British journal of neurosurgery
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Our aim is to measure and compare the academic and research output of neurosurgical departments across the U.K. and Ireland. ⋯ The h-index is useful for ranking neurosurgical departments according to their historical or recent publication output. It is particularly useful when restricted to the last 10-year period. We have been able to quantify and rank the academic output of neurosurgical units across the U.K. and Ireland, except where mentioned. This may be of interest to the clinician who wishes to pursue a career in academia or research.
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Direct posterior reduction by intraoperative manipulation of joints for irreducible traumatic atlantoaxial dislocation (IrTAAD) has gained acceptance in the recent past. However, factors determining its feasibility have not been elucidated. Our study aims to examine the clinico-radiological factors predicting feasibility of direct posterior reduction in IrTAAD secondary to isolated odontoid fracture, in an attempt to differentiate the "truly irreducible" from those "deemed irreducible." ⋯ Worsening pain, progression of myelopathy, some movement on dynamic X-rays, a malunion ruled out on CT scan, and the presence of locked facets make direct posterior reduction feasible in patients with IrTAAD. The difficulty increases in remote fractures due to fibrosis around the dislocated joints. The role of the CT angiogram, in defining the relationship of Vertebral artery (VA) to the dislocated facets, and in determining the extent of VA injury, is vital. Preoperative detection of VA injury reduces the chance of intraoperative reduction, especially if only unilateral joint approach is planned.