bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complications associated with the prophylactic use of methylprednisolone during surgical stabilization after spinal cord injury
Authors: Molano Maria Del Rosario , Broton James G. , Bean Judy A. , Calancie Blair 
Published: May 2009

Object. The authors attempted to determine if there is a significant relationship between the incidence of medical complications and the prophylactic use of methylprednisolone (MP) during spine surgery in patients with acute spinal cord injury (SCI) who had already received MP on hospital admission (typically in the setting of an Emergency Room/Trauma Center).
Methods. The authors studied 73 patients with acute SCI who were admitted to the hospital for at least 7 days postinjury. All patients 1) received a 24-hour regimen of MP in the acute period of hospitalization; and 2) underwent surgery to stabilize the spine and/or decompress the spinal cord. Patients were separated into two groups on the basis of whether they received additional MP therapy during spine surgery. A chart review was conducted retrospectively to determine the incidence of complications up to 6 weeks postinjury. Muscle strength and American Spinal Injury Association grades were determined prospectively throughout the follow-up period.
In patients who received two courses of MP following acute SCI (one at initial hospitalization and one during surgery), a significantly increased probability of complications was demonstrated compared with those who received no MP therapy during surgery. This was particularly evident when the incidences of serious complications were compared.
Conclusions. Prophylactic use of MP as a neuroprotective agent during spine surgery in patients with acute SCI should be avoided in those in whom MP was administered on admission to the hospital.
Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography
Authors: Doi Kazuteru , Otsuka Ken , Okamoto Yukinori , Fujii Hiroshi , Hattori Yasunori , Baliarsing Amresh S. 
Published: May 2009

Object. The authors describe a new magnetic resonance (MR) imaging technique to demonstrate the status of the cervical nerve roots involved in brachial plexus injury. They discuss the accuracy and reproducibility of a MR imaging—derived classification for diagnosis of nerve root avulsion compared with those of myelography combined with computerized tomography (CT) myelography.
Methods. The overlapping coronal—oblique slice MR imaging procedure was performed in 35 patients with traumatic brachial plexus injury and 10 healthy individuals. The results were retrospectively evaluated and classified into four major categories (normal rootlet, rootlet injuries, avulsion, and meningocele) after confirming the diagnosis by surgical exploration with or without spinal evoked potential (EP) measurements and by referring to myelography and CT myelography findings. The reliability and reproducibility of the MR imaging—based classification was prospectively assessed by eight independent observers, and its diagnostic accuracy was compared with that of traditional myelography/CT myelography classification, correlated with surgical and spinal EP findings in another 50 cervical roots in 10 patients with traumatic brachial plexus injury.
Conclusions. In the retrospective study in which MR imaging and myelography/CT myelography findings involving 175 cervical roots in 35 patients were compared, the sensitivity of detection of the cervical nerve root avulsion was the same (92.9%) with both modalities. In the prospective study, interobserver reliability and intraobserver reproducibility showed that there was no statistically significant difference between MR imaging and myelography/CT myelography and that their accuracy for detecting cervical root avulsion was the same as that in the retrospective study.
The overlapping coronal—oblique slice MR imaging technique is a reliable and reproducible method for detecting nerve root avulsion. The information provided by this modality enabled the authors to assess the roots of the brachial plexus and provided valuable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction, or other imaging modalities.
Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics
Authors: Holly Langston T. , Kelly Daniel F. , Counelis George J. , Blinman Thane , McArthur David L. , Cryer H. Gill 
Published: May 2009

Object. Diagnosing and managing cervical spine trauma in head-injured patients is problematic due to an altered level of consciousness in such individuals. The reported incidence of cervical spine trauma in head-injured patients has generally ranged from 4 to 8%. In this retrospective study the authors sought to define the incidence of cervical injury in association with moderate or severe brain injury, emphasizing the identification of high-risk patients.
Methods. The study included 447 consecutive moderately (209 cases) or severely (238 cases) head injured patients who underwent evaluation at two Level 1 trauma centers over a 40-month period. Of the 447 patients, 24 (5.4%) suffered a cervical spine injury (17 men and seven women; mean age 39 years; median Glasgow Coma Scale [GCS] score of 6, range 3–14). Of these 24 patients, 14 (58.3%) sustained spinal cord injuries (SCIs), 14 sustained injuries in the occiput—C3 region, and 10 underwent a stabilization procedure. Of the 14 patients with SCIs, nine experienced an early hypotensive and/or hypoxic insult. Regarding the mechanism of injury, cervical injuries occurred in 21 (8.2%) of 256 patients involved in motor vehicle accidents (MVAs), either as passengers or pedestrians, compared with three (1.6%) of 191 patients with non-MVA-associated trauma (p < 0.01). In the subset of 131 MVA passengers, 13 (9.9%) sustained cervical injuries. Patients with an initial GCS score less than or equal to 8 were more likely to sustain a cervical injury than those with a score higher than 8 (odds ratio [OR] 2.77, 95% confidence interval [CI] = 1.11–7.73) and were more likely to sustain a cervical SCI (OR 5.5, 95% CI 1.22–24.85). At 6 months or more postinjury, functional neurological recovery had occurred in nine patients (37.5%) and eight (33.3%) had died.
Conclusions. Head-injured patients sustaining MVA-related trauma and those with an initial GCS score less than or equal to 8 are at highest risk for concomitant cervical spine injury. A disproportionate number of these patients sustain high cervical injuries, the majority of which are mechanically unstable and involve an SCI. The development of safer and more rapid means of determining cervical spine integrity should remain a high priority in the care of head-injured patients.
Surgical treatment of lumbar stenosis in achondroplasia
Authors: Thomeer Ralph T. W. M. , van Dijk J. Marc C. 
Published: May 2009

Object. The authors conducted a study to evaluate the results of a unique surgical procedure for treating primary lumbar stenosis in patients with achondroplasia, based on its distorted anatomical dimensions.
Methods. A consecutive single-center series of 36 achondroplastic dwarfs with symptomatic lumbar stenosis underwent dynamic lumbar myelography to determine the most stenotic lumbar segment. This level was surgically decompressed by selective widening of the lumbar interapophyseolaminar diameter; laminectomy was not performed.
The L2–3 level was decompressed in 97% of the cases and the L1–2 and L3–4 levels in 58 and 61%, respectively. Lower lumbar levels were rarely affected by stenosis. Stenosis typically did not occur at the level of the lamina, where the pseudoscalloping of the vertebral body compensates for the spinal narrowing, obviating the need for laminectomy. Complete relief of symptoms was demonstrated in 25 (71.4%) of 35 patients. Tolerable disease remained in eight patients (22.9%) postoperatively. In two cases (5.7%) surgery resulted in no benefit. One case was lost to follow up. The presence of a lumbar epidural hematoma complicated one procedure.
Conclusions. In this series the interapophyseolaminar decompression was demonstrated to be an effective and safe procedure for the treatment of symptomatic stenosis in achondroplasia. The upper lumbar segments, particularly the L2–3 level, were most frequently involved. Dynamic lumbar myelography proved mandatory in demonstrating the symptomatic level.
Traumatic thoracic spinal fracture dislocation with minimal or no cord injury
Authors: Shapiro Scott , Abel Todd , Rodgers Richard B. 
Published: May 2009

Object. Thoracic fracture dislocations reportedly lead to complete paraplegia in 80% of cases. It is rare for these dislocations not to cause neurological deficits, as evidenced by the mere 11 well-documented neurologically intact cases in the English-language literature.
Methods. The authors report four cases of thoracic fracture dislocation that remained neurologically intact and discuss 11 other previously published well-documented cases.
Overall there were 10 men and five women with a mean age of 34 years (range 17–66 years). Mechanisms of injury included car crash in six, motorcycle crash in seven, plane crash in one, and fall from a horse in one. On admission, neurological deficits were absent in 11 patients, intercostal neuralgia was present in two, and mild lower-extremity weakness/numbness was demonstrated in two. All suffered significant thoracic pain, with 14 patients having sustained rib fractures and eight a hemothorax. The levels of dislocation were T3–4 in two, T5–6 in four, T6–7 in four, T7–8 in two, T8–9 in one, and T9–10 in two. All suffered some degree of lateral translation (mean 12 mm, range 3–27 mm). There were six cases of well-documented anterior subluxation in addition to translation (mean 12 mm, range 4–23 mm), and all involved some degree of fracture imploding of one vertebral body (VB) into an adjacent VB. There were six cases of burst fracture with translation (mean kyphotic angle 38°, range 28–50°). Bilateral pedicle shear fractures were present in all 15 cases at the site of subluxation, thus separating the anterior from the posterior elements and preserving the spinal canal. Only two of the 15 patients suffered complete spondylolisthesis. Five patients underwent successful nonoperative management with prolonged bed rest; at follow-up examination, neurological status remained normal in all five, lesions were radiographically unchanged in three, and there was less subluxation but not anatomical alignment in two. Ten patients underwent successful internal fixation via anterior approaches (two cases), posterior approaches (five cases), and combined approaches (three cases). Neurological status either improved to normal or remained normal except in one case with persistent intercostal neuralgia. Surgery resulted in no change in alignment in three, improved but not anatomical alignment in 11, and normal alignment in one patient. All patients ambulated unassisted by 6 months.
Conclusions. In cases in which bilateral pedicle fractures occur at the site of significant thoracic subluxation and/or translation, preservation of the spinal canal and spinal cord neurological function can rarely occur when both the lamina and spinal cord do not dislocate along with the anterior VBs. In these instances, perfect anatomical reduction may require forces that unnecessarily put neurological function at risk and the results appear to justify internal fixation with some or no reduction of deformity.
Avulsion transverse ligament injuries in children: successful treatment with nonoperative management
Authors: Lo Patrick A. , Drake James M. , Hedden Douglas , Narotam Pradeep , Dirks Peter B. 
Published: May 2009

✓ Neck injuries in children most commonly affect the upper cervical spine. Injuries of the transverse ligament and its attachments may result in C1–2 instability, but the optimum form of treatment is unknown.
Three patients, who ranged in age from 5 to 11 years, sustained transverse atlantal ligament injuries with unilateral avulsion fracture of the osseous tubercle of C-1. One child was injured in a fall and two were involved in motor vehicle accidents. Although all patients presented with neck pain, none exhibited neurological deficits. Plain radiography demonstrated no evidence of osseous injury, but an increased predental interval was noted in each case. Computerized tomography (CT) scanning demonstrated the avulsion fractures, and magnetic resonance imaging revealed evidence of soft-tissue injuries in the occipital—C2 ligamentous complex. All children were managed with external immobilization (halo vest in two and a Sterno-Occipito-Mandibular Immobilizer brace in one), for 6 to 12 weeks. Follow-up CT scanning demonstrated reattachment of the avulsed osseous tubercle, and dynamic cervical spine radiographs revealed the absence of C1–2 instability.
The results of these cases suggest a role for external immobilization in the treatment of osseous avulsion injuries of the transverse atlantal ligament in children.
Spontaneous intracranial hypotension due to thoracic disc herniation
Authors: Winter Stuart C. A. , Maartens Nicholas F. , Anslow Philip , Teddy Peter J. 
Published: May 2009

✓ Spontaneous intracranial hypotension is frequently idiopathic. The authors report on a patient presenting with symptomatic intracranial hypotension caused by a transdural calcified thoracic disc herniation. Cranial magnetic resonance (MR) imaging revealed classic signs of intracranial hypotension, and a combination of spinal MR and computerized tomography myelography confirmed a mid-thoracic transdural calcified herniated disc as the cause. The patient was treated with an epidural blood patch and burr hole drainage of the subdural effusion on two occasions. Postoperatively the headache resolved and there was no neurological deficit.
Thoracic disc herniation may be a cause of spontaneous intracranial hypotension.
Atraumatic bloodless removal of intramedullary hemangioblastomas of the spinal cord
Authors: Malis Leonard I. 
Published: May 2009

Object. The goal of this study was to summarize the author's personal experience in the surgical treatment of 19 patients with intramedullary spinal cord hemangioblastomas.
Methods. All cases were from the author's private practice and were treated between 1967 and 1990. In all cases the intramedullary hemangioblastomas were totally removed by using a unique microsurgical technique of bipolar coagulation, which is fully described in this paper. A bipolar forceps was used to shrink each tumor and detach it from its feeding and draining vessels. Tumor resection was successfully accomplished in all patients. Blood loss was minimal, averaging less than 100 ml, and what little bleeding occurred did so during laminotomy or laminectomy. No bleeding occurred during tumor removal, and no transfusions were given. All patients were symptomatic preoperatively, and all recovered or improved following surgery.
Conclusions. The technique described in this paper makes tumor removal safe, effective, and relatively easy.
Combined anterior—posterior fusion for cervical spondylotic myelopathy in patients with athetoid cerebral palsy
Authors: Onari Katsuhiro , Kondo Soichi , Mihara Hisanori , Iwamura Yuichi 
Published: May 2009

Object. Cervical spondylotic myelopathy (CSM) or myeloradiculopathy, frequent in adults with athetoid cerebral palsy, is a serious secondary disability in patients with an existing congenital handicap. Although several surgical procedures have been described for CSM in adults with athetoid cerebral palsy, none has had satisfying long-term results. The object of this study was to evaluate the effectiveness and safety of combined anterior—posterior fusion with wave-shaped rods and its influence on the stability of other spinal segments.
Methods. Twenty-three patients with CSM and athetoid cerebral palsy underwent posterior fusion with wave-shaped rods combined with anterior interbody fusion with internal fixation; 20 patients, 17 men and three women, were followed for more than 5 years. This procedure yielded good results. The mean follow-up period was 8.7 years (range 5–17 years). At 1-year follow-up examination, ambulation had improved in 12 patients. Upper-extremity pain, deltoid muscle weakness, and ability to self-feed improved in almost all patients. Myelopathy recurred in one patient 8.5 years after surgery. The mean motion angle at the adjacent level to the fixed segment did not change postoperatively, but the mean motion between C-1 and C-2 increased and slight atlantoaxial subluxation occurred postoperatively in five patients.
Conclusions. Combined anterior—posterior fusion can effectively improve neurological function in patients with CSM and athetoid cerebral palsy, even in those with severe involuntary movements. Postoperative rigid external fixation is not required.
Traumatic central cord syndrome: results of surgical management
Authors: Guest James , Eleraky Mohammed A. , Apostolides Paul J. , Dickman Curtis A. , Sonntag Volker K. H. 
Published: May 2009

Object. The authors compare clinical outcomes demonstrated in patients with traumatic central cord syndrome (CCS) who underwent early (< 24 hours after injury) or late (> 24 hours after injury) surgery.
Methods. The clinical characteristics, radiographic findings, surgery-related results, length of hospital stay (LOS), and clinical outcomes obtained in 50 patients with surgically treated traumatic CCS were reviewed retrospectively. Shorter intensive care unit (ICU) stay and LOS were observed in all patients who underwent early surgery compared with those who underwent late surgery. In patients with CCS secondary to acute disc herniation or fracture/dislocation who underwent early surgery significantly greater overall motor improvement was observed than in those who underwent late surgery (p = 0.04). Overall motor outcome in patients with CCS secondary to spinal stenosis or spondylosis who underwent early surgery was not significantly different from that in those who underwent late surgery (p = 0.51). Worse motor outcomes were found in patients who were older than 60 years of age and in whom initial bladder dysfunction was present (p = 0.03 and 0.02, respectively) compared with younger patients without bladder dysfunction.
Conclusions. Early surgery is safe and more cost effective than late surgery for the treatment of traumatic CCS, based on ICU stay and LOS and improved overall motor recovery, in patients whose CCS was related to acute disc herniation or fracture. In the setting of spinal stenosis or spondylosis, early surgery was safe but did not improve motor outcome compared with late surgery.
Ultrastructural scoring of graded acute spinal cord injury in the rat
Authors: Kaptanoglu Erkan , Palaoglu Selcuk , Surucu H. Selcuk , Hayran Mutlu , Beskonakli Etem 
Published: May 2009

Object. There is a need for an accurate quantitative histological technique that also provides information on neurons, axons, vascular endothelium, and subcellular organelles after spinal cord injury (SCI). In this paper the authors describe an objective, quantifiable technique for determining the severity of SCI. The usefulness of ultrastructural scoring of acute SCI was assessed in a rat model of contusion injury.
Methods. Spinal cords underwent acute contusion injury by using varying weights to produce graded SCI. Adult Wistar rats were divided into five groups. In the first group control animals underwent laminectomy only, after which nontraumatized spinal cord samples were obtained 8 hours postsurgery. The weight-drop technique was used to produce 10-, 25-, 50-, and 100-g/cm injuries. Spinal cord samples were also obtained in the different trauma groups 8 hours after injury. Behavioral assessment and ultrastructural evaluation were performed in all groups.
When the intensity of the traumatic injury was increased, behavioral responses showed a decreasing trend. A similar significant negative correlation was observed between trauma-related intensity and ultrastructural scores.
Conclusions. In the present study the authors characterize quantitative ultrastructural scoring of SCI in the acute, early postinjury period. Analysis of these results suggests that this method is useful in evaluating the degree of trauma and the effectiveness of pharmacotherapy in neuroprotection studies.
Functional recovery after complete contusion injury to the spinal cord and transplantation of human neuroteratocarcinoma neurons in rats
Authors: Saporta Samuel , Makoui A. Shahram , Willing Alison E. , Daadi Marcel , Cahill David W. , Sanberg Paul R. 
Published: May 2009

Object. Human neuroteratocarcinoma (hNT)—derived neurons are differentiated postmitotic neurons derived from a human teratocarcinoma cell line following treatment with retinoic acid. In preclinical transplantation studies investigators have demonstrated both their safety as a source of neurons for transplantation and efficacy in treating stroke-related behavioral deficits. The objective of this study was to examine whether hNT neurons transplanted in an area of complete spinal cord contusion would improve electrophysiological measures of spinal cord function.
Methods. Complete spinal cord contusion injury, defined as the complete loss of motor evoked potentials (MEPs), was produced in 30 rats at T-8. Ten rats with contused spinal cords underwent transplantation with hNT neurons within the site of contusion immediately after injury (immediate transplant group). Ten rats underwent hNT neuron transplantation following a 2-week evaluation for loss of MEPs (delayed transplant group). Ten other rats with contusion injury served as a spinal cord injury control group, and 10 rats underwent only a T-8 laminectomy and served as noninjured controls. All rats survived 8 weeks after transplantation. In the delayed transplant group significant functional recovery was observed, as demonstrated by return of MEPs and a modest improvement of motor function. Immunohistochemical analysis showed the survival, integration, and long fiber outgrowth of the grafted hNT neurons.
Conclusions. These findings suggest that the transplantation of the hNT neurons may be an effective means of reestablishing electrical connectivity of the injured spinal cord.