bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypoxia-inducible expression of vascular endothelial growth factor for the treatment of spinal cord injury in a rat model
Authors: Choi Byung Hyune , Ha Yoon , Huang Xian , Park So Ra , Chung Joonho , Hyun Dong Keun , Park Hyeonseon , Park Hyung Chun , Kim Sung Wan , Lee Minhyung 
Published: January 2008

Object
Vascular endothelial growth factor (VEGF) has been investigated as a therapy for many disorders and injuries involving ischemia. In this report, we constructed and evaluated a hypoxia-inducible VEGF expression system as a treatment for spinal cord injury (SCI).

Methods
The hypoxia-inducible VEGF plasmid was constructed using the erythropoietin (Epo) enhancer with the Simian virus 40 (SV40) promoter (pEpo-SV-VEGF) or the RTP801 promoter (pRTP801-VEGF). The expression of VEGF in vitro was evaluated after transfection into N2A cells. The plasmids were then injected into rat spinal cords with contusion injuries. The expression of VEGF in vivo was measured using reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay. Locomotor recovery in the rats was evaluated using the Basso, Beattie and Bresnahan (BBB) scale for locomotor analysis.

Results
In vitro transfection showed that pEpo-SV-VEGF or pRTP801-VEGF induced VEGF expression under hypoxic conditions, whereas pSV-VEGF did not. The VEGF level was higher in the pEpo-SV-VEGF and pRTP801-VEGF groups than in the control group. The VEGF expression was detected in neurons and astrocytes of the spinal cord. Locomotor recovery was improved in the pEpo-SV-VEGF and pRTP801-VEGF groups, and BBB scores were higher than in the control group. Staining using terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick-end labeling showed that the number of apoptotic cells decreased in the plasmid-injected groups compared with the control group, and significant differences were observed between the hypoxia-responsive groups and the pSV-VEGF group.

Conclusions
These results suggest that the hypoxia-inducible VEGF expression system may be useful for gene therapy of SCI.
Atlantoaxial joint jamming as a treatment for atlantoaxial dislocation: a preliminary report
Authors: Goel Atul 
Published: January 2008

✓In this report the author describes an alternative technique of atlantoaxial fixation that involves blocking or “jamming” of movements of the atlantoaxial joint. The technique involves forcible impaction of spiked titanium metal spacers and bone grafts within the distracted atlantoaxial facet joints. Between January 2003 and January 2006, four patients underwent this method of fixation at the Department of Neurosurgery at King Edward Memorial Hospital in Mumbai, India. All four patients had posttraumatic mobile and reducible atlantoaxial dislocation. The mean follow-up period was 16 months (range 5–35 months). Successful atlantoaxial stabilization along with ultimate bone fusion was achieved in all patients and was documented on dynamic radiographs. There were no neurological, vascular, or infection-associated complications.
The author concludes that the described method of atlantoaxial fixation provides an alternative treatment strategy. “Joint jamming” as a stand-alone method or in combination with other fixation methods may provide firm stabilization in cases of atlantoaxial dislocation.
Percutaneous fibrin glue therapy for meningeal cysts of the sacral spine with or without aspiration of the cerebrospinal fluid
Authors: Zhang Tao , Li Zhenhua , Gong Weiming , Sun Bingwei , Liu Shuheng , Zhang Kai , Yin Dezhen , Xu Peng , Jia Tanghong 
Published: January 2008

Object.
The authors assessed the efficacy of computed tomography (CT)–guided percutaneous injection of fibrin glue to treat meningeal cysts of the sacral spine in patients with back pain, and evaluated the necessity for cerebrospinal fluid (CSF) aspiration before glue injection.

Methods.
Of the 31 patients in this study, 15 underwent injection of fibrin glue under CT guidance after aspiration of more than 15 ml of CSF (Group A), and 16 patients were treated with the glue but without CSF aspiration (Group B). Clinical results were evaluated after an average of 23 months of follow-up, and changes on the imaging studies were also evaluated. The clinical outcome and postoperative complications were analyzed.

Results.
All 31 patients experienced resolution or marked improvement of symptoms for as long as 28 months after fibrin glue therapy. No patient experienced recurrence of symptoms during the follow-up interval. The postoperative pain relief was statistically significant (p < 0.001) according to evaluations in which a 100-mm visual analog pain scale was used. There were no statistical differences between the two groups (p > 0.05).

Conclusions.
Percutaneous CT-guided fibrin glue therapy for sacral arachnoid cysts may be a definitive therapy. It is unnecessary to aspirate the CSF before injection of the fibrin glue.
Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure
Authors: Chang Eric L. , Shiu Almon S. , Mendel Ehud , Mathews Leni A. , Mahajan Anita , Allen Pamela K. , Weinberg Jeffrey S. , Brown Barry W. , Wang Xin Shelly , Woo Shiao Y. , Cleeland Charles , Maor Moshe H. , Rhines Laurence D. 
Published: January 2008

Object.
The authors report data concerning the safety, effectiveness, and patterns of failure obtained in a Phase I/II study of stereotactic body radiotherapy (SBRT) for spinal metastatic tumors.

Methods.
Sixty-three cancer patients underwent near-simultaneous computed tomography–guided SBRT. Spinal magnetic resonance imaging was conducted at baseline and at each follow-up visit. The National Cancer Institute Common Toxicity Criteria 2.0 assessments were used to evaluate toxicity.

Results.
The median tumor volume of 74 spinal metastatic lesions was 37.4 cm3 (range 1.6–358 cm3). No neuropathy or myelopathy was observed during a median follow-up period of 21.3 months (range 0.9–49.6 months). The actuarial 1-year tumor progression–free incidence was 84% for all tumors. Pattern-of-failure analysis showed two primary mechanisms of failure: 1) recurrence in the bone adjacent to the site of previous treatment, and 2) recurrence in the epidural space adjacent to the spinal cord. Grade 3 or 4 toxicities were limited to acute Grade 3 nausea, vomiting, and diarrhea (one case); Grade 3 dysphagia and trismus (one case); and Grade 3 noncardiac chest pain (one case). There was no subacute or late Grade 3 or 4 toxicity.

Conclusions.
Analysis of the data obtained in the present study supports the safety and effectiveness of SBRT in cases of spinal metastatic cancer. The authors consider it prudent to routinely treat the pedicles and posterior elements using a wide bone margin posterior to the diseased vertebrae because of the possible direct extension into these structures. For patients without a history of radiotherapy, more liberal spinal cord dose constraints than those used in this study could be applied to help reduce failures in the epidural space.
Motion in the unstable cervical spine: comparison of manual turning and use of the Jackson table in prone positioning
Authors: Bearden Brook G. , Conrad Bryan P. , Horodyski MaryBeth , Rechtine Glenn R. 
Published: January 2008

Object.
The purpose of this study was to compare manual maneuvering with the use of a Jackson table when moving patients with cervical spine instability from the supine to the surgically appropriate prone position.

Methods.
The range of motion (ROM) of the cervical spine of a fresh cadaver was measured. A ligamentous instability was created at the C5–6 level, and the increased ROM was confirmed. Sensors for an electromagnetic motion analysis device were fixed to the anterior portions of the C-5 and C-6 vertebral bodies (VBs) using machined polyethylene mounts and carbon fiber rods that were inserted into the VBs. The sensors were used to measure cervical flexion, lateral bending, and axial rotation during the two transfer procedures. The cadaver was then moved from the supine position on a hospital bed to the prone position for surgery. The manual technique was performed by four trained individuals who moved the cadaver from the hospital bed while rotating it 180° axially onto the surgical table. In using the Jackson table, the cadaver was moved from the bed to the table in the supine position and then the Jackson table rotated the cadaver to the prone position. The two techniques were tested with and without the use of a collar and were repeated five times.

Results.
Analysis of the data indicated that when moving a patient into the prone surgical position, the use of a cervical collar and the Jackson table significantly reduced the cervical motion in all angular planes compared with that of manual transfer.

Conclusions.
The use of a cervical collar and the Jackson table may reduce the possibility of further spinal cord compromise. Because manual transfers are performed routinely, this warrants further study.
Ossification of the posterior longitudinal ligament of the cervical spine: histopathological findings around the calcification and ossification front
Authors: Sato Ryuichiro , Uchida Kenzo , Kobayashi Shigeru , Yayama Takafumi , Kokubo Yasuo , Nakajima Hideaki , Takamura Takaharu , Bangirana Alexander , Itoh Hiroshi , Baba Hisatoshi 
Published: January 2008

Object.
The authors studied the histological and immunohistochemical features of ossified posterior longitudinal ligament (PLL) of the cervical spine, especially in the calcification and ossification front.

Methods.
Samples of en bloc ossified PLL plaque obtained in 31 patients were stained with H & E and immuno-histochemically prepared for collagens (types I and II), vascular endothelial growth factor (VEGF), transforming growth factor (TGF)–β, and bone morphogenetic protein (BMP)–2, and by terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick-end labeling method for apoptosis.

Results.
Enchondral ossification was evident between the ligamentous enthesis and deep layer of the ligament, with irregularly disorganized arrangement of elastic fibers in association with advancement of the degenerative process. In the ossification front, many hypertrophic metaplastic chondrocytes were noted in the ossifying plaque immediately contiguous to the ligament fibers, together with a considerable degree of neovascularization. Both TGFβ and BMP-2 were highly expressed in metaplastic hypertrophic chondrocytes in the ossification front, and BMP-2 was also expressed in fibroblastic cells near the ossified PLL plaque. Expression of type I collagen was significant in the matrix of the ossified PLL lesion, whereas that of type II was marked in metaplastic chondrocytes in the ossification front. Apoptotic hypertrophic chondrocytes were observed mainly in the fibrocartilaginous area near the calcification front.

Conclusions.
The enchondral ossification process in the ossified PLL was closely associated with degenerative changes of elastic fibers and cartilaginous cartilage formation, together with the appearance of metaplastic hypertrophic cartilage cells and neovascularization. The authors also found that VEGF-positive metaplastic chondrocytes in the ossification front and different expression patterns of collagens probably play some role in the extension of the ossified PLL from the ossification front.
Dural damage due to a loosened hydroxyapatite intraspinous spacer after spinous process–splitting laminoplasty
Authors: Ono Atsushi , Yokoyama Toru , Numasawa Takuya , Wada Kanichiro , Toh Satoshi 
Published: January 2008

✓Excellent results from laminoplasty for cervical spinal myelopathy have been reported in many studies. Nevertheless, C-5 nerve root palsy or axial pain such as neck and shoulder pain after laminoplasty are known postoperative complications. To the authors' knowledge, dural damage from dislocation of the hydroxyapatite intraspinous spacer due to absorption of the tip of the spinous process has not been reported. Two cases of dural damage from dislocation of the hydroxyapatite intraspinous spacer after laminoplasty are described.
Radiographs, computed tomography myelography, and magnetic resonance (MR) imaging revealed the dislocation of the hydroxyapatite intraspinous spacer, the absorption of the tip of the spinous process, and dural sac compression due to the hydroxyapatite intraspinous spacer. In one patient, the MR imaging studies revealed liquorrhea around the hydroxyapatite intraspinous spacers. Both patients underwent removal of the hydroxyapatite intraspinous spacer and attained good neurological recovery.
In patients with dislocation of the hydroxyapatite intraspinous spacer associated with absorption of the tip of the spinous process after spinous process–splitting laminoplasty, each case should be evaluated for aggravating symptoms of myelopathy, dural damage, and liquorrhea around the spacer.
A huge presacral Tarlov cyst
Authors: Ishii Kazuhiko , Yuzurihara Masahito , Asamoto Shunji , Doi Hiroshi , Kubota Motoo 
Published: January 2008

✓ Perineural cysts have become a common incidental finding during lumbosacral magnetic resonance (MR) imaging. Only some of the symptomatic cysts warrant treatment. The authors describe the successful operative treatment of a patient with, to the best of their knowledge, the largest perineural cyst reported to date.
A 29-year-old woman had been suffering from long-standing constipation and low-back pain. During an obstetric investigation for infertility, the clinician discovered a huge presacral cystic mass. Computed tomography myelography showed the lesion to be a huge Tarlov cyst arising from the left S-3 nerve root and compressing the ipsilateral S-2 nerve. The cyst was successfully treated by ligation of the cyst neck together with sectioning of the S-3 nerve root. Postoperative improvement in her symptoms and MR imaging findings were noted.
Identification of the nerve root involved by the cyst wall, operative indication, operative procedure, and treatment of multiple cysts are important preoperative considerations.
A comparison of long-term outcomes of translaminar facet screw fixation and pedicle screw fixation: a prospective study
Authors: Tuli Jayshree , Tuli Sagun , Eichler Marc E. , Woodard Eric J. 
Published: January 2008

Object
In this paper, the authors compare the long-term outcomes of translaminar facet screw fixation (TFSF) and pedicle screw fixation (PSF) in the treatment of degenerative lumbosacral disease.

Methods
This prospective analytical study was performed to compare the long-term outcomes of TFSF and PSF for degenerative lumbosacral disease. Outcomes were defined as the need for reoperation for the development of a nonunion, end-fusion degeneration, or for explantation of hardware.

Results
A total of 77 patients were analyzed. Thirty-seven patients underwent PSF and 40 received TFSF. Twenty-three of the 77 patients required a reoperation: 13 (32.5%) of the 40 patients in the TFSF group and 10 (27%) of the 37 the patients in the PSF group. The overall mean time to reoperation (regardless of outcome) was 4.05 years. For patients in the TFSF group the mean time to reoperation was 2.94 years, whereas it was 4.35 years in the PSF group (p = 0.34). Nonunion was noted in seven of the 40 patients in the TFSF group and one of 37 in the PSF group. The mean time to surgery for nonunion for patients in the TFSF group was 3.46 years and for those in the PSF group it was 6.27 years (p = 0.04). Surgery for end-fusion degeneration was performed in two patients in the TFSF group and five in the PSF group (p = 0.43). Explantation of hardware was performed in two patients with TFSF and four patients with PSF.
Multivariable analysis revealed a statistically significant difference in the time to surgery for nonunion between PSF and TFSF (p = 0.048), with a hazard ratio of 0.097 (95% confidence interval 0.01–0.98).

Conclusions
Findings from the current prospective study suggest that there is an increased risk of requirement for a reoperation for nonunion among TFSF cases compared with PSF cases.
Myoarchitectonic spinolaminoplasty: efficacy in reconstituting the cervical musculature and preserving biomechanical function
Authors: Kim Phyo , Murata Hidetoshi , Kurokawa Ryu , Takaishi Yoshiyuki , Asakuno Keizo , Kawamoto Toshiki 
Published: January 2008

Object
Laminoplasty has been used to expand the cervical spinal canal, based on the belief that reconstruction of the laminae preserves musculoskeletal function. The true efficacy of laminoplasty for maintaining spinal alignment, stability, and flexibility, however, remains to be proven. The authors have developed a new method, myoarchitectonic spinolaminoplasty (MSLP), which preserves all of the nuchal muscles and reconstitutes all of the musculoskeletal couplings to the posterior elements of the vertebrae. The details of this technique are described, and the efficacy of the technique in conserving muscle volume, alignment, and motion, as well as in preventing postoperative musculoskeletal discomfort, is assessed.

Methods
The authors' previous midline-splitting laminoplasty procedure, which utilized a hydroxyapatite (HA) implant as a substitute for the spinous process, was improved. Detachment of the muscles is avoided with this new technique by cutting inside the spinous process. The bone–muscle flaps are affixed to the HA spinous process. Radiographs, computed tomography scans, and neurological evaluations obtained at the 1-year follow-up in the groups of consecutive patients assessed immediately prior to and after the modification of the previous technique (the control and the MSLP groups, respectively) were analyzed and compared.

Results
The HA bone constructs became integrated due to osteoconduction. The cross-sectional area of the semispinalis capitis, semispinalis cervicis, and multifidus muscles remained significantly larger in the MSLP group. Slight attenuation in lordosis was observed in the control group, but was prevented in the MSLP group. Range of motion was somewhat restricted in the MSLP group, but the incidence of neck pain and shoulder strain was significantly reduced.

Conclusions
The new MSLP method was effective in preserving the volume and functions of the nuchal musculature and helping to minimize postoperative musculoskeletal complaints.
Human spinal arachnoid villi revisited: immunohistological study and review of the literature
Authors: Tubbs R. Shane , Hansasuta Ake , Stetler William , Kelly David R. , Blevins Danitra , Humphrey Rita , Chua Gina D. , Shoja Mohammadali M. , Loukas Marios , Oakes W. Jerry 
Published: January 2008

Object
Few have described the relationship between arachnoid protrusions (villi) and adjacent spinal radicular veins, and the descriptions that do exist are conflicting. Some authors have even denied the presence of spinal arachnoid villi, suggesting that they play no role in cerebrospinal fluid (CSF) absorption.

Methods
To further elucidate these structures, laminectomies from C-2 inferiorly to S-2 were performed in 10 fresh human adult cadavers. Following removal of the laminae, the dural nerve sleeves were identified and the spinal nerves excised 1 cm lateral and medial to the intervertebral foramina. Samples were submitted for histological and immunohistological analysis.

Results
The authors identified arachnoid villi in all specimens. The length of these structures was approximately 50 to 170 μm. Regionally, these villi were more concentrated in the lumbar region, but they were not present at every vertebral level, with observed skip zones. Occasionally, more than one villus was identified per vertebral level. The majority of villi were intimately related to an adjacent radicular vein. There was a direct relationship between the size of the adjacent radicular vein, and the presence and number of arachnoid villi.

Conclusions
Findings in the present study have demonstrated that arachnoid villi exist and are morphologically associated with radicular veins. These data support the theory that CSF absorption occurs not only intracranially but also along the spinal axis. Further animal studies are necessary to prove that CSF traverses these villi and is absorbed into the spinal venous system.
Cortex of the pedicle of the vertebral arch. Part II: microstructure
Authors: İnceoğlu Serkan , Kilinçer Cumhur , Tami Andrea , McLain Robert F. 
Published: January 2008

Object
Although the gross anatomy of the pedicle in the human spine has been investigated in great detail, knowledge of the microanatomy of trabecular and cortical structures of the pedicle is limited. An understanding of the mechanical properties and structure of the pedicle bone is essential for improving the quality of pedicle screw placement. To enhance this understanding, the authors examined human cadaveric lumbar vertebrae.

Methods
In this study, the authors obtained seven human cadaveric lumbar vertebrae. The lateral and medial cortices of these pedicle specimens were sectioned and embedded in polymethylmethacrylate. Cross-sectional slices of cortex were obtained from each specimen and imaged with the aid of a high-resolution light microscope. Assessments of osteonal orientation, determinations of relative dimensions, and histomorphometric studies were performed.

Results
The cortex of the pedicle in each human lumbar vertebra had an osteonal structure with haversian canals laid down mainly in the anteroposterior (longitudinal) direction. The organization of osteons across the transverse cross-section was not homogeneous. The layer of lamellar bone that typically envelops cortical bone structures (such as in long bones) was not observed, and the lateral cortex was significantly thinner than the medial cortex (p< 0.05).

Conclusions
The cortical bone surrounding the pedicle differed from bone in other anatomical regions such as the anterior vertebral body and femur. The osteonal orientation and lack of a lamellar sheath may account for the unique deformation characteristics of the pedicle cortex seen during pedicle screw placement.
Surgeon’s radiation exposure during percutaneous vertebroplasty
Authors: Synowitz Michael , Kiwit Juergen 
Published: January 2008

Object
In this study the authors evaluated levels of radiation exposure to surgeons’ protected and unprotected hands during fluoroscopically assisted vertebroplasty.

Methods
The amount of radiation administered to 30 patients during 41 procedures in a controlled prospective trial over 6 months was assessed, comparing radiation exposure to the right and left hands in two neurosurgeons. Effective skin doses were evaluated using thermoluminescent finger dosimeters (ring dosimeters). The ratios of finger dosimeter exposure were compared between the glove-protected and unprotected left hands of two surgeons and both unprotected right hands. In addition, dose-area product (DAP) and fluoroscopy times were recorded in all patients.
The mean treatment-effective dose to the surgeons’ hands was 0.49 ± 0.4 mSv in the glove-protected left hand and 1.81 ± 1.31 mSv in the unprotected left hand (p < 0.05). The mean effective hand doses were 0.59 ± 0.55 mSv in the unprotected right hand of the glove-protected surgeon and 0.62 ± 0.55 mSv in the unprotected right hand of the control surgeon. The total corresponding fluoroscopy time was 38.55 minutes for the protected surgeon and 41.23 minutes for the unprotected one (p > 0.05). Lead glove shielding resulted in a radiation dose reduction of 75%. The total DAP for all procedures was 256,496 mGy/cm2 and 221,408 mGy/cm2 (p >0.05) for the protected and unprotected surgeons, respectively.

Conclusions
This study emphasizes the importance of surgeons wearing lead glove protection on their leading hands during percutaneous vertebroplasty procedures and demonstrates a 75% reduction rate of exposure to radiation.