Trans-foraminal versus posterior lumbar interbody fusion: comparison of surgical morbidity.

Background: Posterior lumbar interbody fusion (PLIF) and trans-foraminal lumbar interbody fusion (TLIF) are both accepted surgical approaches for spinal fusion in spondylolisthesis and degenerative disc disease. The unilateral approach of TLIF may minimize the risk of iatrogenic durotomy and nerve root injury; however, there is no definitive evidence to support either approach. We review our experience with TLIF versus PLIF to compare operative complications.

Short-term progressive spinal deformity following laminoplasty versus laminectomy for resection of intradural spinal tumors: analysis of 238 patients.

Objective: Gross total resection of intradural spinal tumors can be achieved in the majority of cases with preservation of long-term neurological function. However, postoperative progressive spinal deformity complicates outcome in a subset of patients after surgery. We set out to determine whether the use of laminoplasty (LP) vs laminectomy (LM) has reduced the incidence of subsequent spinal deformity following intradural tumor resection at our institution.

Hospital costs associated with shunt infections in patients receiving antibiotic-impregnated shunt catheters versus standard shunt catheters.

Background: The average hospital cost for shunt infection treatment is $50,000, making it the most financially costly implant-related infection in the United States. We set out to determine whether introduction of antibiotic-impregnated shunts (AISs) in our practice has decreased the incidence of shunt infection or decreased infection-related hospital costs at our institution.

Methods: Clinical and hospital billing records of pediatric patients undergoing cerebrospinal fluid (CSF) shunt insertion at a single institution from April 2001 to December 2006 were retrospectively reviewed.

Factors associated with progression-free survival and long-term neurological outcome after resection of intramedullary spinal cord tumors: analysis of 101 consecutive cases.

Object: With the introduction of electrophysiological spinal cord monitoring, surgeons have been able to perform radical resection of intramedullary spinal cord tumors (IMSCTs). However, factors associated with tumor resectability, tumor recurrence, and long-term neurological outcome are poorly understood.

Methods: The authors retrospectively reviewed 101 consecutive cases of IMSCT resection in adults and children at a single institution.

Pediatric tethered cord syndrome: response of scoliosis to untethering procedures. Clinical article.

Object: Tethered cord syndrome (TCS) is frequently associated with scoliosis in the pediatric population. Following spinal cord untethering, many patients continue to experience progression of spinal deformity. However, the incidence rate, time course, and risk factors for scoliosis progression following tethered cord release remain unclear.

Neurological outcome after surgical management of adult tethered cord syndrome.

Object: Although postsurgical neurological outcomes in patients with tethered cord syndrome (TCS) are well known, the rate and development of neurological improvement after first-time tethered cord release is incompletely understood. The authors reviewed their institutional experience with the surgical management of adult TCS to assess the time course of symptomatic improvement, and to identify the patient subgroups most likely to experience improvement of motor symptoms.

Methods: The authors retrospectively reviewed 29 consecutive cases of first-time adult tethered cord release.

Thoracic vertebrectomy and spinal reconstruction via anterior, posterior, or combined approaches: clinical outcomes in 91 consecutive patients with metastatic spinal tumors.

Object: Adequate decompression of the thoracic spinal cord often requires a complete vertebrectomy. Such procedures can be performed from an anterior/transthoracic, posterior, or combined approach. In this study, the authors sought to compare the clinical outcomes of patients with spinal metastatic tumors undergoing anterior, posterior, and combined thoracic vertebrectomies to determine the efficacy and operative morbidity of such approaches.

Inaccuracy of the administrative database: comparative analysis of two databases for the diagnosis and treatment of intracranial aneurysms.

Objective: Administrative databases of hospital admissions are increasingly being used, mostly without validation, for epidemiological and clinical outcomes studies. Although it has been difficult to assess the true accuracy of administrative databases, we have identified an opportunity to directly compare the State of Maryland administrative database against a prospectively maintained departmental database at The Johns Hopkins Hospital.

Methods: Data for patients with the diagnosis of an intracranial aneurysm treated at The Johns Hopkins Hospital over a 17-year period were compared in the State of Maryland administrative database and the neurosurgery departmental database.

Adjuvant treatment with locally delivered OncoGel delays the onset of paresis after surgical resection of experimental spinal column metastasis.

Objective: The optimal management of spinal column metastatic disease is controversial. Local chemotherapy delivery systems allow targeted high-dose adjuvant therapy. We evaluated whether injection of OncoGel paclitaxel-releasing biodegradable polymer (Protherics, Inc.

Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty.

Background: Cord retethering and other postoperative complications can occur after the surgical untethering of a first-time symptomatic tethered cord. It is unclear if using duraplasty vs. primary dural closure in the initial operation is associated with decreased incidence of either immediate postoperative complications or subsequent symptomatic retethering.

Translaminar versus pedicle screw fixation of C2: comparison of surgical morbidity and accuracy of 313 consecutive screws.

Objective: C2 translaminar (TL) screws rigidly capture the posterior elements of C2, avoid risk of vertebral artery injury, and are less technically demanding than C2 pedicle (PD) screws. However, a C2-TL screw breach places the spinal cord at risk, and the durability of C2-TL screws remains unknown. It is unclear if TL versus PD screw fixation of C2 is truly associated with less operative morbidity, greater accuracy of screw placement, or equivalent durability.

Diagnosis and management of sacral tumors.

Sacral tumors pose significant challenges to the managing physician from diagnostic and therapeutic perspectives. Although these tumors are often diagnosed at an advanced stage, patients may benefit from good clinical outcomes if an aggressive multidisciplinary approach is used. In this review, the epidemiology, clinical presentation, imaging characteristics, treatment options, and published outcomes are discussed.

Simvastatin for the prevention of symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage: a single-institution prospective cohort study.

Object: Vasospasm is the major cause of disability and death after aneurysmal subarachnoid hemorrhage (aSAH). Although the results of 2 randomized clinical trials demonstrated that statin decreases the incidence of symptomatic cerebral vasospasm after aSAH, retrospective studies have failed to confirm this. The authors conducted a prospective observational study to determine whether a standardized regimen of simvastatin would reduce the incidence of cerebral vasospasm and improve neurological outcomes in patients with aSAH.

Effect of hyperglycemia on progressive paraparesis in a rat etastatic spinal tumor model.

Object: Hyperglycemia has been shown to potentiate ischemic injury of the spinal cord by quenching vasodilators and potentiating tissue acidosis and free radical production. Steroid-induced hyperglycemia is a common event in the surgical management of metastatic epidural spinal cord compression (MESCC). The goal in this study was to determine whether experimentally induced hyperglycemia accelerates neurological decline in an established animal model of MESCC.

Comparison of shunt infection incidence in high-risk subgroups receiving antibiotic-impregnated versus standard shunts.

Background: Shunt infection is a morbid complication of CSF shunting. Though antibiotic-impregnated shunt (AIS) systems decrease shunt infections by preventing bacterial colonization following device implantation, their effectiveness in populations at high risk for infection has recently been disputed. We set out to determine whether the categorical switch to AIS systems at our institution has resulted in a decreased incidence of shunt infection in high-risk pediatric patients.

Suboccipital decompression for Chiari I malformation: outcome comparison of duraplasty with expanded polytetrafluoroethylene dural substitute versus pericranial autograft.

Objective: Treatment failure for Chiari decompression is frequently associated with scarring, intradural adhesions, and recurrent loss of hindbrain space. While autograft has been our standard for hindbrain duraplasty, we investigated whether introducing anti-adhesive synthetic GORE PRECLUDE MVP Dura Substitute (expanded polytetrafluoroethylene [ePTFE] graft) was associated with improved patient outcomes.

Materials And Methods: We retrospectively reviewed records of patients undergoing first-time suboccipital decompression/duraplasty for Chiari-I malformation utilizing ePTFE graft or pericranial autograft.

Supraciliary keyhole craniotomy for brain abscess debridement.

Object: Treatments for brain abscesses have typically involved invasive craniotomies followed by debridement. These methods often require large incisions with vast exposure and may be associated with high morbidity rates. For supraorbital lesions of the anterior and middle cranial fossa, minimally invasive craniotomies may limit exposure and decrease surgically related morbidity while allowing adequate debridement and decompression.

Symptom recurrence after suboccipital decompression for pediatric Chiari I malformation: analysis of 256 consecutive cases.

Objective: Symptom recurrence remains a problem for some patients after surgical decompression for Chiari I malformation. We set out to identify variables at presentation that could identify subgroups most likely to experience incomplete symptom relief after hindbrain decompression for Chiari I malformation.

Materials And Methods: We retrospectively reviewed the records of all pediatric patients undergoing first-time suboccipital decompression for Chiari I malformation over a 10-year period.