World Neurosurg
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To evaluate efficacy and safety between C3 laminectomy + open-door laminoplasty and open-door laminoplasty alone. ⋯ Although C3 laminectomy + open-door laminoplasty has theoretic advantages, meta-analysis results show that the 2 surgical procedures are similar in terms of clinical symptoms improvement, sagittal balance, and complications. C3 laminectomy combined + open-door laminoplasty is superior only in the preservation of cervical lordosis. The limited number of studies may affect the reliability and generalizability of the results. Future high-quality, multicenter randomized controlled trials are needed to verify efficacy and safety.
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Cauda equina syndrome (CES) is diagnosed both clinically and radiologically. However, it's unclear if a specific degree of cauda equina compression on imaging can confirm the diagnosis. This study aimed to identify an optimal percentage of prolapse to canal ratio (PCR) on magnetic resonance imaging that correlates with cauda equina compression, facilitating reliable decision-making for CES symptoms. ⋯ Simple radiological measurements of PCR can potentially triage CES patients and guide their management. Future studies should correlate PCR with clinical signs and symptoms for a comprehensive assessment.
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Polyetheretherketone (PEEK) cages and structural allografts (SAs) are commonly used in anterior cervical discectomy and fusion (ACDF), yet their postoperative results remain uncertain. This meta-analysis was conducted to determine whether there were any differences in outcomes between patients who received these two grafts in ACDF. ⋯ SA demonstrates better fusion and lower subsidence rates than the PEEK cage in ACDF. Nevertheless, SAs and PEEK cages resulted in equally successful postoperative clinical performances.
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This study aims to evaluate the safety and efficacy of the ultrasonic bone burr (UBB) in facilitating C1 pedicle screw placement for atlantoaxial instability treatment, compared to the conventional high-speed drill (HSD) technique. ⋯ UBB is a viable alternative for C1 pedicle screw placement, associated with reduced blood loss and shorter operation time, while achieving comparable clinical outcomes to the conventional HSD method. Nevertheless, further research with a larger sample size is needed.
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The presented surgical video (Video 1) demonstrates the resection of an intradural extramedullary metastasis in a 62-year-old female patient with a history of metastatic small cell lung cancer (SCLC). SCLC commonly metastasizes to the central nervous system.1,2 However, the vast majority of such metastases are to the brain.1,2 Interestingly, the presented patient had a cerebellar SCLC metastasis operated on 10 months earlier. Several cases of intradural extramedullary spinal drop metastases arising from cerebellar tumors have been described in the literature, suggesting that a drop metastasis is a likely mechanism to explain this rare topography.3-5 Preoperatively, the patient presented with 1 month of back pain and rapidly progressing left lower extremity weakness and myelopathic signs so surgery was offered.6-10 Interval imaging showed an intradural extramedullary T4-T5 lesion suspicious for metastatic disease. ⋯ Complete resection required sacrifice of the left T5 nerve root and cutting of the dentate ligament in 2 locations for adequate visualization. Postoperative neurologic exam demonstrated improvement in her lower extremity weakness, and postoperative magnetic resonance imaging showed gross total resection. The postoperative course was uneventful, and the patient was discharged home on postoperative day 6.