Journal of neurosurgery. Spine
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In this paper the authors evaluate through in vitro biomechanical testing the performance of an interspinous fusion device as a stand-alone device, after lumbar decompression surgery, and as supplemental fixation to expandable cages in a posterior lumbar interbody fusion (PLIF) construct. ⋯ The ISS may be a suitable device to provide immediate flexion-extension balance after a unilateral laminotomy, but the BPSS provides greater immediate stability in lateral bending and axial rotation motions. Both PLIF constructs performed equivalently in flexion-extension and axial rotation, but the PLIF-BPSS construct is more resistant to lateral bending motions. Further biomechanical and clinical evidence is required to strongly support the recommendation of a stand-alone interspinous fusion device or as supplemental fixation to expandable posterior interbody cages.
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Spinal subdural hematomas (SDHs) are rare and some are concomitant with intracranial SDH. Their pathogenesis and etiology remain to be elucidated although their migration from the intracranial space has been suggested. The authors postulated that if migration plays a major role, patients with intracranial SDH may harbor asymptomatic lumbar SDH. The authors performed a prospective study on the incidence of spinal SDH in patients with intracranial SDH to determine whether migration is a key factor in their concomitance. ⋯ As the incidence of concomitant lumbar and intracranial chronic SDH is rare and both patients in this study had sustained a direct impact to the head and hips, the authors suggest that the major mechanism underlying their concomitant SDH was double trauma. Another possible explanation is hemorrhagic diathesis and low CSF syndrome.
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Case Reports
Vascular injury following microendoscopic lumbar discectomy treated with stent graft placement.
The risk of great vessel injury is low in microendoscopic lumbar discectomy applied in a favorable visual field. However, it is important to be aware of the depth of the pituitary rongeur. In this article, the authors report the case of a 55-year-old woman with lumbar disc herniation who underwent microendoscopic discectomy and subsequently presented with an aneurysm and arteriovenous fistula located at the bifurcation of the right common iliac artery. The patient was treated with endoscopic placement of a stent graft and recovered uneventfully.