Journal of neurosurgery. Spine
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Application of the nucleus pulposus (NP) to the nerve root has been developed as a model of lumbar radicular pain. The relationship between disc degeneration and the induction of radicular pain, however, has not yet been fully explored. The authors of this study investigated pain-related behaviors and expression of tumor necrosis factor-alpha (TNF-alpha) in the dorsal root ganglion (DRG) to evaluate the effects of punctured NP on lumbar radiculopathy. ⋯ Needle puncture led to degenerative changes in the rat tail disc, and the degenerated NP enhanced mechanical hyperalgesia induced by application of the NP to the lumbar nerve root. This model of disc degeneration and lumbar radicular pain is appropriate for evaluating the efficacy of biological treatments for degenerative disc diseases.
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In this study, the authors assessed the construct validity and the reliability of the World Health Organization Quality of Life-Bref (WHOQOL-Bref) questionnaire in patients with cervical spondylotic myelopathy (CSM) and compared the performance of the WHOQOL-Bref and the 36-Item Short Form Health Survey (SF-36) in assessing quality of life (QOL) in patients with CSM. ⋯ The WHOQOL-Bref, like the SF-36, is valid and reliable in assessing outcome in patients with CSM. It measures impairment in CSM in a more uniform manner than the SF-36, but its domains are less responsive to postoperative changes. Because the WHOQOL-Bref measures different constructs and has additive value, it should be used along with the SF-36 for QOL assessment in patients with CSM.
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Spontaneous spinal epidural hematoma (SSEH) is a rare disease. The goal of this study was to clarify the treatment results and management options in SSEH. ⋯ Impaired preoperative hemostasis contributes to larger size of SSEH, high probability of postoperative recurrence of spinal epidural hematoma, and poor functional recovery following surgical evacuation. Incomplete spinal cord dysfunction before surgery predicts good outcome and warrants emergent evacuation of SSEH especially in the cervical and thoracic regions, where the clots are located in proximity to the spinal cord.
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Comparative Study
Traumatic spondylolisthesis of the axis: a biomechanical comparison of clinically relevant anterior and posterior fusion techniques.
Surgical management of unstable traumatic spondylolisthesis of the axis includes both posterior and anterior fusion methods. The authors performed a biomechanical study to evaluate the relative stability of anterior fixation at C2-3 and posterior fixation of C-1 through C-3 in hangman's fractures. ⋯ In cadaveric spine specimens subjected to a Type II hangman's fracture, both anterior fixation at C2-3 and posterior fixation with C-1 lateral mass screws and C-2 and C-3 pedicle screws resulted in a consistent increase in stiffness, and hence in stability, over intact specimens.
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Permanent neurological loss after spinal cord injury (SCI) is a well-known phenomenon. There has also been a growing recognition and improved understanding of the pathophysiological mechanisms of late progressive neurological loss, which may occur after SCI as a result of posttraumatic spinal cord tethering (SCT), myelomalacia, and syringomyelia. A clinical study of 404 patients sustaining traumatic SCIs and undergoing surgery to arrest a progressive myelopathy caused by SCT, with or without progressive myelomalacia and cystic cavitation (syringomyelia) was undertaken. Both objective and subjective long-term outcomes were evaluated. To the authors' knowledge, this is the first series of this size correlating long-term patient perception of outcome with long-term objective outcome analyses. ⋯ Surgery for spinal cord detethering, expansion duraplasty, and when indicated, cyst shunting, is a successful treatment strategy for arresting a progressive myelopathy related to posttraumatic SCT and syringomyelia. Results suggest that surgery leads to functional return in ~ 50% of patients, and that in some patients posttraumatic SCT limits maximal recovery of spinal cord function postinjury. A patient's perception of surgery's failure to arrest the progressive myelopathy corresponds closely with the need for repeat surgery because of retethering, cyst reexpansion, and pseudomeningocele formation.