Journal of neurosurgery. Spine
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In the present study, the authors identified the etiology, precipitating factors, and outcomes of perioperative brachial plexus injuries following spine surgery. ⋯ Brachial plexus injuries are an increasingly recognized complication following spinal surgery. Proper attention to patient positioning with the use of intraoperative electrophysiological monitoring techniques could minimize injury.
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Review
Outcome after microsurgery in 14 patients with spinal cavernomas and review of the literature.
Spinal cavernomas are rare, but can cause significant neurological deficits due to mass effect and extralesional hemorrhage. The authors present their results of microsurgical treatment of 14 consecutive patients with spinal cavernoma, and review the literature. ⋯ Microsurgical removal of spinal cavernomas alleviates sensorimotor deficits and pain caused by mass effect and hemorrhage. However, bladder dysfunction remains unchanged after surgery.
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Case Reports Comparative Study
Intrathecal endoscopy to enhance the diagnosis of tethered cord syndrome.
Tethered cord syndrome (TCS) is being diagnosed in an increasing number of adults and late teens. Before referral to neurosurgeons, however, the majority of patients in this group suffers back and leg pain for a long period without a definitive diagnosis. The diagnostic difficulty derives from 2 factors: the signs and symptoms are subtle and easily overlooked, and the combination of an elongated cord and a thickened filum is lacking in 65% of patients. When a patient presents with signs and symptoms typical for TCS but demonstrates no elongated cord or thickened filum on MR imaging, one must search for a more reliable finding to establish a diagnosis of TCS. Based on the authors' earlier surgical experiences, posterior displacement of the terminal filum is consistently found at surgery in all patients with TCS. In previous publications they interpreted this finding as the lower cord and filum traveling along the concave side of the lumbosacral spinal canal to minimize cord tension. In the present prospective study, the authors attempt to confirm posterior displacement of the filum terminale by using intrathecal endoscopy prior to wide exposure of the spinal cord and filum. Further, the stretch test was applied to the terminal filum to evaluate its elasticity. ⋯ Currently, endoscopic identification of the posteriorly displaced filum, which was confirmed at open surgery, is the essential diagnostic study for TCS or the tethered spinal cord. Furthermore, the stretch test of the filum proves its inelasticity, and filum sectioning leads to ascension and relaxation of the caudal spinal cord. These results can be linked to the impaired oxidative metabolism of the lumbosacral cord under excessive tension and to the metabolic and neurological improvements seen after filum sectioning.
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Case Reports
Paraspinal-approach transforaminal lumbar interbody fusion for the treatment of lumbar foraminal stenosis.
Foraminal stenosis is a common cause of lumbar radicular symptoms. Recognition of the dynamic pathology, as well as the static anatomical changes, is important to achieving successful surgical outcomes. Excessive facet and anulus removal leads to subsequent disc space narrowing and/or segmental instability, which can cause poor results after decompressive surgery. The objective of this study was to evaluate the efficacy of the paraspinal-approach transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar foraminal stenosis. ⋯ The paraspinal-approach TLIF is a minimally invasive, safe, and secure procedure for treating lumbar foraminal lesions. Direct visualization and decompression for the foraminal lesion, distraction of the collapsed disc space, and stabilization of the unstable segments can be achieved simultaneously through the paraspinal approach, which produces successful clinical and radiological results.
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The purpose of this study was to evaluate the effect of a fixed atlantoaxial angle on subaxial sagittal alignment, and that of atlantoaxial fixation on adjacent-segment motion and degeneration. ⋯ Atlantoaxial fixation in a hyperlordotic position produced kyphotic sagittal alignment after surgery in both GH and MB groups. Reduction of the atlantoaxial joint can be easily achieved through screw fixation at an optimal angle, thereby ameliorating the risk for subsequent subaxial kyphosis. Degeneration of lower adjacent segments appeared to be less with this procedure compared with using a combination of transarticular screw fixation and posterior wiring.