Journal of neurosurgery
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Journal of neurosurgery · Jul 2003
Comparative StudyAnterior cervical plate fixation: biomechanical effectiveness as a function of posterior element injury.
The primary goal of this study was to determine if the stabilization provided to the spine by anterior cervical fixation with plating (ACFP) was dependent on the degree of posterior element injury. The secondary goal was to evaluate the effectiveness of additional posterior screw/rod stabilization in these injuries. ⋯ Capsular ligaments and articular facets are important structures in limiting three-dimensional vertebral motion in the presence of an anterior plate. Supplementary posterior fixation does reduce motion for all injury conditions.
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Journal of neurosurgery · Jul 2003
Case Reports Comparative StudyFocal fractionated radiotherapy for intramedullary spinal arteriovenous malformations: 10-year experience.
Radiosurgical treatment of spinal arteriovenous malformations (AVMs) is becoming a practical therapeutic option as methodology improves, but no comparative study has yet been published on focal fractionated radiotherapy. The authors report their experience with conventional and hypofractionated radiotherapy for spinal AVM. ⋯ Because no patient experienced adverse effects, the maximum tolerable radiation dose for the spinal cord associated with an AVM could not be identified, although it presumably is higher than those administered. The lack of rebleeding in patients in whom complete angiographic occlusion was absent suggests that the natural history of spinal AVMs may be less aggressive than previously reported.
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Journal of neurosurgery · Jul 2003
Case ReportsVertebroplasty in focal Paget disease of the spine. Case report.
Paget disease is an idiopathic metabolic disease of bone that may involve the axial and appendicular skeleton. In up to one third of patients there may be pagetoid involvement of the spine, which can cause back pain and vertebral collapse, with instability or myeloradiculopathy. ⋯ The authors report on a case of localized Paget disease of the spine treated successfully by performing percutaneous vertebroplasty. They propose this procedure as a useful intervention that can be undertaken safely in patients with spinal Paget disease, in whom acquisition of a transpedicular biopsy sample is required as part of diagnosis.
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Journal of neurosurgery · Jul 2003
Case ReportsSpinal cord edema: unusual magnetic resonance imaging findings in cervical spondylosis.
Spinal cord edema is a rare radiological finding in chronic degenerative disorders of the spine. Between 1997 and 2001, the authors treated six patients with cervical spondylotic myelopathy in whom postoperative spinal cord edema was demonstrated. The authors describe the radiological and clinical features of this unusual condition. ⋯ The radiological characterization of spinal cord edema was based on the reversible white matter lesion most likely caused by disturbed local venous circulation induced by chronic spinal cord compression. Such unusual MR findings in cervical spondylotic myelopathy should be differentiated from intramedullary spinal cord tumors, demyelinating disorders, or inflammatory processes.
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Journal of neurosurgery · Jul 2003
Immunohistochemical analysis of the extracellular matrix in the posterior capsule of the zygapophysial joints in patients with degenerative L4-5 motion segment instability.
Although the hypertrophied shape of the zygapophysial joints in degenerative instability of the lumbar spine is well known, its underlying pathophysiological mechanism is unclear. The authors sought to provide evidence that there is increased fibrocartilaginous metaplasia in the posterior joint capsule resulting from greater mechanical loading; the authors suggest that these capsular changes are central to understanding the altered joint shape. ⋯ The results of this study provide molecular evidence for an altered loading history on the joint capsule. The pronounced loss of intervertebral disc height that occurred in all patients with severe degeneration of the lumbar motion segment promotes an increased range of axial rotation that places the posterior capsule under greater mechanical load. Compared with normal joints studied previously, the posterior capsules involved in these degenerative joint complexes were hypertrophied and fibrocartilaginous throughout. Cartilaginous metaplasia was especially pronounced at the attachment sites (entheses) where the fibrocartilage now extended beyond the original level of the joint space, and capped the osseous spurs arising from these attachment sites.