Journal of neurosurgery
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Journal of neurosurgery · Sep 2003
Comparative StudyIn vitro biomechanical effects of reconstruction on adjacent motion segment: comparison of aligned/kyphotic posterolateral fusion with aligned posterior lumbar interbody fusion/posterolateral fusion.
Posterior lumbar interbody fusion (PLIF) was developed to overcome the limitations of posterolateral fusion in correcting spinal deformity and maintaining lumbar lordosis. In this study the authors compare the biomechanical effects of three different posterior reconstructions on the adjacent motion segment. ⋯ Compared with kyphotic posterolateral fusion, PLIF may lead to even higher load at the superior adjacent level because of the increased stiffness of the fixed segments even if local kyphosis is corrected by PLIF.
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Journal of neurosurgery · Sep 2003
Comparative StudyThe role of multiple hyperbaric oxygenation in expanding therapeutic windows after acute spinal cord injury in rats.
Hyperbaric oxygenation (HBO) therapy has been reported to improve neurological recovery after spinal cord injury (SCI). In the present study, the authors examined whether multiple HBO therapy can expand the therapeutic window after acute SCI. ⋯ The results of this study demonstrate that multiple HBO treatments can expand the therapeutic window for acute SCI to 6 hours after injury.
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Journal of neurosurgery · Sep 2003
Case ReportsCombined transvenous and transarterial embolization of a tentorial-incisural dural arteriovenous malformation followed by primary stent placement in the associated stenotic straight sinus. Case report.
Dural arteriovenous malformations (AVMs) involving the tentoria-incisura are associated with an aggressive clinical course characterized by subarachnoid and intracranial hemorrhage (ICH). In these lesions, venous outflow obstruction precipitates leptomeningeal venous drainage, resulting in the arterialization of pial veins and the formation of venous aneurysms, both of which are prone to hemorrhage. Stenotic lesions of the dural sinuses also contribute to the development of retrograde leptomeningeal drainage, which is responsible for the aggressive clinical course of the dural AVM. ⋯ A combined transvenous and transarterial embolization procedure was performed, resulting in complete obliteration of the dural AVM, followed by primary stent placement across a stenotic segment of the straight sinus and normalization of venous outflow. The authors conclude that dural AVMs can be treated safely by using a combined transarterial and transvenous approach and that an extensive search for venous outflow obstruction often reveals stenosis of a draining sinus. Consideration should be given to primary stent placement in the stenotic sinus to protect against ICH.
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Journal of neurosurgery · Sep 2003
Comparative StudyBiomechanical comparison of facet-sparing laminectomy and Christmas tree laminectomy.
The authors compared differences in biomechanical stability between two decompressive laminectomy techniques for treating lumbar stenosis. A Christmas tree laminectomy (CTL), in which bilateral facetectomies and foraminotomies are performed, was compared with facet-sparing laminectomy (FSL), in which the facets are undercut but not resected. Spinal instability was assessed immediately postoperatively and again after discectomy to model long-term degeneration. ⋯ This study provides objective evidence that the treatment of lumbar stenosis with FSL induces less biomechanical instability and alters kinematics less than FSL. These findings support the use of the FSL in treating lumbar stenosis.