World Neurosurg
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Proximal junctional kyphosis (PJK) is a common phenomenon after long segmental fusion surgery of adolescent idiopathic scoliosis. However, the inability to reliably identify vertebral endplates on lateral upright radiographs has made an accurate measurement of proximal junctional angle (PJA) technically impossible in many patients. The aim of this study was to determine whether a grayscale inversion view is more reliable to measure PJA and to assess PJK accurately. ⋯ Grayscale inversion view can be a more reliable tool for the evaluation of PJK as compared with the conventional measurement. We recommend the application of a grayscale inversion view to measure PJA and assess PJK in clinical practice, particularly for patients instrumented to the upper thoracic spine.
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The mechanical alteration in the adolescent/pediatric cervical spine after spinal fusion remains unknown. The purpose of this study was to investigate morphologic changes in the cervical spine in adolescent/pediatric patients who underwent spinal fusion. ⋯ Cervical kyphosis correction using posterior instrumentation combined with endplate destruction by anterior bone grafting is a risk factor for atrophic morphologic changes in the vertebral body in adolescent/pediatric patients. Endplate destruction and instrumentation-induced stress shielding could alter bone remodeling.
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Examining spine surgery patterns over time is crucial to provide insights into variations and changes in clinical decision making. Changes in the number of surgeries, surgical methods, reoperation rates, and cost-effectiveness were analyzed for all patients who underwent surgery for lumbar spinal stenosis without spondylolisthesis in 2003 (2003 cohort) and 2008 (2008 cohort). ⋯ The increased numbers of spinal surgeries, fusion surgeries, and surgeries in older patients in a recent cohort were noteworthy. However, the increased surgical volume and fusion surgeries did not reduce the reoperation rate.
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Rosette-forming glioneuronal tumor has recently been included in the World Health Organization classification as a low-grade tumor. It usually occurs in young adults, arising from the fourth ventricular region. ⋯ Surgical total resection was performed, and histopathologic examination made the diagnosis, showing a biphasic neurocytic and glial tumor with neurocytic rosettes. Six months after surgery, the patient had fully recovered.
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Spinal arteriovenous fistulas at the filum terminale (filum AVFs) are rare. Treatment strategies have not yet been established, particularly for cases of filum AVF with lipoma. ⋯ Caution is needed when identifying the spinal level of occlusion of the fistula, particularly in cases of a tethered spinal cord by lipoma, because the feeding artery is associated with the artery of Adamkiewicz, which supplies the low-lying spinal cord in the sacral region.