World Neurosurg
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Positional plagiocephaly is the most common cause of cranial asymmetry. The underlying cause of Chiari-1 malformation has many possible theories, and anecdotally some pediatric neurosurgeons have had experience of severe cases of positional brachycephaly with Chiari-1. However, to date, there have been no published cases linking nonsynostotic plagiocephaly with Chiari-1 malformation. ⋯ Chronic hindbrain herniation is well reported in cases of craniosynostosis, but to our knowledge this is the first published case associated with nonsynostotic deformational plagiocephaly. We hypothesize that severe posterior plagiocephaly can cause disproportion of the posterior fossa: hindbrain volume ratio and acquired chronic cerebellar herniation. Nevertheless, positional plagiocephaly and Chiari-1 are common entities, and it is possible that the dual diagnoses were coincidental in this case. This report serves to raise awareness of a putative causal relationship between positional plagiocephaly, reduced posterior fossa volume, and hindbrain herniation.
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Regional neurovascular structures must be avoided during invasive spine hardware placement. During C1 lateral mass screw placement, the C2 nerve root is put in harm's way. Therefore the current anatomic study was performed to identify techniques that might avoid such neural injury. ⋯ On the basis of our cadaveric study, the C2 nerve root can be detethered enough at the level of the posterior lateral mass of C1 to avoid its injury during screw placement into this area.
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Early readmission after spine surgery is being used as a proxy for quality of care. One-fifth of patients are rehospitalized within 30 days after spine surgery, and more than one-third within 90 days; however, there is a paucity of data about the cause of early readmissions in elderly patients after elective spine surgery. ⋯ Our study suggests that in elderly patients undergoing elective spine surgery, infection or a concern for infection, pain, and altered mental status were the most common primary reasons for unplanned readmission.
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The precise mechanism of nucleus pulposus proliferation in the degeneration of the intervertebral disk pathogenesis remains to be implicated. MicroRNAs (MiRNAs) are a class of 18-22 nucleotides, which are small, noncoding RNAs that inhibit protein translation by binding to the 3'-UTR of target gene. Recent studies have shown that miRNAs play a crucial role in various cell biologies such as cell proliferation, invasion, migration, and cell cycle. However, the role of miR-184 in nucleus pulposus proliferation is still unknown. ⋯ These results demonstrated that miR-184 and the GAS1/Akt pathway may be a potential therapeutic target for intervertebral disc degeneration.
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Case Reports
Surgical management for Destructive Atlantoaxial Spondyloarthropathy in Long Term Hemodialysis Patients.
Atlantoaxial spondyloarthropathy most often results from rheumatoid arthritis, cancer metastasis, or basilar invagination. Dialysis-related spondyloarthropathy is a rare cause of spinal deformity and cervical myelopathy at the atlantoaxial joint. We report 2 patients on long-term hemodialysis who presented with atlantoaxial spondyloarthropathy. ⋯ Although the surgical management of these patients involves many challenges, appropriate decompression and fusion surgery is an effective treatment option.