bluuebunny/crossref_metadata_2025_split huggingface dataset:
The influence of approach side on facet preservation in microscopic bilateral decompression via a unilateral approach for degenerative lumbar scoliosis
Authors: Matsumura Akira , Namikawa Takashi , Terai Hidetomi , Tsujio Tadao , Suzuki Akinobu , Dozono Sho , Yasuda Hiroyuki , Nakamura Hiroaki 
Published: December 2010

Object
The authors compared the clinical outcomes of microscopic bilateral decompression via a unilateral approach (MBDU) for the treatment of degenerative lumbar scoliosis (DLS) and for lumbar canal stenosis (LCS) without instability. The authors also compared postoperative spinal instability in terms of different approach sides (concave or convex) following the procedure.

Methods
The authors retrospectively reviewed data obtained in 50 consecutive patients (25 in the DLS group and 25 in the LCS group) who underwent MBDU; the minimum follow-up period was 2 years. Patients with DLS were divided into 2 subgroups according to the surgical approach side: a concave group (23 segment) and a convex group (17 segments). The Japanese Orthopaedic Association Scale scores for the assessment of low-back pain were evaluated before surgery and at final follow-up. The Japanese Orthopaedic Association Scale scores and recovery rates were compared between the DLS and LCS groups, and between the convex and concave groups. Cobb angle and scoliotic wedging angle (SWA) were evaluated on standing radiographs before surgery and at final follow-up. Facet joint preservation (the percentage of preservation) was assessed on pre- and postoperative CT scans, compared between the LCS and DLS groups, and compared between the concave and convex groups. The influence of approach side on postoperative progression of segmental instability was also examined in the DLS group.

Results
The mean recovery rate was 58.7% in the DLS and 62.0% in the LCS group. The mean recovery rate was 58.6% in the convex group and 60.6% in the concave group. There were no significant differences in recovery rates between the LCS and DLS groups, or between the DLS subgroups. The mean Cobb angles in the DLS group were significantly increased from 12.7° preoperatively to 14.1° postoperatively (p < 0.05), and mean preoperative SWAs increased significantly from 6.2° at L3–4 and 4.1° at L4–5 preoperatively to 7.4° and 4.9°, respectively, at final follow-up (p < 0.05). There was no significant difference in percentage of preservation between the DLS and LCS groups. The mean percentages of preservation on the approach side in the DLS group at L3–4 and L4–5 were 89.0% and 83.1% in the convex group, and those in the concave group were 67.3% and 77.6%, respectively. The percentage of preservation at L3–4 was significantly higher in the convex than the concave group. The mean SWA had increased in the concave group (p = 0.01) but not the convex group (p = 0.15) at final follow-up.

Conclusions
The MBDU can reduce postoperative segmental spinal instability and achieve good postoperative clinical outcomes in patients with DLS. The convex approach provides surgeons with good visibility and improves preservation of facet joints.
Percutaneous computed tomography fluoroscopy–guided conformal ultrasonic ablation of vertebral tumors in a rabbit tumor model
Authors: Sciubba Daniel M. , Burdette E. Clif , Cheng Jennifer J. , Pennant William A. , Noggle Joseph C. , Petteys Rory J. , Alix Christopher , Diederich Chris J. , Fichtinger Gabor , Gokaslan Ziya L. , Murphy Kieran P. 
Published: December 2010

Object
Radiofrequency ablation (RFA) has proven to be effective for treatment of malignant and benign tumors in numerous anatomical sites outside the spine. The major challenge of using RFA for spinal tumors is difficulty protecting the spinal cord and nerves from damage. However, conforming ultrasound energy to match the exact anatomy of the tumor may provide successful ablation in such sensitive locations. In a rabbit model of vertebral body tumor, the authors have successfully ablated tumors using an acoustic ablator placed percutaneously via computed tomography fluoroscopic (CTF) guidance.

Methods
Using CTF guidance, 12 adult male New Zealand White rabbits were injected with VX2 carcinoma cells in the lowest lumbar vertebral body. At 21 days, a bone biopsy needle was placed into the geographical center of the lesion, down which an acoustic ablator was inserted. Three multisensor thermocouple arrays were placed around the lesion to provide measurement of tissue temperature during ablation, at thermal doses ranging from 100 to 1,000,000 TEM (thermal equivalent minutes at 43°C), and tumor volumes were given a tumoricidal dose of acoustic energy. Animals were monitored for 24 hours and then sacrificed. Pathological specimens were obtained to determine the extent of tumor death and surrounding tissue damage. Measured temperature distributions were used to reconstruct volumetric doses of energy delivered to tumor tissue, and such data were correlated with pathological findings.

Results
All rabbits were successfully implanted with VX2 cells, leading to a grossly apparent spinal and paraspinal tissue mass. The CTF guidance provided accurate placement of the acoustic ablator in all tumors, as corroborated through gross and microscopic histology. Significant tumor death was noted in all specimens without collateral damage to nearby nerve tissue. Tissue destruction just beyond the margin of the tumor was noted in some but not all specimens. No neurological deficits occurred in response to ablation. Reconstruction of measured temperature data allowed accurate assessment of volumetric dose delivered to tissues.

Conclusions
Using a rabbit intravertebral tumor model, the authors have successfully delivered tumoricidal doses of acoustic energy via a therapeutic ultrasound ablation probe placed percutaneously with CTF guidance. The authors have thus established the first technical and preclinical feasibility study of controlled ultrasound ablation of spinal tumors in vivo.
Biomechanical comparison between C-7 lateral mass and pedicle screws in subaxial cervical constructs
Authors: Xu Risheng , McGirt Matthew J. , Sutter Edward G. , Sciubba Daniel M. , Wolinsky Jean-Paul , Witham Timothy F. , Gokaslan Ziya L. , Bydon Ali 
Published: December 2010

Object
The aim of this study was to conduct the first in vitro biomechanical comparison of immediate and postcyclical rigidities of C-7 lateral mass versus C-7 pedicle screws in posterior C4–7 constructs.

Methods
Ten human cadaveric spines were treated with C4–6 lateral mass screw and C-7 lateral mass (5 specimens) versus pedicle (5 specimens) screw fixation. Spines were potted in polymethylmethacrylate bone cement and placed on a materials testing machine. Rotation about the axis of bending was measured using passive retroreflective markers and infrared motion capture cameras. The motion of C-4 relative to C-7 in flexion-extension and lateral bending was assessed uninstrumented, immediately after instrumentation, and following 40,000 cycles of 4 Nm of flexion-extension and lateral bending moments at 1 Hz. The effect of instrumentation and cyclical loading on rotational motion across C4–7 was analyzed for significance.

Results
Preinstrumented spines for the 2 cohorts were comparable in bone mineral density and range of motion in both flexion-extension (p = 0.33) and lateral bending (p = 0.16). Lateral mass and pedicle screw constructs significantly reduced motion during flexion-extension (11.3°–0.26° for lateral mass screws, p = 0.002; 10.51°–0.30° for pedicle screws, p = 0.008) and lateral bending (7.38°–0.27° for lateral mass screws, p = 0.003; 11.65°–0.49° for pedicle screws, p = 0.03). After cyclical loading in both cohorts, rotational motion over C4–7 was increased during flexion-extension (0.26°–0.68° for lateral mass screws; 0.30°–1.31° for pedicle screws) and lateral bending (0.27°–0.39° and 0.49°–0.80°, respectively), although the increase was not statistically significant (p > 0.05). There was no statistical difference in postcyclical flexion-extension (p = 0.20) and lateral bending (0.10) between lateral mass and pedicle screws.

Conclusions
Both C-7 lateral mass and C-7 pedicle screws allow equally rigid fixation of subaxial lateral mass constructs ending at C-7. Immediately and within a simulated 6-week postfixation period, C-7 lateral mass screws may be as effective as C-7 pedicle screws in biomechanically stabilizing long subaxial lateral mass constructs.
Predictors of survival in patients with prostate cancer and spinal metastasis
Authors: Drzymalski Dan Michael , Oh William K. , Werner Lillian , Regan Meredith M. , Kantoff Philip , Tuli Sagun 
Published: December 2010

ObjectProstate cancer is the second most common malignancy to cause death in men, with metastases to the spine being the most common site of metastatic burden. A retrospective observational study was performed to determine survival of patients in whom spinal metastasis from prostate cancer had been diagnosed.MethodsThe patient population was obtained from the Prostate Clinical Research Information System (CRIS) at the Dana-Farber Cancer Institute. Patients were observed over a period of 19 years, between June 1990 and April 2009. Clinical covariates were studied in their relationship to overall survival, the primary outcome, by using the Kaplan-Meier method and Cox regression.ResultsOf a total of 9010 patients in the Prostate CRIS database, 333 were identified as having developed spinal metastases. The median overall survival after diagnosis of spinal metastasis was 24 months (95% CI 21–28 months). The estimated 1-year overall survival was 73% (95% CI 67%–77%). In 85% of patients, at least 1 additional site of metastasis was documented. Among 28 patients who had no additional sites of metastases, the median survival was 55.9 months, whereas an increasing burden of disease was associated with shorter survival (p = 0.0001). The association was observed regardless of whether the metastatic burden was characterized as the presence of additional (nonspinal) bone metastasis, the presence of additional nonbone metastasis, or as the number of concomitant metastatic sites (all p = 0.0001). In multivariate analysis, a higher prostate-specific antigen level at the diagnosis of spinal metastasis, a longer duration between the diagnosis of prostate cancer and spinal metastasis, and the presence of additional metastasis at the time of diagnosis of spinal metastasis (all p = 0.0001) were independently associated with a shorter overall survival.ConclusionsThe results of this study are important for oncologists, neurosurgeons, and primary care physicians who have patients with prostate cancer that metastasizes to the spine, because these results can be used to form a prognosis and guide the physician in making appropriate decisions regarding the patient's treatment. Future work should include building a predictive model that accurately determines survival in patients with metastatic disease, because this would guide the physician in devising the most appropriate treatment plan for each patient.
Pathophysiology of persistent syringomyelia after decompressive craniocervical surgery
Authors: Heiss John D. , Suffredini Giancarlo , Smith René , DeVroom Hetty L. , Patronas Nicholas J. , Butman John A. , Thomas Francine , Oldfield Edward H. 
Published: December 2010

Object
Craniocervical decompression for Chiari malformation Type I (CM-I) and syringomyelia has been reported to fail in 10%–40% of patients. The present prospective clinical study was designed to test the hypothesis that in cases in which syringomyelia persists after surgery, craniocervical decompression relieves neither the physiological block at the foramen magnum nor the mechanism of syringomyelia progression.

Methods
The authors prospectively evaluated and treated 16 patients with CM-I who had persistent syringomyelia despite previous craniocervical decompression. Testing before surgery included the following: 1) clinical examination; 2) evaluation of the anatomy using T1-weighted MR imaging; 3) assessment of the syrinx and CSF velocity and flow using cine phase-contrast MR imaging; and 4) appraisal of the lumbar and cervical subarachnoid pressures at rest, during a Valsalva maneuver, during jugular compression, and following the removal of CSF (CSF compliance measurement). During surgery, ultrasonography was performed to observe the motion of the cerebellar tonsils and syrinx walls; pressure measurements were obtained from the intracranial and lumbar intrathecal spaces. The surgical procedure involved enlarging the previous craniectomy and performing an expansile duraplasty with autologous pericranium. Three to 6 months after surgery, clinical examination, MR imaging, and CSF pressure recordings were repeated. Clinical examination and MR imaging studies were then repeated annually.

Results
Before reexploration, patients had a decreased size of the CSF pathways and a partial blockage in CSF transmission at the foramen magnum. Cervical subarachnoid pressure and pulse pressure were abnormally elevated. During surgery, ultrasonographic imaging demonstrated active pulsation of the cerebellar tonsils, with the tonsils descending during cardiac systole and concomitant narrowing of the upper pole of the syrinx. Three months after reoperation, patency of the CSF pathways was restored and pressure transmission was improved. The flow of syrinx fluid and the diameter of the syrinx decreased after surgery in 15 of 16 patients.

Conclusions
Persistent blockage of the CSF pathways at the foramen magnum resulted in increased pulsation of the cerebellar tonsils, which acted on a partially enclosed cervical subarachnoid space to create elevated cervical CSF pressure waves, which in turn affected the external surface of the spinal cord to force CSF into the spinal cord through the Virchow-Robin spaces and to propel the syrinx fluid caudally, leading to syrinx progression. A surgical procedure that reestablished the CSF pathways at the foramen magnum reversed this pathophysiological mechanism and resolved syringomyelia. Elucidating the pathophysiology of persistent syringomyelia has implications for its primary and secondary treatment.
Patients with moyamoya disease presenting with movement disorder
Authors: Pandey Paritosh , Bell-Stephens Teresa , Steinberg Gary K. 
Published: December 2010

Moyamoya disease is a rare cerebrovascular disease characterized by idiopathic bilateral stenosis or occlusion of bilateral internal carotid arteries and the development of characteristic leptomeningeal collateral vessels at the base of the brain. Typical presentations include transient ischemic attacks or stroke, and hemorrhage. Presentation with movement disorders is extremely rare, especially in the pediatric population. The authors describe the cases of 4 children with moyamoya disease who presented with movement disorders.
Among 446 patients (118 pediatric) with moyamoya disease surgically treated by the senior author, 4 pediatric patients had presented with movement disorders. The clinical records, imaging studies, surgical details, and postoperative clinical and imaging data were retrospectively reviewed.
The initial presenting symptom was movement disorder in all 4 patients: chorea in 2, hemiballismus in 1, and involuntary limb shaking in 1. All the patients had watershed infarcts involving the frontal subcortical region on MR imaging. Additionally, 1 patient had a ganglionic infarct. Single-photon emission computed tomography studies showed frontoparietal cortical and subcortical hypoperfusion in all patients. Three patients had bilateral disease, whereas 1 had unilateral disease. All the patients underwent superficial temporal artery–middle cerebral artery bypass. Postoperatively, all 4 patients had complete improvement in their symptoms. The SPECT scans revealed normal perfusion in 3 patients and a small residual perfusion deficit in 1.
Movement disorders are a rare presenting feature of moyamoya disease. Hypoperfusion of the frontal cortical and subcortical region was seen in all patients, and the symptomatology was attributed to ischemic dysfunction and imbalance in the cortical-subcortical-ganglionic-thalamic-cortical circuitry. Combined revascularization with superficial temporal artery–middle cerebral artery bypass and encephaloduroarteriosynangiosis leads to excellent results.
Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults
Authors: Piatt Joseph H. 
Published: December 2010

Object
Myelomeningocele is the most severe congenital malformation of the CNS that is compatible with survival. From the time of the development of practical treatment for hydrocephalus in the late 1950s, affected individuals began to survive into adulthood in substantial numbers. Data on the neurological status of these individuals are sparse, as are descriptions of their continuing requirements for neurosurgical care.

Methods
A review of the literature was undertaken using the PubMed database maintained by the National Library of Medicine. Formal grading of the quality of evidence was not attempted, but methodological issues affecting validity or generalizability were noted.

Results
Observations from 2 major longitudinal studies of cohorts of patients treated without selection using contemporary neurosurgical techniques have been published at intervals beginning in the mid-1970s. Numerous cross-sectional, institutional reviews have focused on neurosurgical issues in adulthood: hydrocephalus, Chiari malformation Type II and syringomyelia, and secondary spinal cord tethering. The organization of medical services for adults with myelomeningocele has received limited study.

Conclusions
Surviving adults with myelomeningocele achieve a wide range of neurological and functional outcomes, the most critical and adverse determinant of which is symptomatic CSF shunt failure. From a neurosurgical standpoint, adults with myelomeningocele remain clinically active indefinitely, and they deserve periodic neurosurgical surveillance.
Regulation, Cross-border Trade and Practical Norms in West Nile, North-Western Uganda
Authors: Titeca Kristof , Herdt Tom de 
Published: December 2010

ABSTRACTThis article describes how cross-border trade in West Nile, north-western Uganda to a large extent takes place outside of the legal framework. This does not mean that this trade is unregulated. We make use of the concept of ‘practical norms’ to show the existence of regulation within this trade, which diverges both from official norms and social norms (‘moral economy’). The article describes how these practical norms emerged and how they are enforced. First, it is shown how the moral economy of cross-border trade plays an important role in their articulation. Second, we ask which practical concerns play a role in sustaining these norms and how deviations from them activate open power struggles. And third, we show how concrete events have played a role in their emergence.
Functional Magnetic Resonance Imaging of Binocular Interactions in Visual Cortex in Strabismus
Authors: Chen Vincent J. , Tarczy-Hornoch Kristina 
Published: November 2010

Purpose:
To observe changes in primary visual cortical activation associated with perceptual suppression in individuals with strabismus, using functional magnetic resonance imaging (fMRI).

Methods:
In Phase 1, pilot data were collected from 1 control and 8 strabismic participants, including 5 with amblyopia. In Phase 2, results were collected from 7 participants with strabismus (2 recalled and 5 new), including 2 with amblyopia. fMRI compared primary visual cortex activation in two conditions: visual stimuli presented to both eyes, to evoke perceptual suppression of one eye in individuals with strabismus, and visual stimulation presented only to one eye.

Results:
Visual cortical activity modulations positively correlated with perceptual suppression were seen in 3 of 5 non-amblyopic Phase 2 study participants, but not in amblyopic subjects.

Conclusion:
Cortical activity modulations correlated with modulation of strabismic suppression are detectable in non-amblyopic individuals using fMRI, suggesting a neural basis for strabismic suppression in primary visual cortex.
Management of Corneal Ectasia After LASIK with Combined, Same-Day, Topography-Guided Partial Transepithelial PRK and Collagen Cross-Linking: The Athens Protocol
Authors: Kanellopoulos Anastasios John , Binder Perry S. 
Published: November 2010

Purpose:
To evaluate a series of patients with corneal ectasia after LASIK that underwent the Athens Protocol: combined topography-guided photorefractive keratectomy (PRK) to reduce or eliminate induced myopia and astigmatism followed by sequential, same-day ultraviolet A (UVA) corneal collagen cross-linking (CXL).

Methods:

Thirty-two consecutive corneal ectasia cases underwent transepithelial PRK (WaveLight ALLEGRETTO) immediately followed by CXL (3 mW/cm
2
) for 30 minutes using 0.1% topical riboflavin sodium phosphate. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent, keratometry, central ultrasonic pachymetry, corneal tomography (Oculus Pentacam), and endothelial cell counts were analyzed. Mean follow-up was 27 months (range: 6 to 59 months).

Results:
Twenty-seven of 32 eyes had an improvement in UDVA and CDVA of 20/45 or better (2.25 logMAR) at last follow-up. Four eyes showed some topographic improvement but no improvement in CDVA. One of the treated eyes required a subsequent penetrating keratoplasty. Corneal haze grade 2 was present in 2 eyes.

Conclusions:
Combined, same-day, topography-guided PRK and CXL appeared to offer tomographic stability, even after long-term follow-up. Only 2 of 32 eyes had corneal ectasia progression after the intervention. Seventeen of 32 eyes appeared to have improvement in UDVA and CDVA with follow-up >1.5 years. This technique may offer an alternative in the management of iatrogenic corneal ectasia.
Effect of Saline Conditions on the Tensile Strength of Ophthalmic Sutures
Authors: Brauner Stacey C. , Berry Jesse L. , Pye James , Lee Edwin G. , Rhee Douglas J. 
Published: November 2010

Background and Objective:
The purpose of this study was to compare the tensile strength of sutures commonly used for ophthalmic surgery and the role of physiologically balanced saline comparable to the ocular environment to material failure.

Materials and Methods:
Ophthalmic sutures (9-0 and 10-0 nylon, 7-0 and 8-0 polyglactin 910, and 10-0 polypropylene) were tested using a tensiometer. Wet conditions were defined by soaking the suture in balanced salt solution for 24 hours or 7 days prior to testing.

Results:

The 9-0 nylon was approximately 30% stronger than 10-0 nylon (
P
< .01), whereas 7-0 polyglactin was 60% and 85% stronger than 8-0 polyglactin under dry and 24 hours of wet conditions (
P
= .0014 and .004), respectively. There was no difference in tensile strength between 10-0 nylon and polypropylene sutures. The 8-0 polyglactin suture lost 11% of tensile strength after 7 days of saline exposure.

Conclusion:
The relative difference of suture strength between the difference gauge sutures is not a simple relationship to differences in the diameter. Tensile strength was not affected by saline conditions for the nylon, polypropylene, and 7-0 polyglactin sutures. The 8-0 polyglactin suture had a decrease in tensile strength after 7 days of exposure to saline. Surgeons should be aware of this limitation with 8-0 polyglactin.