Journal of neurosurgery. Spine
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Presacral tumors are rarely found in adults. Resections via open abdominal or sacral approaches have been advocated traditionally as the preferred treatment for these tumors. The endoscopic surgical technique provides direct visualization of the presacral or retroperitoneal space. ⋯ The abdominal computed tomography scan revealed a 5.1 x 4.2-cm, homogeneous, low-density, well-defined mass arising from the left sciatic nerve abutting the left piriformis muscle, favoring a diagnosis of benign neurogenic tumor. Endoscopically guided resection was applied, with a favorable outcome. This procedure represents a less invasive approach that may be useful for benign retroperitoneal pelvic tumors.
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Review
The Spine Patient Outcomes Research Trial results for lumbar disc herniation: a critical review.
The long-anticipated results of the Spine Patient Outcomes Research Trial (SPORT) were recently published in the Journal of the American Medical Association. In this trial the investigators compared operative and nonoperative care in patients with symptomatic lumbar disc herniation. Despite the expenditure of several million dollars on this multicenter, prospective, randomized, controlled clinical trial, the SPORT investigators admitted, "conclusions about the superiority or equivalence of the treatments under study are not warranted based on the intent-to-treat analysis." In the present article the author provides a critical review of the SPORT formulation and hypothesis, study design and methodology, and results and interpretations in an attempt to explain why the authors of this study were unable to assess the study's only intended null hypothesis that there would be no difference in outcomes between operative and nonoperative management of herniated lumbar discs. Issues related to misrepresentation and misinterpretation of the SPORT results for herniated lumbar discs are also assessed.
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Case Reports
Single-stage total C-2 intralesional spondylectomy for chordoma with three-column reconstruction. Technical note.
Chordomas are locally invasive, malignant bone tumors that rarely occur in the cervical spine. En bloc resection or even fully resecting the tumor along its margin offers improved patient survival and a potential disease cure. ⋯ The authors present a case of a chordoma involving the axis that was treated using a single-stage total intralesional C-2 spondylectomy with preservation of both VAs because the patient did not tolerate a preoperative occlusion test. A three-column reconstruction technique is also presented.
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Case Reports
Spinal epidural arteriovenous fistulas associated with progressive myelopathy. Report of four cases.
The authors report the cases of four patients who presented with progressive myelopathy (one patient had been asymptomatic for 25 years) due to spinal epidural arteriovenous fistulas (AVFs). Clinical symptoms and magnetic resonance imaging findings were similar to those of dural AVFs. ⋯ All fistulas were cured by embolization; arterial access was used in two cases and venous in two. The authors' aim in this paper is to emphasize the differences between dural and epidural AVFs in terms of their physiopathology and angioarchitecture as well as the therapeutic strategy.
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Even with good results, conventional disc operations may result in subsequent damage due to trauma. Endoscopic techniques have become the standard in many areas because of the advantages they offer intraoperatively and postoperatively in rehabilitation. The goal of this prospective study was to examine the expanded technical possibilities of full-endoscopic transforaminal and interlaminar resection of herniated lumbar discs in which the authors used newly developed optics and instruments. The focus was on questions of achieving sufficient decompression, as well as the advantages and disadvantages of the minimally invasive procedure. ⋯ The authors view the aforedescribed techniques, which offer the advantages of a truly minimally invasive procedure, as a sufficient and safe supplementation and alternative to conventional procedures, when the appropriate indication criteria are heeded. The new endoscope with its 4.2-mm working channel and corresponding instruments significantly reduced the technical problems.