Journal of neurosurgery. Spine
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The number of low-back fusion procedures for the treatment of spine disorders has increased steadily over the past 10 years. Lumbar pseudarthrosis is a potential complication of lumbar arthrodesis and can be associated with significant pain and disability. The aim of this study was to assess, using validated patient-reported outcomes measures, the long-term effectiveness of revision arthrodesis in the treatment of symptomatic pseudarthrosis. ⋯ The authors' study suggests that revision lumbar arthrodesis for symptomatic pseudarthrosis provides improvement in low-back pain, disability, and quality of life. Revision lumbar arthrodesis should be considered a viable treatment option for patients with pseudarthrosis-related back pain. Mental health symptoms from pseudarthrosis-associated back pain may be more refractory to revision surgery.
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Dural tears are a frequent complication of spinal surgery and contribute to significant morbidity. Occasionally, dural tears cannot be closed primarily and dural patch grafts must be utilized. No data exist on the comparative immediate hydrostatic strength of various patch materials used alone or with a biological adhesive in a spinal dural tear model. Thus, the authors conducted this study to determine the comparative effectiveness of various patch materials used with and without biological adhesive. ⋯ All 3 dural patch materials were of similar hydrostatic strength and allowed greater leakage than at the intact condition. The use of sealant reduced the amount of leakage at all pressures compared with patching alone but allowed more leakage than the intact state at a high hydrostatic pressure (90 mm Hg).
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Spontaneous intracranial hypotension is an important cause of new-onset daily persistent headache. Cerebellar hemorrhage has been identified as a possible feature of spontaneous intracranial hypotension. The authors reviewed the MR imaging studies from a group of patients with spontaneous intracranial hypotension to assess the presence of cerebellar hemorrhage. ⋯ Chronic cerebellar hemorrhage should be included among the manifestations of spontaneous intracranial hypotension. The severity is variable, but the hemorrhage generally is asymptomatic. The underlying spinal CSF leak is ventral and mostly of long duration.
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In this study, the authors' goal was to investigate the long-term progression of disc degeneration and the participating mechanisms induced by needle puncture in a rat caudal disc model. ⋯ This study demonstrates that needle puncture into a tail disc in the rat induces a rapid and progressive disc degeneration process without spontaneous recovery. Changes in gene expression profiles of the disc matrix molecules as well as anabolic and catabolic factors at early time points further delineate the mechanism of disc degeneration in this newly developed animal model.
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Granulocyte colony-stimulating factor (G-CSF) has neuroprotective effects on the CNS. The authors have previously demonstrated that G-CSF also exerts neuroprotective effects in experimental spinal cord injury (SCI) by enhancing migration of bone marrow-derived cells into the damaged spinal cord, increasing glial differentiation of bone marrow-derived cells, enhancing antiapoptotic effects on both neurons and oligodendrocytes, and by reducing demyelination and expression of inflammatory cytokines. Because the degree of angiogenesis in the subacute phase after SCI correlates with regenerative responses, it is possible that G-CSF's neuroprotective effects after SCI are due to enhancement of angiogenesis. The aim of this study was to assess the effects of G-CSF on the vascular system after SCI. ⋯ These results suggest that G-CSF exerts neuroprotective effects via promotion of angiogenesis after SCI.