British journal of neurosurgery
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Postoperative limitation of cervical movement and adjacent disc degeneration are major causes of postoperative neck pain after anterior cervical discectomy and interbody fusion (ACDF). We present a retrospective study of dynamic radiographic change following ACDF with cages. We performed ACDF in 50 patients with cervical degenerative diseases, divided into three groups based on the level of interbody fusion (Group A: one-level; Group B: two-level; Group C: three-level). ⋯ There were no significant differences between the three groups with respect to postoperative change in cervical extension angle, upper adjacent level segmental movement, neck pain VAS, fusion rate or cage subsidence rate. The further decrease in total cervical ROM and flexion movement after multi-level ACDF was observed. However, a more long-term follow-up was needed to assess the actual aetiologies of upper adjacent level degeneration.
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The endoscopic technique is increasingly being used for the resection of pituitary adenomas. Its efficacy and safety have been generally accepted, but its impact on the quality of life of the patients treated has not been previously addressed. Most of the studies assessing the quality of life after long-term cure of pituitary adenomas suggest a significantly impaired quality of life (QoL) in all subgroups of pituitary tumours. ⋯ There were only very few differences in the perceived quality of life within the different subgroups of adenomas. There was a trend to improved scores in the endoscopic group compared with previous studies in patients treated by conventional approaches. Whilst our data suggest minimal impact on the quality of life for patients after endoscopic removal of pituitary adenomas, further studies with larger number of patients and longer follow-up are required to encourage this finding.
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The objective of the study was to determine if negative multidetector computed tomography (MDCT) and lateral radiography of the cervical spine effectively excludes patients with unstable cervical spine injuries. Over a period of 40 months, 6558 people were admitted to our trauma service with blunt injury and 447 (6.8%) were found to have cervical fractures. Fractures were identified by CT and/or lateral radiography. ⋯ We recommend that patients requiring cervical spine clearance undergo a complete MDCT and lateral radiograph of the cervical spine. If these studies are entirely normal, then the cervical spine may be cleared. If any abnormalities, including disc herniation, soft tissue swelling and bony malalignments are noted by radiography and/or MDCT, further studies, including MR, are indicated prior to clearance of the cervical spine.
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Bacterial infection is a major cause of shunt dysfunction. It is well-known that the majority of pathogenic micro-organisms are low-virulent bacteria normally found on intact skin. Probably shunts become contaminated during surgery either by contact to the patient skin, or contact from contaminated gloves or instruments. ⋯ Despite the use of recommended precautions to avoid infections we found that a substantial numbers of gloves from surgeon, scrub nurse and assistant were contaminated with micro-organisms less than 15 min after surgery has been commenced and before the shunts were handled. This study offers a feasible, simple and logical explanation of how shunts may become contaminated and infected. A simple measure would be to change the outer pairs of gloves before handling of the shunt material during surgery, as was done in this study, where non-shunt infections were observed.
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Case Reports
Hydrocephalus complicating a cervical spine fracture in a patient with ankylosing spondylitis.
We present a case of obstructive hydrocephalus secondary to ascending spinal cord oedema, sustained after cervical spine fracture in a patient with ankylosing spondylitis. To our knowledge, this is the first report of ascending oedema from a cervical cord injury causing obstructive hydrocephalus.