bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Heart Rate Variability Predicts Postinduction Hypotension in Patients with Cervical Myelopathy
Authors: Boyle Sarah L , Moodley Alastair , Al Azazi Emad , Dinsmore Michael , Massicotte Eric M , Venkatraghavan Lashmi 
Published: August 2023

Background:Autonomic dysfunction, commonly seen in patients with cervical myelopathy, may lead to a decrease in blood pressure intraoperatively.Objective:The aim of our study is to determine if changes in Heart rate variability (HRV) could predict hypotension after induction of anesthesia in patients with cervical myelopathy undergoing spine surgery.Methods and Material:In this prospective observational study, 47 patients with cervical myelopathy were included. Five-minute resting ECG (5 lead) was recorded preoperatively and HRV of very low frequency (VLF), low frequency (LF), and high frequency (HF) spectra were calculated using frequency domain analysis. Incidence of hypotension (MAP <80 mmHg, lasting >5 min) and the number of interventions (40 mcg of phenylephrine or 5 mg of ephedrine) required to treat the hypotension during the period from induction to surgical incision were recorded. HRV indices were compared between the hypotension group and the stable group.Results:The incidence of hypotension after induction was 74.4% (35/47) and the median (IQR) interventions needed to treat hypotension was 2 (0.5–6). Patients who experienced hypotension had lower HF power and higher LF–HF ratios. A LF/HF >2.5 indicated postinduction hypotension likely. There was a correlation between increasing LF–HF ratio and the number of interventions that needs to maintain the MAP above 80 mmHg.Conclusion:HF power was lower and LF-HF ratio was higher in patients with cervical myelopathy who developed postinduction hypotension. Hence, preoperative HRV analysis can be useful to identify patients with cervical myelopathy who are at risk of post-induction hypotension.
Lumbar Facet Effusions and Other Degeneration Parameters and Its Association with Instability
Authors: Bendersky Damián , Asem Martín , Navarrete Oscar 
Published: August 2023

Background:Controversy exists in the literature about whether facet effusions and other degeneration parameters are associated with instability.Objective:To assess the association between facet effusions and other lumbar degeneration parameters and segmental instability.Material and Methods:In this study, 207 L4–L5 and L5–S1 levels in 104 patients were assessed. We divided the spinal levels into two groups: the small facet effusions (SFE) group in whom facet effusions were <1.5 mm or non-effusions were found, and the large facet effusions (LFE) group in whom they were ≥1.5 mm. The association between other degeneration parameters and instability was also assessed, such as disc degeneration, Modic changes (MC), spondylolisthesis, facet orientation and tropism, facet subchondral sclerosis, and facet cartilage degeneration. Furthermore, we subdivided the levels into subgroups to evaluate the association of LFE and instability within each one.Results:The main analysis comparing the presence of instability in SFE and LFE groups showed a non-statistically significant association between LFE and instability. The presence of MC type 1 and the existence of L4–L5 spondylolisthesis had a statistically significant association with instability. In the subset of 43 levels with L4–L5 degenerative spondylolisthesis, the presence of LFE and the existence of MC type 1 reached a significant association with instability.Conclusion:The presence of LFE and/or MC type 1 may act as red flags in patients with L4–L5 degenerative spondylolisthesis to suspect segmental instability.
Quantifying Neurological Examination in 21st Century
Authors: Yilmaz Murat , Ilbay Gul , Yilmaz Huriye E , Ertem Onder , Erbayraktar Serhat , Ilbay Konuralp M 
Published: August 2023

Background:Current methods used to measure the muscle strength required to achieve plantar flexion may yield highly variable results depending on the perception of the physician conducting the examination because these tests involve subjective and qualitative evaluation.Objective:To describe and evaluate the efficacy of a novel examination technique that can quantitatively measure plantar flexion in L5–S1 disc herniation.Materials and Methods:A total of 32 patients (average age: 49.4 years, range: 23–78) with L5–S1 disc herniations were included. The patient to be tested stood next to a table on which they could lean with their hands. The leg closer to the table was fully flexed at the knee, and the other foot was brought to maximum plantar flexion on the toes. At this point, a stopwatch was started to measure the time that passed until the muscles fatigued and the heel fell. The differences between the right and left plantar flexion times were noted. In addition, three different physicians graded muscle strength by using the classical “The Medical Research Council of the United Kingdom” method.Results:The time until fatigue in right and left plantar flexion was measured using the proposed method, and each test underwent a video recording. The Yilmaz–Ilbay plantar flexion test yielded the correct classification for all cases.Conclusion:We suggest that the proposed method “Yilmaz–Ilbay plantar flexion test” can serve as a useful, practical, and effective test to detect quantitative evaluation of plantar flexion in L5–S1 herniation.
Craniovertebral Junction Anomalies
Authors: Garg Kanwaljeet , Tandon Vivek , Kumar Rajinder , Chandra P Sarat , Kale Shashank S , Sharma Bhawani Shankar , Mahapatra Ashok K 
Published: August 2023

Background:Vertebral artery dissection (VAD) is a treatable cause of vertebrobasilar ischemic stroke and can be spontaneous or more commonly traumatic. Craniovertebral junction (CVJ) anomalies are a rare and often overlooked cause of VAD.Objective:The objective of this study was to study cases where CVJ anomaly presented as posterior circulation infarct and to conduct a relevant literature review.Materials and Methods:The medical records of seven patients who were managed for posterior circulation infarct associated with CVJ anomaly at our center from January 2009 through August 2013 were reviewed. PubMed and MEDLINE databases were also searched for similar cases, and the published case reports/series were reviewed.Results:Seven patients met our inclusion criteria and were included in the study. The mean age was 17.4 years (range: 10–35 years). All the patients were males. The most common symptoms were headache, vomiting, and gait ataxia. Slurring of speech was seen in one patient. One patient had repeated episodes of gait ataxia with left-sided weakness with complete recovery in between the episodes. One patient presented in unconscious state. Four patients complained of vertigo. The median duration of symptoms was 7 days (range: 3 days–12 months).Conclusions:CVJ anomalies can present as posterior circulation infarct. One must evaluate all patients with posterior circulation stroke, especially young patients, for possible CVJ anomalies. Dynamic lateral cervical spine X-ray is an important tool to diagnose AAD. CVJ anomalies represent a treatable cause of VAD.
Single-Stage Posterior Only Approach for Unilateral Atlantoaxial Spondyloptosis with type-II odontoid Fracture in Pediatric Patients
Authors: Varshney Gaurav , Kumar Amandeep , Doddamani Ramesh S , Meena Rajesh , Sawarkar Dattaraj P , Verma Satish , Singh Pankaj Kumar , Gupta Deepak , Satyarthee Gurudutta , Chandra P Sarat , Kale Shashank Sharad 
Published: August 2023

Objective:
When there is a complete slippage of facet joints of C1 over C2 such that there is no contact between the articulating surfaces of C1 and C2, the condition is known as atlantoaxial spondyloptosis (AAS). AAS represents an extremely rare manifestation of atlantoaxial instability. This study was performed to highlight the presentation, radiological features, and management of unilateral AAS in pediatric patients.

Material and Methods:
We retrospectively identified four pediatric patients with AAS from our hospital records in the last 6 years (2014–2019).

Results:
Among the four patients with unilateral AAS, three were posttraumic and one was diagnosed with craniovertebral junction tuberculosis (CVJ TB). All the patients had a varying degree of spastic quadriparesis on presentation. One patient with CVJ TB presented with neck tilt. All patients with traumatic unilateral AAS were associated with an odontoid fracture. These patients underwent C1-C2 fixation with complete reduction of spondyloptosis using the techniques of joint manipulation and joint remodeling with a posterior only approach. Complete reduction of AAS in patients with trauma was also associated with the realignment of the odontoid fracture. All patients improved neurologically after surgery and achieved excellent correction of the deformity on a follow-up imaging.

Conclusion:
Pediatric unilateral AAS is an extremely rare phenomenon. A single-stage posterior approach with C1-C2 fixation is a feasible technique for the treatment of this seemingly difficult to correct deformity in pediatric patients and the clinical outcomes are excellent.
AIIMS Cervical Myelopathy Score – A New Comprehensive and Objective Patient-Reported Modification of mJOA
Authors: Garg Kanwaljeet , Vij Vaibhav , Mishra Shashwat , Vibha Deepti , Singh Manmohan , Chandra P Sarat , Kale Shashank S 
Published: August 2023

Background:Several scoring systems have been developed for assessment of patients with compressive cervical myelopathy. However, all of these have some shortcomings. We proposed a new modification of the modified Japanese Orthopedic Association (mJOA) score—the AIIMS cervical myelopathy score (ACMS).Objective:The aim of this study was to compare the ACMS with mJOA score and Nurick score.Methods:We prospectively studied patients with cervical compressive myelopathy. The new ACMS, mJOA, Nurick proposed by Benzel, and Nurick scores were recorded preoperatively and at three months postoperatively in patients.Results:Sixty-two patients completed the 3-month follow-up and were included in the final analysis. The mean preoperative and postoperative Nurick, mJOA, and ACMS scores were 3.3 and 3.0, 12.3 and 13.8, and 15.1 and 17.7, respectively. High correlation (Pearson'sr> 0.8, 95% CI: 0.94 to 0.97,P< 0.005) was observed between ACMS and mJOA scores for all the individual components of both scales, both in pre- and postoperative assessments. A negative correlation was observed between the occupational ability scores ACMS and the Nurick scale (r= −0.76, 95% CI: −0.83 to − 0.68). No correlation was found with cord/canal ratio on magnetic resonance imaging (MRI) with any of the three scoring systems (preoperative, postoperative, or recovery rates).Conclusions:The ACMS score showed a good correlation with the mJOA score for evaluation of functional disability in the setting of cervical myelopathy. The patients could themselves report the scores using the ACMS scoring chart. The occupational component of the ACMS also correlated well with the Nurick score.
Correlation Between Obliquity of Exiting Nerve Root on Lateral Sagittal MRI Images and Degenerative Spondylolisthesis
Authors: Katikar Dattaprasanna B 
Published: August 2023

Background:MRI has become the investigation of choice for patients of low back pain with radiculopathy. However, MRI does not consistently detect spondylolisthesis. In far lateral sagittalT2 MRI images, exiting nerve roots are seen descending vertically. We observed that the obliquity of these descending nerve roots may be related to spondylolisthesis.Objective:Aim of this study is to evaluate the correlation between obliquity of exiting nerve root on MRI and lumbar instability on dynamic radiographs.Methods and Material:We retrospectively studied 248 patients who underwent discectomy or laminectomy and stabilization for degenerative lumbar disease at our institute from January 2017 to February 2020. For objectively measuring the obliquity of the exiting nerve root, we described an angle between the vertebra and exiting nerve root on far lateral T2 MRI images. We measured the exiting root angle and studied its correlation with degenerative spondylolisthesis on dynamic X-rays.Results:Out of 108 patients having spondylolisthesis, 106 (98.15%) had an angle of obliquity of the exiting nerve root as >105° and only two (1.85%) had an angleof <105°. Among 140 patients without spondylolisthesis, 137 (97. 86%) had an angle of obliquity of <105°and only three (2.14%) had an angle of >105°. Statistical parameters for our test of “angle of obliquity for the exiting nerve root in spondylolisthesis”are as follows: sensitivity of the test- 98.14%, specificity of the test- 97.85%.Conclusion:Obliquity of the exiting nerve root is a very easy to detect. It has avery high sensitivity and very high specificity for detecting spondylolisthesis on supine MRI.
Comparison of Different Tidal Volumes for Ventilation in Patients with an Acute Traumatic Cervical Spine Injury
Authors: Sengupta Deep , Bindra Ashish , Kapoor Indu , Mathur Purva , Gupta Deepak , Khan Maroof A 
Published: August 2023

Background:
There is scant literature comparing high tidal volume ventilation (HTV) over low tidal volume (LTV) ventilation in acute traumatic cervical spinal cord injury (CSCI).

Objective:
The aim of this prospective randomized controlled parallel-group, single-blinded study was to compare the effect of two different tidal volumes (12–15 mL/kg and 6–8 mL/kg) in CSCI on days to achieve ventilator-free breathing (VFB), PaO2/FIO2 ratio, the incidence of complications, requirement of vasopressor drugs, total duration of hospital stay, and mortality.

Materials and Methods:
We enrolled patients with acute high traumatic CSCI admitted to the neurotrauma intensive care unit within 24 h of injury, requiring mechanical ventilation. Participants were randomized to receive either HTV, 12–15 mL/kg (group H) or LTV, 6–8 mL/kg (group L) tidal volume ventilation.

Results and Conclusions:
A total of 56 patients, 28 in each group were analyzed. Patient demographics and injury severity were comparable between the groups. VFB was achieved in 23 and 19 patients in groups H and L, respectively. The median number of days required to achieve VFB was 3 (2, 56) and 8 (2, 50) days, P = 0.33; PaO2: FIO2 ratio was 364.0 ± 64 and 321.0 ± 67.0, P = 0.01; the incidence of atelectasis was 25% and 46%, P = 0.16, respectively, in group H and group L. The hemodynamic parameters and the vasopressor requirement were comparable in both groups. There was no barotrauma. The duration of hospital stay (P = 0.2) and mortality (P = 0.2) was comparable in both groups. There was no significant difference in days to achieve ventilator-free breathing with HTV (12–15 mL/kg) ventilation compared to LTV (6–8 mL/kg) ventilation in acute CSCI. The PaO2:FiO2 ratio was higher with the use of 12–15 mL/kg. No difference in mortality and duration of hospital stay was seen in either group.
Investigation of Sexual Function in Men with Spinal Cord Injury in a Rehabilitation Hospital in Turkey
Authors: Koyuncu Engin , Taşoğlu Özlem , Özgirgin Neşe 
Published: August 2023

Background:
Sexual function is one of the most important functions for males with spinal cord (SC) injuries, and there are wide ranges and conflicting results about sexual dysfunction and the frequency of education of these patients.

Objectives:
The aim of our retrospective study is to evaluate sexual function and to determine the level of sexual education provided by medical professionals in males with SC injury.

Patients and Methods:
Eighty-one inpatient males with SC injury were included in the study. “International Index of Erectile Function” and “International Spinal Cord Injury Male Sexual Function Basic Data Set” were used to evaluate sexual function.

Results:
The median age of the patients was 31 years old (range 20–63), and the median disease duration was 190 days (range 30–5475). Of 81 patients, 55.6% had C1-T10, 33.3% had T11-L2, and 11.1% had L3 and lower injury. Of the patients, 90.1% were never informed about the impact of SC injury on sexual function. The rates of normal psychogenic and reflex erection were 16 and 18.5%, respectively. Erectile dysfunction was severe in 66.7% and moderate in 16% of patients. Only 4.9% of patients had normal ejaculation and 7.4% had normal orgasmic function. Sexual desire was very high or high in 49.4% and moderate in 32.1%. Overall, sexual satisfaction was high or moderate in only 6.2% of patients.

Conclusion:
Sexual education rates of male SC injured persons are very low. Although most of the patients have normal sexual desire, erection, ejaculation, orgasmic function, and sexual satisfaction are severely damaged.
Combined Effect of Virtual Reality Training (VRT) and Conventional Therapy on Sitting Balance in Patients with Spinal Cord Injury (SCI)
Authors: Nair Manasa S , Kulkarni Vivek N , Shyam Ashok K 
Published: August 2023

Background:
Post spinal cord injury (SCI), sitting balance is considered a prerequisite for the effective performance of activities of daily living. Virtual Reality Training (VRT) may provide an interactive medium of rehabilitation, preventing a reduction in active participation of the patients while allowing for the training of sitting balance.

Aim:
The aim of this study was to evaluate the effect of the addition of VRT to conventional therapy in improving sitting balance in persons with SCI.

Subjects and Methods:
This was a single blinded randomized control trial conducted on 21 subjects with SCI (level of injury: D10 or below). They were randomly allocated into two groups; both groups received their routine exercise program. In addition, the intervention group, that is, Group B (n = 11) received 30 min of VRT in the seated position using Xbox-Kinect, while the conventional therapy group, that is, Group A (n = 10) received 30 min of additional conventional therapy to equalize the duration of the intervention (3 days/week, 4 weeks). The modified functional reach test and T-shirt test were measured at the beginning and at the end of 4 weeks.

Results:
MFRT changes for forward (Group A: 1.7 ± 1.09 cm; Group B: 4.83 ± 2.95 cm), right lateral (Group A: 2.43 ± 2.81 cm, Group B: 5.08 ± 1.85 cm), left lateral (Group A: 3.05 ± 4.65 cm, Group B: 6.19 ± 1.51 cm) were statistically significant for Group B (P < 0.05). No significant difference was observed between the two groups for T-shirt test (P > 0.05).

Conclusion:
VRT can be used as a part of a comprehensive rehabilitation program to improve sitting balance post-SCI.
Laminectomy with Rib Shears
Authors: R Rai Survendra Kumar , Dandapat Saswat K , Jadhav Dikpal , Jadhav Neha , Shah Abhidha , Rangnekar Ranjit D 
Published: August 2023

Introduction:Laminectomy/laminoplasty either free or vascularized pedicle flap is currently performed with a variety of expensive instruments. Use of Tudor Edwards rib shears to perform above procedure is described.Materials and Methods:Tudor Edwards rib shear was used to cut lamina in 18 cases for a variety of spinal lesions. Depending upon the size of lesion, laminectomy/laminoplasty was required for 2 to 8 levels. Vascularized pedicle laminoplasty or free flap laminoplasty was done with Tudor Edwards rib shears. Ligamentum flavum and interspinous and supraspinous ligaments were preserved in cases of vascularized pedicled laminoplasty, which was carried out in 12 cases. Free flap laminoplasty was carried out in 6 cases.Results:In all our cases, laminectomy was successfully achieved with rib shears without any injury to the dura or its underlying structures. It was possible to perform vascularized pedicle laminoplasty or free flap laminoplasty in all cases. Laminectomy was easier to perform in the cervical region and dorsal region, while it was difficult in the lumbar region due to the wider, thick lamina and its angulation, especially in adults.Conclusion:Laminectomy/laminoplasty with Tudor Edwards rib shears is quick, safe, and easy. Beveled cut edges with minimal bony loss prevents sinking of laminoplasty, thereby facilitates lamina fixation. This is an alternative method of performing laminectomy/laminoplasty, especially for those not having accessibility to expensive equipment.
A Novel Brain Retractor for Endoscopic Evacuation of Chronic Subdural Hematoma
Authors: Yadav Yad R , Bajaj Jitin , Ratre Shailendra , Yadav Nishtha , Parihar Vijay 
Published: August 2023

Background:
Endoscopic chronic subdural hematoma (CSDH) evacuation is a safe and effective alternative to the conventional burr hole technique. Although a rigid endoscope has the advantage of good visualization, there are risks of brain damage due to limited space to accommodate the scope and frequent lens soiling.

Objective:
This technical note describes a novel brain retractor to overcome the limitations of rigid endoscopy.

Methods:
The novel brain retractor (by senior author) was made by dividing a silicon tube longitudinally into two halves, and tapered for easy introduction in the operative cavity. Sutures were placed at the outer end of the retractor to prevent migration and to assist in angulation.

Results:
The novel retractor along with endoscopic assistance was used in 362 CSDH procedures. Endoscopy combined with this retractor provided additional help in complete removal of hematoma in organized/solid clots, septa, bridging vessels, and rapid expansion of brain in 83, 23, 21, and 24 patients, respectively (n = 151, 44%). Although there were three deaths (due to poor preoperative status), and two recurrences, there were no retractor-induced complications.

Conclusions:
The novel brain retractor assists endoscope in proper visualization of complete hematoma cavity by gentle and dynamic brain retraction, helps in thorough irrigation of hematoma cavity, protects the brain, and prevents lens soiling. It allows easy insertion of the endoscope and instruments using bimanual technique even in patients with a small width of hematoma cavity.
A Case of Parinaud Syndrome in a Patient with Parkinson's Disease
Authors: Dubey Souvik , Ghosh Ritwik , Ray Biman Kanti , Gutiérrez-Ortiz Consuelo , Benito-León Julián 
Published: August 2023

Background:
Parinaud syndrome is a dorsal mid-brain syndrome characterized by upgaze paralysis, convergence retraction nystagmus, and pupillary light-near dissociation. Infarctions or hemorrhages involving the mid-brain are the most frequent causes in older adults.

Objective:
To report a novel case of a patient who presented with classical parkinsonian signs and Parinaud syndrome.

Material and Methods:
Patient data were obtained from medical records from the Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India.

Results:
A 62-year-old previously healthy man presented with motor and non-motor symptoms of Parkinson's disease (PD) for the past 6 years. The neurological examination revealed an asymmetric resting tremor of the upper limbs with rigidity, bradykinesia, hypophonia, hypomimia, decreased blinking, and micrographia. The neuro-ophthalmological examination showed Parinaud syndrome. He was treated with levodopa-carbidopa and trihexyphenidyl. After 6 months and 1 year of follow-up, his neurological condition was re-assessed; motor symptoms improved substantially, but Parinaud syndrome persisted.

Conclusions:
Parinaud syndrome can be a potential manifestation of PD. A detailed neuro-ophthamological examination should be carried out even in patients having a diagnosis of classic PD in whom eye-movement abnormalities are distinctly infrequent.