bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation of anomalous vascular and osseous anatomy in congenital kyphosis Type I
Authors: Chwajol Mark , Houten John K. 
Published: January 2008

✓Congenital kyphosis Type I results from failure of formation of the vertebral body (VB). The clinical course is characterized by progressive deformity and neurological dysfunction unless the patient undergoes fusion. It has been postulated that failure of VB formation may be secondary to anomalies of the segmental arteries arising from the aorta. There is limited clinical evidence in the literature, however, to support this hypothesis. The authors report on the case of an adult patient with congenital kyphosis Type I in whom spinal angiography correlated vascular with vertebral anomalies.
This 32-year-old man presented with back pain, lower-extremity paresthesias, and incomplete voiding, which had progressed over several years. Imaging revealed that the L-1 and L-2 vertebrae had not fully formed, causing kyphotic deformity such that the anterior portion of T-12 nearly articulated with that of L-3; this anomaly produced significant mobility in flexion and extension. Magnetic resonance imaging revealed distal spinal cord atrophy and signal change on T2-weighted images.
Spinal angiography showed that the right and left segmental arteries at both L-1 and L-2 arose from a common trunk from the aorta. This was confirmed during subsequent T12–L3 anterior–posterior fusion. Postoperatively the patient experienced relief of pain and remained neurologically stable throughout a 3-year follow-up period.
The presence of corresponding anomalies of the segmental arteries and vertebrae in this case of congenital kyphosis Type I indicates that a relationship may exist in the genesis of aberrant spinal vertebral and vascular structures.
Exposure of the V1–V3 segments of the vertebral artery via the posterior cervical triangle: a cadaveric feasibility study
Authors: Tubbs R. Shane , Shoja Mohammadali M. , Acakpo-Satchivi Leslie , Wellons John C. , Blount Jeffrey P. , Oakes W. Jerry , Iskandar Bermans J. 
Published: January 2008

Object
Surgical exposure of the extracranial part of the vertebral artery (VA) is occasionally necessary. Historically, the greater portion of the extracranial portion of the VA has been approached by traversing the anterior cervical triangle. The authors speculated that this entire segment of the VA could be reached with equal efficacy via the posterior cervical triangle (PCT).

Methods
Six adult cadavers underwent dissection of the left and right VAs via the PCT. The entire extracranial VA was easily exposed through this approach. Only three of 12 sides required the transection of the clavicular head of the sternocleidomastoid muscle for exposure of the most proximal segment of the VA as it originated from the subclavian artery. No gross injury to the VA or other regional vessels or nerves was noted.

Conclusions
The authors found that the extracranial VA can be exposed easily through the PCT. Following confirmation of this technique in vivo, this approach may be added to the surgeon’s armamentarium for exposing the extracranial segment of the VA.
Endoscopic transoral surgery for craniovertebral junction anomalies
Authors: Husain Mazhar , Rastogi Manu , Ojha Bal Krishna , Chandra Anil , Jha Deepak K. 
Published: January 2008

✓Craniovertebral junction (CVJ) anomalies continue to be challenging for neurosurgeons because of the complex anatomy of this region. To date, microsurgical decompression via a transoral route is the standard treatment for anteriorly located compressive lesions of the cervicomedullary junction (CMJ). The results obtained by minimizing surgical trauma are fewer complications, shorter hospital stays, and reduced overall psychological burden. Endoscopic surgery is becoming a leading modality in minimally invasive neurosurgical treatment.
The authors performed surgery in 11 patients with irreducible osseous dislocations resulting from CVJ abnormality during a 2-year period. Anterior CMJ decompression was achieved in all patients by performing neuroendoscopically controlled transoral excision of bone and soft tissues. The surgical technique and results will be discussed. The use of the endoscope offers several advantages in cases requiring a transoral approach to the lower clivus and atlantoaxial region. The use of minimally invasive endoscopic techniques has the potential to reduce the need for a wider cranial base opening and to decrease postoperative complications.
Incidence of unusual and clinically significant histopathological findings in routine discectomy
Authors: Wu Adam S. , Fourney Daryl R. 
Published: January 2008

Object
Routine histopathological examination of discectomy specimens remains common practice in many hospitals, although it rarely detects unsuspected clinically significant disease. Controversy exists as to the effectiveness of this practice. The objectives of this study were to compare the authors’ experience with a review of the literature.

Methods
In a retrospective database analysis the authors identified all intervertebral disc specimens obtained during spinal procedures over an 8-year period (1996–2004). Cases of benign (nonneoplastic and noninfectious) indications for surgery were included in the study, whereas cases of nonbenign indications were excluded. The final pathological diagnoses were reviewed, and a chart review was performed to determine whether any unexpected findings affected subsequent patient care. A total of 1858 discectomy specimens were identified: 1775 of these were obtained in 1719 routine discectomy procedures. Unexpected histopathological findings were identified in four cases, and none was clinically significant.

Conclusions
Routine histopathological examination of disc specimens is not justified. The decision to send specimens for pathological examination should be determined on a case-by-case basis after consideration of the clinical presentation, results of laboratory and imaging studies, and intraoperative findings.
Surgical treatment of lumbar epidural varices
Authors: Slin’ko Eugene I. , Al-Qashqish Iyad I. 
Published: January 2008

Object
An epidural varix of the lumbar spine is an acquired pathological entity that results from dilation of the internal vertebral venous plexus. The dilated veins in the epidural spaces or in the intervertebral foramen cause irritation or compression of the thecal sac and nerve roots, and this in turn causes lumbar radiculopathy. The lesions develop as an independent process or are accompanied by degenerative changes of the lumbar spine. Resection of varicose veins can be complicated when significant venous bleeding occurs. The purpose of the present study was to develop diagnostic criteria for lumbar epidural varices and methods of surgical treatment and to analyze the results of treatment.

Methods
There were 43 surgically treated patients in whom lumbar radiculopathy was caused by epidural varices. The mean duration of symptoms was 11 months (range 5–49 months) and the mean age of the patients was 41 years (range 26–68 years). Segmentary varices were found in 14 patients, local varices in 21, and extensive varices in eight. Patients underwent preoperative magnetic resonance imaging and vertebral venography.
Of 43 cases, the varicose veins were completely occluded in all 14 patients with segmentary varices of the segmentary-type lesion. Of 21 patients with local varices, total occlusion was obtained in 17 patients and partial occlusion in four. In the patients with extensive varices, total occlusion was not performed; instead, partial occlusion was undertaken.
Resolution of lumbar radicular syndromes was observed, to some extent, in all patients. Radicular pain regressed in 12 of 14 patients with segmentary varices, in 18 of 19 patients with local varices, and in three of four patients with extensive varices. Nerve root–related sensory disturbances regressed in six of 10 patients with segmentary varices, in 11 of 15 patients with local varices, and in one patient with extensive varices. Motor deficits regressed in three of eight patients with segmentary varices, in three of six patients with local varices, and in none among those with extensive varices.

Conclusions
Epidural varicosity is a specific form of spinal disease. Its diagnostic clarification and surgical treatment are difficult and have only recently been developed. Precise diagnosis and a well-planned surgery allow for a positive outcome.
The use of hemopoietic stem cells derived from human umbilical cord blood to promote restoration of spinal cord tissue and recovery of hindlimb function in adult rats
Authors: Nishio Yutaka , Koda Masao , Kamada Takahito , Someya Yukio , Yoshinaga Katsunori , Okada Seiji , Harada Hideki , Okawa Akihiko , Moriya Hideshige , Yamazaki Masashi 
Published: January 2008

Object
The use of human umbilical cord blood (HUCB) cells has been reported to improve functional recovery in cases of central nervous system injuries such as stroke, traumatic brain injury, and spinal cord injury (SCI). The authors investigated the effects of hemopoietic stem cells that were derived from HUCB and transplanted into the injured spinal cords of rats.

Methods
One week after injury, an HUCB fraction enriched in CD34-positive cells was transplanted into the experimental group. In control animals, vehicle (Matrigel) was transplanted. Recovery of motor functions was assessed using the Basso, Beattie, and Bresnahan Locomotor Scale, and immunohistochemical examinations were performed.
Cells from HUCB that were CD34 positive improved functional recovery, reduced the area of the cystic cavity at the site of injury, increased the volume of residual white matter, and promoted the regeneration or sparing of axons in the injured spinal cord. Immunohistochemical examination revealed that transplanted CD34-positive cells survived in the host spinal cord for at least 3 weeks after transplantation but had disappeared by 5 weeks. The transplanted cells were not positive for neural markers, but they were positive for hemopoietic markers. There was no evidence of an immune reaction at the site of injury in either group.

Conclusions
These results suggest that transplantation of a CD34-positive fraction from HUCB may have therapeutic effects for SCI. The results of this study provide important preclinical data regarding HUCB stem cell–based therapy for SCI.
Complete removal of an intraspinal and extraspinal cervical chordoma in one stage using the lateral approach
Authors: Barrey Cédric , Saint-Pierre Ghislaine , Frappaz Didier , Hermier Marc , Mottolese Carmine 
Published: January 2008

✓The authors describe a precise surgical technique in which a large intraspinal and extraspinal, multivertebral, cervical chordoma was completely removed in one stage using the lateral approach.
The patient in this case was a 29-year-old woman who presented with signs of radicular pain in the left C-3 area. Computed tomography and magnetic resonance imaging demonstrated a large intra- and extraspinal multivertebral tumor from C-2 to C-5, a finding that suggested a cervical chordoma. The tumor was completely removed in one stage using the lateral approach while controlling the vertebral artery (VA), and a partial corporectomy of C2–5 was also performed. Results from a postoperative histopathological examination confirmed that the tumor was a typical chordoma. The patient’s postoperative course was uneventful.
Cervical chordomas are typically excised using a posterior–anterior surgical approach with partial resection of the tumor. The lateral approach was appropriate in this patient for complete resection in one stage, because it enabled the surgeons to control the VA and access both extraspinal and intraspinal components of the chordoma.
Translaminar screw fixation in the upper thoracic spine
Authors: Kretzer Ryan M. , Sciubba Daniel M. , Bagley Carlos A. , Wolinsky Jean-Paul , Gokaslan Ziya L. , Garonzik Ira M. 
Published: January 2008

Object
The use of pedicle screws (PSs) for instrument-assisted fusion in the cervical and thoracic spine has increased in recent years, allowing smaller constructs with improved biomechanical stability and repositioning possibilities. In the smaller pedicles of the upper thoracic spine, the placement of PSs can be challenging and may increase the risk of damage to neural structures. As an alternative to PSs, translaminar screws can provide spinal stability, and they may be used when pedicular anatomy precludes successful placement of PSs. The authors describe the technique of translaminar screw placement in the T-1 and T-2 vertebrae.

Methods
Seven patients underwent cervicothoracic fusion to treat trauma, neoplasm, or degenerative disease. Nineteen translaminar screws were placed, 13 at T-1 and six at T-2. A single asymptomatic T-2 screw violated the ventral laminar cortex and was removed.
The mean clinical and radiographic follow up exceeded 14 months, at which time there were no cases of screw pull-out, screw fracture, or progressive kyphotic deformity.

Conclusions
Rigid fixation with translaminar screws offers an attractive alternative to PS fixation, allowing the creation of sound spinal constructs and minimizing potential neurological morbidity. Their use requires intact posterior elements, and care should be taken to avoid violation of the ventral laminar wall.
Trombone tongue: a new clinical sign for significant medullary compression at the craniovertebral junction
Authors: Lee Cheong H. , Casey Adrian T. H. , Allibone James B. , Chelvarajah Ramesh 
Published: January 2008

✓The authors describe a previously unreported clinical sign that may indicate the onset of significant compression of the medulla oblongata in cases of craniovertebral junction abnormalities. This 17-year-old boy presented with mild bilateral leg weakness. Imaging studies revealed severe basilar invagination and a marked Chiari malformation. While awaiting surgery, his tongue developed an involuntary constant protrusion–intrusion repetitive motion. The onset of this so-named “trombone tongue” sign was followed shortly afterward by rapidly progressive spastic tetraparesis. After the authors performed a transmaxillary clivectomy, foramen magnum decompression, and occipitocervical fusion, they noted that the abnormal tongue motion promptly resolved and the tetraparesis gradually improved.
The authors discuss their current understanding of the central control of tongue movements and present a hypothesis on the pathogenesis of trombone tongue based on the neuroanatomical basis of another abnormal tongue movement sign, lingual myoclonus.
Survivors of occipitoatlantal dislocation injuries: imaging and clinical correlates
Authors: Horn Eric M. , Feiz-Erfan Iman , Lekovic Gregory P. , Dickman Curtis A. , Sonntag Volker K. H. , Theodore Nicholas 
Published: January 2008

ObjectAlthough rare, traumatic occipitoatlantal dislocation (OAD) injuries are associated with a high mortality rate. The authors evaluated the imaging and clinical factors that determined treatment and were predictive of outcomes, respectively, in survivors of this injury.MethodsThe medical records and imaging studies obtained in 33 patients with OAD were reviewed retrospectively. Clinical factors that predicted outcomes, especially neurological injury at presentation and imaging findings, were evaluated.The most sensitive method for the diagnosis of OAD was the measurement of basion axial–basion dens interval on computed tomography (CT) scanning. Five patients with severe traumatic brain injuries (TBIs) were not treated and subsequently died. Of the 28 patients in whom treatment was performed, 23 underwent fusion and five were fitted with an external orthosis. Abnormal findings of the occipitoatlantal ligaments on magnetic resonance (MR) imaging, associated with no or questionable abnormalities on CT scanning, provided the rationale for nonoperative treatment. Of the 28 patients treated for their injuries, perioperative death occurred in five, three of whom had presented with severe neurological injuries. The mortality rate was highest in patients with a TBI at presentation. The mortality rate was lower in patients presenting with a spinal cord injury, but in this group there was a higher rate of persistent neurological deficits.ConclusionsThe spines in patients with CT-documented OAD are most likely unstable and need surgical fixation. In patients for whom CT findings are normal and MR imaging findings suggest marginal abnormalities, nonoperative treatment should be considered. The best predictors of outcome were severe brain or upper cervical injuries at initial presentation.
Serum creatine phosphokinase activity and histological changes in the multifidus muscle: a prospective randomized controlled comparative study of discectomy with or without retraction
Authors: Kotil Kadir , Tunckale Tamer , Tatar Zeynep , Koldas Macit , Kural Alev , Bilge Turgay 
Published: January 2008

Object
The aim of this study was to determine the extent of muscle injury caused by continuous or intermittent muscle retraction during macro- and microdiscectomy in lumbar disc surgery. Pain scores, serum creatine phosphokinase (CPK) levels, and histological findings obtained in muscle specimens were compared.

Methods
Sixty patients who underwent surgery for a one-level disc herniation during a 1-year period (January 2004–January 2005) and who had similar demographic characteristics were randomly assigned to one of four groups, each consisting of 15 patients: Group A, microdiscectomy in which the retractor was never released; Group B, microdiscectomy in which the retractor was released every 15 minutes; Group C, macrodiscectomy in which the retractor was never released; and Group D, macrodiscectomy in which the retractor was released every 15 minutes.
Muscle biopsy samples were acquired in each group, and biochemical studies were conducted to determine serum CPK levels. The duration of muscle retraction was 15 minutes followed by 3 minutes of relaxation in Groups B and D. In all groups, muscle degeneration and elevation in serum CPK levels were observed immediately after surgery. The overall results, however, were different. The decline of serum CPK levels started 1 week after surgery. The smallest degree of muscle injury (reflected by the lowest serum CPK level) was observed in Group B. When the pre- and postoperative CPK values were compared in all groups, the patients in Groups B and D reported the least amount of back pain (p < 0.001). No significant differences in serum CPK levels were observed between Groups A and C or between Groups B and D. The extent of back pain was evaluated using a visual analog scale, and the consumption of analgesics was also assessed. The groups exhibited significantly different responses: the lowest analgesic consumption and the lowest pain scores were demonstrated in Groups B and D.

Conclusions
In this prospective randomized clinical trial, the authors determined that muscle injury during lumbar disc surgery was closely related to muscle retraction and relaxation times whereas the size of the paravertebral skin incision had no effect on postoperative back pain and disability. There was no significant difference among the groups in terms of back pain during the long-term follow-up period (18–19 months).
Intraoperative electromyography monitoring in minimally invasive transforaminal lumbar interbody fusion
Authors: Bindal Rajesh K. , Ghosh Subrata 
Published: January 2008

Object
Minimally invasive transforaminal lumbar interbody fusion (TLIF) is an increasingly popular method for achieving lumbar decompression and fusion. The procedure is technically more demanding than open fusion, with correspondingly more theoretical risk of complication. The authors describe the use of intraoperative electromyography (EMG) as an adjunct to surgery to reduce the risk of complications.

Methods
Between August 2005 and April 2006, 25 consecutive patients underwent minimally invasive TLIF in which a total of 105 pedicle screws were placed. Intraoperative EMG was performed and included passive recordings during decompression and interbody graft placement, as well as active recording during the placement of the pedicle access needle and testing of the pedicle tap. A uniform protocol for active monitoring was used, with the pedicle access needle set at 7 mA. To assess hardware placement, all patients underwent postoperative radiography and 20 underwent postoperative computed tomography (CT) scanning.
In no patient did the authors observe significant EMG activation during decompression. In five cases, intermittent nerve root firing was noted after the interbody graft was placed, but this did not correlate with any postoperative deficits. Using the active stimulation protocol, 76.2% of screw placements required one or more changes to the trajectory of the pedicle access needle. With successful placement of the pedicle access needle, in all 105 screws, the pedicle tap nerve root stimulation threshold was greater than 15 mA. Postoperative radiography was performed in all patients and CT scanning was performed in 20 patients (with 85 screws being placed). Postoperative imaging revealed only three cases of pedicle breach. In all cases, the breach was at the lateral wall of the pedicle and not thought to be clinically relevant.

Conclusions
A continuous stimulation pedicle access needle alerts the surgeon to incorrect medial trajectories and may lead to safer pedicle cannulation. As a result of electrophysiological feedback, the pedicle access needle trajectory was altered in 76.2% of the reported cases. The use of the authors’ protocol resulted in a 0% incidence of clinically relevant malpositioned hardware and a low overall neurological complication rate. Intraoperative nerve root monitoring is a useful adjunct to minimally invasive TLIF.
En plaque intradural extramedullary spinal tuberculoma and concurrent intracranial tuberculomas: paradoxical response to antituberculous therapy
Authors: Muthukumar Natarajan , Sureshkumar Venkatachalam , Ramesh Vengalathur Ganesan 
Published: January 2008

✓Spinal intradural extramedullary tuberculoma is a rare entity. Rarer still are extensive en plaque intradural extramedullary tuberculomas occurring concurrently with multiple intracranial tuberculomas as a paradoxical response to chemotherapy for tuberculosis (TB). The authors describe the case of a 21-year-old man who was treated for tuberculous meningitis. Three months after the episode of meningitis, while undergoing chemotherapy for TB, he developed features of thoracic myelopathy. Investigations revealed an extensive en plaque intradural extramedullary lesion spanning seven segments in the lower thoracic spine. Magnetic resonance imaging of the brain revealed multiple asymptomatic intracranial tuberculomas. Even after further treatment with antituberculous chemotherapy was initiated, the lesion failed to respond. The authors performed a laminectomy and excised the en plaque intradural extramedullary lesion. The patient’s condition responded well to this treatment.Although the appearance of intracranial tuberculoma as a paradoxical response to chemotherapy has been previously reported, no authors have reported on the development of an extensive en plaque intradural extramedullary tuberculoma in conjunction with asymptomatic multiple intracranial tuberculomas as a paradoxical response.In cases in which patients present with compressive myelopathy following therapy for tuberculous meningitis, it is important to consider in the differential diagnosis that intradural extramedullary tuberculoma may be a paradoxical response to chemotherapy. The authors’ experience and their review of the literature indicate that surgery has a definitive role to play in the management of spinal intradural extramedullary tuberculoma.