Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Vertigo is a common cause of emergency department attendance. Detection of spontaneous nystagmus may be a useful sign in distinguishing vestibular neuritis from other vestibular diagnoses. We aimed to assess the contribution of spontaneous nystagmus in the diagnosis of acute vertigo. ⋯ The head impulse test was positive in 12 of 15 with vestibular neuritis. The emergency department referral diagnosis was correct in six of 23 patients. The ability to detect spontaneous nystagmus is useful in vestibular diagnosis, both in support of a diagnosis of vestibular neuritis and in avoiding false positive diagnoses of benign paroxysmal positional vertigo.
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The aim of this study was to compare reoperation, complication rates, and healthcare resource utilization of expansile laminectomies with instrumented fusion versus laminoplasty. Using the MarketScan database (Truven Health Analytics, Ann Arbor, MI, USA), we selected patients aged >18 years who underwent either cervical laminoplasty or laminectomy with fusion between 2000-2009. Propensity score modeling produced a matched cohort balanced for age, sex, comorbidities, and other relevant factors. ⋯ They also had lower costs (United States dollars) during index hospitalization ($26,129 versus $35,483, p<0.0004), and overall during the 2 year postoperative period ($77,960 versus $106,453, p<0.0001). Two year reoperation rates were similar between both groups (9.77% versus 7.36%, p=0.20). Our study suggests that cervical laminoplasty has significantly lower complication rates, similar long-term reoperation rates and lower healthcare resource utilization after 2 years than laminectomy with fusion.
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The purpose of this study was to find whether excessive distraction of the disc space for cage insertion was a risk factor for adjacent segment degeneration (ASD) after anterior cervical decompression and fusion (ACDF). One hundred and sixteen consecutive patients who underwent ACDF for single-level cervical disc herniation between June 2006 and November 2008 were retrospectively reviewed. Preoperative, postoperative and final follow-up disc height (DH), sagittal segmental alignment (SSA), and sagittal alignment of the cervical spine (SACS) were measured and compared between the ASD group and non-ASD group. ⋯ The clinical outcomes of ACDF for single-level degenerative cervical disc disease were satisfactory. Postoperative DH (the distracted distance) had the greatest impact on the incidence of ASD. Excessive disc space distraction is a considerable risk factor for the development of radiographic ASD.