bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rare cause of subarachnoid hemorrhage: spinal meningeal carcinomatosis
Authors: Inci Servet , Bozkurt Gokhan , Gulsen Salih , Firat Pinar , Ozgen Tuncalp 
Published: May 2009

✓Subarachnoid hemorrhage (SAH) of spinal origin is a rare entity accounting for approximately 1% of all cases of SAH. Its most frequent causes are trauma and vascular malformations. Although primary spinal tumors, especially ependymomas, are also relatively common causes, SAH secondary to a metastatic spinal tumor arising from outside the central nervous system is an extremely rare condition; only one case has been reported in the literature. The authors present a case of spinal meningeal carcinomatosis secondary to cutaneous malignant melanoma in which the patient presented with only symptoms of SAH.
Although very rare, this case underscores several factors. 1) Spinal SAH due to spinal metastases should be considered in the differential diagnosis of patients with previously known malignancy. 2) Spinal SAH may manifest without paraparesis or sensory deficit. 3) Magnetic resonance imaging of the spinal cord may be important to determine the source of SAH in patients in whom four-vessel cerebral angiography demonstrates no abnormal findings.
Use of the Solis cage and local autologous bone graft for anterior cervical discectomy and fusion: early technical experience
Authors: Shad Amjad , Leach John C. D. , Teddy Peter J. , Cadoux-Hudson Tom A. D. 
Published: May 2009

Object. The authors prospectively evaluated the clinical and radiological outcomes after anterior cervical discectomy and fusion (ACDF) involving placement of a Solis cage and local autograft in patients who presented with symptomatic cervical spondylosis.
Methods. Twenty-two consecutive patients underwent ACDF for radiculopathy (13 cases), myeloradiculopathy (eight cases), or myelopathy alone (one case) and were assessed at 3, 6, and 12 months. Plain cervical spine radiography demonstrated a significant change in both local (p < 0.05) and regional (p < 0.05) kyphotic angles as well as an increase in segmental height (p < 0.05). At 12 months, plain radiography demonstrated Grades I, II, and III new bone formation in two, three, and 17 patients, respectively. Clinical outcomes were assessed using a visual analog scale for both neck and arm pain and a modified Japanese Orthopaedic Association (JOA) scale for myelopathy. There was a significant improvement in both arm (p < 0.05) and neck pain (p < 0.05). At 12 months, 16 (84%) of 19 and 19 (86%) of 22 patients reported complete resolution of arm pain and neck pain, respectively. There was a significant improvement in JOA scores following surgery (p < 0.05). There were two complications in the series: one case of deep venous thrombosis and one case of postoperative arm pain that resolved after conservative treatment. There were no technical complications.
Conclusions. Early experience with Solis cage—augmented ACDF indicates good clinical and radiological outcomes; additionally, there are the advantages of absent donor site morbidity and anterior plate system—related morbidity.
Chronological changes of postsympathectomy compensatory hyperhidrosis and recurrent sweating in patients with palmar hyperhidrosis
Authors: Chiou Thomas S. M. 
Published: May 2009

Object. The author sought to investigate the temporal changes of postsympathectomy compensatory hyperhidrosis and recurrent sweating in patients with primary palmar hyperhidrosis.
Methods. The author examined 91 consecutive patients for this prospective 6-year study. The patients were interviewed at least twice during a 6-month interval; the first follow up was conducted at a median of 1.7 years after surgery (range 2.5–60.5 months). Overall, 24 patients (26.4%) were followed for more than 2 years. Attention was focused on patient satisfaction and the incidence of compensatory hyperhidrosis and recurrent sweating.
The overall mean patient satisfaction rate was 78%, with a median 80% improvement on a visual analog scale from 0% (poor) to 100% (excellent). Overall, 88 patients (96.7%) developed compensatory hyperhidrosis, with the mean initial occurrence at 8.2 weeks. The symptoms of compensatory hyperhidrosis progressively worsened to the maximum degree within another 2 weeks after onset (mean 10.3 ± 1.83 weeks). In 19 patients (21.6%), symptoms of compensatory hyperhidrosis improved spontaneously within 3 months after sympathectomy (mean 13.3 weeks). Postoperative compensatory hyperhidrosis occurred in 71.4% of patients within the 1st year. Recurrent sweating occurred in only 17.6% of patients. None of these patients required repeated operation. The earliest onset of recurrent sweating was noted at 2 weeks postoperatively by three patients, and the mean initial postoperative reccurrence was 32.7 weeks after surgery.
Conclusions. Compensatory hyperhidrosis and recurrent sweating are normal thermoregulatory responses that occurred after upper thoracic sympathectomy. Compensatory hyperhidrosis was more prevalent and developed earlier than recurrent sweating. The severity of both compensatory hyperhidrosis and recurrent sweating symptoms remained stable 6 months after surgery.
Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 67 pediatric patients
Authors: Gluf Wayne M. , Brockmeyer Douglas L. 
Published: May 2009

Object. In this, the second of two articles regarding C1–2 transarticular screw fixation, the authors discuss their surgical experience in treating patients 16 years of age and younger, detailing the rate of fusion, complication avoidance, and lessons learned in the pediatric population.
Methods. The authors retrospectively reviewed 67 consecutive patients (23 girls and 44 boys) younger than 16 years of age in whom at least one C1–2 transarticular screw fixation procedure was performed. A total of 127 transarticular screws were placed in these 67 patients whose mean age at time of surgery was 9 years (range 1.7–16 years). The indications for surgery were trauma in 24 patients, os odontoideum in 22 patients, and congenital anomaly in 17 patients. Forty-four patients underwent atlantoaxial fusion and 23 patients underwent occipitocervical fusion. Two of the 67 patients underwent halo therapy postoperatively.
All patients were followed for a minimum of 3 months. In all 67 patients successful fusion was achieved.Complications occurred in seven patients (10.4%), including two vertebral artery injuries.
Conclusions. The use of C1–2 transarticular screw fixation, combined with appropriate atlantoaxial and craniovertebral bone/graft constructs, resulted in a 100% fusion rate in a large consecutive series of pediatric patients. The risks of C1–2 transarticular screw fixation can be minimized in this population by undertaking careful patient selection and meticulous preoperative planning.
Endoscopic partial laminectomy for cervical myelopathy
Authors: Yabuki Shoji , Kikuchi Shin-ichi 
Published: May 2009

Object. The authors report the results of endoscopic partial laminectomy performed in 10 patients with degenerative cervical compressive myelopathy.
Methods. Endoscopic partial laminectomy was performed safely in 10 patients with cervical myelopathy. All of the patients experienced symptomatic improvement with slight postoperative wound pain. The mean operative duration was 164 ± 35 minutes and the mean intraoperative blood loss was 45.5 ± 27 ml.
Conclusions. Endoscopic partial laminectomy may be used as a minimally invasive alternative for the treatment of cervical compressive myelopathy.
En bloc resection of multilevel cervical chordoma with C-2 involvement
Authors: Rhines Laurence D. , Fourney Daryl R. , Siadati Abdolreza , Suk Ian , Gokaslan Ziya L. 
Published: May 2009

✓ Chordomas are locally aggressive neoplasms with an extremely high propensity to recur locally following resection, despite adjuvant therapy. This biological behavior has led most authors to conclude that en bloc resection provides the best chance for the patient's prolonged disease-free survival and possible cure.
The authors present a case of an extensive upper cervical chordoma treated by en bloc resection, reconstruction, and long-segment stabilization. Total spondylectomy of C2–4 with sacrifice of the right C2–4 nerve roots and a segment of the right vertebral artery was performed. The inherent anatomical complexities of en bloc resection in the upper cervical spine are discussed. To the authors' knowledge, this represents the first report of an en bloc resection for multilevel cervical chordoma.
Efficacy of percutaneous vertebroplasty combined with radiotherapy in osteolytic metastatic spinal tumors
Authors: Jang Jee-Soo , Lee Sang-Ho 
Published: May 2009

Object. Vertebroplasty involves the percutaneous injection of polymethylmethacrylate into collapsed vertebral bodies due to hemangioma, osteoporosis, or malignant tumor. The purpose of this study was to evaluate the merits and efficacy of percutaneous vertebroplasty (PVP) combined with radiotherapy in treating patients with osteolytic metastatic spinal tumors (OMSTs).
Methods. Twenty-eight patients with OMSTs underwent PVP for the treatment of 72 vertebrae after administration of a local anesthetic or induction of general anesthesia for pain relief and spinal stabilization. Radiotherapy for suppressing tumor or inducing pain relief was performed immediately after PVP in 22 patients. Pain levels were assessed before and after the procedure by using a visual analog scale (VAS), and follow-up assessment was conducted at 1, 3, 6, and 9 months. On postoperative Day 3, marked-to-complete VAS score—based pain relief was achieved in 13 patients (48%) and moderate relief was demonstrated in 11 (41%). The mean VAS pain score was reduced from 8.2 to 3, and major complications were absent in all cases. Follow-up plain radiography was performed to assess vertebral column stability. Neither additional vertebral collapse in the treated vertebrae nor neurological deterioration was observed.
Conclusions. Percutaneous vertebroplasty is a minimally invasive procedure and, when combined with radiotherapy, seems to be effective in providing pain relief and stabilization in patients with OMSTs.
Intramedullary spinal cord tumors in patients older than 50 years of age: management and outcome analysis
Authors: Shrivastava Raj K. , Epstein Fred J. , Perin Noel I. , Post Kalmon D. , Jallo George I. 
Published: May 2009

Object. Intramedullary spinal cord tumors (IMSCTs) in the older-age adult population pose complex management issues regarding the extent of resection and functional outcome, especially in terms of quality of life. Historically, IMSCTs in the older adult population were treated with irradiation alone because it was assumed that functional recovery would be poor. The authors examined their IMSCT database and report the first large series of IMSCTs in patients older than 50 years of age.
Methods. In this retrospective clinical and chart review there were 30 cases meeting inclusion criteria drawn from databases at three different institutions. A modified McCormick Scale was used to assess functional levels in all 30 patients pre- and postoperatively. The mean age of patients in this cohort was 59.8 years (range 50–78 years), and the mean follow- up period was 10.6 years (range 2–16 years).
Ependymoma was the most common tumor (83%), and 55% were located in the thoracic spine. The most common presenting symptom was sensory dysesthesia, with rare motor loss. The prodromal period to treatment was 19.4 months. Based on the McCormick Scale score at last follow-up examination 67% of patients were clinically functionally the same, 9% were worse, and 24% were improved after surgery. There were two deaths due tumor progression (both malignant tumors) and one recurrence (anaplastic astrocytoma). All three patients in whom malignant astrocytomas were diagnosed underwent postoperative radiation therapy.
Conclusions. In the population of patients older than age 50 years, thoracic ependymomas are the most common IMSCTs that present characteristically with sensory symptoms. The longer prodromal period in the older adult population may reflect the fact that their diagnosis and workup is inadequate. There was no significant increase in the length of stay in the neurosurgical ward. The authors recommend motor evoked potential-guided aggressive microsurgical resection, because the long-term outcome of benign lesions is excellent (good functional recovery and no tumor recurrence).
Conical working tube: a special device for endoscopic surgery of herniated lumbar discs
Authors: Husain Mazhar , Jha Deepak K. , Agrawal Sunil , Husain Nuzhat , Gupta Rakesh K. 
Published: May 2009

Object. The instrumentation for endoscopic discectomy continues to evolve to allow for acceptable clinical outcomes and expanding applications. The authors describe their experience in using a conical working tube equipped with a guide for angular entry of the telescope to perform endoscopic discectomy in patients with lumbar disc herniation.
Methods. Fifty-one patients (38 men and 13 women) with herniated lumbar discs underwent endoscopic lumbar surgery during the past 2.5 years at the authors' institutions. A conical working tube was inserted over sequential coaxial dilators via a muscle-splitting approach. Conventional neurosurgical instruments were used in conjunction with an angled insertion telescope. Endoscopic discectomy was performed at the L1–2 (one case), L3–4 (two cases), L4–5 (32 cases), and L5—S1 (18 cases) levels. The surgical approach was bilateral in two patients: bilateral L4–5 in one, and right L4–5 and left L5—S1 in the other. The remaining patient suffered adjacent two-level (right-sided L4–5 and L5—S1) herniations. Outcome was assessed at a mean of 11 months after surgery by using modified Macnab criteria.
Outcomes were excellent in 46 (90%), fair in three (6%), and poor in two patients (4%). Complications occurred in four patients and included a dural tear in one case, postoperative neurological deterioration in two, and discitis in two; in two of these patients open surgical exploration was required.
Conclusions. A separate angled entry of the telescope shortens the effective length of the working sheath and creates a better working space, thereby allowing greater instrument maneuverability and ability to use conventional neurosurgical instruments. In addition, use of this telescope in other endoscopic procedures reduces overall cost of instrumentation and treatment, and results are comparable to those reported in association with microscopic lumbar discectomy.
A novel rat model for the study of intraosseous metastatic spine cancer
Authors: Mantha Ajay , Legnani Federico G. , Bagley Carlos A. , Gallia Gary L. , Garonzik Ira , Pradilla Gustavo , Amundson Eric , Tyler Betty M. , Brem Henry , Gokaslan Ziya L. 
Published: May 2009

Object. Although metastatic spinal disease constitutes a significant percentage of all spinal column tumors, an accessible and reproducible animal model has not been reported. In this study the authors describe the technique for creating an intraosseous spinal tumor model in rats and present a functional and histological analysis.
Methods. Eighteen female Fischer 344 rats were randomized into two groups. Group 1 animals underwent a transabdominal exposure and implantation of CRL-1666 breast adenocarcinoma into the L-6 vertebral body (VB). Animals in Group 2 underwent a sham operation. Hindlimb function was tested daily by using the Basso-Beattie-Bresnahan scale. Sixteen days after tumor implantation, animals were killed and their spines were removed for histological assessment. Statistical analysis was performed using the Wilcoxon signed-rank test.
By Day 15 functional analysis showed a significant decrease in motor function in Group 1 animals (median functional score 2 of 21) compared with Group 2 rats (median functional score 21 of 21) (p = 0.0217). The onset of paraparesis in Group 1 occurred within 14 to 16 days of surgery. Histopathological analysis showed tumor proliferation through the VB and into the spinal canal, with marked osteolytic activity and spinal cord compression.
Conclusions. Analysis of these findings demonstrates the consistency of tumor growth in this model and validates the utility of functional testing for onset of paresis. This new rat model allows for the preclinical evaluation of novel therapeutic treatments for patients harboring metastatic spine disease.
Neuroprotection and functional recovery after application of the caspase-9 inhibitor z-LEHD-fmk in a rat model of traumatic spinal cord injury
Authors: Çolak Ahmet , Karaoǧlan Alper , Barut Şeref , Köktürk Sibel , Akyildiz Aysşenur Iǧdem , Taşyürekli Mustafa 
Published: May 2009

Object. Apoptosis is considered one of the most significant mechanisms in the pathogenesis of neuronal damage after spinal cord injury (SCI). This form of cell death occurs via mediators known as caspases. The aim of this study was to evaluate the neuroprotective effect of the caspase-9 inhibitor, z-LEHD-fmk, in a rat model of spinal cord trauma.
Methods. Fifty-four Wistar albino rats were studied in the following three groups of 18 animals each: sham-operated controls (Group 1); trauma-only controls (Group 2); and trauma combined with z-LEHD-fmk—treated animals (0.8 µM/kg; Group 3). Spinal cord injury was produced at the thoracic level by using the weight-drop technique. Responses to SCI and the efficacy of z-LEHD-fmk treatment were determined on the basis of terminal deoxynucleotidyl transferase—mediated deoxyuridine triphosphate nick—end labeling staining and light and electron microscopy findings in cord tissue at 24 hours and 7 days posttrauma. Six rats from each group were also assessed for functional recovery at 3 and 7 days after SCI. This was conducted using the inclined-plane technique and a modified version of the Tarlov motor grading scale.
At 24 hours postinjury, light microscopic examination of Group 2 tissue samples showed hemorrhage, edema, necrosis, polymorphonuclear leukocyte infiltration, and vascular thrombi. Those obtained in Group 3 rats at this stage showed similar features. At 24 hours postinjury, the mean apoptotic cell count in Group 2 was significantly higher than that in Group 3 (90.25 ± 2.6 and 50.5 ± 1.9, respectively; p < 0.05). At 7 days postinjury, the corresponding mean apoptotic cell counts were 49 ± 2.1 and 17.7 ± 2.6, also a significant difference (p < 0.05). Electron microscopy findings confirmed the occurrence of programmed cell death in different cell types in the spinal cord and showed that z-LEHD-fmk treatment protected neurons, glia, myelin, axons, and intracellular organelles.
Conclusions. Examination of the findings in this rat model of SCI revealed that apoptosis occurs not only in neurons and astrocytes but also in oligodendrocytes and microglia. Furthermore, immediate treatment with the caspase-9 inhibitor z-LEHD-fmk blocked apoptosis effectively and was associated with better functional outcome. More in-depth research of the role of programmed cell death in spinal cord trauma and further study of the ways in which caspases are involved in this process may lead to new strategies for treating SCI.
Posterior atlantoaxial transpedicular screw and plate fixation
Authors: Chen Jyi-Feng , Wu Chieh-Tsai , Lee Sai-Cheung , Lee Shih-Tseng 
Published: May 2009

✓ The authors describe a modified posterior atlantoaxial fixation technique for the treatment of reducible atlantoaxial instability, which can be performed simply and easily, and can decrease the risk of vessel and/or neural damage.
During an 18-month period, this technique was undertaken in 11 patients with atlantoaxial instability. There was no procedure-related morbidity. The follow-up period ranged from 8 to 18 months (mean 13.2 months). Fusion was documented in all 11 patients, and there was no progression of spinal deformity.
This technique can be considered an effective alternative in the treatment of atlantoaxial subluxation.
Early results after ProDisc-C cervical disc replacement
Authors: Bertagnoli Rudolf , Yue James J. , Pfeiffer Frank , Fenk-Mayer Andrea , Lawrence James P. , Kershaw Trace , Nanieva Regina 
Published: May 2009

Object.Cervical anterior decompression and total-disc replacement is currently being investigated as an alternative treatment in patients with symptomatic intervertebral cervical spondylosis with and without radiculopathy. The authors prospectively investigated the safety and efficacy of using the ProDisc-C disc for cervical arthroplasty in the treatment of symptomatic cervical spondylosis.Methods.Sixteen patients in whom a diagnosis of symptomatic cervical spondylosis had been established were prospectively treated with complete anterior cervical discectomy and ProDisc-C cervical disc arthroplasty. Overall 12 single- and four two-level procedures were performed (20 prostheses). Patients underwent pre- and multiple postoperative assessments (3 and 6 weeks and 3, 6, and 12 months).The median age of all patients was 50 years (range 32–60 years). Levels of surgery included seven C5–6, six C6–7, and three C4–5. Neck and arm pain as well as disability scores were significantly improved by 3 months and remained significantly improved at 1 year. No additional fusion surgeries were necessary at the affected or unaffected levels. Radiography revealed an affected disc motion from 4 to 12°. No surgery- or device-related complications were documented.Conclusions.Analysis of preliminary results involving ProDisc-C arthroplasty indicates significant improvement in pain and functional outcome scores. No spontaneous fusions at the level of surgery or at adjacent levels were noted. Long-term follow-up studies will be necessary before more definitive treatment recommendations can be formulated.
Long-term health-related quality of life outcomes following Jefferson-type burst fractures of the atlas
Authors: Dvorak Marcel F. , Johnson Michael G. , Boyd Michael , Johnson Garth , Kwon Brian K. , Fisher Charles G. 
Published: May 2009

Object.The primary goal of this study was to describe the long-term health-related quality of life (HRQOL) outcomes in patients who have suffered Jefferson-type fractures. These outcomes were compared with matched normative HRQOL data and with the patient's perceptions of their HRQOL prior to the injury. Variables that potentially influence these HRQOL outcomes were analyzed.No standardized outcome assessments have been published for patients who suffer these fractures; their outcomes have long thought to be excellent following treatment. Determining the optimal surrogate measure to represent preinjury HRQOL in trauma patients is difficult.Methods.A retrospective review, radiographic analysis, and cross-sectional outcome assessment were performed. The Short Form (SF)—36 and the American Academy of Orthopaedic Surgeons/North American Spine Society (AAOS/NASS) outcome instruments were filled out by patients at final follow-up examination (follow-up period 75 months, range 19–198 months) to represent their current status as well as their perceptions of preinjury status.In 34 patients, the SF-36 physical component score and the AAOS/NASS pain values were significantly lower than normative values. There was no significant difference between normative and preinjury values. Spence criteria greater than 7 mm and the presence of associated injuries predicted poorer outcome scores during the follow-up period.Conclusions.Long-term follow-up examination of patients with Jefferson fractures indicated that patients' status does not return to the level of their perceived preinjury health status or that of normative population controls. Those with other injuries and significant osseous displacement (≥ 7 mm total) may experience poorer long-term outcomes. Limitations of the study included a relatively low (60%) response rate and the difficulties of identifying an appropriate baseline outcome in a trauma population with which the follow-up outcomes can be compared.