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Comparing Combined Anterior and Posterior to Posterior-Only Decompression and Fusion Crossing the Cervico-Thoracic Junction in Octogenarians.

Global Spine J 2021 Mar 10:2192568221994793. Epub 2021 Mar 10.

Swedish Neuroscience Institute, Seattle, WA, USA.

Study Design: Retrospective cohort study.

Objective: The purpose of the study was to compare early complication, morbidity and mortality risks associated with fusion surgery crossing the cervico-thoracic junction in patients aged over 80 years undergoing combined anterior and posterior approach versus a posterior-only approach.

Methods: We retrospectively identified octogenarian patients with myelopathy who underwent fusion crossing the cervico-thoracic junction. Read More

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Role of Combined Vertebroplasty and Spinal Decompression in the Management of Aggressive Vertebral Hemangiomas.

Asian J Neurosurg 2020 Oct-Dec;15(4):919-925. Epub 2020 Oct 18.

Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt.

Background: There are different surgical modalities designed to manage aggressive vertebral hemangioma (VH) that causes neurological symptoms. The selection of the best approach is still controversial. It is crucial to safely achieve neurological recovery with the elimination of the risk of recurrence. Read More

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October 2020

Predictors of Falls in Patients with Degenerative Cervical Myelopathy: A Prospective Multi-Institutional Study.

Spine (Phila Pa 1976) 2021 Jan 25. Epub 2021 Jan 25.

Department of Orthopaedic and Trauma Research, Tokyo Medical and Dental University Department of Orthopedic Surgery, Tokyo Medical and Dental University Department of Orthopaedics, Jichi Medical University Department of Orthopaedic Surgery, Tokyo Medical University Department of Orthopedic Surgery, Chiba University Graduate School of Medicine Department of Orthopedic Surgery, Shiga University of Medical Science Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama Department of Orthopedic Surgery, Imakiire General Hospital Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University.

Study Design: Prospective multicenter study.

Objectives: The purpose of this study was to characterize a population of patients with degenerative cervical myelopathy (DCM) combined with a history of falling, and to identify the predictors associated with those falls.

Summary Of Background Data: Falls among patients with DCM are common and can lead to the worsening of neurological symptoms. Read More

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January 2021

Application of an Expandable Cage for Reconstruction of the Cervical Spine in a Consecutive Series of Eighty-Six Patients.

Medicina (Kaunas) 2020 Nov 25;56(12). Epub 2020 Nov 25.

Department of Neurosurgery, University of Marburg, 35043 Marburg, Germany.

: Expandable cages are frequently used to reconstruct the anterior spinal column after a corpectomy. In this retrospective study, we evaluated the perioperative advantages and disadvantages of corpectomy reconstruction with an expandable cage. Eighty-six patients (45 male and 41 female patients, medium age of 61. Read More

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November 2020

Cervical myelopathy caused by ventrally located atlanto-axial synovial cysts: An open quest for the safest and most effective surgical management. Case series and systematic review of the literature.

Neurochirurgie 2020 Dec 14;66(6):447-454. Epub 2020 Oct 14.

Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France.

Of Background Data: Despite a good understanding of the natural history of spinal synovial cysts (SCs), a widespread agreement regarding their optimal management is still lacking. This is particularly true for SCs occurring at the C1-C2 level, which are rare, but oftentimes lead to a rapidly evolving cervical myelopathy.

Methods: We report a series of 4 patients (M:F ratio=1:1; mean age 63. Read More

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December 2020

Do Intraoperative Neurophysiological Changes During Decompressive Surgery for Cervical Myeloradiculopathy Affect Functional Outcome? A Prospective Study.

Global Spine J 2020 Sep 22:2192568220951779. Epub 2020 Sep 22.

Apollo Hospital, Chennai, India.

Study Design: Prospective cohort.

Objective: To investigate whether intraoperative neuromonitoring (IONM) positive changes affect functional outcome after surgical intervention for myeloradiculopathy secondary to cervical compressive pathology (cervical compressive myelopathy).

Methods: Twenty-eight patients who underwent cervical spine surgery with IONM for compressive myeloradiculopathy were enrolled. Read More

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September 2020

Clinical and Radiologic Features of Degenerative Cervical Myelopathy Depending on the Presence of Cord Signal Change.

World Neurosurg 2020 09 7;141:e97-e104. Epub 2020 May 7.

Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea. Electronic address:

Background: Cord signal change (CSC) on magnetic resonance (MR) imaging is an important radiologic feature of degenerative cervical myelopathy (DCM). Occasionally, DCMs correlate with clinical symptoms with no CSC. The aim of this study was to evaluate clinical and radiologic features, depending on the presence of CSC in DCM. Read More

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September 2020

Laminectomy versus open-door laminoplasty for cervical spondylotic myelopathy: A clinical outcome analysis.

Surg Neurol Int 2020 18;11:73. Epub 2020 Apr 18.

Departments of Neurosurgery, University, Via Conca, Ancona, Marche, Italy.

Background: Cervical spondylotic myelopathy (CSM) is one of the most common diseases in the geriatric population. Decompressive laminectomy or laminoplasty is the predominant surgical procedure of choice, but there remains debate as to which procedure is optimal for managing CSM.

Methods: Here, we retrospectively analyzed 64 patients with CSM undergoing laminectomy (39 patients) versus laminoplasty (25 patients). Read More

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Dynamic imaging of the craniovertebral junction is mandatory in patients with posterior circulation strokes.

Eur Spine J 2020 05 19;29(5):1078-1086. Epub 2020 Feb 19.

Department of Neurological Sciences, Christian Medical College, Vellore, India.

Introduction: The course of the vertebral artery after exiting from the C1 foramen transversarium and prior to entering the dura lends itself to compression in C1-2 instability. However, atlantoaxial dislocation presenting with vertebrobasilar insufficiency and posterior circulation stroke (PCS) is rare.

Methods: In this retrospective study, we identified 96 patients with PCS who had complete radiological data. Read More

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Evaluation of the effectiveness of expandable cages for reconstruction of the anterior column of the spine.

J Orthop Surg (Hong Kong) 2020 Jan-Apr;28(1):2309499019900472

Regional Spinal Department, UOC Ortopedia A, AOUI, Verona, Italy.

Purpose: For anterior spine column reconstruction after corpectomy, expandable cages offer solid anterior support and allow correction of deformity, providing excellent primary stability. To provide a larger body of clinical observations concerning the effectiveness of the approach, this retrospective study examines patients treated by corpectomy and reconstruction with an expandable cage for different pathologies.

Methods: Across 5 years, 39 patients underwent vertebral reconstruction with expandable cages after single ( = 34), double ( = 4), or triple ( = 1) corpectomy. Read More

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September 2020

Effect of Sub-axial Cervical Lateral Mass Screw Fixation on Functional Outcome in Patients with Cervical Spondylotic Myelopathy.

Asian J Neurosurg 2019 Jan-Mar;14(1):140-147

Department of Neurosurgery, South Valley University, Qena, Egypt.

Background: The role of laminectomy alone as an etiology of postoperative cervical instability is well known. Cervical sagittal malalignment of the spine has been linked to unfavorable functional outcome, so the effect of restoration of sagittal spinal alignment on functional outcomes and treatment effectiveness has recently gained attention.

Objective: This is a prospective observational study aims to observe the possible relation between cervical sagittal alignment and functional outcomes following sub-axial cervical lateral mass screw fixation in patients with cervical spondylotic myelopathy. Read More

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The use of anterior cervical interbody spacer with integrated fixation screws for management of cervical disc disease.

SICOT J 2019 Jan 8;5. Epub 2019 Feb 8.

Agouza Armed Forces Spine Surgery Center, Farid Shawky Street, Giza, Egypt.

Introduction: Integrated cage and screw designs were introduced for anterior cervical discectomy and fusion (ACDF) and allegedly are superior to anterior plating due to their minimal anterior profile.

Methods: A descriptive study was designed as a prospective case series of 25 patients (30 operated discs) with cervical disc disease treated with a zero-profile cage, and followed up for an average of 16 months (range 12 -18 months). Functional assessment was done with the Neck Disability Index (NDI) and Visual analog scale (VAS) scores for arm and neck pain. Read More

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January 2019

Novel Strategy of Ventral Dural Repair for Idiopathic Thoracic Spinal Cord Herniation: Report of Outcomes and Review of Techniques.

Oper Neurosurg (Hagerstown) 2019 07;17(1):21-31

Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.

Background: Idiopathic ventral thoracic spinal cord herniation is a rare condition that usually presents with progressive myelopathy or Brown-Séquard syndrome. More than 100 cases have been reported with significant variance in surgical treatment strategies and likewise, significant variance in patient outcomes. Although laminectomy has often been used, to date, there is no consensus regarding the optimal surgical approach or strategy for ventral dural repair. Read More

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Clinical and radiological outcomes following open door laminoplasty: a single center evolution of the technique.

J Neurosurg Sci 2018 Oct 23. Epub 2018 Oct 23.

Institute of Neurosurgery. Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Background: A comparison of clinical and radiological outcomes after two different variants of open door laminoplasty for cervical spondylotic myelopathy (CSM) is described.

Methods: Fifty-five patients underwent cervical laminoplasty for CSM. Between 2005 to 2009, 32 patients underwent open-door laminoplasty (Group A) performed with a monolateral exposure with contralateral "green stick" laminar fracture. Read More

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October 2018

Short-Term Clinical Evaluation of Enhanced Unilateral Open-Door Laminoplasty Using Titanium Mesh.

Asian Spine J 2018 Oct 10;12(5):810-816. Epub 2018 Sep 10.

Division of Neurosurgery, Department of Surgery, Dr. Sardjito Hospital, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.

Study Design: Observational, cross-sectional study.

Purpose: The purpose of this study was to evaluate the clinical efficacy and safety profile of open-door laminoplasty (ODL) using titanium mesh.

Overview Of Literature: The most appropriate surgical management of degenerative spine disorders, particularly ossification of the posterior longitudinal ligament, remains controversial and continues unabated in the neurosurgical community. Read More

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October 2018

Endoscopic Anterior Approach for Cervical Disc Disease (Disc Preserving Surgery).

World Neurosurg 2018 Jul 24;115:e599-e609. Epub 2018 Apr 24.

Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India. Electronic address:

Objective: To report our experience of endoscopic disc removal by anterior approach for management of cervical myelopathy in 210 patients.

Methods: A retrospective study of 187 cases of single- and 23 cases of double-level disc disease was performed. Cases of myelopathy with or without unilateral or bilateral radiculopathy and unilateral radiculopathy with either soft or hard disc prolapse were included. Read More

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Modified Laminoplasty for Degenerative Cervical Spondylosis: The Technique of Floating Laminoplasty.

Niger J Surg 2018 Jan-Jun;24(1):1-5

Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria.

Background: Laminoplasty is an established alternative to laminectomy for posterior cervical decompression in spondylotic myelopathy. However, standard laminoplasty requires internal fixation, which is often not obtainable in developing countries. We present our experience with a technique of noninstrumented (floating) laminoplasty developed to avoid the need to anchor the laminoplasty to the anterior elements. Read More

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Postoperative Resolution of Magnetic Resonance Imaging Signal Intensity Changes and the Associated Impact on Outcomes in Degenerative Cervical Myelopathy: Analysis of a Global Cohort of Patients.

Spine (Phila Pa 1976) 2018 06;43(12):824-831

Divisions of Neurosurgery, Orthopedic Surgery and Spinal Program, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada.

Study Design: Subanalysis of the prospective AOSpine CSM North America and International studies.

Objective: To describe the postoperative changes in magnetic resonance imaging (MRI) spinal cord signal intensity in degenerative cervical myelopathy (DCM) patients and to investigate the impact of its postoperative resolution on clinical outcomes.

Summary Of Background Data: When examining the spinal cord, hyperintensity found in MRI T2-weighted images and hypointensity in T1-weighted images are known to correlate with preoperative severity of DCM and to predict postoperative neurological recovery. Read More

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Evaluation of hand function in healthy individuals and patients undergoing uninstrumented central corpectomy for cervical spondylotic myelopathy using nine-hole peg test.

Neurol India 2017 Sep-Oct;65(5):1025-1030

Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.

Objectives: To evaluate the hand function in healthy individuals and in patients with cervical spondylotic myelopathy (CSM) undergoing central corpectomy using the nine-hole peg test (NHPT).

Materials And Methods: The NHPT was performed in healthy adults and in patients with CSM; overall, five trials were performed in the right and left hand separately. The preoperative and follow up NHPT score was compared to the normal and correlated with Nurick and modified Japanese Orthopedic Association (mJOA) scales. Read More

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Fresh frozen cortical strut allograft in two-level anterior cervical corpectomy and fusion.

PLoS One 2017 25;12(8):e0183112. Epub 2017 Aug 25.

Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.

Anterior cervical corpectomy and fusion (ACCF) is one of the main surgical strategies for the management of multilevel cervical spondylotic myelopathy (MCSM). High complication rates of graft bone fracture, resorption, displacement, and fusion collapse or pseudarthrosis have been previously reported. The strategies to prevent the aforementioned complications include using fresh frozen cortical strut allograft (FFCSA) to keep most of the original bone quality and using additional anterior plate fixation to improve the fusion stability and union rate. Read More

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October 2017

High posterior cervical fusion rates with iliac autograft and Nanoss/bone marrow aspirate.

Authors:
Nancy E Epstein

Surg Neurol Int 2017 20;8:152. Epub 2017 Jul 20.

Chief of Neurosurgical Spine/Education, NYU Winthrop Hospital, Mineola, New York, USA.

Background: Patients with severe cervical multilevel stenosis and an adequate lordotic curvature often undergo multilevel laminectomies with posterior instrumented fusions. Although the "gold standard" for the fusion mass remains iliac crest autograft, many require additional volume provided by bone graft expanders. Here, we studied the fusion rates for 32 patients undergoing multilevel cervical laminectomy and vertex/rod/eyelet/titanium cable fusions utilizing lamina/iliac autograft and the bone graft expander Nanoss (RTI Surgical, Alachua, FL, USA) with autogenous bone marrow aspirate (BMA). Read More

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Prognostic Value of Preoperative Nurick Grade and Time with Symptoms in Patients with Cervical Myelopathy and Gait Impairment.

World Neurosurg 2017 Sep 26;105:314-320. Epub 2017 Jun 26.

The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address:

Objective: To investigate the prognostic value of preoperative Nurick grade and time with symptoms for gait improvement and recovery in patients with ataxia secondary to cervical myelopathy.

Methods: A retrospective chart review of all adult patients who underwent surgical decompression for cervical myelopathy between 1996 and 2013 was performed. Only adults with a Nurick grade of at least 2 or worse were included. Read More

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September 2017

Is cervical disc arthroplasty good for congenital cervical stenosis?

J Neurosurg Spine 2017 May 10;26(5):577-585. Epub 2017 Mar 10.

Department of Neurosurgery, Neurological Institute, and.

OBJECTIVE Cervical disc arthroplasty (CDA) has been demonstrated to be as safe and effective as anterior cervical discectomy and fusion (ACDF) in the management of 1- and 2-level degenerative disc disease (DDD). However, there has been a lack of data to address the fundamental discrepancy between the two surgeries (CDA vs ACDF), and preservation versus elimination of motion, in the management of cervical myelopathy associated with congenital cervical stenosis (CCS). Although younger patients tend to benefit more from motion preservation, it is uncertain if CCS caused by multilevel DDD can be treated safely with CDA. Read More

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Minimally Invasive Microscopic Posterior Cervical Decompression: Simple, Safe, and Effective.

J Neurol Surg A Cent Eur Neurosurg 2017 Sep 9;78(5):440-445. Epub 2017 Feb 9.

Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom of Great Britain and Northern Ireland.

 Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the elderly population. Surgery is usually successful in preventing any deterioration, as well as improving functional status and quality of life. This study assesses the safety and efficacy of minimally invasive microscopic posterior cervical decompression for the treatment of CSM. Read More

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September 2017

C2-C3 Anterior Cervical Fusion: Technical Report.

Clin Spine Surg 2016 12;29(10):E536-E541

*Department of Neurosurgery, University of Utah, Salt Lake City †Intermountain Medical Center, Murray, UT.

Study Design: Retrospective review of patients at a university hospital.

Objective: To describe the anterior approach for cervical discectomy and fusion (ACDF) at C2-C3 level and evaluate its suitability for treatment of instability and degenerative disease in this region.

Summary Of Background Data: The anterior approach is commonly used for ACDF in the lower cervical spine but is used less often in the high cervical spine. Read More

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December 2016

Surgical management of ventrally located spinal meningiomas via posterior approach.

Eur J Orthop Surg Traumatol 2017 Feb 26;27(2):181-186. Epub 2016 Sep 26.

Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan.

Background: Spinal meningioma is a relatively common tumor among intradural extramedullary spinal tumors. When the locus of the meningioma is located on the ventral side, tumor removal, dura mater resection, and reconstruction via a posterior approach safety become technically difficult.

Methods: Twelve patients, who received surgical treatment for ventral spinal meningioma via a posterior approach, were included. Read More

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February 2017

Psychometric properties of the 30-m walking test in patients with degenerative cervical myelopathy: results from two prospective multicenter cohort studies.

Spine J 2017 02 31;17(2):211-217. Epub 2016 Aug 31.

Department of Neurosurgery, University of Kansas Medical Center, Mail Stop 3021, 3901 Rainbow Blvd, Kansas City, KS 66160 USA. Electronic address:

Background Context: The timed 30-m walking test (30MWT) is used in clinical practice and in research to objectively quantify gait impairment. The psychometric properties of 30MWT have not yet been rigorously evaluated.

Purpose: This study aimed to determine test-retest reliability, divergent and convergent validity, and responsiveness to change of the 30MWT in patients with degenerative cervical myelopathy (DCM). Read More

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February 2017

Recovery of sympathetic skin response after central corpectomy in patients with moderate and severe cervical spondylotic myelopathy.

Br J Neurosurg 2017 Apr 14;31(2):199-204. Epub 2016 Jul 14.

a Department of Neurological Sciences , Christian Medical College , Vellore , India.

Background: There are sparse data on the recovery of sympathetic skin response (SSR) following decompressive surgery in patients with cervical spondylotic myelopathy (CSM). We designed a study to assess SSR in patients with moderate and severe (Nurick grades 3, 4 and 5) CSM, and its recovery following central corpectomy (CC).

Method: We conducted a prospective study on 19 patients with moderate and severe CSM who underwent CC from June 2008 to December 2010. Read More

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Surgical Management of Adult Reducible Atlantoaxial Dislocation, Basilar Invagination and Chiari Malformation with Syringomyelia.

Turk Neurosurg 2016;26(4):615-21

Sichuan University, West China Hospital, Department of Neurosurgery, China.

Aim: To analyze retrospectively the surgical management of reducible atlantoaxial dislocation (AAD), basilar invagination (BI) and Chiari malformation (CHM) with syringomyelia through a single-stage posterior approach.

Material And Methods: Forty-three patients with reducible AAD, BI and CHM with syringomyelia underwent surgery from January 2009 to January 2013. Intraoperative restoration followed by posterior decompression and plate-rod placement with occipital cortical screws and C2/C3 lateral mass cortical screws fixation devices were used in all patients. Read More

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December 2016

Subclinical respiratory dysfunction in chronic cervical cord compression: a pulmonary function test correlation.

Neurosurg Focus 2016 Jun;40(6):E3

Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru;

OBJECTIVE Respiratory abnormalities are well documented in acute spinal cord injury; however, the literature available for respiratory dysfunction in chronic compressive myelopathy (CCM) is limited. Respiratory dysfunction in CCM is often subtle and subclinical. The authors studied the pattern of respiratory dysfunction in patients with chronic cord compression by using spirometry, and the clinical and surgical implications of this dysfunction. Read More

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