Neurosurgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial.
Persistent or recurrent radicular pain after lumbosacral spine surgery is often associated with nerve root compression and is treated by repeated operation or, as a last resort, by spinal cord stimulation (SCS). We conducted a prospective, randomized, controlled trial to test our hypothesis that SCS is more likely than reoperation to result in a successful outcome by standard measures of pain relief and treatment outcome, including subsequent use of health care resources. ⋯ SCS is more effective than reoperation as a treatment for persistent radicular pain after lumbosacral spine surgery, and in the great majority of patients, it obviates the need for reoperation.
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Comparative Study
Biomechanical comparison of two stabilization techniques of the atlantoaxial joints: transarticular screw fixation versus screw and rod fixation.
To compare the biomechanical stability imparted to the C1 and C2 vertebrae by either transarticular screw fixation (TSF) or screw and rod fixation (SRF) techniques in a cadaver model. ⋯ In general, a surgeon should undertake a bilateral fixation to achieve sufficient stability across the atlantoaxial complex, and either technique will provide satisfactory results, although the SRF technique may be better in the flexion and extension modes. One should use the SRF procedure while trying to achieve stability with a unilateral system.
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Case Reports Comparative Study
Functional identification of the primary motor area by corticospinal tractography.
For quick and stable identification of the primary motor area (PMA), diffusion tensor imaging (DTI) data were acquired and corticospinal tractography was mathematically visualized. ⋯ Corticospinal tractography enables identification of the PMA and is beneficial, particularly for patients who present with dysfunction of the PMA.
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We present a technique that allows intraoperative display of brain shift and its effects on fiber tracts. ⋯ By definition and sequential intraoperative registration of ultrasound landmarks near the fiber tract, brain shift-associated deformation of a tract that is not visible sonographically can be assessed correctly. This approach seems to help identify and avoid eloquent brain areas during intracranial surgery.