Journal of neurosurgery. Spine
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Thoracic myelopathy is uncommon compared with cervical myelopathy. In this study, data obtained in patients with thoracic myelopathy caused by degenerative processes of the spine were retrospectively analyzed to clarify the surgical outcomes and to examine the various factors affecting the postoperative improvement. ⋯ Patients with a shorter preoperative duration of symptoms and milder myelopathy experienced significantly better postoperative neurological conditions, which indicated that those who present earlier with fewer disabilities should be recommended to undergo surgery in time, although the surgical treatment for OPLL still involves many problems.
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Comparative Study
Range of motion change after cervical arthroplasty with ProDisc-C and prestige artificial discs compared with anterior cervical discectomy and fusion.
Range of motion (ROM) changes were evaluated at the surgically treated and adjacent segments in cadaveric specimens treated with two different cervical artificial discs compared with those measured in intact spine and fusion models. ⋯ Both ProDisc-C and Prestige artificial discs were associated with increased ROM at the surgically treated segment compared with the intact spine with or without significance for all modes of testing. In addition, adjacent-level ROM decreased in all modes of motion except extension in specimens fitted with both artificial discs.
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Case Reports
Lumbar vertebral hemangioma presenting with the acute onset of neurological symptoms. Case report.
Vertebral hemangiomas are common entities that rarely present with neurological deficits. The authors report the unusual case of a large L-3 vertebral hemangioma with epidural extension in a 27-year-old woman who presented with hip flexor and quadriceps weakness, foot drop, and leg pain. The characteristics of the mass on magnetic resonance imaging suggested an aggressive, hypervascular lesion. ⋯ On repeated imaging studies obtained 21 months postoperatively, the size of the hemangioma and the degree of vertebral body compression were stable. As demonstrated in this case, patients with vertebral hemangiomas can present with acute nerve root compression and signs and symptoms similar to those of disc herniation. Vertebral hemangiomas can be treated effectively with interventional techniques such as embolization and ethanol injection.
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The authors report the case of a 62-year-old woman who suffered an accidental fall and complained of severe neck pain and right C-7 radiculopathy. A right C6-7 facet fracture-subluxation was diagnosed. Bone fragments impinged on the right C-7 nerve root at the neural foramen. ⋯ After surgery, the patient's neurological deficit dramatically improved and spinal fusion was completed without any loss of deformity correction. Prior to surgery for cervical injuries, the possible presence of an abnormal VA course should be considered. Preoperative detection of anomalous VAs will affect decisions on the appropriate corrective surgery option in cases of cervical spine injuries.
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Instrumentation of the osteoporotic spine can be fraught with complications such as hardware failure. A cadaver study was performed to determine the biomechanical performance of polymethylmethacrylate (PMMA)-augmented pedicle screws. ⋯ Polymethylmethacrylate-augmented pedicle screw fixation results in a significant increase in the axial pullout strength of augmented pedicle screws in both primary and revision procedures. This technique may be a valuable adjunct in cases in which bolstering of the screw-bone interface is necessary.