bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome after surgical treatment of progressive posttraumatic cystic myelopathy
Authors: Lee Thomas T. , Alameda Gustavo J. , Gromelski Erika B. , Green Barth A. 
Published: May 2009

Object. Progressive posttraumatic cystic myelopathy (PPCM) can occur after an injury to the spinal cord. Traditional treatment of PPCM consists of inserting a shunt into the cyst. However, some authors have advocated a more pathophysiological approach to this problem. The authors of the present study describe their surgical treatment protocol and outcome in a series of patients with syringomyelia.
Methods. Medical records of 34 patients undergoing surgical treatment for PPCM were reviewed. Laminectomies and intraoperative ultrasonography were performed. In patients without focal tethering of the spinal cord and in whom only a confluent cyst had been revealed on ultrasonography, a syringosubarachnoid shunt was inserted; in those with both tethering and a confluent cord cyst, an untethering procedure was performed first. When a significant reduction (> 50%) in the size of the cyst was shown after the untethering procedure, no shunt was inserted. When no changes in cyst size were demonstrated on ultrasonography, a short syringosubarachnoid shunt was used. The mean follow-up period was 28.7 months (range 12–102 months).
The interval between the mechanism of injury and the operation ranged from 5 months to 37 years (mean 11 years). Pain was the most frequent symptom, which was followed by motor deterioration and spasticity. Postoperative improvement was noted in 55% of patients who experienced motor function deterioration and in 53% of those who demonstrated worsening spasticity. In 14 of 18 patients with an associated tethered spinal cord, tethering alone caused significant collapse of the cyst. Postoperative magnetic resonance imaging demonstrated cyst collapse in 92% of patients who had undergone untethering alone and in 93% of those who underwent syringosubarachnoid shunt placement. Treatment failure was observed in 7% of the former group and in 13% of the latter.
Conclusions. Posttraumatic cystic myelopathy can occur with or without the presence of tethered cord syndrome. Intraoperative ultrasonography can readily demonstrate this distinction to aid in surgical decision making. Untethering alone in patients with tethered cord syndrome and cyst formation can reduce the cyst size and alleviate symptoms and signs of posttraumatic cystic myelopathy in the majority of these cases. Untethering procedures in which duraplasty is performed to expand the subarachnoid space may be a more physiologically effective way of treating tethered cord with associated syringomyelia.
Somatosensory evoked potential monitoring in anterior thoracic vertebrectomy
Authors: Deutsch Harel , Arginteanu Marc , Manhart Karen , Perin Noel , Camins Martin , Moore Frank , Steinberger A. Abe , Weisz Donald J 
Published: May 2009

Object. Spine surgeons have used intraoperative cortical and subcortical somatosensory evoked potential (SSEP) monitoring to detect changes in spinal cord function when intraoperative procedures can be performed to prevent neurological deterioration. However, the reliability of SSEP monitoring as applied to anterior thoracic vertebral body resections has not been rigorously assessed.
Methods. The authors retrospectively reviewed hospital charts and operating room records obtained between August 1993 and December 1998 and found that SSEP monitoring was used in 44 surgical procedures involving an anterior approach for thoracic vertebral body resections.
There were no patients in whom SSEP changes did not return to baseline during the surgical procedure. Patients in four cases, despite their stable SSEP recordings throughout the procedure, were noted immediately postoperatively to have experienced significant neurological deterioration. The false-negative rate in SSEP monitoring was 9%. Sensitivity was determined to be 0%.
Conclusions. It is important to recognize high false-negative rates and low sensitivity of SSEP monitoring when it is used to record spinal cord function during anterior approaches for thoracic vertebrectomies. The insensitivity of SSEPs for motor deterioration during anterior thoracic vertebrectomies is likely due to the limitation of SSEPs, which monitor only posterior column function whereas motor paths are conveyed in the anterior and anterolateral spinal cord. The authors believe that SSEPs can not be relied on to detect reversible spinal damage during anterior thoracic vertebrectomies.
Treatment of severe retromastoid pain secondary to C1–2 arthrosis by using cervical fusion
Authors: HOLLY Langsto T. , Batzdorf Ulrich , Foley Kevin T. 
Published: May 2009

Object. In this report the authors review their 5-year experience in the diagnosis and management of nine patients with severe retromastoid pain secondary to C1–2 arthrosis. Patients with symptomatic joints unresponsive to nonoperative therapy underwent cervical fusion procedures.
Methods. The mean age of the patients was 71 years, and the onset of prior symptoms ranged from 6 months to 18 years. All patients suffered similar discrete nonneuropathic pain without radicular symptoms ipsilateral to the diseased facet joint. Four patients experienced relief from pain with the use of nonoperative therapy. Five patients continued to experience intractable pain and underwent C1–2 fusion. The follow-up period ranged from 6 to 26 months. The cervical fusion procedure was successful in treating the retromastoid pain in all patients. In patients who underwent surgery, complete relief of pain was demonstrated in four and significantly reduced in the fifth.
Conclusions. The authors have drawn several conclusions. First, C1–2 arthrosis has a rather unique presentation and is a potential cause of upper posterior neck and head pain predominantly in elderly patients. Second, nonoperative management significantly improved the pain in nearly half of their patients and should be the first line of treatment. Last, C1–2 fusion was successful in treating the pain in patients in whom nonoperative management had failed to resolve symptoms.
Image-guided surgery: applications to the cervical and thoracic spine and a review of the first 120 procedures
Authors: Bolger Ciaran , Wigfield Crispin 
Published: May 2009

Object. The authors undertook a study to demonstrate that frameless stereotaxy can be applied safely to the cervical and thoracic spine to minimize complications and associated morbidity.
Methods. A retrospective review of cases was conducted involving the use of an image-guidance system for the accurate placement of surgical implants or for resection of lesions within the cervical and thoracic spine. The outcome measures considered were neural injury, vascular injury, wound infection, surgical revision, and death.
Conclusions. Image-guidance systems are useful intraoperative tools that can be applied accurately to spinal surgery. In addition, such systems can be of great use in the preoperative planning of complex spinal surgery.
Coaxial double-lumen methylmethacrylate reconstruction in the anterior cervical and upper thoracic spine after tumor resection
Authors: Miller Daniel J. , Lang Frederick F. , Walsh Garrett L. , Abi-Said Dima , Wildrick David M. , Gokaslan Ziya L. 
Published: May 2009

Object. A unique method of anterior spinal reconstruction after decompressive surgery was used to prevent methylmethacrylate—dural contact in cancer patients who underwent corpectomy. The purpose of this study was to assess the efficacy and stability of polymethylmethacrylate (PMMA) anterior surgical constructs in conjunction with anterior cervical plate stabilization (ACPS) in these patients.
Methods. Approximately 700 patients underwent spinal surgery at The University of Texas M. D. Anderson Cancer Center over a 4-year period. The authors conducted a retrospective outcome study for 29 of these patients who underwent anterior cervical or upper thoracic tumor resections while in the supine position. These patients were all treated using the coaxial, double-lumen, PMMA technique for anterior spinal reconstruction with subsequent ACPS. No postoperative external orthoses were used. Twenty-seven patients (93%) harbored metastatic spinal lesions and two (7%) harbored primary tumors. At 1 month postsurgery, significant improvement was seen in spinal axial pain (p < 0.001), radiculopathy (p < 0.00 1), gait (p = 0.008), and Frankel grade (p = 0.002). A total of nine patients (31%) underwent combined anterior—posterior 360° stabilization. Twenty-one patients (72%) experienced no complications. Complications related to instrumentation failure occurred in only two patients (7%). There were no cases in which the patients' status worsened, and there were no neurological complications or infections. The median Kaplan—Meier survival estimate for patients with spinal metastases was 9.5 months. At the end of the study, 13 patients (45%) had died and 16 (55%) were alive. Postoperative magnetic resonance images consistently demonstrated that the dura and PMMA in all patients remained separated.
Conclusions. The anterior, coaxial, double-lumen, PMMA reconstruction technique provides a simple means of spinal cord protection in patients in the supine position while undergoing surgery and offers excellent results in cancer patients who have undergone cervical vertebrectomy.
The apical ligament: anatomy and functional significance
Authors: Tubbs R. Shane , Grabb Paul , Spooner Alan , Wilson Wally , Oakes W. Jerry 
Published: May 2009

Object. The authors conducted a study to describe the detailed anatomy of the apical ligament and to acknowledge or refute its historical description as a functionally significant contributor to craniocervical stability.
Methods. In 20 adult human cadavers measurements of the apical ligament were obtained, and its detailed anatomy was observed. Ranges of motion were also assessed to discern the function of the apical ligament.
Conclusions. Results of the study support the concept that the apical ligament is best described as a vestigial structure that offers no significant added stability to the craniocervical junction. In fact, this ligament was absent in 20% of the specimens examined. These data will aid physicians who frequently view images or manage clinical problems of the craniocervical junction because they may focus on other ligaments of this area and not the apical ligament.
Segmental cervical spine motion during orotracheal intubation of the intact and injured spine with and without external stabilization
Authors: Lennarson Peter J. , Smith Darin , Todd Michael M. , Carras Douglas , Sawin Paul D. , Brayton John , Sato Yutaka , Traynelis Vincent C. 
Published: May 2009

Object. The purpose of this study was to establish a cadaveric model for evaluating cervical spine motion in both the intact and injured states and to examine the efficacy of commonly used stabilization techniques in limiting that motion.
Methods. Intubation was performed in fresh human cadavers with intact cervical spines, following the creation of a C4–5 posterior ligamentous injury. Movement of the cervical spine during direct laryngoscopy and intubation was recorded using video fluoroscopy and examined under the following conditions: 1) without external stabilization; 2) with manual in-line cervical immobilization; and 3) with Gardner—Wells traction. Subsequently, segmental motion of the occiput through C-5 (Oc—C5) was measured from digitized frames of the recorded video fluoroscopy.
The predominant motion, at all levels measured in the intact spine, was extension. The greatest degree of motion occurred at the atlantooccipital (Oc—C1) junction, followed by the C1–2 junction, with progressively less motion at each more caudal level. After posterior destabilization was induced, the predominant direction of motion at C4–5 changed from extension to flexion, but the degree of motion remained among the least of all levels measured. Traction limited but did not prevent motion at the Oc—C1 junction, but neither traction nor immobilization limited motion at the destabilized C4–5 level.
Conclusions. Cadaveric cervical spine motion accurately reflected previously reported motion in living, anesthetized patients. Traction was the most effective method of reducing motion at the occipitocervical junction, but none of the interventions significantly reduced movement at the subaxial site of injury. These findings should be considered when treating injured patients requiring orotracheal intubation.
Methylprednisolone for acute spinal cord injury: an inappropriate standard of care
Authors: Hurlbert R. John 
Published: May 2009

Object. Since publication in 1990, results from the National Acute Spinal Cord Injury Study II (NASCIS II) trial have changed the way patients suffering an acute spinal cord injury (SCI) are treated. More recently, recommendations from NASCIS III are being adopted by institutions around the world. The purpose of this paper is to reevaluate carefully the results and conclusions of these studies to determine the role they should play in influencing decisions about care of the acutely spinal cord—injured patient.
Methods. Published results from NASCIS II and III were reviewed in the context of the original study design, including primary outcomes compared with post-hoc comparisons. Data were retroconverted from tabular form back to raw form to allow direct inspection of changes in treatment groups. These findings were further analyzed with respect to justification of practice standards.
Although well-designed and well-executed, both NASCIS II and III failed to demonstrate improvement in primary outcome measures as a result of the administration of methylprednisolone. Post-hoc comparisons, although interesting, did not provide compelling data to establish a new standard of care in the treatment of patients with acute SCI.
Conclusions. The use of methylprednisolone administration in the treatment of acute SCI is not proven as a standard of care, nor can it be considered a recommended treatment. Evidence of the drug's efficacy and impact is weak and may only represent random events. In the strictest sense, 24-hour administration of methylprednisolone must still be considered experimental for use in clinical SCI. Forty-eight-hour therapy is not recommended. These conclusions are important to consider in the design of future trials and in the medicolegal arena.
Spectrum of occipitoatlantoaxial injury in young children
Authors: Sun Peter P. , Poffenbarger Glen J. , Durham Susan , Zimmerman Robert A. 
Published: May 2009

Object. Injuries of the occipitoatlantoaxial (Oc—C2) region are the predominant form of cervical injury in children younger than 10 years of age. Magnetic resonance (MR) imaging can be used to visualize directly the traumatic ligamentous and soft-tissue abnormalities of the Oc—C2 region. A retrospective review was undertaken to examine the spectrum of pediatric Oc—C2 injuries seen on MR imaging, their correlation with plain x-ray film and computerized tomography findings, and their clinical course.
Methods. Seventy-one consecutive children younger than 10 years of age underwent cervical MR imaging for evaluation of traumatic injury. Magnetic resonance imaging was used to document abnormalities in 23 children; 20 of these injuries involved the Oc—C2 region. Abnormalities in the Oc—C2 region included disruptions of the musculature, apical ligament, atlantooccipital joint(s), tectorial membrane, and spinal cord. A spectrum of injury with progressive involvement of these structures was seen, ranging from isolated muscular injury to the multiple soft-tissue and ligamentous disruptions with craniocervical dislocation. Involvement of the tectorial membrane was the critical threshold in the transition from stable to unstable injury. Analysis of plain x-ray films revealed that a novel interspinous C1–2:C2–3 ratio criteria of greater than or equal to 2.5 was predictive of tectorial membrane abnormalities on MR imaging, with 87% sensitivity and 100% specificity. In patients with tectorial membrane abnormalities who underwent immobilization alone, interim platybasia was demonstrated on follow-up MR images.
Conclusions. A progressive spectrum of distinct Oc—C2 injuries can occur in young children; the tectorial membrane is a critical stabilizing ligamentous structure in the Oc—C2 complex; and tectorial membrane abnormalities may be identified by a C1–2:C2–3 ratio of greater than or equal to 2.5.
New method for intraoperative determination of proper screw insertion or screw malposition
Authors: Açıkbaş Sabri Cem , Tuncer Mehmet Recai 
Published: May 2009

Object. Inadequate imaging techniques may lead to misjudgment of screw positioning when applying transpedicular instrumentation; this can create potential risks of major vessel and nerve damage. In this article the authors present a new method to determine screw malpositioning intraoperatively.
Methods. The authors retrospectively evaluated pre- and postoperative plain radiographs of 97 spinal segments in which screws had been placed in 41 patients suffering from thoracolumbar injury who had previously undergone transpedicular screw fixation. They developed a new mathematical equation with which they determine the distance ratios of two screw tips in the same segment by comparing the distance between the pedicles on preoperative radiographs with those on postoperative radiographs. Subsequently, the results are compared with postoperative computerized tomography findings to determine which screws are in the correct position and which are penetrating the medial or lateral cortex of the pedicle. It was found that the ratio range of correctly placed screw tips was 46 ± 10% (mean ± standard deviation) in the thoracic region and 60 ± 9% in the lumbar region (ranges 43–50% and 57–63%, respectively, 95% confidence intervals). Higher ratios (higher percentages) than these values indicated extreme closeness of screw tips and therefore medial malpositioning. Lower ratios (lower percentages) indicated lateral malpositioning.
Conclusions. This proposed method may provide intraoperative determination of correct screw positioning or malpositioning. This method allows surgeons to replace the malpositioned screw, and, consequently, early resolution of neurovascular injuries is made possible. Additionally, repositioning of the screw correctly will avoid rigidity failure of the fixation device.
Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience
Authors: Lyons Mark K. , Atkinson John L. D. , Wharen Robert E. , Deen H. Gordon , Zimmerman Richard S. , Lemens Susan M. 
Published: May 2009

Object. The authors report a retrospective analysis of 194 patients surgically treated at their institutions for symptomatic lumbar synovial cysts from January 1974 to January 1996.
Methods. Patient characteristics including age, sex, symptoms, signs, and preoperative neuroimaging studies were reviewed. Surgical procedures, complications, results, and pathological findings were correlated with preoperative assessment. One hundred ninety-four patients were surgically treated for symptomatic lumbar synovial cysts. Eighty percent were diagnosed and treated between 1987 and 1996. There were 100 men and 94 women with an average age of 66 years (range 28–94 years). The most common symptoms were painful radiculopathy (85%) and neurogenic single or multiroot claudication (44%). However, sensory loss (43%) and motor weakness (27%) were also presenting symptoms. Eleven percent of patients had undergone previous lumbar surgery prior to being referred to the Mayo Clinic. Preoperative neurological examination demonstrated motor weakness (40%), sensory loss (45%), reflex changes (57%), and variants of cauda equina syndrome (13%). In 19% of patients, normal neurological status was demonstrated. There was equal left/right-sided laterality, and eight patients presented with bilateral synovial cysts. The most commonly affected level was L4–5 (64%). All patients underwent laminectomy and resection of the cyst. Concomitant fusion was performed in 18 patients in whom clinical evidence of instability had been observed. However, subsequent fusion was required in only four patients who developed symptomatic spondylolisthesis. Surgery-related complications included cerebrospinal fluid leak (three patients), discitis (one patient), epidural hematoma (one patient), seroma (one patient), and deep vein thrombosis (one patient). One patient died 3 days after surgery of cardiac dysrhythmia. Follow-up data obtained for at least 6 months postoperatively were available in 147 patients. Of these, 134 (91%) reported good relief of their pain and 82% experienced improvement in their motor deficits.
Conclusions. Lumbar synovial cysts are a more common cause of lumbar radicular pain than previously thought. Surgical removal of the cyst is a safe and effective treatment for symptomatic relief in patients with lumbar synovial cysts. A concomitant fusion procedure may be performed in select cases. In this study, only a few patients developed symptomatic spinal instability requiring a second operation.
Protein kinase inhibition by fasudil hydrochloride promotes neurological recovery after spinal cord injury in rats
Authors: Hara Masahito , Takayasu Masakazu , Watanabe Kazuhiko , Noda Atsushi , Takagi Teruhide , Suzuki Yoshio , Yoshida Jun 
Published: May 2009

Object. In Japan fasudil hydrochloride (HA1077), a protein kinase inhibitor, is widely administered to prevent vasospasm in patients after subarachnoid hemorrhage. The effects of fasudil on experimental spinal cord injury (SCI) were investigated and compared with those obtained using methylprednisolone.
Methods. Spinal cord contusion was induced in rats by applying an aneurysm clip extradurally to the spinal cord at T-3 for 1 minute. After injury three groups of rats were treated with intravenously administered saline (control), intraperitoneally administered fasudil (10 mg/kg), or intravenously administered methylprednisolone (four 30 mg/kg injections). Neurological recovery was evaluated periodically over 1 month by using a modified combined behavioral scale and histopathological examination. Leukocyte infiltration near the injury site was evaluated by measuring myeloperoxidase (MPO) activity at 24 hours. Spinal cord blood flow was measured at intervals up to 3 hours after injury by using laser Doppler flowmetry.
In rats in the fasudil-treated group significant improvement in modified combined behavioral score was demonstrated at each time point, whereas in the methylprednisolone-treated rats no beneficial effects were shown. In the fasudil-treated group, reduction of traumatic spinal cord damage was evident histologically in the caudal portion of the injured areas, and tissue MPO activity in tissue samples was reduced. Spinal cord blood flow was not significantly different between fasudiltreated and control group rats.
Conclusions. Fasudil hydrochloride showed promise of effectiveness in promoting neurological recovery after traumatic SCI. Possible mechanisms of this effect include protein kinase inhibition and decreased infiltration by neutrophils.