World Neurosurg
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Cervical kyphosis (CK) has been reported in patients with adolescent idiopathic scoliosis (AIS). The report about the incidence of CK between patients with AIS and normal populations was little. Patients included in previous studies often required scoliosis surgery (Cobb angle ≥40°), which does not represent all patients with AIS. The aims of this study were to compare incidence of CK between patients with AIS (Cobb angle >10°) and an age-matched normal population and to identify risk factors related to CK, especially coronal parameters that have rarely been studied in current literature. ⋯ Incidence of CK increases in patients with AIS relative to normal subjects. Coronal parameters of the spine could influence cervical sagittal alignment.
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The middle cluneal nerves (MCNs) are stated to arise from the sacral dorsal rami of S1 to S3 and supply the gluteal skin, but their detailed anatomy is unclear and often variably depicted and described. Therefore, the goal of this study was to revisit the anatomy of the MCNs and provide a clearer picture of their morphology. ⋯ We clarified the anatomy and variations of the MCNs and revisited its current nomenclature. Such knowledge might improve diagnoses and invasive procedure outcomes in patients with pathology in the region of the MCNs.
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Postoperative visual recovery is a major concern after transsphenoidal surgery. Optical coherence tomography (OCT) can visualize the anatomy of the retina, and retinal nerve fiber layer (RNFL) thinning reflects loss of optic nerve axons. Visual-evoked potential (VEP) is an electrophysiological response that confirms the nerve conductance. Therefore, these factors reflecting the optic nerve condition may be closely associated with the visual outcome after transsphenoidal surgery. ⋯ OCT is a useful diagnostic modality to assess optic nerve condition, and RNFL thickness of the temporal quadrant is correlated with visual outcome after transsphenoidal surgery. Patients with severe visual disturbance may still achieve visual recovery, so surgery should be considered even if optic disc atrophy is evident.
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As the prevalence of spinal fusion surgery has increased, reliable and safe bone graft substitutes have been developed in response. Biocompatible osteoconductive polymer (BOP) has been used as a bone graft alternative for spine surgery. We present a case of cervical myelopathy due to extrusion of BOP 23 years after surgery and discuss the pathophysiology in terms of spinal fusion. ⋯ Spine surgeons should recognize the pathophysiology of the BOP used for spine fusion surgery. Although BOP is not currently used for spinal surgery, patients undergoing previous surgery with the BOP can present with related complications. Revision surgery is recommended to remove the unincorporated BOP and achieve solid spine fusion.
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Almost 30% of patients with subarachnoid hemorrhage (SAH) are found to have multiple aneurysms. This can potentially present a serious management dilemma when planning treatment. Magnetic resonance imaging vessel wall imaging (VWI) has been proposed as a reliable technique in differentiating between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms who present with SAH. Expert consensus now supports this as a possible use for the technique. ⋯ Although a case of concurrent false positive and false negative in the same patient has not previously been reported, the positive predictive value of VWI for rupture status is known to be much lower than its negative predictive value, and a case like this might be expected to occur in 0.6% of patients. Therefore, whereas VWI is a valuable tool, it should be used in conjunction with, and not in lieu of, traditional indicators of aneurysm rupture.