bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis
Authors: Przybylski Gregory J. , Sharan Ashwini D. 
Published: May 2009

Object. Patients with deep wound infections complicating previously placed internal instrumentation have been successfully treated by debridement and prolonged postoperative antibiotic therapy, which avoided removal of the hardware. Comparatively fewer patients with pyogenic discitis and vertebral osteomyelitis (PDVO) have undergone single-stage debridement, arthrodesis, and internal fixation. The purpose of this study was to determine the efficacy of combining debridement, arthrodesis in which iliac autograft is used, and segmental internal fixation in a single-stage procedure for patients in whom nonoperative management of PDVO has failed.
Methods. A retrospective analysis of 17 consecutive patients with PDVO treated between July 1996 and September 1999 was performed. Follow-up data (mean 30 months) included office examinations and telephone interviews, and patients were grouped according to the duration of preoperative antibiotic therapy. All patients experienced significant postoperative reduction in pain, and those with neurological deficits improved. Eleven patients were independently ambulatory, and three required a walker; only five had been ambulating independently preoperatively. Two patients died during the 1st postoperative week of medical complications; another developed a wound dehiscence that was managed with debridement, prolonged antibiotic administration, and removal of the hardware 1 year later. In no case was pseudarthrosis demonstrated on dynamic radiography. Most patients received only a 6-week course of intravenous antibiotics postoperatively.
Conclusions. The authors conclude that single-stage debridement, arthrodesis, and internal fixation can be effective in the treatment of PDVO. A 6-week course of postoperative intravenous antibiotics may be sufficient in patients with few risk factors. The harvesting of iliac autograft through the same operative exposure may not increase the risk of secondary infection.
Transcostovertebral approach for thoracic disc herniations
Authors: Dinh Dzung H. , Tompkins John , Clark Shawn B. 
Published: May 2009

Object. The authors describe a new posterolateral transcostovertebral approach for the removal of herniated thoracic discs.
Methods. From January 1994 to January 2000, 28 thoracic discs in 22 patients were excised via a new transcostovertebral surgical approach. Seventeen patients (77%) presented with axial pain, 14 (64%) with radicular pain, 13 (59%) with myelopathy, eight (36%) with sensory loss, and 10 (45%) with genitourinary (GU) symptoms such as urinary hesitancy or incontinence. The affected discs were approached using a midline incision to gain access of the costovertebral junction. The surgical corridor was posterolateral; the costovertebral joint and lateral edge of the vertebral endplates were drilled to expose the lateral annulus. The ribs were preserved, obviating the need for insertion of a chest tube postoperatively.
The average operating time per level was 200.5 minutes (range 90–360 minutes). The average blood loss was 231 ml (50–750 ml). The average length of stay was 3.8 days. Most patients were discharged home on postoperative Day 2 or 3. No patients were worse postoperatively. Improvement was demonstrated in 13 (76%) of 17 patients with axial pain, 11 (79%) of 14 patients with radicular pain, 11 (85%) of 13 patients with myelopathy, seven (88%) of eight patients with sensory loss, and six (60%) of 10 patients with GU symptoms.
Conclusions. This procedure is well suited for any thoracic disc level and offers several advantages over the traditional costotransversectomy or transthoracic approaches: shorter operating time, less blood loss, less extensive soft-tissue and bone dissection, reduced postoperative pain, and shorter hospital stays.
Use of a collagen-based sealant to prevent in vivo epidural adhesions in an adult rat laminectomy model
Authors: Liu Song , Boutrand Jean Pierre , Tadie Marc 
Published: May 2009

Object. The authors investigated the effect of a collagen-based sealant, Gel Amidon Oxydé (GAO), in the prevention of epidural scar adhesions in an adult rat model of laminectomy.
Methods. Seventy-two adult Sprague—Dawley rats underwent an L5–6 laminectomy, after which the dura mater and the left L-4 and L-5 nerve roots were exposed. In the 36 animals that received GAO, the sealant was applied over the dura and around the nerve roots, and it was used to fill the laminectomy cavity before it polymerized. In 36 control animals, the same surgical treatment was performed, but the rats did not receive GAO. During the early postoperative period, a significant decrease in the occurrence of epidural hematoma was found in the GAO-treated rats. In contrast to findings in control rats, a thin white connective tissue layer was found between the dura and surrounding muscles after GAO had degraded and been absorbed. One month posttreatment, no epidural scar adhesion was found between the tissue layer and the dura in the GAO-treated animals. Three months postoperatively, both gross inspection and histological examination further confirmed that formation of epidural adhesions was significantly inhibited in the rats treated with GAO. No special inflammatory reaction was observed, and the healing of skin and muscle lesions was not affected by either treatment.
Conclusions. The data obtained in this study suggest that the GAO collagen—based sealant may be an effective biomaterial to prevent epidural adhesions in vivo after laminectomy.
Effects of neck movements on stability and subsidence in cervical interbody fusion: an in vitro study
Authors: Kettler Annette , Wilke Hans-Joachim , Claes Lutz 
Published: May 2009

Object. The aim of this in vitro study was to determine the influence of simulated postoperative neck movements on the stabilizing effect and subsidence of four different anterior cervical interbody fusion devices. Emphasis was placed on the relation between subsidence and spinal stability.
Methods. The flexibility of 24 human cervical spine specimens was tested before and directly after being stabilized with a WING, BAK/C, AcroMed I/F cage, or with bone cement in standard flexibility tests under 50 N axial preload. Thereafter, 700 pure moment loading cycles (± 2 Nm) were applied in randomized directions to simulate physiological neck movements. Additional flexibility tests in combination with measurements of the subsidence depth were conducted after 50, 100, 200, 300, 500, and 700 loading cycles.
In all four groups, simulated postoperative neck movements caused an increase of the range of motion (ROM) ranging from 0.4 to 3.1° and of the neutral zone from 0.1 to 4.2°. This increase in flexibility was most distinct in extension followed by flexion, lateral bending, and axial rotation. After cyclic loading, ROM tended to be lower in the group fitted with AcroMed cages (3.3° in right lateral bending, 3.5° in left axial rotation, 7.8° in flexion, 8.3° in extension) and in the group in which bone cement was applied (5.4°, 2.5°, 7.4°, and 8.8°, respectively) than in those fixed with the WING (6.3°, 5.4°, 9.7°, and 6.9°, respectively) and BAK cages (6.2°, 4.5°, 10.2°, and 11.6°, respectively).
Conclusions. Simulated repeated neck movements not only caused an increase of the flexibility but also subsidence of the implants into the adjacent vertebrae. The relation between flexibility increase and subsidence seemed to depend on the implant design: subsiding BAK/C cages partially supported stability whereas subsiding WING cages and AcroMed cages did not.
Effects of cervical spine posture on axial load bearing ability: a biomechanical study
Authors: Öktenoǧlu Tunç , Özer A. Fahir , Ferrara Lisa A. , Andalkar Niteen , Sarioǧlu Ali Çetin , Benzel Edward C. 
Published: May 2009

Object. The authors conducted a study to assess the effects of cervical posture on the loadbearing ability of the cervical spine.
Methods. Twelve cervical spine specimens obtained in 12 adult sheep were tested. The specimens were randomly separated into two groups. In Group I the specimens were fixed in a lordotic posture, and in Group II they were fixed in a straight posture. Axial compressive loads were applied at a constant rate of 5 cm/minute. Load-to-failure, time-to-failure, piston displacement at failure, and failure modes were recorded. Statistical analyses were performed to detect differences between the groups.
There was no significant difference in load-to-failure values between the two groups. However, the time-to-failure and the piston displacement values for the straight spines were significantly less than those for the lordotic spines. Additionally, the straight spines failed predominantly through ventral elements, whereas the lordotic spines predominantly failed dorsally.
Conclusions. It is concluded that a loss of a lordosis increases the risk of injury to the cervical spine following axial loading.
Microdialysis study of amino acid neurotransmitters in the spinal dorsal horn of patients undergoing microsurgical dorsal root entry zone lesioning
Authors: Mertens Patrick , Ghaemmaghami Chantal , Bert Lionel , Perret-Liaudet Armand , Guenot Marc , Naous Hussein , Laganier Laurent , Later Roger , Sindou Marc , Renaud Bernard 
Published: May 2009

✓ The aim of this study was to develop, for the first time in the human spinal dorsal horn (DH), an in vivo method for the study of amino acids (AAs).
A microdialysis technique was used to sample AAs in the extracellular fluid of the DH apex in eight patients in whom surgery in the dorsal root entry zone (DREZ) was performed. Before making microsurgical lesions, specific concentric-type microdialysis probes were implanted over a 60-minute period in the DREZ and directed to the DH apex (10 implantations). The AA concentrations in the dialysates were determined using high-performance liquid chromatography with fluorescence detection. The concentrations of excitatory AAs (glutamate and aspartate) and inhibitory AAs (γ-aminobutyric acid and glycine) decreased and were stabilized by 45 minutes after probe implantation, whereas the levels of nonneurotransmitter AAs (alanine and threonine) were not stabilized at 60 minutes. The ability of the probe to track the changes of extracellular AAs was demonstrated. Neither intra- nor postoperative microdialysis-related complications were observed (with a follow up of 18 months).
The present study demonstrates that microdialysis can be performed safely in the human DH during DREZ lesioning. Despite technical and analytical limitations related to the intraoperative conditions, this technique offers new possibilities for clinical research on neurotransmitters involved in some relevant pathological states, especially in chronic pain and spasticity.
Surgical and endovascular treatment of spinal dural arteriovenous fistulas: long-term disability assessment and prognostic factors
Authors: Song Joon K. , Viñuela Fernando , Gobin Y. Pierre , Duckwiler Gary R. , Murayama Yuichi , Kureshi Inam , Frazee John G. , Martin Neil A. 
Published: May 2009

Object. The authors assessed clinical outcomes of patients with treated spinal dural arteriovenous fistulas (DAVFs) and investigated prognostic factors.
Methods. Thirty consecutive patients with spinal DAVFs were treated at the authors' institution during the past 15 years: seven underwent surgery; seven underwent surgery after failed embolization; and 16 underwent embolization alone. The outcomes of gait and micturition disability were analyzed. Follow up averaged 3.4 years (range 1 month–11.8 years). Age, duration of symptoms, pre- and postintervention magnetic resonance (MR) imaging findings, and preintervention disability were correlated with outcome.
Seventeen patients (57%) experienced improved gait, 12 (40%) were unchanged, and one (3%) was worse. In 11 patients (37%) micturition function was improved, in 15 (50%) it was unchanged, and in four (13%) it was worse. Gait disability, as measured by the Aminoff—Logue Scale, was significantly improved after treatment, from 3.4 ± 1.4 (average ± standard deviation) to 2.7 ± 1.5 (p = 0.007). Mean micturition disability scores decreased, but not significantly, from 1.9 ± 1 to 1.6 ± 1.1 (p = 0.20). Preintervention gait disability was not associated with improvement except for patients with Aminoff—Logue Scale Grade 4 disability (eight of nine improved; p = 0.024). For patients treated within 13 months of symptom onset, mean micturition disability decreased (p = 0.035). No association was found between clinical improvement and age, a symptom duration less than 30 months, or pre- and postintervention MR imaging—documented spinal cord edema.
Conclusions. Spinal DAVF treatment significantly improved patients' mean gait disability score by almost one grade at last follow up. The mean micturition disability score was not significantly improved, unless treatment was performed within 13 months of symptom onset. Longer and more uniform follow-up study is needed to determine if improved and stabilized clinical outcomes are sustained.
Surgery in adults with tethered cord syndrome: outcome study with independent clinical review
Authors: van Leeuwen Redmer , Notermans Nicolette C. , Vandertop W. Peter 
Published: May 2009

Object. The authors conducted a study to evaluate the risks and short-term benefits of surgical treatment for tethered cord syndrome (TCS) in patients older than 18 years of age.
Methods. The authors studied a series of 57 consecutive adult patients with TCS of varying origins. Patients were examined by the same neurologist in a standardized fashion before and after surgery, and most were followed for at least 2 years postoperatively.
Patient age ranged from 19 to 75 years. The mean age at onset of symptoms and diagnosis was 30 years and 37 years, respectively. Muscle strength improved (15 cases) or showed no change postoperatively (38 cases) in a large majority of patients (93%). In four patients a minor decrease in muscle strength was demonstrated, and there was significant deterioration in two (3.5%). In the two latter patients, a rapid decline in motor function was present preoperatively. Subjective assessment of pain, gait, sensory function, and bladder/bowel function at 4 weeks, 6 months, and 2 years postsurgery revealed improvement in a substantial percentage of patients. No major surgery-related complications occurred.
Conclusions. This is the largest series to date in which adult patients with TCS comprise the report. Untethering procedures in these patients were safe and effective, at least in the short term. Patients with rapid loss of motor function, lipomyelomeningocele, or split cord malformation seem to be at a higher risk of postsurgery deterioration. A follow-up period of many more years will be necessary to determine whether aggressive surgery is beneficial in the long term.
Giant invasive spinal schwannomas: definition and surgical management
Authors: Sridhar K. , Ramamurthi Ravi , Vasudevan M.C. , Ramamurthi B. 
Published: May 2009

Object. Confusion exists regarding the term giant spinal schwannoma. There are a variety of nerve sheath tumors that, because of their size and extent, justify the label “giant schwannoma.” The authors propose a classification system for spinal schwannomas as a means to define these giant lesions. The classification is confined to tumors that are essentially intraspinal, with or without extraspinal components. Lesions that erode the vertebral bodies (VBs) and extend posteriorly and laterally into the myofascial planes are classified as giant “invasive” spinal schwannomas.
Methods. The records of patients with giant invasive spinal schwannoma were analyzed. The radiological features, operative approaches, and intraoperative findings were noted.
Ten patients with giant invasive tumors were surgically treated over the last 8 years. Six patients were male. Erosion of the posterior surface of the VBs was the diagnostic finding demonstrated on plain x-ray films. Magnetic resonance imaging delineated the extent of the tumors and helped in preoperative planning. Radical excision of the tumors in multiple stages was possible in eight of the 10 patients. Dural reconstruction was required in four patients. All patients required fusion, and an additional stabilization procedure was undertaken in three patients.
Conclusions. The authors conclude that giant invasive schwannomas are uncommon lesions and propose a new classification system. Because of their locally “invasive” nature and extension in all directions, careful preoperative planning of the surgical approach is very important. Although radical excision is possible and promises good results, recurrences may occur and multiple surgical procedures may be required.
Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations
Authors: Lew Sean M. , Mehalic Thomas F. , Fagone Kristin L. 
Published: May 2009

Object. Far-lateral (extraforaminal) and foraminal disc herniations comprise up to 11% of all herniated intervertebral discs. Operative management can be technically difficult, and the optimum surgical treatment remains controversial. Accessing these lateral disc herniations endoscopically via a percutaneous transforaminal approach offers several theoretical advantages over the more traditional procedures. The object of this study was to assess the safety and efficacy of treating patients with far-lateral and foraminal disc herniations via a percutaneous transforaminal endoscopic approach.
Methods. A retrospective analysis was performed of 47 consecutive patients who underwent surgery via this approach. All procedures were performed after induction of a local anesthetic on an outpatient basis. Outcome was measured with Macnab criteria and by determining a patient's return-to-work status. The median follow-up period was 18 months (range 4–51 months). Excellent or good outcome was obtained in 40 (85%) of 47 patients. Of the 38 patients working before the onset of symptoms, 34 (90%) returned to work. Five patients (11%) experienced poor outcomes and subsequently underwent open procedures at the same level. Of the 10 recipients of Workers' Compensation, Macnab criteria indicated a significantly worse outcome (70% excellent or good), but an excellent return-to-work status was maintained (90%). There were no complications.
Conclusions. Transforaminal percutaneous endoscopic discectomy is safe and efficacious in the treatment of far-lateral and foraminal disc herniations.
Long-lasting analgesic effect of radiofrequency treatment of the lumbosacral dorsal root ganglion
Authors: van Wijk Roelof M. A. W. , Geurts Jos W. M. , Wynne Herman J. 
Published: May 2009

Object. The authors conducted a study to establish the benefit of radiofrequency (RF) treatment of the lumbosacral dorsal root ganglion (DRG) as a therapy to reduce symptomatic pain in patients with chronic spinal pain radiating to the leg.
Methods. Two hundred seventy-nine patients were evaluated after undergoing their first RF treatment of the DRG. A four-point pain perception scale was used. Short-term effect was documented after 2 months. The influence of surgical history on outcome was examined by using chi-square analysis. The mean duration of analgesic effect was calculated by applying a probit survival analysis.
Two months after undergoing RF treatment, 59% of patients reported satisfactory pain reduction. No serious adverse effects were noted. Surgical history was shown to have no significant effect on outcome. The long-term half-life time of pain reduction was 44.5 months.
Conclusions. The use of RF in the treatment of DRG appears to be a useful and safe therapy in patients with chronic spinal pain that radiates to the leg. The initial success rate is approximately 60%. It seems to lead to a time-limited effect on the target structure, and the mean duration of pain reduction is approximately 3.7 years. The mechanism of action remains unclear.
Evaluation of the neuroprotective effects of sodium channel blockers after spinal cord injury: improved behavioral and neuroanatomical recovery with riluzole
Authors: Schwartz Gwen , Fehlings Michael G. 
Published: May 2009

Object. Persistent activation of voltage-sensitive Na+ channels is associated with cellular toxicity and may contribute to the degeneration of neural tissue following traumatic brain and spinal cord injury (SCI). Pharmacological blockade of these channels can attenuate secondary pathophysiology and reduce functional deficits acutely.
Methods. To determine the therapeutic effects of Na+ channel blockers on long-term tissue sparing and functional neurological recovery after traumatic SCI, the authors injected Wistar rats intraperitoneally with riluzole (5 mg/kg), phenytoin (30 mg/kg), CNS5546A, a novel Na+ channel blocker (15 mg/kg), or vehicle (2-HPβCD; 5 mg/kg) 15 minutes after induction of compressive SCI at C7—T1.
Functional neurological recovery of coordinated hindlimb function and strength, assessed 1 week postinjury and weekly thereafter for 6 weeks, was significantly enhanced in animals treated with riluzole compared with the other treatment groups. Seven weeks postinjury the preservation of residual tissue and integrity of descending axons were determined with digital morphometrical and fluorescent histochemical analysis. All three Na+ channel blockers significantly enhanced residual tissue area at the injury epicenter compared with control. Riluzole significantly reduced tissue loss in rostrocaudal regions surrounding the epicenter, with overall sparing of gray matter and selective sparing of white matter. Also, counts of red nuclei neurons retrogradely labeled with fluorogold introduced caudal to the injury site were significantly increased in the riluzole group.
Conclusions. Systemic Na+ channel blockers, in particular riluzole, can confer significant neuroprotection after in vivo SCI and result in behavioral recovery and sparing of both gray and white matter.
The denticulate ligament: anatomy and functional significance
Authors: Tubbs R. Shane , Salter George , Grabb Paul A. , Oakes W. Jerry 
Published: May 2009

Object. The authors conducted a study to examine the detailed anatomy of the denticulate ligaments and to assess their classic role in spinal cord stability within the spinal canal.
Methods. Detailed observation of the denticulate ligaments in 12 adult cadavers was performed. Stress was applied in all major planes to discern when the ligaments would become taut, and at the same time, gross motion of the cord was observed at sites distal to the stresses applied. Tension necessary for avulsion of the ligaments in various areas of the spinal cord was also measured.
Conclusions. These results show that the denticulate ligaments do not inhibit cord motion to such discrete areas of the cord as was once thought. The authors have determined that the ligaments are stronger in the cervical region and that they decrease in strength as the spinal cord descends. These findings are demonstrative of the denticulate ligaments being more resistant to caudal compared with cephalad stresses in the cord. Anterior and posterior motion is constrained by these ligaments but to a limited degree, especially as one descends inferiorly along the cord. Further embryological and functional studies of these ligaments is needed in non—formalin fixed tissues.