Journal of neurosurgery
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Journal of neurosurgery · Jan 2000
ReviewPediatric cervical spine injuries: report of 102 cases and review of the literature.
To evaluate and review their experience with pediatric cervical injuries and factors affecting outcome, the authors conducted a retrospective clinical study of 102 cases (65% boys, 35% girls) of pediatric cervical spine injuries treated in the last decade. This study is an extension of and comparison with their earlier experience. ⋯ The prognosis of neurological recovery from pediatric cervical spine injuries is related to the severity of the initial neurological injury. Management must be tailored to the patient's age, neurological status, and type and level of injury. Compared with our earlier experience, fusion and instrumentation procedures were used more frequently. Different types of fusion and instrumentation procedures can be performed safely in children and produce good outcomes.
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Journal of neurosurgery · Jan 2000
Cervical facet dislocation: techniques for ventral reduction and stabilization.
To demonstrate the safety and utility of one surgical approach, the authors reviewed their experience with the ventral surgical approach for decompression, reduction, and stabilization in 10 patients with either unilateral or bilateral cervical facet dislocation. ⋯ The authors conclude that a ventral surgical decompression, reduction, and stabilization procedure provides a safe and effective alternative for the treatment of patients with unilateral or bilateral cervical facet dislocation without significant bone disruption.
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Journal of neurosurgery · Jan 2000
Randomized Controlled Trial Multicenter Study Clinical TrialIntracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial.
Recently, a renewed emphasis has been placed on managing severe head injury by elevating cerebral perfusion pressure (CPP), which is defined as the mean arterial pressure minus the intracranial pressure (ICP). Some authors have suggested that CPP is more important in influencing outcome than is intracranial hypertension, a hypothesis that this study was designed to investigate. ⋯ Treatment protocols for the management of severe head injury should emphasize the immediate reduction of raised ICP to less than 20 mm Hg if possible. A CPP greater than 60 mm Hg appears to have little influence on the outcome of patients with severe head injury.
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Journal of neurosurgery · Jan 2000
No reduction in cerebral metabolism as a result of early moderate hyperventilation following severe traumatic brain injury.
Hyperventilation has been used for many years in the management of patients with traumatic brain injury (TBI). Concern has been raised that hyperventilation could lead to cerebral ischemia; these concerns have been magnified by reports of reduced cerebral blood flow (CBF) early after severe TBI. The authors tested the hypothesis that moderate hyperventilation induced early after TBI would not produce a reduction in CBF severe enough to cause cerebral energy failure (CBF that is insufficient to meet metabolic needs). ⋯ The authors conclude that early, brief, moderate hyperventilation does not impair global cerebral metabolism in patients with severe TBI and, thus, is unlikely to cause further neurological injury. Additional studies are needed to assess focal changes, the effects of more severe hyperventilation, and the effects of hyperventilation in the setting of increased ICP.
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Journal of neurosurgery · Jan 2000
Indirect posterior reduction and fusion of the traumatic herniated disc by using a cervical pedicle screw system.
In this study the authors retrospectively review 16 patients with traumatic disc herniation secondary to middle and lower cervical spine injuries who underwent a single posterior reduction and fusion procedure in which a cervical pedicle screw system was used. The study was undertaken to evaluate whether the procedure effectively reduced the disc herniation and whether it can be safely conducted without performing anterior decompressive surgery. ⋯ Traumatic disc herniation may occur frequently in association with injury of the cervical spine. The incidence of traumatic disc herniation in our series was 32%. The cervical pedicle screw system allowed three-dimensional reduction of the injured cervical segment and reduction or reversal of a disc herniation. After surgery, compression of the thecal sac and/or spinal cord had disappeared. The cervical pedicle screw system provides effective and safe fixation of the cervical spine injury-related traumatic disc herniation, and the surgery can be performed safely in a single posterior-approach procedure without need of additional anterior decompressive interventions.