Journal of neurosurgery. Spine
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The incidence of postoperative spinal epidural hematoma (SEH) is low, and to the best of the authors' knowledge, no researchers have evaluated its actual incidence and clinical features. The purpose of this study was to investigate the clinical consequences of SEH after microendoscopic posterior decompression (MEPD) in patients with lumbar spinal stenosis. ⋯ The incidence of postoperative SEHs may be greater than reported. Postoperative SEHs caused poor expansion of the dural sac despite its spontaneous regression. In addition, postoperative SEHs caused a delay in the patient's recovery and led to a poor clinical improvement. The prevention of postoperative SEHs might be required to prevent not only neurological deterioration but also a delay in the patient's recovery.
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During surgical procedures focused on the cervical nerve roots, the surgeon works in proximity to the V2 segment of the vertebral artery (VA). Depending on the specific surgical approach, it may be necessary to identify, expose, or mobilize the artery. In most cases, the artery may be left undisturbed. To reduce the risk of iatrogenic injury to the V2 segment during anterior and anterolateral approaches to the cervical spine, the authors analyzed the relationship between the V2 segment and the proximal segment of the C3-6 nerve roots. ⋯ Proximal-to-distal dissection of a cervical nerve root may proceed with relative safety for at least 4 mm. The V2 segment of the VA gives rise to at least one radicular arterial pedicle between C-4 and C-6. These trunks give rise to purely radicular, ligamentous, and medullary branches in an unpredictable pattern.
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Comparative Study
Biomechanical comparison of two new atlantoaxial fixation techniques with C1-2 transarticular screw-graft fixation.
Two new techniques for atlantoaxial fixation have been recently described. In one technique, C-2 intralaminar screws are connected with C-1 lateral mass screws; in the second, C-1 and C-3 lateral mass screws are interconnected and C-2 is wired sublaminarly. Both techniques include a C1-2 interspinous graft. The authors compared these techniques with the gold-standard, interspinous graft-augmented C1-2 transarticular screw fixation and with a control C1-2 interspinous graft fixation procedure alone. ⋯ Biomechanically, the gold-standard C1-2 transarticular screw fixation outperformed the two new techniques during lateral bending and axial rotation. Wiring C-2 to C1-3 rods provided greater stability than C1-2 laminar screws, but it sacrificed C2-3 mobility. It is unknown whether the small differences observed biomechanically would lead to clinically relevant differences in fusion rates.
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The authors sought to clarify the role, if any, of advanced glycation end-products (AGEs) in disc degeneration. ⋯ These results suggest that the accumulation of AGEs and their interaction with their receptor in the nucleus pulposus might result in the downregulation of aggrecan production responsible for disc degeneration.
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The purpose of this study was to investigate the therapeutic time window for antiinflammatory treatment within the first 24 hours of spinal cord injury (SCI). The authors have shown that an anti-CD11d antibody treatment attenuates leukocyte infiltration and improves neurological function when administered beginning 2 hours after SCI. A more clinically relevant time for the initiation of treatment after SCI, however, is 6 or more hours postinjury. ⋯ These findings suggest that antiinflammatory treatments that reduce secondary tissue damage after SCI may be delayed until 6 hours postinjury and still be effective.