Publications by authors named "John Michael Duff"

Article Synopsis
  • The IMTAR technique was developed for removing spinal intradural lesions, and researchers compared results from patients using either 2D or 3D fluoroscopic guidance over a 14-year study involving 60 patients.
  • The study found that the majority of patients (86.7%) underwent gross-total resection, with a low rate of neurological complications and tumor recurrence across both techniques, indicating similar effectiveness.
  • The IMTAR method resulted in significantly less bone resection compared to the non-IMTAR approach, highlighting its potential benefits in optimizing surgical outcomes while reducing risks.
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Degenerative cervical myelopathy (DCM) is characterized by a progressive deterioration in spinal cord function. Its evaluation requires subjective clinical examination with wide interobserver variability. Objective quantification of spinal cord function remains imprecise, even though validated myelopathy-grading scales have emerged and are now widely used.

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Study Design: This was a retrospective review of patients with compressive cervical radiculopathy treated with a minimally invasive anterior cervical foraminotomy (ACF).

Purpose: This study aimed to evaluate the results and complication rates of ACF in a consecutive series of patients and to report our clinical results of ACF as a minimally invasive technique in a series of 45 consecutive patients treated for compressive cervical radiculopathy.

Overview Of Literature: ACF is a motion-sparing procedure and an alternative to anterior cervical discectomy and fusion (ACDF) and posterior cervical foraminotomy for direct nerve root decompression in patients with compressive cervical radiculopathy.

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Article Synopsis
  • The standard treatment for cervical radiculopathy is typically anterior discectomy and fusion, but the authors propose a minimally invasive alternative called anterior cervical foraminotomy for direct nerve root decompression.
  • Using a modified surgical approach, the procedure involves mobilizing tissue, removing a small muscle portion, and carefully drilling to access the intervertebral foramen for direct decompression.
  • The conclusion emphasizes that anterior cervical foraminotomy is a safe and effective option that preserves motion and avoids the need for cervical fusion in appropriately selected patients.
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Background: Intraoperative identification of the correct level during thoracic spine surgery is essential to avoid wrong-level procedures. Despite technological progress, intraoperative imaging modalities for identifying the correct thoracic spine level remain unreliable and often lead to wrong-level surgery. To counter potential wrong-level operations, here, we have proposed a novel pedicle/bone cylinder marking technique for use in the thoracic spine utilizing biplanar fluoroscopy and confirmed with computed tomography (CT).

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Background: Primary Ewing sarcoma of the mobile spine is a rare disease. Its management requires careful surgical planning, because radical, margin-free excision is directly correlated with prognosis. Extensive bone removal in the cervical spine can lead to instability and cause postoperative iatrogenic cervical deformity.

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The treatment of fixed cervical deformity is complex, but the principles guiding its correction remain the same as in deformity of other spinal regions, with the goal of deformity correction that results in a solid fusion with adequate decompression of the neural elements. In these challenging cases, osteotomies are necessary to mobilize the rigid spine and to obtain the desired correction, but they can be associated with increased risk of complications. Therefore, careful preoperative planning and a complete understanding of the anatomic variations allow patient-tailored approaches with and case specific techniques for the optimal and safe treatment of a variety of complex cervical deformities.

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Article Synopsis
  • A rare case of duplicated filum terminale (FT) in a patient with tethered cord syndrome (TCS) is reported, occurring without typical split cord malformations (SCM) present.
  • The patient, a 47-year-old man, exhibited severe back pain and MRI revealed an intradural dorsal lipoma alongside two identified filum structures, both confirmed through histology.
  • The study emphasizes the importance of thorough surgical exploration and nerve stimulation to recognize such anomalies, suggesting this might be an embryological variant of SCM needing further research.
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Article Synopsis
  • The study introduces an innovative image-guided minimal access technique for resecting intradural extramedullary (IDEM) tumors, aiming to minimize soft tissue dissection and spinal instability risks.
  • A review of 13 patients showed that all achieved gross total tumor removal, with most experiencing neurological improvement post-surgery and no significant complications.
  • The technique combines intraoperative fluoroscopic images and preoperative MRI for optimal surgical planning, proving to be as effective as traditional methods while potentially lowering the risk of neurological deficits.
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Article Synopsis
  • Dumbbell tumors are spinal tumors that have both intradural and extradural components, making surgical removal difficult; this study explores a novel single-stage transforaminal retrojugular (TFR) approach for resection.
  • A retrospective review of 17 patients included 4 with true dumbbell tumors, all of whom successfully underwent gross total resection using the TFR method with minimal bone removal and no fusion necessary.
  • Follow-up results showed that while one patient experienced mild complications, the other three maintained normal neurological function, indicating the TFR approach's effectiveness.
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Purpose: To present a rare case of deep penetrating neck trauma in which a retained foreign body in the cervical spine (a broken knife blade) resulted in delayed radicular injury. We describe the surgical management using a retrojugular approach.

Case Report: Our patient sustained a stab wound to the supraclavicular triangle from a small pocketknife.

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Back pain is a considerable economical burden in industrialised countries. Its management varies widely across countries, including Switzerland. Thus, the University Hospital and University of Lausanne (CHUV) recently improved intern processes of back pain care.

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