World Neurosurg
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Pedicle screw and translaminar screw fixation in C2 may not be applicable in many patients with anatomic abnormalities or narrow laminar thickness and spinous process height. The aim of this study was to assess morphometric and mechanical feasibilities of a novel alternative screw trajectory that pierces the bifid base of C2. ⋯ SPB screw fixation may be viable anatomically and mechanically for C2 fixation. Feasibility of SPB screw fixation is determined by length, thickness, and mutual angle of the bilateral bifid bases. Patients with thin (<4 mm) and short (<9 mm) bifid bases are not likely to be suitable candidates. SPB screw fixation shows potential as an alternative approach or a salvage technique for patients with high-riding vertebral arteries or severely thin C2 lamina and warrants further investigation.
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T1 slope minus C2-7 lordosis (TS-CL) and cervical sagittal alignment reportedly affect health-related quality of life (HRQOL) scores after multilevel posterior cervical fusion surgery. There are no reports of a relationship between cervical alignment and patient outcomes after anterior cervical discectomy and fusion (ACDF) involving 3 or more levels. This study aimed to investigate the relationship between cervical sagittal alignment and patient-reported HRQOL after ACDF involving 3 or more levels. ⋯ ACDF surgery involving 3 or more levels under neutral supine position did not significantly change the postoperative cervical alignment, and thus may not significantly affect cervical alignment or HRQOL.
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The rate of cervical spinal fusion has been increasing significantly. However, there is a paucity of literature describing trends based on surgical approach using complete population databases. We investigated the approach-based trends in epidemiology, indications, and in-hospital outcomes of cervical spinal fusion. ⋯ The rate of subaxial spinal fusions increased 114% from 1997 to 2012 in New York State. Rates remained stable in younger patients but increased in the older population. Preoperative indications and postoperative courses differed significantly among the various approaches, with patients undergoing anterior fusion having better short-term outcomes.
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We report a unique case of recanalized left internal carotid artery aneurysm with thrombus adherent to the aneurysm neck and M1 origin diagnosed on 2-dimensional angiography causing embolic stroke in a 66-year-old female who was successfully treated with stent-assisted coiling. This is important to recognize as a cause of embolic stroke.
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Subaxial spinal injury surgery is expensive, and its significance is uncertain because of limited rehabilitation and postoperative care. ⋯ Patients with complete cervical injuries had high rates of mortality and morbidity, indicating that it might be better not to operate on these patients in resource-limited settings. There is a moderate recovery rate in patients with incomplete SCI despite a lack of adequate rehabilitation facilities.