World Neurosurg
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Traumatic high-grade cervical spinal dislocations are rare injuries, generally associated with severe neurological compromise. In particular, cervical spondyloptosis (>100% subluxation) is rarely reported. The object of our study is to present a case series describing presentation, management, and outcome in traumatic high-grade cervical spinal dislocations. ⋯ In this series, 26.7% of patients had improvement in their AIS grade postoperatively, and the majority of patients (60%) maintained their preoperative AIS grade. In 57% of patients placed in traction, reduction was possible. Likely due to the severity of these injuries, there was a high incidence of complications. However, review of patient outcomes reveals that these patients can have improvement of neurological function. We recommend aggressive reduction and surgical stabilization. Our preference is either a combined anterior-posterior approach or a posterior-only approach.
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Previous studies have suggested disparities in quality of health care and time to treatment across socioeconomic groups. Such differences can be of greatest consequence in the setting of emergent medical conditions. Surgical or endovascular treatment of ruptured cerebral aneurysms within the first 3 days of aneurysmal subarachnoid hemorrhage (aSAH) is associated with improved outcome. We hypothesize that race and payer status disparities effect the time to treatment for ruptured aneurysms. ⋯ Racial and socioeconomic factors are associated with delayed time to treatment in aSAH. Identification of factors underlying these delays and standardization of care may allow for more uniform treatment protocols and improved patient care.
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Iliac crest autograft is the historic gold standard for bone grafting, but is associated with a significant patient morbidity. Fusion rates of C1-C2 up to 88.9% using allograft and 96.7% using autologous iliac crest bone graft can be achieved when combined with rigid screw fixation. We sought to determine our fusion rate when combining allograft with recombinant human bone morphogenetic protein-2 (rh-BMP2) and rigid screw fixation. ⋯ The use of small doses of rh-BMP2 added to allograft in addition to rigid screw fixation is a safe and highly effective means of promoting a solid fusion of the atlantoaxial complex and spares the patient the morbidity of iliac crest harvest.
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Historical Article
A journey into the technical evolution of neuroendoscopy.
Neuroendoscopy has become a well-accepted technique in neurosurgery. After the introduction of the endoscope in medical practice by Phillip Bozzini in 1806, influential individuals such as Harold Hopkins and Karl Storz paved the way for its current success. ⋯ The importance of each development for the purpose of the instrument is explained. Gaps in the literature regarding the technical aspects of neuroendoscopy, including the optical physics in the endoscope, three-dimensional endoscopy, and clinical applications of neuroendoscopy and robotics, are addressed.
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The microsurgical transoral approach has traditionally been the preferred access for ventral decompression of the craniovertebral junction. This natural corridor, although direct, may be a challenging approach because of potential morbidities. The evolution of endoscopic methods in skull base surgeries has reduced morbidity and improved results. Endoscopic approaches are also being used for ventral decompression at the craniovertebral junction. Some technical modifications in this approach are described. ⋯ Used judiciously, this modified endoscopic approach to the craniovertebral junction and odontoid process is minimally invasive and adds to the surgeon's armamentarium.