reaction nor aseptic loosening of the device was observed.

Conclusions. Intervertebral disc replacement with the 3D fabric disc was viable and when used in conjunction with the bioresorbable HA/PLLA spinal augmentation. Further refinements of device design to create a stand-alone type are necessary to obviate the need for additional spinal stabilization.
Total spondylectomy for en bloc resection of lung cancer invading the chest wall and thoracic spine
Authors: Komagata Masashi , Nishiyama Makoto , Imakiire Atshuhiro , Kato Hirobumi
Published: May 2009

✓ Lung cancers invading the chest wall and spinal column are often considered unresectable, and consequently there are few reports describing resection of invasive vertebral lesions. The authors developed a new anterior approach procedure for the en bloc resection of primary lung adenocarcinoma invading the thoracic spine and chest wall, in which the primary tumor does not need to be separated from the vertebrae. The authors describe a total spondylectomy for the en bloc resection of lung cancer invading the spine. A combination of surgical techniques was required, including resection of the osseous elements T-2 and T-3 (the pedicles were excised using a thread saw), anterolateral thoracotomy, apical lobectomy, chest wall resection, vertebrectomy, anterior spinal column reconstruction with a titanium mesh cage containing bioactive glass ceramic, and placement of anterior and posterior spinal instrumentation. At 46 months after surgery, there is no evidence of local recurrence or distant metastasis, and the patient continues to improve.

This new procedure allows for the en bloc resection of primary lung tumors and adherent vertebral invasion without separation of the lesion from the vertebra. Thus, surgical management by complete excision of Pancoast tumors can achieve longer-term survival rates without sequelae.
Microsurgical infrapedicular paramedian approach for retrovertebral lumbar disc herniations
Authors: Hejazi Nedal
Published: May 2009

✓ The author performed a microsurgical infrapedicular paramedian approach in 35 patients (23 men and 12 women) to remove herniated lumbar retrovertebral discs that did not have an apparent origin at either the superior or inferior disc level.

The goal of this surgery was to minimize the bone resection, preserve the facet joint, and avoid the risk of secondary vertebral instability. The Macnab outcome classification was used to assess all patients who attended follow-up examination for at least 15 months. The clinical results were excellent or good in 34 (97%) of 35 cases. This minimally invasive lumbar spine technique resulted in minimal morbidity, excellent clinical benefits, and a long-term outcome without evidence of secondary segmental instability.
Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment
Authors: Filler Aaron G. , Haynes Jodean , Jordan Sheldon E. , Prager Joshua , Villablanca J. Pablo , Farahani Keyvan , Mcbride Duncan Q. , Tsuruda Jay S. , Morisoli Brannon , Batzdorf Ulrich , Johnson J. Patrick
Published: May 2009

Object.Because lumbar magnetic resonance (MR) imaging fails to identify a treatable cause of chronic sciatica in nearly 1 million patients annually, the authors conducted MR neurography and interventional MR imaging in 239 consecutive patients with sciatica in whom standard diagnosis and treatment failed to effect improvement.

Methods.After performing MR neurography and interventional MR imaging, the final rediagnoses included the following: piriformis syndrome (67.8%), distal foraminal nerve root entrapment (6%), ischial tunnel syndrome (4.7%), discogenic pain with referred leg pain (3.4%), pudendal nerve entrapment with referred pain (3%), distal sciatic entrapment (2.1%), sciatic tumor (1.7%), lumbosacral plexus entrapment (1.3%), unappreciated lateral disc herniation (1.3%), nerve root injury due to spinal surgery (1.3%), inadequate spinal nerve root decompression (0.8%), lumbar stenosis (0.8%), sacroiliac joint inflammation (0.8%), lumbosacral plexus tumor (0.4%), sacral fracture (0.4%), and no diagnosis (4.2%).

Open MR—guided Marcaine injection into the piriformis muscle produced the following results: no response (15.7%), relief of greater than 8 months (14.9%), relief lasting 2 to 4 months with continuing relief after second injection (7.5%), relief for 2 to 4 months with subsequent recurrence (36.6%), and relief for 1 to 14 days with full recurrence (25.4%). Piriformis surgery (62 operations; 3-cm incision, transgluteal approach, 55% outpatient; 40% with local or epidural anesthesia) resulted in excellent outcome in 58.5%, good outcome in 22.6%, limited benefit in 13.2%, no benefit in 3.8%, and worsened symptoms in 1.9%.

Conclusions.This Class A quality evaluation of MR neurography's diagnostic efficacy revealed that piriformis muscle asymmetry and sciatic nerve hyperintensity at the sciatic notch exhibited a 93% specificity and 64% sensitivity in distinguishing patients with piriformis syndrome from those without who had similar symptoms (p < 0.01).

Evaluation of the nerve beyond the proximal foramen provided eight additional diagnostic categories affecting 96% of these patients. More than 80% of the population good or excellent functional outcome was achieved.
Cervical spine chordoid meningioma
Authors: Ibrahim Ahmed , Galloway Malcolm , Leung Clarence , Revesz Tamas , Crockard Alan
Published: May 2009

✓ Chordoid meningiomas are a rare but increasingly recognized subtype of meningioma. Although some cases have been associated with systemic symptoms, in many instances the clinical features are indistinguishable from those associated with other subtypes of meningioma. Given the prognostic significance of the diagnosis of chordoid meningioma, careful consideration should be given to the diagnosis during histological assessment. The authors describe a rare case of chordoid meningioma in the cervical spinal region.
Unilateral removal of pars interarticularis
Authors: Tender Gabriel C. , Baratta Richard V. , Voorhies Rand M.
Published: May 2009

Object. Lumbar radiculopathy secondary to foraminal entrapment can be treated by unilateral removal of the overlying pars interarticularis. The authors prospectively evaluated the outcome after this procedure.

Methods. Thirty-six consecutive patients underwent unilateral resection of the pars interarticularis between August 1999 and July 2002. In 18 patients acute foraminal disc herniations compressed the nerve root against the superior pedicle; in the other 18 foraminal stenosis was secondary to degenerative changes. All patients, at each visit, completed the following questionnaires: visual analog scale for overall, leg, and back pain; the Prolo Functional Economic Rating scale; and the Pain Rating Index (PRI) of the Short-Form McGill Pain Questionnaire.

At 1 year, leg pain improved in 33 patients (91%). Low-back pain appeared or worsened in eight patients (22%; one in the acute herniation group and seven in the chronic degenerative group). Only one patient required lumbar fusion for pain. The Prolo economic and function scores improved in 21 (58%) and 27 (75%) patients, respectively. The PRI scores improved in 30 cases (83%). No spondylolisthesis was observed at any level at which resection had been performed.

Conclusions. Unilateral removal of the pars interarticularis is effective in relieving lumbar radicular symptoms in patients with intraforaminal entrapment. The incidence of low-back pain in patients with acute foraminal disc herniations does not increase as a result of this procedure. In patients with degenerative foraminal stenosis, unilateral resection of the pars interarticularis may be a better alternative to facetectomy and segmental fusion. This procedure may be a useful tool in spine surgery.
Postoperative recovery of complete sudden paraplegia due to lumbar schwannoma
Authors: Mahadewa Tjokorda , Harsan Harsan , Nugroho Setyowidi , Bernstein Mark
Published: May 2009

✓ The authors present a rare case of acute complete paraplegia due to a lumbar schwannoma. The clinical presentation, magnetic resonance imaging features, and management strategy are discussed.

A 29 year-old man presented with acute complete paraplegia and bladder and bowel incontinence. He had a history of stable back pain and a 4-year history of lower-extremity numbness bilaterally. Magnetic resonance imaging revealed an enhancing extraaxial mass filling the spinal canal over two segments below the conus medullaris. An L1–3 laminectomy was performed and the tumor was completely removed. Pathological evaluation showed features characteristic of a schwannoma. The patient regained almost complete motor function after 6 months.

To the authors' knowledge, this is the first reported case of acute complete paraplegia secondary to lumbar schwannoma. Possible mechanisms of this occurrence are discussed.
Thoracic transfacet pedicle screw fixation: a new instrumentation technique
Authors: Akbay Atilla , İnceoğlu Serkan , Milks Ryan , Schlenk Richard , Palaoglu Selcuk , Benzel Edward C.
Published: May 2009

Object.Pedicle screw instrumentation of the thoracic spine remains technically challenging. Transverse process and costotransverse screw fixation techniques have been described as alternatives to pedicle screw fixation (PSF). In this study, the authors introduce thoracic transfacet PSF and compare its experimental biomechanical results with those of standard PSF in short-term cyclic loading in cadaveric thoracic specimens.

Methods.Specimens were tested intact for six cycles at compressive loads of 250 N offset by 1 cm along appropriate axes to induce flexion, extension, and left and right lateral bending. The specimens were then fixed with either a pedicle screw/rod construct or transfacet pedicle screws and retested in the same fashion. After this sequence, specimens were loaded until failure in flexion mode at a rate of 5 mm/minute was observed.

Both fixation constructs provided significantly greater stiffnesses than that demonstrated when the specimen was intact (p < 0.05, two-way analysis of variance). Additionally, the two constructs were statistically equivalent in terms of stiffness and load-to-failure values (p < 0.05, two-tailed nonpaired t-test). The only difference observed was that the low midthoracic region (T7–9) was biomechanically weaker than the upper midthoracic and lower thoracic areas in flexion after the destabilization and instrumentation-augmented stabilization procedures.

Conclusions.In selected thoracic surgical procedures, transfacet PSF may, after analysis of long-term biomechanical data, potentially become a reasonable alternative to conventional PSF.
Combination kyphoplasty and spinal radiosurgery: a new treatment paradigm for pathological fractures
Authors: Gerszten Peter C. , Germanwala Anand , Burton Steven A. , Welch William C. , Ozhasoglu Cihat , Vogel William J.
Published: May 2009

Object.Patients with symptomatic pathological compression fractures require spinal stabilization surgery for mechanical back pain control and irradiation for the underlying malignant process. The authors evaluated a treatment paradigm of closed fracture reduction and fixation involving kyphoplasty and subsequent spinal radiosurgery.

Methods.Twenty-six patients (six men and 20 women, mean age 72 years) with pathological compression fractures (16 thoracic and 10 lumbar) were prospectively evaluated. Histological diagnoses included 11 lung, nine breast, four renal, one cholangiocarcioma, and one ocular melanoma. Seven lesions had received prior external-beam radiation therapy. All patients underwent kyphoplasty that involved the percutaneous transpedicular technique. Fiducial markers allowing for image guidance during CyberKnife treatment were placed, at time of the kyphoplasty, in the pedicles at adjacent levels. Patients underwent single-fraction radiosurgery (mean time after kyphoplasty 12 days) in an outpatient setting. The tumor dose was maintained at 16 to 20 Gy (mean 18 Gy) to the 80% isodose line. The treated tumor volume ranged from 12.7 to 37.1 cm3. No acute radiation-induced toxicity or new neurological deficit occurred during the follow-up period (range 11–24 months, median 16 months). Axial pain improved in 24 (92%) of 26 patients.

Conclusions.The combined kyphoplasty and spinal radiosurgery treatment paradigm was found to be clinically effective in patients with pathological fractures; there was no significant spinal canal compromise. In this technique two minimally invasive surgical procedures are combined to avoid the morbidity associated with open surgery while providing both immediate fracture fixation and administering a single-fraction tumoricidal radiation dose.
A unique two-level noncontiguous ligamentous flexion—distraction injury in the thoracolumbar spine
Authors: Ketz John P. , Molinari Robert W.
Published: May 2009

✓ The authors report the case of a patient who sustained traumatic two-level noncontiguous ligamentous flexion-distraction injuries in the thoracolumbar spine. To the best of their knowledge, this is the first reported case of this combined injury pattern.
Effects of pilot hole preparation technique on pedicle screw fixation in different regions of the osteoporotic thoracic and lumbar spine
Authors: Carmouche Jonathan J. , Molinari Robert W. , Gerlinger Tad , Devine John , Patience Troy
Published: May 2009

Object.The authors evaluated the effects of pilot hole preparation technique on insertional torque and axial pullout resistance in osteoporotic thoracic and lumbar vertebrae.

Methods.Using a probe technique and fluoroscopy, 102 pedicle screws were placed in 51 dual-energy x-ray absorptiometry—proven osteoporotic thoracic and lumbar levels. Screws were inserted using the same-size tapping, one-size-under tapping, or no-tapping technique. Insertional torque and axial pullout resistance were measured. Analysis of variance, Fisher exact test, and regression analysis were performed.

Same-size tapping decreased pullout resistance in the lumbar spine. There was no effect on pullout resistance in the thoracic spine. Pullout resistance values were lower for all insertion techniques in the upper thoracic spine. Insertional torque and bone mineral density correlated with pullout resistance in the thoracic and lumbar spine.

Conclusions.Tapping decreased pedicle screw pullout resistance in the osteoporotic human lumbar spine, although it did not affect pullout strength in the thoracic spine. Tapping decreased insertional torque in upper thoracic levels. Surgeons should optimize overall construct rigidity when placing thoracic pedicle screws in patients with spinal segment osteoporosis.
Safety of transforaminal lumbar interbody fusion and intervertebral recombinant human bone morphogenetic protein—2
Authors: Villavicencio Alan T. , Burneikiene Sigita , Nelson E. Lee , Bulsara Ketan R. , Favors Mark , Thramann Jeffrey
Published: May 2009

Object.Recombinant human bone morphogenetic protein—2 (rhBMP-2) is being increasingly used for spinal fusion. There are few data regarding its clinical safety, effectiveness, and clinical outcome when applied on an absorbable collagen sponge (ACS) in conjunction with allograft for transforaminal lumbar interbody fusion (TLIF).

Methods.Seventy-four consecutive patients undergoing TLIF for degenerative disc disease were divided into five groups depending on whether the patient underwent a minimally invasive or open approach, as well as the number of spinal levels surgically treated. Surgery-related data, fusion results, complications, and clinical outcome were evaluated. The mean follow-up duration was 20.6 months (range 14–28 months). The radiographic fusion rate was 100% at 12 and 24 months after the surgery. No bone overgrowth or other complications related to BMP use were demonstrated.

Conclusions.Analysis of the results demonstrated that TLIF combined with a BMP-2—soaked ACS is a feasible, effective, and safe method to promote lumbar fusion. There were no significant intergroup differences in clinical outcome between patients who underwent open compared with minimally invasive procedures. Patient satisfaction rates, however, were higher in the minimally invasive procedure group. The efficacy of BMP-2 was not dependent on which approach was used or the number of spinal levels that were treated.
GroEL-Assisted Protein Folding: Does It Occur Within the Chaperonin Inner Cavity?
Authors: Marchenkov Victor V. , Semisotnov Gennady V.
Published: May 2009

The folding of protein molecules in the GroEL inner cavity under the co-chaperonin GroES lid is widely accepted as a crucial event of GroEL-assisted protein folding. This review is focused on the data showing that GroEL-assisted protein folding may proceed out of the complex with the chaperonin. The models of GroEL-assisted protein folding assuming ligand-controlled dissociation of nonnative proteins from the GroEL surface and their folding in the bulk solution are also discussed.
Isolation and Immunomodulatory Effect of Homoisoflavones and Flavones from Agave sisalana Perrine ex Engelm.
Authors: Chen Pi Yu , Kuo Yuh Chi , Chen Chin Hui , Kuo Yueh Hsiung , Lee Ching Kuo
Published: May 2009

Three known flavones and seven known homoisoflavonoids were isolated from the methanolic extract of the leaves of Agave sisalanaPerrine ex Engelm. Their structures were elucidated on the basis of spectroscopic analysis. The isolated compounds were also evaluated for immunopharmacological activity. PBMC were used as target cells, and cell proliferation was determined by 3H-thymidine uptake. (±)-3,9-Dihydroeucomin (4), dihydrobonducellin (5), and 5,7-dihydroxy-3-(4′-hydroxybenzyl)-4-chromanone (7) showed inhibitory effects on PBMC proliferation activated by PHA with IC50 values 19.4, 73.8, and 58.8 µM, respectively. All three compounds significantly inhibited the production of IL-2 and IFN-γ in activated PBMC in a concentration-dependent manner.
The Contemporary Role of Surgery in Kidney Cancer
Authors: Lattouf J. B. , Trinh Q. D. , Saad F.
Published: May 2009

The diagnosis and treatment of renal cell carcinoma (RCC) has been the subject of major changes since the late 1980s. Initially, surgery was the only treatment available, but more recently, systemic therapies have been developed, and their introduction has modified some of the surgical indications for RCC. In addition, refinements in surgical technique and the introduction of minimally invasive approaches have revolutionized patient care and bear the promise of even more improvements to come. This paper provides an up-to-date overview of recent developments in the surgical treatment of RCC.
Clinical Features and Prognosis of Adult-onset Still’s Disease: 61 Cases from China
Authors: ZENG TING , ZOU YU-QIONG , WU MEI-FANG , YANG CHENG-DE
Published: May 2009

Objective.

To describe the onset, clinical features, prognostic factors, and treatment of adult-onset Still’s disease (AOSD) in cases from China.

Methods.

Sixty-one Chinese patients with AOSD were analyzed retrospectively.

Results.

Common clinical features were fever (100.0%), rash (88.5%), and arthritis (82.0%). The laboratory findings were as follows: leukocytosis (83.6%), increased erythrocyte sedimentation rate (100.0%), elevated transaminase concentrations (23.0%), elevated ferritin levels (79.6%), negative antinuclear antibody (88.5%), and negative rheumatoid factor (88.5%). Of the 61 patients, 44.3% exhibited a monocyclic disease pattern, 29.5% experienced disease relapse at least once, 16.4% exhibited chronic articular course, and 9.8% died; most deaths were due to pulmonary infection and respiratory failure. Based on the disease course, we divided the 61 patients into 2 groups: those with favorable outcome (cyclic disease course, n = 45) and unfavorable outcome (chronic disease course or death, n = 16). We analyzed the prognostic factors for the 2 groups, and found that pleuritis, interstitial pneumonia, elevated ferritin levels, and failure of fever to subside after 3 days of prednisolone at 1 mg/kg/day were unfavorable prognostic factors for patients with AOSD.

Conclusion.

Patients with AOSD had complex symptoms with no specific laboratory findings. Our results indicate that AOSD is not a relatively benign disease, especially in cases that are refractory to high doses of prednisone.
Recovery in Whiplash-Associated Disorders: Do You Get What You Expect?
Authors: CARROLL LINDA J. , HOLM LENA W. , FERRARI ROBERT , OZEGOVIC DEJAN , CASSIDY J. DAVID
Published: May 2009

Objective.

Positive expectations predict better outcome in a number of health conditions, but the role of expectations in predicting health recovery after injury is not well understood. We investigated whether early expectations of recovery in whiplash associated disorders (WAD) predict subsequent recovery, and studied the role of “expectations” to predict recovery as determined by pain cessation and resolution of pain-related limitations in daily activities.

Methods.

A cohort of 6,015 adults with traffic-related whiplash injuries was assessed, using multivariable Cox proportional hazards analysis, for association between these expectations and self-perceived recovery over a 1-year period following the injury. Recovery was assessed using 3 indices: self-perceived global recovery (primary outcome); resolution of neck pain severity; and resolution of pain-related limitations in daily activities.

Results.

After adjusting for the effect of sociodemographic characteristics, post-crash symptoms and pain, prior health status and collision-related factors, those who expected to get better soon recovered over 3 times as quickly (hazard rate ratio = 3.62, 95% confidence interval 2.55–5.13) as those who expected that they would never get better. Findings were similar for resolution of pain-related limitations and resolution of neck pain intensity, although the effect sizes for the latter outcome were smaller.

Conclusion.

Patients’ early expectations for recovery are an important prognostic factor in recovery after whiplash injury, and are potentially modifiable. Clinicians should assess these expectations in order to identify those patients at risk of chronic whiplash, and future studies should focus on the effect of changing these early expectations.
Faire face au changement
Authors: Diamond Jared
Published: May 2009

Résumé Cet article s’intéresse à l’adaptation au changement. La capacité, ou non, à faire face à des situations nécessitant des changements de mode de vie radicaux est en effet déterminante pour permettre la survie d’individus, de groupes ou de sociétés. Le monde actuel implique, au niveau mondial, de telles adaptations, que ce soit pour faire face au changement climatique ou encore assurer la sécurité collective. Cet article s’appuie d’abord sur l’analyse des méthodes pour surmonter des crises au niveau individuel, avant de discuter dans quelle mesure ces solutions peuvent orienter l’adaptation des sociétés à des défis majeurs, par l’analyse d’exemples historiques et contemporains.
« La rose et le squelette ». L'angoisse de la vieillesse à la fin de la Renaissance à travers les poésies de Ronsard
Authors: Benito de la Fuente Javier
Published: May 2009

Résumé Au moment de son déclin, qui coïncide avec l’idée très répandue du déclin de la France, en pleines guerres de Religion, Ronsard, qui a été toute sa vie obsédé par l’idée de vieillesse, renie le mythe salvateur de « l’amour printemps », exprimé par la Poésie, qu’il avait érigé contre son obsession, et entrouvre ainsi l’une des portes de la modernité sceptique du xvii e siècle, qui aura du mal à croire au progrès harmonieux de l’homme. Avec les nouvelles découvertes, l’homme cesse d’être le centre du monde. Dans cette vision, la vieillesse n’est qu’un effroi que l’on ressent envers soi-même.
Le problème de la vieillesse pour un historien de la mort
Authors: Vovelle Michel
Published: May 2009

Résumé Cet entretien discute du problème de la vieillesse à travers son histoire. La vieillesse n’est pas une découverte récente. Des récits de la Bible, de la fable et de l’histoire jusqu’à la pensée médiévale depuis la Renaissance, la vieillesse a occupé les esprits. De l’âge classique aux Lumières, on enregistre le passage d’une vision ambiguë partagée entre le respect du patriarche et la dérision du barbon à une relecture par le discours de la philosophie des Lumières. La Révolution française tentera d’une certaine façon de le faire passer en acte.
« Vers où mon corps me mène ». Derniers échanges entre Freud et Abraham
Authors: Tauzia Natalia
Published: May 2009

Résumé À travers les derniers échanges de la correspondance de Freud avec Abraham, éclairés des théories freudiennes de la seconde topique et de travaux reprenant la question de la pulsion de mort et ses remaniements à l’œuvre dans les processus de vieillissement, l’auteur interroge l’économie psychique de l’homme vieillissant, confronté à la finitude par la contrainte que son corps lui inflige. Pris dans un double mouvement de deuil anticipé du moi, de renoncement, et de maintien de l’ambition d’immortalité nécessaire à la sauvegarde de ses investissements libidinaux, l’âgé doit faire naître de cette contradiction apparente l’équilibre qui lui permettra de mettre à distance le corps pour survivre malgré les pertes, s’ancrer dans la sublimation.