bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early nuclear factor–κB activation and inducible nitric oxide synthase expression in injured spinal cord neurons correlating with a diffuse reduction of constitutive nitric oxide synthase activity
Authors: Miscusi Massimo , Ebner Florian , Ceccariglia Sabrina , Menegazzi Marta , Mariotto Sofia , Berra Luigi , Fa Aurora Del , Gangitano Carlo , Lauretti Liverana , Missori Paolo , Delfini Roberto , Suzuki Hisanori 
Published: January 2008

Object
Because of toxicity at high concentrations, nitric oxide (NO) contributes to spinal cord injury (SCI) secondary lesions. At low concentrations NO modulates nuclear factor–κB (NF-κB) activation. The authors investigated the activity of neuronal and endothelial NO synthase (nNOS and eNOS) to determine correlations with NF-κB activation and inducible NOS (iNOS) expression soon after SCI.

Methods
In 48 adult male Wistar rats clip-based (50 g/mm2/10 seconds) SCI was induced, and spinal cords were removed at different intervals for the following evaluations: 1) assaying specific activity of nNOS and eNOS; 2) electrophoresis mobility shift assay for activated NF-κB; 3) Northern blotting for iNOS; 4) immunohistochemistry for iNOS and NF-κB; and 5) immunofluorescence for iNOS and NF-κB.
At 15 minutes postinjury, eNOS activity decreased significantly (p < 0.001), as did nNOS activity at 1 hour compared with these levels in control animals and rats killed at 15 and 30 minutes after SCI (p < 0.001). Basal NF-κB levels were variable in controls and at 15 and 30 minutes after injury. One hour postinjury, NF-κB activation was diffuse. Inducible NOS messenger RNA localized diffusely, peaking 6 hours after injury and remaining stable until 24 hours postinjury. Immunohistochemical analysis showed diffuse iNOS and NF-κB staining, especially in neurons inside and around the lesion. Immunofluorescence demonstrated that injured neurons were a source of NF-κB and iNOS soon after injury.

Conclusions
Both nNOS and eNOS exhibited different regulation and roles soon after injury: nNOS correlated with NF-κB activation, whereas eNOS may have participated in vascular changes of the injured spinal cord. Neurons seemed to play a pivotal role in modulating and amplifying the inflammatory response in the injured spinal cord.
Mid-term and long-term follow-up data after placement of the Graf stabilization system for lumbar degenerative disorders
Authors: Onda Akira , Otani Koji , Konno Shinichi , Kikuchi Shinichi 
Published: January 2008

Object
The Graf pedicle screw and ligament device is designed to provide flexible stabilization to prevent abnormal spinal movement. The purpose of this study was to investigate radiographic and clinical outcomes during a minimal 5-year follow-up period.

Methods
Between 1991 and 1997, 43 consecutive patients (whose mean age was 61 years) with lumbar degenerative disease underwent decompression and stabilization in which the Graf system was placed. Data were available for 31 patients who attended follow up for the minimal 5-year period. In a retrospective review, the authors assessed measurements on radiographs, clinical results (using Japanese Orthopaedic Association [JOA] Scale scores), and low-back pain (using a visual analog scale [VAS] score), preoperatively and postoperatively at 1, 3, 5, and/or 10 years. Radiographic measurements included sagittal and frontal range of motion (ROM), regional lordosis, and posterior disc height as well as the extent of degenerative spondylolisthesis.
Final follow-up JOA and VAS scores were significantly better than preoperative scores. Sagittal and frontal ROM was significantly reduced at 1 and 5 years, respectively, compared with preoperative values, and a gradual reduction persisted throughout the follow-up period. Compared with its preoperative status, the disc height ratio (adjacent segments to the operated level) was reduced 5 years after surgery. A significant inhibition of the vertebral slippage was detected only in the flexion position.

Conclusions
Analysis of these data indicated that the Graf system eventually leads to successful fusion, suggesting the presence of stability in all three dimensions. The use of the Graf system should continue to be evaluated as an alternative device in the treatment of lumbar degenerative disease.
The effect of posterior bridging of C-1 on craniovertebral junction surgery
Authors: Senoglu Mehmet , Gümüşalan Yakup , Yüksel Kasim Zafer , Uzel Murat , Çelik Mustafa , Özbağ Davut 
Published: January 2008

Object
The groove for the vertebral artery (VA) may be bridged on C-1, forming a canal through which the artery passes. Because this variant may significantly affect the commonly performed C-1 posterior laminectomy, the authors studied the incidence and radiological appearance of this anatomical feature in surgical specimens.

Methods
Anatomical measurements were performed using a Vernier caliper (accurate to 0.1 mm) on 166 dry C-1 vertebrae. In addition, a convenience sample of 172 cervical x-ray films was evaluated. Partial osseous bridging was detected in eight (4.8%), and a complete osseous bridge, forming the canalis arteriae vertebralis (canal for the VA), was seen unilaterally (eight on the left and two on the right) in 10 (6%) and bilaterally in eight (4.8%) of the dry vertebrae. On lateral radiography, a complete bone bridge was observed on nine (5.2%) and a partial bridge on 10 (5.8%) of the 172 studies.

Conclusions
The discovery of a common variant may necessitate an immediate change in surgical management, and this anomaly could even increase the rate of surgery-related complications. The VA canal, present in the C-1 vertebra in approximately 5% of the specimens evaluated, was a variant that may be protective against VA injury. Knowledge of this variant may help the surgeon undertaking procedures in the C-1 region.
Hypoglossal nerve palsy after posterior screw placement on the C-1 lateral mass
Authors: Hong Jae Taek , Lee Sang Won , Son Byung Chul , Sung Jae Hoon , Kim Il Sub , Park Chun Kun 
Published: January 2008

✓ Atlantoaxial fixation in which C1–2 screw–rod fixation is performed is a relatively new method. Because reports about this technique are rather scant, little is known about its associated complications. In this report the authors introduce hypoglossal nerve palsy as a complication of this novel posterior atlantoaxial stabilization method.
A 67-year-old man underwent a C1–2 screw–rod fixation for persistent neck pain resulting from a Type 2 odontoid fracture that involved disruption of the transverse atlantal ligament. Posterior instrumentation in which a C-1 lateral mass screw and C-2 pedicle screw were placed was performed. Postoperatively, the patient suffered dysphagia with deviation of the tongue to the left side. At the 4-month follow-up examination, bone fusion was noted on plain x-ray studies of the cervical spine. His hypoglossal nerve palsy resolved completely 2 months postoperatively.
To the authors’ knowledge, this is the first report in the literature of hypoglossal nerve palsy following C1–2 screw–rod fixation. The hypoglossal nerve is one of the structures that can be damaged during C-1 lateral mass screw placement.
Multiple myeloma of the cervical spine: treatment strategies for pain and spinal instability
Authors: Rao Ganesh , Ha Chul S. , Chakrabarti Indro , Feiz-Erfan Iman , Mendel Ehud , Rhines Laurence D. 
Published: January 2008

Object
Metastases of multiple myeloma often occur in the cervical spine. These metastases may cause pain and associated spinal instability. The authors report the results of radiotherapy and surgical treatment for myeloma involving the cervical spine. The results of radiation therapy for multiple myeloma metastases to the cervical spine that cause clinical or radiographically documented instability have not been reported previously.

Methods
A retrospective chart review of patients with multiple myeloma metastases to the cervical spine was undertaken. Between 1993 and 2005, 35 patients were treated with external-beam radiation and/or surgical stabilization at the University of Texas M. D. Anderson Cancer Center in Houston, Texas. Nineteen of 20 patients with sufficient follow-up data experienced resolution of their pain when treated with radiation without surgical intervention. Twenty-three patients had evidence of spinal instability on radiographic images; 15 of these were treated with radiation alone. Of these, 10 had sufficient follow-up data, and none showed any clinical progression of instability. Radiographic follow-up images demonstrated an arrest of further progression of instability and, in some cases, healing of pathological fractures by means of radiation alone.

Conclusions
The results of this series suggest that, in selected cases, external-beam radiation for multiple myeloma metastases to the cervical spine is an effective palliative treatment, even in cases involving clinical or radiographically documented instability.
Development and psychometric properties of the Vertebral Compression Fracture Pain and Functional Disability Questionnaire
Authors: Evans Avery J. , Kip Kevin E. , Boutin Selene M. 
Published: January 2008

Object
Vertebral compression fractures (VCFs) result in severe and disabling pain, diminished quality of life, and substantial medical costs. There exists no standard instrument with which to measure pain and functional status before and after treatment of VCFs.

Methods
A questionnaire was specifically developed to assess pain and disability in patients with VCFs before and after undergoing percutaneous polymethylmethacrylate–augmented vertebroplasty. The first section of the baseline questionnaire (before treatment) contains 11 items that address the patient’s previous and current levels of back pain and distress. The second section of the baseline questionnaire lists 24 activities of daily living (ADLs), each measured on a four-point scale ranging from “able to do without pain” to “cannot do because of pain.” The follow-up questionnaire (after treatment) is similar in format.
Among 72 vertebroplasty-treated patients, the internal consistency reliability of the 24 ADLs ranged from 0.87 to 0.98, with similar results observed before and after treatment. Correlations of 0.29 to 0.72 were observed among the 24 ADLs and the internal measures of pain and distress measured on both visual analog and adjectival scales. Similar correlations (range 0.35–0.63) were observed between the questionnaire and 10 dimensions of the Oswestry Disability Index’s low-back pain questionnaire, an external instrument used to assess criterion-referenced validity. Evidence in support of the validity of the questionnaire was present before and after treatment.

Conclusions
The Vertebral Compression Fracture Pain and Functional Disability Questionnaire appears to be a reliable and valid instrument for assessing back pain and functional ability in patients before and after treatment for VCFs.
Spinal cord–fragment interactions following burst fracture: an in vitro model
Authors: Hall Richard M. , Oakland Robert J. , Wilcox Ruth K. , Barton David C. 
Published: January 2008

Object
The purpose of the study was to develop an in vitro model of the bone fragment and spinal cord interactions that occur during a burst fracture and further the understanding of how the velocity of the bone fragment and the status of the posterior longitudinal ligament (PLL) affect the deformation of the cord.

Methods
An in vitro model was developed such that high-speed video and pressure measurements recorded the impact of a simulated bone fragment on sections of explanted bovine spinal cord. The model simulated the PLL and the posterior elements.
The status of the PLL had a significant effect on both the maximum occlusion of the spinal cord and the time for occlusion to occur. Raising the fragment velocity led to an overall increase in the spinal cord deformation. Interestingly the dura mater appeared to have little or no effect on the extent of occlusion.

Conclusions
These findings may indicate the importance of the dura’s interaction with the cerebrospinal fluid in protecting the cord during this type of impact.
Metastatic disease from spinal chordoma: a 10-year experience
Authors: McPherson Christopher M. , Suki Dima , McCutcheon Ian E. , Gokaslan Ziya L. , Rhines Laurence D. , Mendel Ehud 
Published: January 2008

Object.
Metastastic lesions have been reported in 5 to 40% of patients with spinal and sacrococcygeal chordoma, but few contemporary series of chordoma metastastic disease exist in the literature. Additionally, the outcome in patients with chordoma-induced metastastic neoplasms remains unclear. The authors performed a retrospective review of the neurosurgery database at the University of Texas M. D. Anderson Cancer Center in Houston to determine the incidence of metastatic disease in a contemporary series of spinal and sacrococcygeal chordoma as well as to determine the outcomes.

Methods.
Thirty-seven patients underwent surgery for spinal and sacrococcygeal chordoma between June 1, 1993, and March 31, 2004. All records were reviewed, and appropriate statistical analyses were used to compare patient data for preoperative characteristics, treatments, and outcomes.
The authors identified seven patients (19%) in whom metastatic disease developed; in three the disease had metastasized to the lungs only, in two to the lungs and liver, and in two to distant locations in the spine. There were no significant differences in age, sex, tumor location, or history of radiation treatments between patients with and those without metastases. In cases with local recurrent tumors, metastastic disease was more likely to develop than in those without recurrence (28 compared with 0%, respectively; p = 0.07). In two (12%) of 17 patients who underwent en bloc resection, metastatic disease developed, whereas it developed in five (25%) of 20 patients treated by curettage (p = 0.42). The median time from first surgery to the appearance of metastatic disease, as calculated using the Kaplan–Meier method, was 143.4 months (95% confidence interval [CI] 66.8–219.9). The median survival duration of patients with metastatic disease after the first surgery was 106 months (95% CI 55.7–155.7), and this did not differ significantly from that in patients in whom no metastases developed (p = 0.93).

Conclusions.
Spinal chordoma metastasized to other locations in 19% of the patients in this series. In patients with local disease recurrence, metastatic lesions are more likely to develop. Metastatic lesions were shown to be aggressive in some cases. Surgery and chemotherapy can play a role in controlling metastatic disease.
Hollow cylindrical polymethylmethacrylate strut for spinal reconstruction after single-level cervical corpectomy
Authors: Chen Jyi-Feng , Wu Chieh-Tsai , Lee Sai-Cheung , Lee Shih-Tseng 
Published: January 2008

Object
This prospective study was conducted to assess the safety of using a cylindrical polymethylmethacrylate (PMMA) strut for fusion and reconstruction of the cervical spine after single-level cervical corpectomy. The authors describe the clinical results obtained in patients after surgery.

Methods
Fifty-four patients underwent single-level cervical corpectomy, fusion, and spinal reconstruction that involved the placement of hollow cylindrical PMMA struts. In each patient, the spine was reinforced with anterior cervical plates. The PMMA struts were filled with autologous bone obtained from the resected vertebral body. Follow-up radiographic evaluation involved plain lateral dynamic radiographs and computed tomography (CT) scans. Neurological status was assessed pre- and postoperatively using the Nurick Scale. A total of 46 patients (85.1%) attended follow-up visits for a minimum of 2 years. Spinal stability was documented in all patients on 12-month plain dynamic lateral radiographs; in 37 patients (80.4%), complete osseous fusion was demonstrated on the 12-month CT reconstructions. In the remaining nine patients, complete fusion had been achieved by 24 months. The overall mean preoperative Nurick grade was 2.94 ± 0.97, and this improved significantly to 1.71 ± 0.77 (p < 0.05) by 24 months. There were no complications related to the hollow cylindrical PMMA strut.

Conclusions
The findings of this preliminary study indicate that hollow cylindrical PMMA struts can be safely used in cervical fusion after single-level corpectomy and that the clinical results are satisfactory. The hollow cylindrical PMMA strut is a good substitute for spinal reconstruction and fusion when combined with plate fixation in patients who have undergone anterior cervical single-level corpectomy.
Diagnosis and treatment of spinal cord herniation: a combined experience
Authors: Barrenechea Ignacio J. , Lesser Jonathan B. , Gidekel Alberto L. , Turjanski Leon , Perin Noel I. 
Published: January 2008

Object
Idiopathic spinal cord herniation (ISCH) is an uncommon clinical entity typically presenting with lower-extremity myelopathy. Despite the existence of 85 ISCH cases in the literature, misdiagnosis and delayed diagnosis remain a major concern.

Methods
The authors conducted a retrospective review of patients who underwent surgery for ISCH at their institutions between 1993 and 2004. Seven patients were treated for ISCH, five in New York and two in Buenos Aires. The patients’ ages ranged from 32 to 72 years. There were three men and four women. The interval between the onset of symptoms and surgery ranged from 12 to 84 months (mean 42.1 months).
Preoperatively, spinal cord function in four patients was categorized as American Spinal Injury Association (ASIA) Grade D, and that in the other three patients was ASIA Grade C. In all patients a diagnosis of posterior intradural arachnoid cyst had been rendered at other institutions, and three had undergone surgery for the treatment of this entity. In all cases, the herniation was reduced and the defect repaired with a dural patch. The follow-up period ranged from 10 to 147 months (mean 49.2 months). Clinical recovery following surgery varied; however, there was no functional deterioration compared with baseline status. Syringomyelia, accompanied by neurological deterioration, developed postoperatively in two patients at 2 and 10 years, respectively.

Conclusions
Patients presenting with a diagnosis of posterior intradural arachnoid cyst should be evaluated carefully for the presence of an anterior spinal cord herniation. Based on the authors’ literature review and their own experience, they recommend offering surgery to patients even when neurological compromise is advanced.
Advanced glycation end-products downregulating intervertebral disc cell production of proteoglycans in vitro
Authors: Yokosuka Kimiaki , Park Jin Soo , Jimbo Kotaro , Yamada Kei , Sato Kimiaki , Tsuru Michiyo , Takeuchi Masayoshi , Yamagishi Sho-Ichi , Nagata Kensei 
Published: January 2008

Object
The authors sought to clarify the role, if any, of advanced glycation end-products (AGEs) in disc degeneration.

Methods
Intervertebral discs were analyzed for the presence of AGEs and of their receptor (RAGE) by immunohistochemical analysis. Reverse transcriptase polymerase chain reaction (RT-PCR) was performed to detect any RAGE gene expression, and real-time PCR was used to quantify messenger RNA (mRNA) levels of aggrecan and collagen types I and II in nucleus pulposus cells treated with AGEs. Aggrecan protein concentration was determined by enzyme-linked immunosorbent assay.
Immunohistochemical analysis revealed that AGEs and RAGE were localized in the nucleus pulposus of the intervertebral disc. Advanced glycation end-products were found to significantly suppress the expression of aggrecan at both mRNA and protein levels in a dose- and time-dependent manner. The levels of collagen types I and II remained unchanged after treatments with AGEs.

Conclusions
These results suggest that the accumulation of AGEs and their interaction with their receptor in the nucleus pulposus might result in the downregulation of aggrecan production responsible for disc degeneration.
Biomechanical comparison of two new atlantoaxial fixation techniques with C1–2 transarticular screw–graft fixation
Authors: Härtl Roger , Chamberlain Robert H. , Fifield Mary S. , Chou Dean , Sonntag Volker K. H. , Crawford Neil R. 
Published: January 2008

Object
Two new techniques for atlantoaxial fixation have been recently described. In one technique, C-2 intra-laminar screws are connected with C-1 lateral mass screws; in the second, C-1 and C-3 lateral mass screws are interconnected and C-2 is wired sublaminarly. Both techniques include a C1–2 interspinous graft. The authors compared these techniques with the gold-standard, interspinous graft–augmented C1–2 transarticular screw fixation and with a control C1–2 interspinous graft fixation procedure alone.

Methods
In six human cadaveric occiput–C4 specimens, nonconstraining 1.5-Nm pure moments were applied to induce flexion, extension, lateral bending, and axial rotation during which three-dimensional angular motion was measured optoelectronically. Each specimen was tested in the normal state, with graft alone (after odontoidectomy), and then in varying order after applying each construct with a rewired graft. All three constructs allowed significantly less angular motion at the C1–2 junction than the wired interspinous graft alone during lateral bending and axial rotation (p < 0.01, paired Student t-test) but not during flexion or extension. Transarticular screw fixation with an interspinous graft allowed less motion at the atlantoaxial junction than the two new constructs in several conditions. Differences were greater between the transarticular screw construct and the intralaminar screw construct than between the transarticular screw construct and the C1–3 lateral mass screw construct. During lateral bending and axial rotation, the C1–3 construct allowed less motion at the atlantoaxial junction than the intralaminar screw construct.

Conclusions
Biomechanically, the gold-standard C1–2 transarticular screw fixation outperformed the two new techniques during lateral bending and axial rotation. Wiring C-2 to C1–3 rods provided greater stability than C1–2 laminar screws, but it sacrificed C2–3 mobility. It is unknown whether the small differences observed biomechanically would lead to clinically relevant differences in fusion rates.