As the number of elderly persons in the United States continues to increase, there will be an associated increase in age-related diseases, such as degenerative conditions of the lumbar spine. Elderly patients frequently present to their geriatrician or primary care provider with low back and leg pain. Spine surgery is one of several options the geriatric patient may consider for symptomatic relief, but the literature describing the safety and efficacy of spine surgery in older patients is inconclusive and at times confusing.
View Article and Find Full Text PDFThere are many techniques available for the recovery of fingermarks at scenes of crime including the possibility of taking casts of the marks. Casts can be advantageous in cases where other destructive recovery techniques might not be suitable, such as when recovering finger marks deposited on valued or immobile items. In this research, Isomark (a silicone-based casting material) was used to recover casts of finger marks placed on a variety of substrates.
View Article and Find Full Text PDFFour presumptive blood tests, Hexagon OBTI, Hemastix(R), Leucomalachite green (LMG), and Kastle-Meyer (KM) were compared for their sensitivity in the identification of dried bloodstains. Stains of varying blood dilutions were subjected to each presumptive test and the results compared. The Hexagon OBTI buffer volume was also reduced to ascertain whether this increased the sensitivity of the kit.
View Article and Find Full Text PDFStudy Design: Retrospective review of clinical case series.
Objective: We present our experience with extended (> or =3 levels) anterior cervical corpectomy (EACC) and reconstruction.
Summary Of Background Data: Multilevel cervical corpectomy has traditionally been associated with increased graft-related complications and worse clinical outcomes compared with single-level procedures.
Object: Increased structural stability is considered sufficient justification for higher-risk surgical procedures, such as circumferential fixation after severe spinal destabilization. However, there is little biomechanical evidence to support such claims, particularly after traumatic lumbar burst fracture. The authors sought out to compare the biomechanical performance of the following 3 fixation strategies for spinal reconstruction after decompression for an unstable thoracolumbar burst fracture: 1) short-segment anterolateral fixation; 2) circumferential fixation; and 3) extended anterolateral fixation.
View Article and Find Full Text PDFObject: Stabilization of the atlantoaxial complex has proven to be very challenging. Because of the high mobility of the C1-2 motion segment, fusion rates at this level have been substantially lower than those at the subaxial spine. The set of potential surgical interventions is limited by the anatomy of this region.
View Article and Find Full Text PDFBackground: Controversy exists about the impact of ischemia on renal function. We evaluated the creatinine clearance of patients having undergone laparoscopic renal extirpative and ablative surgery.
Study Design: The records of patients undergoing laparoscopic procedures for renal masses from February 2000 to March 2004 were examined.
Neural stem cells (NSCs) are the main vehicle for genetic and molecular therapies in the central nervous system (CNS). The sustainability of NSCs has been ensured through genetic manipulation both in vitro and in vivo. NSC lines have also been immortalized and controlled for cell growth in similar fashion.
View Article and Find Full Text PDFBackground: Complications associated with rigid posterior instrumented fusions of the lumbar spine include pseudarthrosis, accelerated adjacent-segment disease, hardware failure, and iatrogenic fixed sagittal imbalance. Posterior pedicle screw/rod-based dynamic stabilization systems, in which semirigid rods or cords are used to restrict or control, rather than completely eliminate spinal segmental motion, aim to reduce or eliminate these fusion-associated drawbacks. In this study, we analyzed the early radiographic and clinical outcomes of patients treated with the NFix II System (N Spine, Inc.
View Article and Find Full Text PDFNeurosurg Clin N Am
January 2008
Conservative surgical strategies are appropriate for most symptomatic hemangiomas causing cord compression without instability or deformity. Even so, complete intralesional spondylectomy following embolization of aggressive vertebral hemangiomas with circumferential vertebral involvement can be safely accomplished. Such a spondylectomy can also prevent recurrence of hemangiomas.
View Article and Find Full Text PDFOnly five reports of multilevel spondylectomy for tumor have been reported in the literature, mostly in the thoracic spine. We report a successful two-level spondylectomy with en bloc dural resection in a patient with metastatic renal carcinoma to the L3 and L4 vertebrae.
View Article and Find Full Text PDFTotal en bloc spondylectomy is a useful technique in treating primary and secondary spinal malignancies, but requires extensive instrumentation to achieve difficult fusions, and requires extensive exposure of neurovascular structures that poses additional risk of nerve root and vascular injury. More limited resections may reduce these risks, especially in the cervical or lumbosacral spine. We report a technique used in two patients with lateralized primary vertebral tumors of the cervical or lumbosacral spine where tumor removal was achieved through a partial spondylectomy.
View Article and Find Full Text PDFWe evaluate our preliminary experience using the Cyberknife Radiosurgery System in treating benign spinal tumors. A retrospective review of 16 consecutively treated patients, comprising 19 benign spinal tumors, was performed. Histologic types included neurofibroma [11], chordoma [4], hemangioma [2], and meningioma [2].
View Article and Find Full Text PDFBackground: The stability of the lumbar spine after ALIF with lateral plate fixation and/or posterior fixation has previously been investigated; however, stand-alone ALDF with plate has not. Previous clinical studies have demonstrated poor fusion rates with stand-alone anterior interbody fusion in the absence of posterior instrumentation. We review our initial experience with stand-alone ALDF with segmental plate fixation for degenerative disc disease of the lumbar spine and compare these results with our experience with traditional ALIF and supplemental posterior instrumentation.
View Article and Find Full Text PDFNeurosurg Clin N Am
April 2007
The surgical management of high-grade spondylolisthesis in adults remains challenging and controversial. Symptomatic patients often present with severe pain, neurologic deficits, or deformity. Although there are several surgical options, the decision to proceed with decompression and fusion depends on the patient's presenting symptoms and degree of instability.
View Article and Find Full Text PDFStudy Design: Prospective clinical trial.
Objective: The authors present their initial multicenter experience in the surgical management of 1-level degenerative disc disease of the cervical spine with anterior cervical discectomy and fusions (ACDF) using a bioabsorbable polymer plate.
Summary Of Background Data: The introduction of a radiolucent bioabsorbable polymer plate and screws for ACDF presents a novel opportunity to gain the some of the potential added benefit of stabilization with internal immobilization while possibly reducing some of the long-term complications and imaging artifacts associated with titanium instrumentation.
Purpose: We analyzed the smoke plume produced by various energy-based laparoscopic instruments and determined its effect on laparoscopic visibility.
Materials And Methods: The Bipolar Macroforceps, Harmonic Scalpel, Floating Ball, and Monopolar Shears were applied in vitro to porcine psoas muscle. An Aerodynamic Particle Sizer and Electrostatic Classifier provided a size distribution of the plume for particles >500 nm and <500 nm, and a geometric mean particle size was calculated.
Study Design: Retrospective review of the medical, radiographic, surgical, and postoperative records of patients who underwent resection of multilevel intradural extramedullary spinal cord tumors of the ventral cervical and cervicothoracic spine via a modified paramedian transpedicular approach at the University of California, San Francisco, between 2003 and 2005.
Objective: To assess the surgical, clinical, and radiographic outcomes of using the modified paramedian transpedicular approach to resect ventral intradural extramedullary spinal cord tumors of the ventral cervical and cervicothoracic spine.
Summary Of Background Data: A common theme of skull-base surgery for many years has been to remove the bone rather than retract neural elements.
Objectives: To report our experience with laparoscopic renal cryoablation for patients who have completed a minimum of 3 years of follow-up.
Methods: From July 2000 to March 2005, 81 patients underwent laparoscopic renal cryoablation for renal masses. Of these 81 patients, 31 (38%) underwent laparoscopic renal cryoablation for 36 tumors and have completed a minimal follow-up of 3 years (mean 45.
Background Context: Locking posterior instrumentation in the cervical spine can be attached using 1) pedicle screws, 2) lateral mass screws, or 3) laminar hooks. This order of options is in order of decreasing technical difficulty and decreasing depth of fixation, and is thought to be in order of decreasing stability.
Purpose: We sought to determine whether substantially different biomechanical stability can be achieved in a two-level construct using pedicle screws, lateral mass screws, or laminar hooks.
It is important that contamination from extraneous DNA should be minimised on items used at crime scenes and when dealing with exhibits within the laboratory. Four sterilisation techniques (UV, gamma and beta radiation and ethylene oxide treatment) were examined for their potential to degrade contaminating DNA to such an extent that subsequent DNA profiling was impossible. This work indicated that the most successful technique to reduce DNA contamination was ethylene oxide treatment.
View Article and Find Full Text PDFObjective: To evaluate the association of variables of body habitus with direct measurements of ureteric length, as the correct choice of ureteric stent length might help to prevent complications and improve stent tolerance, and to date there are limited data correlating height or other body variables with ureteric length.
Patients And Methods: We prospectively measured pelvi-ureteric junction to vesico-ureteric junction length in 100 patients by placing a ruled 5 F ureteric catheter. Ureteric length was then correlated with patient height, weight, body mass index, and distance from the shoulder (acromium process) to the wrist (head of the ulna; S-W), the elbow (olecranon process) to the wrist (head of the ulna), xyphoid process to umbilicus, xyphoid process to pubis (X-P), umbilicus to pubis, and anterior iliac spine to anterior iliac spine.
Object: The treatment of vertebral osteomyelitis includes antibiotics with or without surgical intervention. The decision to place instrumentation into an infected spinal column remains controversial. The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in patients with osteomyelitis is also extremely controversial.
View Article and Find Full Text PDFCircumferential cervical decompression and fusion (CCDF) is an important technique for treating patients with severe cervical myelopathy. While circumferential cervical decompression and fusion may provide improved spinal cord decompression and stability compared to unilateral techniques, it is commonly associated with increased morbidity and mortality. We performed a retrospective analysis of patients undergoing CCDF at the University of California, San Francisco (UCSF) between January 2003 and December 2004.
View Article and Find Full Text PDFChildren with autism respond atypically to eye-gaze cues, arguably because they fail to understand that eye-gaze conveys mentalistic information. Three experiments investigated whether a difficulty in inferring desire from eye-gaze in autism reflects a failure to understand the mentalistic significance of eye-gaze, an inhibitory deficit or a deficit of cue inference. While there was an inhibitory component to the tasks, children with autism were no more affected by this than controls.
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