1,720,980 research outputs found
Posterior lumbar interbody fusion with peek cages: personal experience with 20 patients.
No full textAIM: The use of interbody cages to obtain fusion in the lumbar spine has increased noticeably in the last few years. They are used both with and without posterior stabilization. In our institution a prospective analysis to determine whether PEEK cages can be used as a stand alone device has been performed.
METHODS: The 20 patients with PEEK cages had clinical and radiological follow-up with controls at 1, 3, 6 and 9 months.
RESULTS: The clinical results were considered satisfactory in 75% of the cases. There were no intra-or perioperative complications. There was no displacement of the cages. No signs of unsuccessful fusion were observed.
CONCLUSIONS: Interbody PEEK cages fulfill the objective of stabilizing the treated segment immediately and subsequently. They can be used as stand alone devices with the correct surgical technique and following precise indications
Extradural haematoma of posterior cranial fossa.
No full textTwo cases of extradural haematoma of posterior fossa with an acute course are reported. After trauma, the two patients did not show any symptom for a time of 16 and 18 hours respectively. Both of them showed a status of coma at the moment of hospitalization. The haematoma was diagnosed by CT scan. Both of them were immediately operated in order to evacuate the haematoma. Afterwards, one of the patients presented cerebellar symptoms while the other did not show any neurologic deficiency. The authors have analysed cases of this rare form of post-traumatic pathology referred in the literature since 1941, examining them from a clinical, therapeutic and prognostic point of view. The best diagnostic and therapeutic procedures to follow on this subject are then stressed
Non fusion stabilization of the degenerative lumbar spine
No full textObject. The goal of this study was to assess whether a stable but nonrigid nonfusion implant can stabilize the spine in degenerative diseases and also prevent instability following decompression. Instrumented spondylodesis is a recognized surgical treatment in degenerative disease of the lumbar spine. However, pain can develop at the bone graft donor site and the operative trauma can be very stressful in elderly patients, and it is suspected that there may be increased degenerative changes in the adjacent segments. In 2002, a nonrigid but rotationally stable pedicle screw and rod system was introduced, which could be used without additional fusion (referred to hereafter as the Cosmic system).
Methods. A total of 139 patients with degenerative disease of the lumbar spine underwent spinal stabilization with the Cosmic system without additional spondylodesis. Seventy patients had an additional decompression. The minimum follow-up was 2 years. The perioperative course, the clinical results, and the erect anteroposterior and lateral radiographs were recorded and compared with the preoperative data. The data were obtained from 6 different spine centers in Europe and documented on an Internet platform.
Results. The Oswestry Disability Index score improved from 48.9% to 22.5%, and the visual analog scale score decreased from 7.3 to 2.5. Lumbar lordosis did not change, nor did the adjacent disc height. Eleven patients underwent revision, 4 of them for implant failure. Of the 139 patients, 110 assessed the result as excellent, very good, or good; 24 as fair; and 5 as poor. A total of 122 patients would undergo surgery again. There were no significant differences between patients with or without an additional decompression.
Conclusions. The Cosmic system is a stable but nonrigid posterior nonfusion system. Implant complications are low and the clinical outcome is good. Longer follow-up is necessary to confirm the 2-year results. (DOI: 10.3171/2011.3.SPINE0969
Occipital condyle fractures: a hidden nosologic an entity. An experience with 10 cases
No full textIntroduction. To report the incidence, treatment and outcome of occipital condyle fractures (OCFs) based on the experience of a single neurosurgical department over a period of two years.
Material and methods. From April 1999 to April 2001, ten cases of OCFs were identified in 110 cervical traumas observed over a period of two years. Patients were studied by cervical x-rays, high-resolution CT scan with a 1-2 mm slice of the cranio-cervical junction (CCJ) and MRI in selected cases to evaluate the integrity of supporting ligaments. According to the Anderson and Montesano classification, 5 cases of type III, 3 cases of type II and 2 cases of type I fractures were found. Dysfunction of lower cranial nerves was observed in 8 cases. Treatment was conservative in all cases.
Results. At follow-up, ranging from 18 months to 2 years, fusion was obtained in all cases; 8 patients were neurologically intact, one patient presented a mild persistent dysphonia and another mild trapezius weakness.
Conclusion. OCFs are actually not rare, rather they are often overlooked. In cases of high-energy trauma of the cervical spine, the diagnostic suspicion should be kept in mind.
High-resolution CT scan with slice at 1-2 mm of the CCJ is the key radiological examination in the diagnosis of this lesion. Conservative treatment using a hard collar is sufficien
A one-session circumferential reconstruction in thoracic and lumbar spine fractures using a small expandable cage
No full textAim. Circumferential reconstruction of thoracic and lumbar vertebrae is most frequently performed in two sessions. The authors assessed feasibility, safety and results of a surgical technique in which the use of a small cage allows a less invasive strategy. In addition, since the authors perform urgent decompression in specific cases of spinal cord injury, feasibility of this technique in emergency was verified.
Methods. In two Neurosurgical Departments, between May 2001 and May 2006, 62 patients with thoracic or lumbar fractures were operated on using this technique. X-rays were performed postoperatively and around 45 days from surgery. Three-dimension-computed tomography (3D-CT) scans were performed at 3, 6 and 12 months. Neurological evaluations were repeated at every outpatient visit. After screw insertion at the adjacent levels and traditional transpedicular circumferential decompression, further bone is removed to excavate a niche in the vertebral body and the contiguous discs are removed. The expandable cage, filled with bone fragments, is inserted horizontal or oblique laterally to the sac and applied vertical inside that niche and then expanded. The circumferential stabilization is completed with bone grafting and posterior instrumentation.
Results. 3D-CT scans showed sound fusion and no manifest correction loss. Nineteen patients improved at least one grade in the ASIA scale and 11 gained neuromeric levels.
Conclusion. This technique, fairly undemanding and feasible also in emergency, proved to be safe and resistant. Two-year follow-up demonstrated thriving fusion and steady alignment. It is a valuable surgical therapy to selected cases of burst fracture
Multicentric glioma: presentation of a case
No full textA case of multiformis glioblastoma with a parieto-temporal and brainstem localization is presented. Multicentric gliomas are unfrequently reported in the literature, and very often rise diagnostic problems with other multiple lesions of the Central Nervous System, either of neoplastic nature or not. After briefly reviewing the pathogenetic hypothesis concerning this lesion, indication and limits of clinical and radiological investigations are discussed
Vagal nerve stimulation effects on cerebellar tremor in multiple sclerosis
No full textAlthough vagal nerve stimulation (VNS) is a common alternative
add-on treatment for epilepsy, the effects of the possible combination
of VNS programmable options other than those established in
antiepileptic protocols (e.g., current intensity, on-off operating
time) have not been fully investigated. This study reports the
effect of low-intensity, low cycling VNS on a subject with persistent
cerebellar tremor due to multiple sclerosis (MS)
Chronic subdural hematoma: Results of a homogeneous series of 159 patients operated on by residents
No full textAims: A series of cases with chronic subdural hematoma operated upon by residents in neurosurgery is analysed. Materials and Methods: 159 patients treated between 1998 and 2001 were included in the study. Mean age was 76.4 years and male/female ratio was 1.7/1. The patients were classified both on admission and at discharge according to the Markwalder scale. The standard operative procedure consisted of an enlarged single burr-hole, rinsing the subdural space with iso-osmotic saline solution and insertion of a subdural drain. Conclusion: In CSDH, operation by the residents is safe and the results are comparable to those of the major series of the literature as the surgical procedure is standardized
Cranial bone flap fixation with microplates and screws: a new application technique. Technical note.
No full textA new technique of microplates/screws application for bone flap refixation is described. The microplates are fitted into a shaped bone groove in such a way that the hardware is flush with the edges of the groove thus avoiding definite palpable scalp prominence of the skin under hairless portions of the scalp
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