European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Nucleus pulposus and/or chronic compression can induce spinal nerve root injury. Inflammation has been proposed as having major importance in the pathophysiologic mechanisms involved in the induction of such injuries. Corticosteroids, potent anti-inflammatory drugs, have been demonstrated to reduce nucleus pulposus-induced spinal nerve root injury. The aim of the present study was to assess the effects of two potent non-steroidal anti-inflammatory drugs (NSAIDs), diclofenac and ketoprofen, in experimental nucleus pulposus-induced spinal nerve root injury in a pig model. ⋯ This study of two potent NSAIDs indicates that nucleus pulposus-induced nerve root dysfunction may be reduced by diclofenac but not by ketoprofen. The reason for this difference is not known, but it might be related to the fact that ketoprofen and diclofenac belong to different NSAID subgroups and have a different selectivity for the two cyclo-oxygenases COX-1 and COX-2.
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Atlantooccipital dislocation (AOD) is a rare and usually fatal injury. In the current study, the authors reported an extremely rare case of posterior AOD with Jefferson fracture and fracture-dislocation of C6-C7. ⋯ To our knowledge, this is the first report of posterior AOD with two other non-contiguous cervical spine injuries. A high index of suspicion and careful examination of the upper cervical spine should be considered as the key to the diagnosis of AOD in cases that involve multiple or lower cervical spine injuries.
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Capillary haemangioma is a benign tumour frequently encountered in the skin and other soft tissues. Histologically, these vascular lesions are characterised by nodules of capillary-sized vessels lined by flattened endothelium, each of which is subserved by a feeding vessel. Capillary haemangioma of the central and peripheral nervous system is extremely rare. ⋯ Complete resection is the treatment of choice, and during surgery the vascular tumour is usually found encapsulated and sharply bordered from the surrounding parenchyma of the spinal cord and affected nerve roots. In the present account we give an overview of the clinical features, neuroradiological findings, therapeutic options and histopathological differential diagnostic aspects of spinal intradural capillary haemangioma. In general, vascular lesions of this entity are preoperatively misdiagnosed as neoplasms, and a higher level of clinical and radiological suspicion may avoid surgical overtreatment of these benign tumours.
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The short segmental pedicle screw device is widely used for the decompression of neural elements and reduction of normal anatomy. Many biomechanical studies concerning proper decompression are available. However, no study has determined the optimal device adjustment for reduction of the burst fracture to the normal anatomy. ⋯ With this adjustment, on average the spine became 0.9 mm compressed and 2.0 degrees lordotic, compared to the intact. The results of the study show that the device adjustments of axial translation and sagittal angulation can be applied in any sequence, with the same results. The combination of 5 mm distraction with 6 degrees extension was the device adjustment that produced the closest anatomical reduction.
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In internal posterior fixation of thoracolumbar fractures combined with transpedicular cancellous bone graft and posterior fusion of the intervertebral facet joints at the level of the destroyed end plate it is still uncertain as to whether significant vertebral body collapse and loss of correction of the regional angle (RA) and the intervertebral angle (IVA) occur (after removal of the implants). These questions were investigated in a retrospective study of 183 consecutive patients, 18-65 years old, with a spinal fracture between the 9th thoracic and the 5th lumbar vertebral body (inclusive), treated operatively between 1988 and 1996 (27% had objective neurological deficit, 37% had multiple injuries). According to the Comprehensive Classification, 128 type A, 32 type B and 21 type C fractures were identified preoperatively. ⋯ Correction of the RA was statistically significant before implant removal, but the RA 2 years after surgery had become almost the same as the preoperative values. Changes at the level of the intervertebral space, occurring after implant removal, contributed to the loss in the RA. Broken pedicle screws (10.9% of the patients) resulted in significant changes in the AWA and RA before implant removal, but did not influence the IVA.