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  • 1
    Online Resource
    Online Resource
    Incidence and Clinical Significance of Vascular Encroachment Resulting From Freehand Placement of Pedicle Screws in the Thoracic and Lumbar Spine : Analysis of 6816 Consecutive Screws
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Spine Vol. 39, No. 8 ( 2014-04), p. 683-687
    Details
    In: Spine, Ovid Technologies (Wolters Kluwer Health), Vol. 39, No. 8 ( 2014-04), p. 683-687
    Type of Medium: Online Resource
    ISSN: 0362-2436
    URL: Article
    DOI: 10.1097/BRS.0000000000000221
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 2002195-1
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  • 2
    Online Resource
    Online Resource
    Subependymoma: clinical features and surgical outcomes
    Informa UK Limited ; 2012
    In:  Neurological Research Vol. 34, No. 7 ( 2012-09), p. 677-684
    Details
    In: Neurological Research, Informa UK Limited, Vol. 34, No. 7 ( 2012-09), p. 677-684
    Type of Medium: Online Resource
    ISSN: 0161-6412 , 1743-1328
    URL: Article
    DOI: 10.1179/1743132812Y.0000000064
    RVK:
    XA 10000
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2012
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  • 3
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    Online Resource
    Radiotherapy for Mobile Spine and Sacral Chordoma: A Critical Review and Practical Guide from the Spine Tumor Academy
    MDPI AG ; 2023
    In:  Cancers Vol. 15, No. 8 ( 2023-04-18), p. 2359-
    Details
    In: Cancers, MDPI AG, Vol. 15, No. 8 ( 2023-04-18), p. 2359-
    Abstract: Chordomas are rare tumors of the embryologic spinal cord remnant. They are locally aggressive and typically managed with surgery and either adjuvant or neoadjuvant radiation therapy. However, there is great variability in practice patterns including radiation type and fractionation regimen, and limited high-level data to drive decision making. The purpose of this manuscript was to summarize the current literature specific to radiotherapy in the management of spine and sacral chordoma and to provide practice recommendations on behalf of the Spine Tumor Academy. A systematic review of the literature was performed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) approach. Medline and Embase databases were utilized. The primary outcome measure was the rate of local control. A detailed review and interpretation of eligible studies is provided in the manuscript tables and text. Recommendations were defined as follows: (1) consensus: approved by 〉 75% of experts; (2) predominant: approved by 〉 50% of experts; (3) controversial: not approved by a majority of experts. Expert consensus supports dose escalation as critical in optimizing local control following radiation therapy for chordoma. In addition, comprehensive target volumes including sites of potential microscopic involvement improve local control compared with focal targets. Level I and high-quality multi-institutional data comparing treatment modalities, sequencing of radiation and surgery, and dose/fractionation schedules are needed to optimize patient outcomes in this locally aggressive malignancy.
    Type of Medium: Online Resource
    ISSN: 2072-6694
    URL: Article
    DOI: 10.3390/cancers15082359
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2527080-1
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  • 4
    Online Resource
    Online Resource
    Cholesteatomas of the Petrous Apex – Report of 5 Cases and their Management
    Georg Thieme Verlag KG ; 2016
    In:  Journal of Neurological Surgery Part B: Skull Base Vol. 77, No. S 01 ( 2016-3-3)
    Details
    In: Journal of Neurological Surgery Part B: Skull Base, Georg Thieme Verlag KG, Vol. 77, No. S 01 ( 2016-3-3)
    Type of Medium: Online Resource
    ISSN: 2193-6331 , 2193-634X
    URL: Article
    DOI: 10.1055/s-0036-1580072
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2016
    detail.hit.zdb_id: 2653367-4
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  • 5
    Online Resource
    Online Resource
    Retrosigmoid Craniectomy for Resection of Epidermoid causing Trigeminal Neuralgia
    Georg Thieme Verlag KG ; 2019
    In:  Journal of Neurological Surgery Part B: Skull Base Vol. 80, No. S 03 ( 2019-06), p. S320-S321
    Details
    In: Journal of Neurological Surgery Part B: Skull Base, Georg Thieme Verlag KG, Vol. 80, No. S 03 ( 2019-06), p. S320-S321
    Abstract: The differential diagnosis for trigeminal neuralgia like-symptoms includes cerebellopontine angle lesions causing regional mass effect upon the trigeminal nerve (Fig. 1). Here we present an operative video manuscript of a patient experiencing trigeminal neuralgia, secondary to an epidermoid cyst, in which a retrosigmoid craniectomy was performed to resect the epidermoid and decompress the trigeminal nerve (Fig. 2). This video highlights the operative nuances to achieving a successful surgery, including appropriate patient positioning, dural exposure to the transverse-sigmoid sinus junction, arachnoid dissection, and decompression of cranial nerves. A gross total resection was achieved; the patient reported immediate relief of facial pain postoperatively and has been pain free at the ten month follow-up. The link to the video can be found at: https://youtu.be/Ja2eE0uGk4E.
    Type of Medium: Online Resource
    ISSN: 2193-6331 , 2193-634X
    URL: Article
    DOI: 10.1055/s-0038-1676998
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2019
    detail.hit.zdb_id: 2653367-4
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  • 6
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    Online Resource
    Short-segment cement-augmented fixation in open separation surgery of metastatic epidural spinal cord compression: initial experience
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2021
    In:  Neurosurgical Focus Vol. 50, No. 5 ( 2021-05), p. E11-
    Details
    In: Neurosurgical Focus, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 50, No. 5 ( 2021-05), p. E11-
    Abstract: High-grade metastatic epidural spinal cord compression from radioresistant tumor histologies is often treated with separation surgery and adjuvant stereotactic body radiation therapy. Historically, long-segment fixation is performed during separation surgery with posterior transpedicular fixation of a minimum of 2 spinal levels superior and inferior to the decompression. Previous experience with minimal access surgery techniques and percutaneous stabilization have highlighted reduced morbidity as an advantage to the use of shorter fixation constructs. Cement augmentation of pedicle screws is an attractive option for enhanced stabilization while performing shorter fixation. Herein, the authors describe their initial experience of open separation surgery using short-segment cement-augmented pedicle screw fixation for spinal reconstruction. METHODS The authors performed a retrospective chart review of patients undergoing open (i.e., nonpercutaneous, minimal access surgery) separation surgery for high-grade epidural spinal cord compression using cement-augmented pedicle screws at single levels adjacent to the decompression level(s). Patient demographics, treatment data, operative complications, and short-term radiographic outcomes were evaluated. RESULTS Overall, 44 patients met inclusion criteria with radiographic follow-up at a mean of 8.5 months. Involved levels included 19 thoracic, 5 thoracolumbar, and 20 lumbar. Cement augmentation through fenestrated pedicle screws was performed in 30 patients, and a vertebroplasty-type approach was used in the remaining 14 patients to augment screw purchase. One (2%) patient required an operative revision for a hardware complication. Three (7%) nonoperative radiographic hardware complications occurred, including 1 pathologic fracture at the index level causing progressive kyphosis and 2 incidences of haloing around a single screw. There were 2 wound complications that were managed conservatively without operative intervention. No cement-related complications occurred. CONCLUSIONS Open posterolateral decompression utilizing short-segment cement-augmented pedicle screws is a viable alternative to long-segment instrumentation for reconstruction following separation surgery for metastatic spine tumors. Studies with longer follow-up are needed to determine the rates of delayed complications and the durability of these outcomes.
    Type of Medium: Online Resource
    ISSN: 1092-0684
    URL: Article
    DOI: 10.3171/2021.2.FOCUS217
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2021
    detail.hit.zdb_id: 2026589-X
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  • 7
    Online Resource
    Online Resource
    Ability of electromyographic monitoring to determine the presence of malpositioned pedicle screws in the lumbosacral spine: analysis of 2450 consecutively placed screws : Clinical article
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2011
    In:  Journal of Neurosurgery: Spine Vol. 15, No. 2 ( 2011-08), p. 130-135
    Details
    In: Journal of Neurosurgery: Spine, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 15, No. 2 ( 2011-08), p. 130-135
    Abstract: Pedicle screws provide efficient stabilization along all 3 columns of the spine, but they can be technically demanding to place, with malposition rates ranging from 5% to 10%. Intraoperative electromyographic (EMG) monitoring has the capacity to objectively identify a screw breaching the medial pedicle cortex that is in proximity to a nerve root. The purpose of this study is to describe and evaluate the authors' 7-year institutional experience with intraoperative EMG monitoring during placement of lumbar pedicle screws and to determine the clinical utility of intraoperative EMG monitoring. Methods The authors retrospectively studied 2450 consecutive lumbar pedicle screws placed in 418 patients from June 2002 through June 2009. All screws were inserted using a free-hand technique and anatomical landmarks, stimulated at 10.0 mA, and evaluated with CT scanning within 48 hours postoperatively. Medial pedicle screw breach was defined as having greater than 25% of the screw diameter extend outside of the pedicle, as confirmed on CT scanning or intraoperatively by a positive EMG response indicating a medial breach. The sensitivity and specificity of intraoperative EMG monitoring in detecting the presence of a medial screw breach was evaluated based on the following definitions: 1) true positive (a positive response to EMG stimulation confirmed as a breach intraoperatively or on postoperative CT scans); 2) false positive (positive response to EMG stimulation confirmed as a correctly positioned screw on postoperative CT scans); 3) true negative (no response to EMG stimulation confirmed as a correctly positioned screw on postoperative CT scans); or 4) false negative (no response to EMG stimulation but confirmed as a breach on postoperative CT scans). Results One hundred fifteen pedicle screws (4.7%) showed positive stimulation during intraoperative EMG monitoring. At stimulation thresholds less than 5.0, 5.0–8.0, and 〉 8.0 mA, the specificity of a positive response was 99.9%, 97.9%, and 95.9%, respectively. The sensitivity of a positive response at these thresholds was only 43.4%, 69.6%, and 69.6%, respectively. At a threshold less than 5.0 mA, 91% of screws with a positive EMG response were confirmed as true medial breaches. However, at thresholds of 5.0–8.0 mA or greater than 8.0 mA, a positive EMG response was associated with 89% and 100% false positives (no breaches), respectively. Conclusions When using intraoperative EMG monitoring, a positive response at screw stimulation thresholds less than 5.0 mA was highly specific for a medial pedicle screw breach but was poorly sensitive. A positive response to stimulation thresholds greater 5.0 mA was associated with a very high rate of false positives. The authors' experience suggests that pedicle screws showing positive stimulation below 5.0 mA warrants intraoperative investigation for malpositioning while responses at higher thresholds are less reliable at accurately representing a medial breach.
    Type of Medium: Online Resource
    ISSN: 1547-5654
    URL: Article
    DOI: 10.3171/2011.3.SPINE101
    RVK:
    XA 55270.1
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2011
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  • 8
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    Online Resource
    The rib head as a landmark in the anterolateral approach to the thoracic spine: a computed tomography–based morphometric study : Laboratory investigation
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2013
    In:  Journal of Neurosurgery: Spine Vol. 18, No. 5 ( 2013-05), p. 484-489
    Details
    In: Journal of Neurosurgery: Spine, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 18, No. 5 ( 2013-05), p. 484-489
    Abstract: The rib head is an important landmark in the anterolateral approach to the thoracic spine. Resection of the rib head is typically the first step in gaining access to the underlying pedicle and ultimately the spinal canal. The goal of this work is to quantify the relationship of the rib head to the spinal canal and adjacent aorta at each thoracic level using CT-based morphometric measurements. Methods One hundred thoracic spine CT scans (obtained in 50 male and 50 female subjects) were evaluated in this study. The width and depth of each vertebra body were measured from T-1 to T-12. In addition, the distance of each rib head to the spinal canal was determined by drawing a line connecting the rib heads bilaterally and measuring the distance to this line from the most ventral aspect of the spinal canal. Finally, the distance of the left rib head to the thoracic aorta was measured at each thoracic level below the aortic arch. Results The vertebral body depth progressively increased in a rostral to caudal direction. The vertebral body width was at its minimum at T-4 and progressively increased to T-12. The rib head extended beyond the spinal canal maximally at T-1. This distance incrementally decreased toward the caudal levels, with the tip of the rib head lying approximately even with the ventral canal at T-11 and T-12. The distance between the aorta and the left rib head increased in a rostral to caudal direction as well. Conclusions The rib head is an important landmark in the anterolateral approach to the thoracic spine. At more cephalad levels, a larger portion of rib head requires resection to gain access to the spinal canal. At more caudad levels, there is a safer working distance between the rib head and aorta.
    Type of Medium: Online Resource
    ISSN: 1547-5654
    URL: Article
    DOI: 10.3171/2013.1.SPINE12605
    RVK:
    XA 55270.1
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2013
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  • 9
    Online Resource
    Online Resource
    Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws : Clinical article
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2014
    In:  Journal of Neurosurgery: Spine Vol. 21, No. 3 ( 2014-09), p. 320-328
    Details
    In: Journal of Neurosurgery: Spine, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 21, No. 3 ( 2014-09), p. 320-328
    Abstract: A number of imaging techniques have been introduced to minimize the risk of pedicle screw placement. Intraoperative CT has been recently introduced to assist in spinal instrumentation. The aim of this study was to study the effectiveness of intraoperative CT in enhancing the safety and accuracy of pedicle screw placement. Methods The authors included all cases from December 2009 through July 2012 in which intraoperative CT scanning was used to confirm pedicle screw placement. Results A total of 203 patients met the inclusion criteria. Of 1148 screws, 103 screws (8.97%) were revised intraoperatively in 72 patients (35.5%): 14 (18.42%) were revised in the cervical spine (C-2 or C-7), 25 (7.25%) in the thoracic spine, and 64 (8.80%) in the lumbar spine. Compared with screws in the thoracic and lumbar regions, pedicle screws placed in the cervical region were statistically more likely to be revised (p = 0.0061). Two patients (0.99%) required reoperations due to undetected misplacement of pedicle screws. Conclusions The authors describe one of the first North American experiences using intraoperative CT scanning to confirm the placement of pedicle screws. Compared with a similar cohort of patients from their institution who had pedicle screws inserted via the free-hand technique with postoperative CT, the authors found that the intraoperative CT lowers the threshold for pedicle screw revision, resulting in a statistically higher rate of screw revision in the thoracic and lumbar spine (p 〈 0.0001). During their 2.5-year experience with the intraoperative CT, the authors did not find a reduction in rates of reoperation for misplaced pedicle screws.
    Type of Medium: Online Resource
    ISSN: 1547-5654
    URL: Article
    DOI: 10.3171/2014.5.SPINE13567
    RVK:
    XA 55270.1
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2014
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  • 10
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    Online Resource
    Implications of Spinopelvic Alignment for the Spine Surgeon
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Neurosurgery Vol. 70, No. 3 ( 2012-03-01), p. 707-721
    Details
    In: Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 70, No. 3 ( 2012-03-01), p. 707-721
    Abstract: The relation of the pelvis to the spine has previously been overlooked as a contributor to sagittal balance. However, it is now recognized that spinopelvic alignment is important to maintain an energy-efficient posture in normal and disease states. The pelvis is characterized by an important anatomic landmark, the pelvic incidence (PI). The PI does not change after adolescence, and it directly influences pelvic alignment, including the parameters of pelvic tilt (PT) and sacral slope (SS) (PI = PT 1 SS), overall sagittal spinal balance, and lumbar lordosis. In the setting of an elevated PI, the spineadapts with increased lumbar lordosis. To prevent or limit sagittal imbalance, the spine may also compensate with increased PT or pelvic retroversion to attempt to maintain anupright posture. Abnormal spinopelvic parameters contribute to multiple spinal conditions including isthmic spondylolysis, degenerative spondylolisthesis, deformity, and impact outcome after spinal fusion. Sagittal balance, pelvic incidence, and all spinopelvic parameters are easily and reliably measured on standing, full-spine (lateral) radiographs, and it is essential to accurately assess and measure these sagittal values to understand their potential role in the disease process, and to promote spinopelvic balance at surgery. In this article, we provide a comprehensive review of the literature regarding the implications of abnormal spinopelvic parameters and discuss surgical strategies for correction of sagittal balance. Additionally, the authors rate and critique the quality of the literature cited in a systematic review approach to give the reader an estimate of the veracity of the conclusions reached from these reports.
    Type of Medium: Online Resource
    ISSN: 0148-396X , 1524-4040
    URL: Article
    DOI: 10.1227/NEU.0b013e31823262ea
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1491894-8
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