bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of anorectal function in patients with tethered cord syndrome: saline enema test and fecoflowmetry
Authors: Kayaba Hiroyuki , Hebiguchi Tatsuzo , Itoh Yasunobu , Yoshino Hiroaki , Mizuno Masaru , Morii Mayako , Adachi Tetsuya , Chihara Junichi , Kato Tetsuo 
Published: May 2009

Object. Disturbance in anorectal function is a major factor restricting the activities of daily living in patients with spinal cord disorders. To detect changes in anorectal motilities due to a tethered spinal cord, anorectal functions were evaluated using a saline enema test and fecoflowmetry before and after patients underwent untethering surgery.
Methods. The bowel functions in five patients with a tethered cord syndrome (TCS) were evaluated by performing a saline enema test and fecoflowmetry. The contractile activity of the rectum, the volume of infused saline tolerated in the rectum, anal canal pressure, and the ability to evacuate rectal content were examined.
The characteristic findings in anorectal motility studies conducted in patients with TCS were a hyperactive rectum, diminished rectal saline-retention ability, and diminished maximal flow in saline evacuation. A hyperactive rectum was considered to be a major contributing factor to fecal incontinence. In one asymptomatic patient diminished anal squeezing pressure was exhibited and was incontinent to liquid preoperatively, but recovered after surgery. Two patients who underwent surgery for myeloschisis as infants complained of progressive fecal incontinence when they became adolescents. In one patient fecal incontinence improved but in another patient no improvement was observed after untethering surgery.
Conclusions. Fecodynamic studies allow the detection of neurogenic disturbances of the anorectum in symptomatic and also in asymptomatic patients with TCS. More attention should be paid to the anorectal functions of patients with TCS.
Atlantoaxial interlaminar distances in cervical flexion in children
Authors: Tubbs R. Shane , Smyth Matthew D. , Wellons John C. , Blount Jeffrey P. , Grabb Paul A. , Oakes W. Jerry 
Published: May 2009

Object. To the best of the authors' knowledge, no quantitative analysis of the atlantoaxial interlaminar distance in flexion (ILD) in children exists in the medical literature. In this study they sought to determine the age-matched relationship between the posterior elements of the atlas and axis in children in cervical spine flexion, to be used as an adjunct to the atlantodental interval in common clinical use.
Methods. Lateral radiographs of the cervical spine in full flexion were analyzed in 74 children. The atlantoaxial ILD was defined as the distance between a midpoint of the anterior cortices of the atlantal and axial posterior arches.
The mean ILD for the entire group was 19 mm (range 8–30 mm). No significant difference was seen between male and female patients (p = 0.084). When stratified by age, the mean ILD was 12.3 ± 3 mm (15 cases) in children age 3 years or younger and 20.5 ± 4.7 mm (59 cases) in children age older than 3 years. Further stratification of the groups yielded a mean ILD of 10.4 ± 1.4 [eight cases]) in children age 1 to 2 years, and 14.4 ± 4.7 mm (seven cases) in children age 3 years. In children older than 3 years of age the mean ILD was consistently approximately 20 ± 5 mm regardless of age.
Conclusions. Rapid, safe, and accurate diagnosis of the cervical spine is essential in critical care. Knowledge of the distance between the posterior elements of the atlas and axis in flexion should enhance the clinicians' (those who clear cervical spines) ability to diagnose accurately atlantoaxial instability on lateral radiographs obtained in flexion.
Titanium cage reconstruction after cervical corpectomy
Authors: Dorai Zeena , Morgan Howard , Coimbra Caetano 
Published: May 2009

Object
The authors evaluated the efficacy of titanium cage— and anterior cervical plate (ACP)—augmented fusion for reconstruction following decompressive cervical corpectomy in nontraumatic disease.

Methods
Forty-five patients ranging from 37 to 77 years of age underwent anterior cervical corpectomy followed by titanium cage—assisted reconstruction in which the cages were filled with autologous bone obtained from the resected vertebral bodies (VBs). Plates were placed in all patients. Follow-up radiographic evaluation included computerized tomography scanning and plain flexion—extension radiography.
Fusion was demonstrated in all but one patient without reconstruction-related complications. The single complication involved an endplate VB fracture with pistoning of the cage into the VB. The mean follow-up period was 12.9 months.

Conclusions
Autologous corpectomy bone—filled titanium cages supplemented with ACPs are an effective means of reconstruction after compressive cervical corpectomy. This technique provides a reasonable alternative to procedures involving long solid strut grafts obtained from the bone bank or from the patient.
Diagnostic accuracy of magnetic resonance imaging for detecting posterior ligamentous complex injury associated with thoracic and lumbar fractures
Authors: Haba Hitoshi , Taneichi Hiroshi , Kotani Yoshihisa , Terae Satoshi , Abe Satoru , Yoshikawa Hiroyuki , Abumi Kuniyoshi , Minami Akio , Kaneda Kiyoshi 
Published: May 2009

Object
The posterior ligamentous complex (PLC) in the thoracic and lumbar spine is one of the region's important stabilizers. The precise diagnosis of PLC injury is required to evaluate the instability of the injured spine; however, the accuracy of magnetic resonance (MR) imaging for diagnosing PLC injury has remained unclear. In this study, the authors compared preoperative MR imaging findings with direct intraoperative observation of PLC injury, clarifying the former's diagnostic accuracy regarding detection of PLC injury associated with the thoracic and lumbar fractures.

Methods
Data obtained in 35 patients who sustained thoracic or lumbar injuries were reviewed. There were 17 burst fractures, six flexion—distraction injuries, and 12 fracture dislocations. Each patient underwent MR imaging examination within 3 weeks of injury. Three radiologists independently evaluated sagittal MR images in a blinded fashion. The PLC-related information was retrospectively collected from each operative record. The diagnostic accuracy of MR imaging was analyzed by comparing imaging-documented intraoperative findings.
The PLC injuries were detected in 23 patients (65.7%) by direct observation during posterior spinal procedures. The diagnostic accuracy of MR imaging in detecting injury of the supraspinous ligament (SSL) and interspinous ligament (ISL) was 90.5 and 94.3%, respectively. The specificity of T1-weighted MR imaging alone for depicting the SSL was significantly greater than T2-weighted imaging alone (p < 0.05). The overall mean κ coefficient for MR imaging findings of PLC injury was 0.803, which indicated excellent interobserver reliability; that for ISL (0.915) was significantly greater than that for SSL (0.69) (p < 0.05).

Conclusions
This study clarified a high diagnostic accuracy and interobserver reliability of MR imaging for PLC injury. The precise diagnosis of PLC injury is essential to determine the mechanical instability of the injured thoracic and lumbar spine, especially in differentiating unstable (three-column) burst fractures from the relatively stable (two-column) type. The authors conclude that MR imaging is a powerful diagnostic tool to evaluate PLC injury associated with thoracic and lumbar fractures.
Immunohistochemical analysis of the extracellular matrix in the posterior capsule of the zygapophysial joints in patients with degenerative L4–5 motion segment instability
Authors: Boszczyk Bronek M. , Boszczyk Alexandra A. , Korge Andreas , Grillhösl Andreas , Boos Wolf-Dietrich , Putz Reinhard , Milz Stefan , Benjamin Michael 
Published: May 2009

Object
Although the hypertrophied shape of the zygapophysial joints in degenerative instability of the lumbar spine is well known, its underlying pathophysiological mechanism is unclear. The authors sought to provide evidence that there is increased fibrocartilaginous metaplasia in the posterior joint capsule resulting from greater mechanical loading; the authors suggest that these capsular changes are central to understanding the altered joint shape.

Methods
The L4–5 posterior articular complex was removed in 14 patients undergoing fusion for degenerative instability. After methanol-assisted fixation, cryosections were immunolabeled for a wide range of extracellular matrix molecules. These were collagens (Types I, II, III, V, and VI), glycosaminoglycans (chondroitin 4 and 6 sulfates; dermatan- and keratan-sulfate), and proteoglycans (versican, tenascin, aggrecan, and its associated link protein). The grade of degeneration of the articular complexes was assessed radiologically and histologically.

Conclusions
The results of this study provide molecular evidence for an altered loading history on the joint capsule. The pronounced loss of intervertebral disc height that occurred in all patients with severe degeneration of the lumbar motion segment promotes an increased range of axial rotation that places the posterior capsule under greater mechanical load. Compared with normal joints studied previously, the posterior capsules involved in these degenerative joint complexes were hypertrophied and fibrocartilaginous throughout. Cartilaginous metaplasia was especially pronounced at the attachment sites (entheses) where the fibrocartilage now extended beyond the original level of the joint space, and capped the osseous spurs arising from these attachment sites.
Thoracoscopic limited T-3 sympathicotomy for primary hyperhidrosis: prevention for compensatory hyperhidrosis
Authors: Yoon Do Heum , Ha Yoon , Park Yong Gou , Chang Jin Woo 
Published: May 2009

Object
Compensatory hyperhidrosis is a major and troublesome complication of thoracoscopic sympathectomy for primary hyperhidrosis. The incidence of compensatory hyperhidrosis has been reported to be as high as 50 to 97% in the patients who underwent sympathetic ganglia resection. In this study the authors evaluate the role of thoracoscopic T-3 sympathicotomy for primary hyperhidrosis and the prevention of compensatory hyperhidrosis.

Methods
Thoracoscopic T-3 sympathicotomy was performed in 27 patients with either isolated palmar hyperhidrosis (24 cases) or that in combination with axillary hyperhidrosis (three cases) during a 3-year period. In the cases of combined palmar/axillary hyperhidrosis, the T-4 sympathetic ganglion also was coagulated. The mean follow-up period was 19.7 months. Surgery-related results were determined on the basis of complications, compensatory hyperhidrosis, and patient-related satisfaction.
In the immediate postoperative period all 24 patients with palmar hyperhidrosis reported complete alleviation of their symptoms. One patient with palmar/axillary hyperhidrosis in whom axillary hyperhidrosis did not completely resolve underwent a repeated T-4 sympathicotomy 1 month after the initial surgery. Another patient suffered mild compensatory hyperhidrosis of the trunk 1 month postoperatively. The long-term satisfaction rate in all 27 patients was high. One patient required placement of a chest tube to treat pneumothorax. Other complications such as Horner syndrome, intercostal neuralgia, gustatory hyperhidrosis, and pulmonary edema were not observed.

Conclusions
Thoracoscopic limited T-3 sympathicotomy is an effective method to treat primary hyperhidrosis, its rate of compensatory hyperhidrosis is low, and its rate of long-term patient satisfaction is high.
Kyphoplasty for vertebral compression fractures: 1-year clinical outcomes from a prospective study
Authors: Coumans Jean-Valéry C. E. , Reinhardt Mary-Kay , Lieberman Isador H. 
Published: May 2009

Object
Over the past 15 years, vertebroplasty has emerged as a treatment for vertebral compression fractures. This technique, however, does not restore vertebral height and is associated with a high rate of cement leakage. Recently, kyphoplasty was developed in an effort to circumvent this problem. Although its immediate results have been reported, it is unclear whether the benefits endure.

Methods
Seventy-eight consecutive patients underwent 188 kyphoplasty procedures. The patients responded to Short Form—36 (SF-36) questionnaires, a visual analog scale (VAS) for pain rating, and the Oswestry disability index (ODI) instrument; additionally they underwent detailed neurological and radiographic examinations pre- and postoperatively. The preoperative SF-36, VAS, and ODI scores, the neurological examination results, and the radiographic data were compared with the postoperative findings.
Thirteen patients died of disease progression or unrelated illness. Of the surviving patients, complete data were available in 62% (minimum follow-up period 12 months, mean 18 months). Complications included one myocardial infarction and five cases of asymptomatic cement extravasation. No case of neurological deterioration occurred during the follow-up period. Significant improvements in seven measures of the SF-36 inventory as well as on the ODI and VAS were noted early postoperatively, and these persisted throughout the follow-up period, despite a statistically insignificant decline in the measure of general health at last follow-up examination.

Conclusions
Kyphoplasty is an effective treatment for vertebral compression fractures. The benefits presented in the early postoperative period and persisted at 1 year posttreatment.
Volumetric quantification of cement leakage following percutaneous vertebroplasty in metastatic and osteoporotic vertebrae
Authors: Mousavi Payam , Roth Sandra , Finkelstein Joel , Cheung Gordon , Whyne Cari 
Published: May 2009

Object
The goal of this study was to quantify volumetrically cement fill and leakage in patients with osteoporotic and metastatic vertebral lesions undergoing percutaneous vertebroplasty and to establish whether these factors have any clinical significance at follow up.

Methods
Digital computerized tomography data were retrospectively collected from all cases at the authors' institution in which percutaneous vertebroplasty was performed for osteoporosis or metastatic disease. Patient selection was based on the consensus of a multidisciplinary team consisting of an orthopedic surgeon, an oncologist, and a neuroradiologist. A semiautomated thresholding technique was used to measure vertebral body volume, the volume of cement injected directly into the vertebra, and the volume of cement leakage. Pain-related scores were collected at four early stages of treatment, and all clinical complications were recorded.
Cement leakage was found in 87.9% of vertebrae treated with percutaneous vertebroplasty. In osteoporotic vertebrae it occurred mainly in the disc, whereas in metastatic lesions, it was found in multiple areas. Irrespective of leakage, both patients with osteoporotic and metastatic disease experienced significant immediate pain relief postoperatively.

Conclusions
Although there was no correlation between cement fill or cement leakage and pain relief, there exists a risk of serious complications due to cement leakage.
Sonic hedgehog—induced neural precursor proliferation after adult rodent spinal cord injury
Authors: Bambakidis Nicholas C. , Wang Rui-Zhen , Franic Linda , Miller Robert H. 
Published: May 2009

Object
The glycoprotein molecule sonic hedgehog (Shh) has been shown to play a critical role in neuraxial development. To assess its role in the repair of demyelination following spinal cord injury (SCI), escalating doses of Shh were injected into demyelinated lesions in adult rat spinal cords.

Methods
Twenty-seven adult rats underwent thoracic laminectomy and chemical demyelination of the spinal cord dorsal columns without neurological deficit. A subset of 20 rats was treated after 3 days by direct injection of Shh at two different doses. Rats were killed at 7 or 21 days after SCI, and tissue samples underwent immediate fixation or were placed into cell culture. Diffuse cellular proliferative responses throughout the gray and white matter were observed in up to 70% of Shh-treated rats. Proliferation around the central canal, believed to be derived from the ventricular ependyma consistent with neuronal stem cell induction, was demonstrated in up to 60% of the treated rats. No significant proliferation in these areas was detected in control rats. Dorsal areas of nestin-positive cells were also observed in 70% of rats treated with high doses of Shh, and these observations were reproduced in cell culture as well as in cultures of dorsal spinal cord explants. Cell counts revealed significant increases in the percentage of oligodendrocyte precursors and neurons in treated compared with control rats.

Conclusions
Exogenous Shh administration promotes nestin-positive cell proliferation after SCI in adult rodents. These cells are believed to be derived from neural precursor cells. The populations of oligodendrocyte precursors and neurons were likewise increased in Shh-treated rats, suggesting that these cells may be derived from neural stem cells.
In vitro biomechanical comparison of pedicle screws, sublaminar hooks, and sublaminar cables
Authors: Hitchon Patrick W. , Brenton Matthew D. , Black Andrew G. , From Aaron , Harrod Jeremy S. , Barry Christopher , Serhan Hassan , Torner James C. 
Published: May 2009

Object
Three types of posterior thoracolumbar implants are in use today: pedicle screws, sublaminar titanium cables, and sublaminar hooks. The authors conducted a biomechanical comparison of these three implants in human cadaveric spines.

Methods
Spine specimens (T5–12) were harvested, radiographically assessed for fractures or metastases, and their bone mineral density (BMD) was measured. Individual vertebrae were disarticulated and fitted with either pedicle screws, sublaminar cables, or bilateral claw hooks. The longitudinal component of each construct consisted of bilateral 10-cm rods connected with two cross-connectors. The vertebral body was embedded in cement, and the rods were affixed to a ball-and-socket apparatus for the application of a distraction force.
The authors analyzed 1) 20 vertebrae implanted with screws; 2) 20 with hooks, and 3) 20 with cables. The maximum pullout (MPO) forces prior to failure (mean ± standard deviation) for the screw, hook, and cable implants were 972 ± 330, 802 ± 356, and 654 ± 248 N, respectively (p = 0.0375). Cables allowed significantly greater displacement (6.80 ± 3.95 mm) prior to reaching the MPO force than hooks (3.73 ± 1.42 mm) and screws (4.42 ± 2.15 mm [p = 0.0108]). Eleven screw-implanted vertebrae failed because of screw pullout. All hook-and-cable—implanted vertebrae failed because of pedicle, middle column, or laminar fracture.

Conclusions
These findings suggest that screws possess the greatest pullout strength of the three fixation systems. Sublaminar cables are the least rigid of the three. When screw failure occurred, the mechanism was generally screw backout, without vertebral fractures.
Clinicopathological study of “snake-eye appearance” in compressive myelopathy of the cervical spinal cord
Authors: Mizuno Junichi , Nakagawa Hiroshi , Inoue Tatsushi , Hashizume Yoshio 
Published: May 2009

Object. The goal of this study was to elucidate the pathophysiological features and clinical significance of the magnetic resonance imaging—documented small intramedullary high signal intensity known as “snake-eye appearance” (SEA) in cases of compressive myelopathy such as cervical spondylosis or ossification of the posterior longitudinal ligament.
Methods. One hundred forty-four patients with compression myelopathy who underwent surgery between 1998 and 2000 were selected. Intramedullary high signal intensity was found in 79 cases and was divided into two types, SEA and non-SEA (NSEA). The Japan Orthopaedic Association (JOA) scoring system was used for evaluation of pre- and postoperative neurological status. In nine cases of SEA autopsy was performed and specimens were histologically analyzed.
The improvement ratio determined by JOA score was 32.2 ± 15.1% in SEA, 47.1 ± 12.1% in NSEA, and 50 ± 18.3% (p < 0.01) in control cases in which high signal intesity was absent. There were significant differences among SEA, NSEA, and control groups. In a separate group of nine patients who died of unrelated causes, histological examination showed small cystic necrosis in the center of the central gray matter of the ventrolateral posterior column and significant neuronal loss in the flattened anterior horn.
Conclusions. Snake-eye appearance was found to be a product of cystic necrosis resulting from mechanical compression and venous infarction. Destruction of the gray matter accompanying significant neuronal loss in the anterior horn suggested that SEA is an unfavorable prognostic factor for the recovery of upper-extremity motor weakness.
Atypical presentation of C-7 radiculopathy
Authors: Ozgur Burak M. , Marshall Lawrence F. 
Published: May 2009

Object. The authors retrospectively reviewed the presenting symptomatology and 6-month outcome in 241 consecutive patients who underwent C6–7 anterior cervical discectomy (ACD) from an overall series of 1008 patients in whom the senior author performed one-level procedures.
Methods. In 28 (12%) of the 241 patients, the sole complaint was subscapular pain on the side ipsilateral to nerve root compression. In 11 patients (5%), the primary complaint was unilateral deep breast or chest pain. No patient experienced any of the traditional radicular signs involving C-7 such as numbness of the second or third digits, pain in the triceps, and/or atrophy or weakness of the triceps or pronator muscles. Of the 28 patients presenting with subscapular pain 238 (93%) of 241 experienced complete symptom relief within 6 months, and of the 11 who presented with chest pain complete relief or relief to the point of requiring nonnarcotic analgesic agents occurred in nine cases.
Conclusions. Approximately 15% of patients with a C-7 radiculopathy are likely to present with atypical symptoms that, if persisting after nonsurgical therapy, will often resolve after ACD and fusion.