bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expansile, enhancing cervical cord lesion with an associated syrinx secondary to demyelination
Authors: Waziri Allen , Vonsattel Jean-Paul , Kaiser Michael G. , Anderson Richard C. E. 
Published: January 2008

✓The authors describe the case of a patient with an enhancing, intramedullary cervical spinal cord lesion and associated syrinx. Biopsy sampling of the cervical lesion was performed, and the histological findings were consistent with a demyelinating process supporting the diagnosis of multiple sclerosis (MS). Syrinx formation associated with demyelinating disease has only been described in isolated cases, almost exclusively in Japanese patients with MS.
A 22-year-old woman of Caribbean descent presented with a subacute, progressive myelopathy including symptoms of pain and weakness in all extremities, bladder incontinence, and the inability to ambulate. Magnetic resonance imaging of the brain and spinal cord demonstrated an enlarged cervical cord with enhancement and central cavitation consistent with a syrinx.
The patient underwent a C3–7 laminoplasty and placement of a dural graft for cord decompression as well as fenestration of the central syrinx. Biopsy sampling of the lesion was performed, and the histopathological analysis, in conjunction with subsequent laboratory and diagnostic testing, supported the diagnosis of demyelinating disease. After treatment with a course of high-dose dexamethasone and inpatient rehabilitation therapy, the patient demonstrated significant clinical improvement.
Spinal cord involvement is not uncommon in patients with demyelinating disease; however, enhancing lesions associated with extensive tissue loss and syrinx formation have rarely been reported. For the consulting neurological surgeon, demyelinating disease should be included in the differential diagnosis of such lesions given the level of complexity and risk to the patient associated with open biopsy of the spinal cord.
Combined percutaneous transpedicular tumor debulking and kyphoplasty for pathological compression fractures
Authors: Gerszten Peter C. , Welch William C. 
Published: January 2008

✓Percutaneous balloon kyphoplasty has become a widely adopted treatment option for patients with pain due to pathological compression fractures. One potential risk of the procedure is the displacement of tumor into the spinal canal and resulting spinal cord or cauda equina injury during inflation of the balloon prior to polymethylmethacrylate (PMMA) placement. In addition, the presence of any remaining tumor between the PMMA and the fractured cortical bone can lead to suboptimal improvement in stabilization and subsequent pain relief. The authors describe a technique to remove tumor from within the vertebral body (VB) through a percutaneous working channel prior to kyphoplasty balloon inflation and augmentation.
The technique was successfully used in all three patients who had presented with pain, and the pain improved in all three cases. There was no extravasation of PMMA into the spinal canal in any case.
A combined VB tumor debulking and kyphoplasty technique offers the ability to improve the placement of PMMA within the diseased vertebral body, potentially leading to increased safety as well as clinical effectiveness for stabilization of these fractures.
Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature
Authors: Kuntz Charles , Levin Linda S. , Ondra Stephen L. , Shaffrey Christopher I. , Morgan Chad J. 
Published: January 2008

Object
An increasing emphasis is being placed on the preservation or restoration of neutral upright sagittal spinal alignment in both deformity surgery and routine spinal operations. Sagittal spinal alignment is becoming recognized as an important predictor of a patient’s outcome after spinal surgery. In this literature review, the authors analyze data obtained from previously published studies conducted to evaluate neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults.

Methods
A review of the English-language literature was conducted to identify studies conducted to evaluate neutral upright sagittal spinal (occiput–pelvis) alignment in asymptomatic adult volunteers with no spinal disease. The authors identified 12 articles that met the strict primary inclusion criteria of the current study. From these articles, 23 angles and displacements were selected to depict neutral upright sagittal occiput–pelvis alignment. Pooled estimates of the mean and variance were calculated for angles and displacements that met secondary inclusion criteria. The greatest variation in the regional spinal curves occurred in the cervical spine from C-2 to C-7, whereas the greatest focal angulation in the spine occurred from L-4 to S-1. Sagittal spinal balance was maintained in a narrow range for alignment of the spine over the pelvis and femoral heads.

Conclusions
Neutral upright sagittal occiput–pelvis alignment in asymptomatic adults has been well studied regionally. Despite a wide variation in the undulating lordotic and kyphotic regional curves from the occiput to the pelvis, sagittal spinal balance is maintained in a narrower range for alignment of the spine over the pelvis and femoral heads.
Endoscopic image-guided odontoidectomy for decompression of basilar invagination via a standard anterior cervical approach
Authors: Wolinsky Jean-Paul , Sciubba Daniel M. , Suk Ian , Gokaslan Ziya L. 
Published: January 2008

✓Symptomatic irreducible basilar invagination has traditionally been approached through a transoral–transpharyngeal route with resection of the anterior portion of C-1 and the odontoid. Modification of this exposure with either a Le Fort osteotomy or a transmandibular osteotomy and circumglossal approach has increased the access to pathological conditions in this region. These traditional routes all require traversing the oral cavity and accepting the associated potential complications. The authors have developed a novel surgical approach, an endoscopic transcervical odontoidectomy, which allows access for resection of the odontoid and for brainstem and spinal cord decompression without traversing the oral cavity. In this paper they describe the technique and its advantages and present three cases in which patients underwent the endoscopic transcervical odontoidectomy for basilar invagination.Three consecutive patients (age range 42–74 years) who had irreducible basilar invagination underwent the endoscopic transcervical odontoidectomy. All were symptomatic and had neck pain and myelopathy. All were evaluated preoperatively and postoperatively with computed tomography and magnetic resonance imaging. In all cases the procedure resulted in complete decompression. There were no serious complications. No patient required prolonged intubation, tracheostomy, or enteral tube feeding. One patient had an intraoperative cerebrospinal fluid leak, which had no postoperative sequelae.The authors present an alternative surgical approach for treating ventral compression of the brainstem and spinal cord. The technique is safe and effective for decompression and provides a surgical route that can be added to the armamentarium of treatments for pathological conditions in this region.
Working area, safety zones, and angles of approach for posterior C-1 lateral mass screw placement: a quantitative anatomical and morphometric evaluation
Authors: Rocha Rogerio , Safavi-Abbasi Sam , Reis Cassius , Theodore Nicholas , Bambakidis Nicholas , De Oliveira Evandro , Sonntag Volker K. H. , Crawford Neil R. 
Published: January 2008

Object
The authors measured relevant quantitative anatomical parameters to define safety zones for the placement of C-1 posterior screws.

Methods
Nineteen linear, two angular, and four surface parameters of 20 dried atlantal specimens were evaluated. The Optotrak 3020 system was used to define the working area. Ideal angles for screw positioning were measured using digital radiographs and a free image-processing program. Six silicone-injected cadaveric heads were dissected bilaterally to study related neurovascular anatomy.
The depth (range 5.2–9.4 mm, mean 7.2 ± 1.1 mm) and width (range 5.2–8.1 mm, mean 6.5 ± 0.9 mm) of the transverse foramen varied considerably among specimens. The mean posterior working area was 43.3 mm2. All specimens accommodated 3.5-mm-diameter screws, and 93% accepted 4-mm-diameter screws. In 10 specimens (50%), partial removal of the posterior arch was necessary to accommodate a 4-mm screw. The mean maximum angle of medialization was 16.7 ± 1.3°; the mean maximum superior angulation was 21.7 ± 4.7°.

Conclusions
The anatomical configuration of the atlas and vertebral artery (VA) varied considerably among the cadaveric specimens. The heights of the C-1 pedicle, posterior arch, and posterior lamina determine the posterior working area available for screw placement. The inferior insertion of the posterior arch may have to be drilled to increase this working area, but doing so risks injury to the VA. A dense venous plexus with multiple anastomoses may cover the screw entry site, potentially obscuring the operative view and increasing the risk of hemorrhage.
Neurophysiological detection of iatrogenic C-5 nerve deficit during anterior cervical spinal surgery
Authors: Bose Bikash , Sestokas Anthony K. , Schwartz Daniel M. 
Published: January 2008

Object
The incidence of postoperative C-5 spinal nerve root palsy following decompressive cervical spinal surgery has been reported to be as high as 12% for anterior procedures and 30% for posterior procedures. The present study was conducted to document the prevalence of iatrogenic C-5 nerve root deficit during anterior cervical spinal surgery, as well as to evaluate the sensitivity and specificity of intraoperative transcranial electrical stimulation (TES)–induced motor evoked potentials (MEPs) and spontaneous electromyographic (EMG) activity for identifying evolving C-5 nerve root impairment.

Methods
The authors conducted a retrospective study of 238 consecutive anterior cervical spinal procedures performed by a single surgeon at Christiana Care Hospital within a 48-month period. Techniques used to monitor spinal nerve root function included TES-induced MEPs and spontaneous EMG activity from deltoid, biceps, triceps, wrist extensor, and hand intrinsic muscles innervated by the C5–T1 spinal nerve roots. Spinal cord function was monitored by recording TES-induced MEPs from upper- and lower-extremity muscles as well as somatosensory evoked potentials from stimulation of the ulnar and posterior tibial nerves.

Conclusions
Transcranial electrical stimulation–induced MEPs and spontaneous EMG activity offer complementary information about evolving iatrogenic C-5 spinal nerve root impairment during anterior cervical spinal surgery. The TES-induced MEPs provide prognostic information and show increased sensitivity to C-5 deficit compared with spontaneous EMG activity alone. Monitoring of spinal nerve root function using only EMG activity carries a risk of false-negative findings; without timely warning of impending neurological impairment, timely intervention to prevent permanent deficit cannot occur.
Postlaminoplasty cervical range of motion: early results
Authors: Kang Suk-Hyung , Rhim Seung-Chul , Roh Sung-Woo , Jeon Sang-Ryong , Baek Hyun-Chul 
Published: January 2008

ObjectThe authors studied cervical range of motion (ROM) before and after cervical laminoplasty to determine factors associated with cervical ROM in patients with cervical myelopathy.MethodsBetween July 2003 and August 2005, 20 patients underwent a modified Hirabayashi-type unilateral open-door laminoplasty to treat multilevel cervical spondylosis or ossification of the posterior longitudinal ligament (OPLL). Clinically, the authors assessed Japanese Orthopaedic Association (JOA) score, duration of symptoms, disease entity, and the age and sex of patients to ascertain the relation of these factors to ROM before and after cervical laminoplasty. Intraoperative findings such as ligament detachment from the C-2 spinous process and cervicothoracic junction involvement were noted. Radiological and imaging findings such as the length of the lesion, cervical axial canal area, antero-posterior (AP) diameter of the cervical canal, angle of the opened lamina after surgery, cervical sagittal angles, cervical curvature index (CCI), and signal change of the cord on magnetic resonance imaging were evaluated.The mean follow-up period was 19.45 months (range 13–38 months). The preoperative average ROM in 18 patients (after excluding two patients with trauma) was 36.73 ± 15.73°; postoperatively it was 25.24 ± 16.06°. Thus, ROM decreased by 9.64 ± 10.09° (31.80%) after surgery (p = 0.002), reflecting the mean in the same 18 patients. Preoperative ROM was related to the age of patients, CCI, preoperative JOA score, and AP diameter of the cervical canal. In cases of OPLL the ROM was lower than that in cases of spondylosis. Postoperative cervical ROM was related to preoperative ROM, postoperative AP diameter of the cervical canal, laminar angle, patient age, and follow-up duration. None of the studied parameters, however, correlated with a decreased cervical ROM.ConclusionsCervical ROM was reduced after cervical laminoplasty. Postlaminoplasty cervical ROM had a positive correlation with extended motion; however, gradually it became reduced. In this study, no correlative factor was associated with a reduction in cervical ROM. Further study is also needed.
Negative-pressure wound therapy in the treatment of complex postoperative spinal wound infections: complications and lessons learned using vacuum-assisted closure
Authors: Jones G. Alexander , Butler John , Lieberman Isador , Schlenk Richard 
Published: January 2008

ObjectDeep infections of the spine are a significant cause of morbidity and death. Such infections complicate 0.7 to 11.9% of spinal procedures. Management includes intravenous antibiotic therapy, debridement and irrigation with primary closure, placement of drains, use of irrigation systems, and/or healing through secondary intention with wound packing. Vacuum-assisted closure (VAC) is a new alternative for treatment of patients with complex postoperative spinal infections. The aim of this study was to investigate the safety of this treatment method in this patient population.MethodsThe authors reviewed the charts of 16 consecutive patients treated with negative-pressure wound therapy at their institution between 2002 and 2006. All had deep infections of the spine and were treated with surgical debridement and placement of VAC dressings. All infections were postoperative. Members of the infectious disease service were involved in the care of all patients, and all patients received intravenous antibiotic therapy. The authors reviewed operative notes, discharge summaries, and notes from follow-up visits and assessed outcome on the basis of the same records.Three patients were lost to follow up, leaving a group of 13 with follow up of at least 90 days. Two patients experienced bleeding complications related to the continuous negative pressure of the VAC device. In two cases, the infections persisted and required reoperation. In one case, a skin graft was required because of nonhealing granulation tissue. One of the patients with bleeding complications died as a result of delayed complications related to intraoperative blood loss, blood loss via the VAC system, and refusal of a blood transfusion on religious grounds.ConclusionsNegative-pressure wound therapy has been employed as a treatment strategy for patients with complex postoperative spinal infections, but little is known of the complications associated with VAC in the spinal surgery patient population. Serious complications, including death, may be associated with use of the VAC system.
The expression of Fas ligand on normal and stabbed-disc cells in a rabbit model of intervertebral disc degeneration: a possible pathogenesis
Authors: Wang Jing , Tang Tiansi , Yang Huilin , Yao Xiaoshen , Chen Liang , Liu Wei , Li Tao 
Published: January 2008

ObjectThe nucleus pulposus has been reported to be an immunologically privileged site. The expression of Fas ligand (FasL) on normal and herniated lumbar disc cells has been reported. The relationship between a physiological barrier and the role of FasL has not yet been addressed. To clarify this relationship and to investigate a possible pathogenesis of intervertebral disc degeneration (IDD), the expression of Fas and FasL (a mean apoptosis index) on normal and stabbed-disc cells was examined in a rabbit model of IDD.MethodsUsing defined needle gauges and depths, the anular puncture model of IDD was established in rabbits. The normal and stabbed discs were harvested at 3, 6, and 10 weeks after surgery. Immunohistochemical staining of these discs for Fas and FasL was performed using standard procedures. The mean apoptosis indices of the disc cells were determined using flow cytometry analysis.The nucleus pulposus cells from the normal discs exhibited relatively weak immunopositivity, whereas the nucleus pulposus cells from the stabbed discs exhibited strong immunopositivity. There was a significant difference (p < 0.001) in the percentage of FasL-positive nucleus pulposus cells between the normal discs and the stabbed discs. The mean apoptosis indices of the stabbed-disc cells at 3, 6, and 10 weeks poststab were significantly higher than those in normal disc cells (p < 0.001, 0.002, and 0.006, respectively). There was a significant correlation between the degree of FasL-positive expression and the degree of Fas-positive expression of the nucleus pulposus cells poststab (r = 0.571, p = 0.0036).ConclusionsThese observations indicate that the nucleus pulposus is an immunologically privileged site. This immunological privilege is maintained by FasL and the physiological barrier together. When the physiological barrier was damaged (by stabbing the disc), the role of FasL changed, and FasL was coexpressed with Fas to induce apoptosis of disc cells. These results indicate that an autoimmune reaction may be a possible pathogenesis of IDD.
Evaluation of hydroxyapatite ceramic vertebral spacers with different porosities and their binding capability to the vertebral body: an experimental study in sheep
Authors: Ito Manabu , Kotani Yoshihisa , Hojo Yoshihiro , Abumi Kuniyoshi , Kadosawa Tsuyoshi , Minami Akio 
Published: January 2008

Object
The aim of this study was to evaluate the degree of bone ingrowth and bonding stiffness at the surface of hydroxyapatite ceramic (HAC) spacers with different porosities in an animal model and to discuss the ideal porous characteristics of these spacers for anterior spinal reconstruction.

Methods
Twenty-one adult sheep (age 1–2 years, mean weight 70 kg) were used in this experiment. Surgery consisted of anterior lumbar interbody fusion at L2–3 and L4–5, insertion of an HAC spacer (10 × 13 × 24 mm) with three different porosities (0, 3, and 15%), and single-rod anterior instrumentation. At 4 and 6 months postoperatively, the lumbar spines were harvested. Bonding conditions at the bone–HAC spacer interface were evaluated using neuroimages and biomechanically. A histological evaluation was also conducted to examine the state of bone ingrowth at the surface of the HAC spacer.
Biomechanical testing showed that the bonding strength of HAC at 6 months postoperatively was 0.047 MPa in 0% porosity spacers, 0.39 MPa in 3%, and 0.49 MPa in 15% porosity spacers. The histological study showed that there was a soft-tissue layer at the surface of the HAC spacer with 0% porosity. Direct bonding was observed between bone and spacers with 3 or 15% porosity. Micro–computed tomography scans showed direct bonding between the bone and HAC with 3 or 15% porosity. No direct bonding was observed in HAC with 0% porosity.

Conclusions
Dense (0%) HAC anterior vertebral spacers did not achieve direct bonding to the bone in the sheep model. The HAC vertebral spacers with 3 or 15% porosity showed proof of direct bonding to the bone at 6 months postoperatively. The higher porosity HAC spacer showed better bonding stiffness to the bone.
Rethinking Nature: Public Visions in the Netherlands
Authors: Van Den Born Riyan J.G. 
Published: January 2008

This study addresses two questions: (1) what visions of nature do lay people subscribe to? (2) to what extent do these visions reflect those of professional philosophers? Four philosophical images of the human-nature relationship were discussed with respondents; Master, Steward, Partner and Participant. Respondents recognise these images, but prefer to construct their own. Elements of their images are (1) that humans are part of nature, but (2) that they are responsible for nature as well. This study indicates that empirical philosophy can contribute to the further development of environmental philosophy. Through an empirical turn we can discover people's own voice.
Engineering Miracles: Water Control, Conversion and the Creation of a Religious Landscape in the Medieval Ardennes
Authors: Arnold Ellen F. 
Published: January 2008

Abstract
Though sometimes at odds, the religious and economic identities of medieval monks could also reinforce one another. Benedictine monks throughout the medieval world engaged in the economic transformation of the world while also seeking to flee many kinds of secular involvement. In the early and high Middle Ages, the monks of the Ardennes actively worked to reconcile this by constructing a religious framework for their practical activities. They controlled, managed and engineered water resources, and created miracle stories that highlighted these activities. Medieval monks had cultural and religious reasons for creating stories about water control, and religious stories need a firmer place in discussions of environment and technology. This article demonstrates that monks were able to use their religious authority and their control of religious message to support and supplement their temporal powers. The control of water resources was more than an economic or practical necessity; it was deeply connected to monastic identity and the relationships between monks and the secular world.
Book Reviews
Authors: Widgren Mats , Goodall Heather , Pratt Stphen 
Published: January 2008

Abstract
Sing C. Chew, The Recurring Dark Ages: Ecological Stress, Climate Changes and System Transformation (MATS WIDGREN)
Amita Baviskar (ed.), Waterscapes (HEATHER GOODALL)
Sharon Beder, Environmental Principles and Policies: An Interdisciplinary Approach (STEPHEN PRATT)
Book Reviews
Authors: Rotherham Ian D. , Frawley Jodi , van Dam Petra J.E.M. 
Published: January 2008

Abstract
Peter Coates, Strangers on the Land: American Perceptions of Immigrant and Invasive Species (IAN D. ROTHERHAM)
S. Ravi Rajan, Modernizing Nature: Forestry and Imperial Eco-Development 1800-1950 (JODI FRAWLEY)
Marie Luisa Allemeyer, 'Kein Land ohne Deich...!' Lebenswelten einer Kuestengesellschaft in der Frühen Neuzeit (PETRA J.E.M. VAN DAM)
Fire Extinguishing Agents
Authors: Slye Orville M. 
Published: January 2008

AbstractThe article contains sections titled:1.Introduction2.Water as an Extinguishing Agent3.Fire‐Fighting Foams3.1.Limitations and Uses3.2.Foam Concentrates3.3.Guidelines for Using Fire‐Fighting Foams4.Dry Chemical Extinguishing Agents5.Inerting Gas Extinguishing Agents6.Halogenated Extinguishing Agents7.Direct Halon Replacement Agents and Systems8.Extinguishing Agents for Combustible Metal Fires