Application of restorative neurostimulation for chronic mechanical low back pain in an older population with 2-year follow up.

Introduction: Data on the Medicare-aged population show that older patients are major consumers of low back pain (LBP) interventions. An effective approach for patients with mechanical LBP that has been refractory to conservative management is restorative neurostimulation. The efficacy of restorative neurostimulation has been demonstrated in multiple prospective studies, with published follow-up over 4 years, showing a consistent durable effect.

Real-World Evidence for Restorative Neurostimulation in Chronic Low Back Pain-a Consecutive Cohort Study.

Background: Neuromuscular instability of the lumbar spine resulting from impaired motor control and degeneration of the multifidus muscle is a known root cause of refractory chronic low back pain (LBP). An implantable neurostimulation system that aims to restore multifidus motor control by stimulating the L2 medial branch of the dorsal ramus thereby relieving pain and reducing disability has demonstrated clinically significant benefits in the clinical trial setting. The 1-year results of a single-site real-world cohort study are presented.

Clinical performance of a bone-anchored annular closure device in older adults.

Lumbar discectomy is a common surgical procedure in middle-aged adults. However, outcomes of lumbar discectomy among older adults are unclear. Lumbar discectomy patients with an annular defect ≥6 mm width were randomized to receive additional implantation with a bone-anchored annular closure device (ACD, n=272) or no additional implantation (controls, n=278).

Surgical Experience and Complications in 50 Patients Treated with an Anular Closure Device Following Lumbar Discectomy.

Objective: To examine the results of an anular closure device for prevention of lumbar disc reherniation in daily routine practice.

Methods: Fifty patients with large anular defects were treated with limited discectomy and a bone-anchored anular closure device. The device physically occludes the defect in the anulus fibrosus and is intended for prevention of lumbar disc reherniation.

Two-year real-world results of lumbar discectomy with bone-anchored annular closure in patients at high risk of reherniation.

Purpose: To determine the safety and effectiveness of limited lumbar discectomy with additional implantation of an annular closure device (ACD) among patients at high risk of herniation recurrence treated in routine clinical practice.

Methods: This was a prospective, single-center study of lumbar discectomy for sciatica caused by intervertebral disc herniation with adjunctive ACD implantation to reduce herniation recurrence risk among high-risk patients with large annular defects. Patients returned for follow-up visits at 6 weeks, 12 weeks, 26 weeks, 1 year, and 2 years.

A retrospective and consecutive analysis of the epidemiology and management of spinal cavernomas over the last 20 years in a single center.

Spinal cavernous malformations (SCM) are rare lesions often presenting with acute onset of symptoms and progressive neurological deterioration due to hemorrhage into the spinal cord. With the aid of modern techniques, their surgical removal became much safer. The present study was undertaken to analyze the outcome of our series of surgically and conservatively treated patients with SCM.

Management of traumatic spinal injuries in children and young adults.

Purpose: Spinal injuries are rarely seen in pediatric patients and therapeutic options are still poorly defined. The present study is aimed to present our experience with a rather large series of children and young adults suffering from traumatic spinal injury.

Patients And Methods: Between 1990 and 2010, 75 consecutive pediatric patients with spinal injuries were treated in our institution.

Cervical spondylodiscitis--a clinical analysis of surgically treated patients and review of the literature.

Objective: The aim of this study was to analyze our clinical and neurological results of surgically treated patients suffering from cervical spondylodiscitis with focusing particularly on the surgical methods used and to review the literature.

Patients And Methods: We present a series of 21 patients operated with cervical spondylodiscitis between 1998 and 2011. Basic demographic data, comorbidities, the radiological segments involved, the surgical strategy with special consideration of the material used and the clinical outcome were evaluated retrospectively.

Elderly patients are at increased risk for mortality undergoing surgical repair of dens fractures.

Objective: Dens fractures are common cervical injuries in advanced aged patients. The presented study was undertaken to analyze the clinical results and risks of surgically treated patients with dens fractures over 70 years.

Methods: Data of 28 patients (17 female, 11 male) over 70 years treated from September 2004 to October 2009 were recorded.

Intramedullary spinal cord astrocytomas: the influence of localization and tumor extension on resectability and functional outcome.

Background: Intramedullary spinal cord tumors (IMSCT) are rare lesions, ependymomas and astrocytomas being the most common ones. Different studies have been published showing results of different treatment strategies as extensive/ limited surgery, biopsy and adjuvant radiation therapy with regard to functional outcome and survival. The present study was undertaken to analyse our series of surgically treated intramedullary astrocytomas in order to identify factors with impact on functional outcome and resectability.

Evaluation of new radiolucent polymer headholder pins for use in intraoperative computed tomography.

Object: With the introduction of intraoperative CT (iCT) scanning, neurosurgeons can now obtain images of the brain during surgery, offering the possibility of intraoperative resection control and monitoring of potential intraoperative complications. The combination of iCT with neuronavigation makes it possible to update the reference scans intraoperatively when necessary. However, the headholder pins normally used for iCT scanning still show artifacts.

Multiple cerebral cavernous malformations associated with extracranial mesenchymal anomalies.

Cerebral cavernous malformations (CCM) are common hamartous dysplasias characterized by abnormally dilated vascular channels. CCM mostly occur sporadically, and multiple occurrence of CCM is highly suggestive of a genetic origin of the disorder. Typical clinical symptoms are seizures, hemorrhages, focal neurological deficits, and headaches.

Microsurgical anatomy of the mesencephalic veins.

Object: The mesencephalic veins drain crucial brainstem areas. Due to the narrowness of the tentorial notch, these veins can become obstructed as a result of herniation or surgery, leading to hemorrhage and severe consequences for the patient. There is little in the literature about the mesencephalic veins.

Surgery of the anterior part of the frontal lobe and of the central region: normative morphometric data based on magnetic resonance imaging.

Modern magnetic resonance imaging (MRI) techniques have improved the planning of surgery to remove lesions in or around the frontal lobe. Since MRI-based morphometric analyses of the anterior part of the frontal lobe and the central region as part of it have not yet been performed, the present study was undertaken to obtain relative normative morphometric data. Median sagittal MRI scans from 53 magnetization prepared rapid acquisition gradient echo (MPRAGE) sequences of individual brains without pathological lesions were analyzed.

Microsurgical anatomy of the lateral mesencephalic vein and its meaning for the deep venous outflow of the brain.

The cerebral venous outflow consists of the superficial system and the deep draining system. The deep one drains the areas of the great vein of Galen, the two basal veins of Rosenthal, and their tributaries. Simultaneous obstruction of these veins can effect great harm.

Subtemporal approach to the tentorial incisura: normative morphometric data based on magnetic resonance imaging scans.

Objective: The tentorial notch can be contained within a transversal line made in front of the cerebral peduncles and another line through the posterior border of the quadrigeminal plate into the anterior, middle and posterior parts. Different approaches to the tentorial incisura have been established. The subtemporal approach represents one of those options.