Tuberculosis of the cervical spine.

A 25-year-old male state-prisoner presented with altered mental status, right neck pain, and uncontrolled hypertension.

Cervical spinal cord, root, and bony spine injuries: a closed claims analysis.

Background: The aim of this study was to characterize cervical cord, root, and bony spine claims in the American Society of Anesthesiologists Closed Claims database to formulate hypotheses regarding mechanisms of injury.

Methods: All general anesthesia claims (1970-2007) in the Closed Claims database were searched to identify cervical injuries. Three independent teams, each consisting of an anesthesiologist and neurosurgeon, used a standardized review form to extract data from claim summaries and judge probable contributors to injury.

Cervical spinal motion during intubation: efficacy of stabilization maneuvers in the setting of complete segmental instability.

Object: The purpose of this study was to characterize and compare segmental cervical motion during orotracheal intubation in cadavers with and without a complete subaxial injury, as well as to examine the efficacy of commonly used stabilization techniques in limiting that motion.

Methods: Intubation procedures were performed in 10 fresh human cadavers in which cervical spines were intact and following the creation of a complete C4-5 ligamentous injury. Movement of the cervical spine during direct laryngoscopy and intubation was recorded using video fluoroscopy and examined under the following conditions: 1) without stabilization; 2) with manual in-line cervical immobilization; and 3) with Gardner-Wells traction.

The effects of dexamethasone on bone fusion in an experimental model of posterolateral lumbar spinal arthrodesis.

Object: The use of corticosteroid agents during the healing phase after spinal arthrodesis remains controversial. Although anecdotal opinion suggests that corticosteroids may inhibit bone fusion, such an effect has not been substantiated in clinical trials or laboratory investigations. This study was undertaken to delineate the effect of exogenous corticosteroid administration on bone graft incorporation in an experimental model of posterolateral lumbar fusion.

Segmental cervical spine motion during orotracheal intubation of the intact and injured spine with and without external stabilization.

Object: The purpose of this study was to establish a cadaveric model for evaluating cervical spine motion in both the intact and injured states and to examine the efficacy of commonly used stabilization techniques in limiting that motion.

Methods: Intubation was performed in fresh human cadavers with intact cervical spines, following the creation of a C4-5 posterior ligamentous injury. Movement of the cervical spine during direct laryngoscopy and intubation was recorded using video fluoroscopy and examined under the following conditions: 1) without external stabilization; 2) with manual in-line cervical immobilization; and 3) with Gardner-Wells traction.

Spinal cord ganglioglioma in a child with neurofibromatosis type 2. Case report and literature review.

Gangliogliomas of the spinal cord are rare disease entities that occur in early childhood. Their occurrence in association with neurofibromatosis Type 2 (NF2) has not been described. The authors describe the unique case of a 2-year-old child with stigmata of NF2 who harbored a spinal cord ganglioglioma that presented as a rapidly growing, exophytic intramedullary mass lesion at the cervicomedullary junction.

Computed imaging-assisted stereotactic brain biopsy: a risk analysis of 225 consecutive cases.

Background: Treatment strategies for intracranial mass lesions are most effective when based upon histopathological diagnoses. Image-guided stereotaxy has provided the means to sample tissue from small or deeply seated intraparenchymal lesions with a relatively high degree of safety and accuracy. Although procedural complications are infrequent, devastating neurological sequelae may result from hemorrhage or direct trauma.

A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions.

Object: Autogeneic bone graft is often incorporated into posterior cervical stabilization constructs as a fusion substrate. Iliac crest is used frequently, although donor-site morbidity can be substantial. Rib is used rarely, despite its accessibility, expandability, unique curvature, and high bone morphogenetic protein content.

Neuromuscular scoliosis: diagnostic and therapeutic considerations.

Neuromuscular scoliosis in a child presents as a diagnostic and therapeutic dilemma to the pediatric neurologist, the pediatric neurological surgeon, and the pediatric orthopaedist. Because of its progressive nature, it tends to be refractory to conservative management and requires active intervention. Neuromuscular scoliosis is a symptom, and the diseases leading to the deformity must be addressed together with the spinal abnormality.

Chymopapain-induced reduction of proinflammatory phospholipase A2 activity and amelioration of neuropathic behavioral changes in an in vivo model of acute sciatica.

The mechanism of action underlying chymopapain (Chymodiactin) chemonucleolysis remains obscure. Radiographic studies suggest that chymopapain does not alter disc fragment size acutely; nonetheless, patients often report symptom resolution within a few days, even hours, of treatment. The authors postulate that, in addition to its chemonucleolytic action, chymopapain may possess antiinflammatory properties.

Basilar invagination in osteogenesis imperfecta and related osteochondrodysplasias: medical and surgical management.

Osteogenesis imperfecta (OI) is a heritable disorder of bone development caused by defective collagen synthesis. Basilar invagination is an uncommon but devastating complication of this disease. The authors present a comprehensive strategy for management of craniovertebral anomalies associated with OI and related osteochondrodysplasias.

Diagnosis of spontaneous subarachnoid hemorrhage.

Spontaneous subarachnoid hemorrhage is usually the result of rupture of an intracranial saccular aneurysm or arteriovenous malformation. The hemorrhage is typically a cataclysmic event, heralded by severe headache, meningeal signs and neurologic dysfunction. About one-half of patients with aneurysmal rupture experience "sentinel headaches" days to weeks before a major hemorrhage.

Quantitative analysis of cerebrospinal fluid spaces in children with occipital plagiocephaly.

The etiology of occipital plagiocephaly (OP) is not fully understood. The authors have observed that many infants with this condition have external hydrocephalus. This study was undertaken to quantify cerebrospinal fluid (CSF) space caliber in children with OP and to compare these measurements to those derived from normal age-matched controls to further elucidate the pathogenesis of this condition.

Intracranial pressure and hemodynamic effects of remifentanil versus alfentanil in patients undergoing supratentorial craniotomy.

Remifentanil hydrochloride is an ultra-short-acting esterase metabolized mu-opioid receptor agonist. The purpose of this study was to provide preliminary information regarding the effects of this drug on intracranial pressure (ICP) and mean arterial pressure (MAP) in patients scheduled for craniotomy. Twenty-six patients undergoing excision of supratentorial space-occupying lesions were anesthetized with 0.

Cervical spine motion with direct laryngoscopy and orotracheal intubation. An in vivo cinefluoroscopic study of subjects without cervical abnormality.

Background: Cervical spine kinetics during airway manipulation are poorly understood. This study was undertaken to quantify the extent and distribution of segmental cervical motion produced by direct laryngoscopy and orotracheal intubation in human subjects without cervical abnormality.

Methods: Ten patients without clinical or radiographic evidence of cervical spine abnormality underwent laryngoscopy using a #3 Macintosh blade while under general anesthesia and neuromuscular blockade.

Symptomatic intrasellar hemangioblastoma in a child treated with subtotal resection and adjuvant radiosurgery. Case report.

The first documented case of a symptomatic intrasellar hemangioblastoma is described, occurring in an 11-year-old girl with stigmata of von Hippel-Lindau disease who presented with headaches, progressive bitemporal hemianopsia, and adenohypophysial dysfunction. A subtotal resection of the lesion was achieved with two separate surgical procedures: a transsphenoidal approach and a subfrontal craniotomy. Subsequent growth of residual tumor was treated with combined conventional radiotherapy and stereotactic radiosurgery.

Biomechanical evaluation of Caspar and Cervical Spine Locking Plate systems in a cadaveric model.

There exist two markedly different instrumentation systems for the anterior cervical spine: the Cervical Spine Locking Plate (CSLP) system, which uses unicortical screws with a locking hub mechanism for attachment, and the Caspar Trapezial Plate System, which is secured with unlocked bicortical screws. The biomechanical stability of these two systems was evaluated in a cadaveric model of complete C5-6 instability. The immediate stability was determined in six loading modalities: flexion, extension, right and left lateral bending, and right and left axial rotation.

Spinal cord compression from metastatic Leydig's cell tumor of the testis: case report.

A case of spinal cord compression from metastatic Leydig's cell tumor of the testis is presented. This 67-year-old man exhibited paraparesis and neurogenic bladder dysfunction secondary to a spinal epidural mass at the T5 level as the initial manifestation of his cancer. Surgical resection was undertaken for tissue diagnosis and spinal cord decompression.

Aneurysmal bone cyst of the temporal bone presenting as hearing loss in a child.

We present an unusual case of a temporal bone and skull base tumor in a ten-year-old child. The patient presented with unilateral hearing loss and headaches. Radiologic, surgical, and histologic findings were consistent with an aneurysmal bone cyst.

Posterior interosseous nerve palsy after brachiocephalic arteriovenous fistula construction: report of two cases.

Two cases of delayed posterior interosseous nerve palsy after brachiocephalic arteriovenous fistula creation are presented. Both patients suffered from end-stage renal disease, necessitating chronic hemodialysis. After fistula construction, both developed progressive weakness of the muscles innervated by the posterior interosseous nerve.

Spinal epidural hematoma following coronary thrombolysis with tissue plasminogen activator. Report of two cases.

Two cases of spinal epidural hematoma following intravenous administration of recombinant tissue-type plasminogen activator are presented. Both patients received thrombolytic therapy for acute myocardial infarction; back pain and progressive neurological dysfunction ensued, secondary to spinal cord compression caused by epidural hematoma. Both individuals underwent emergency surgery for decompression and hematoma evacuation, resulting in improvement in neurological function.

Pressure-flow relations in canine collateral-dependent cerebrum.

Background And Purpose: The pressure-flow relation has been characterized in normal cerebrum, but it has not been studied in cerebrum dependent on collateral flow. The purpose of this investigation was to examine the relation between systemic pressure, regional cerebral blood flow, and middle cerebral artery branch pressure in collateral-dependent and normal brain.

Methods: In 10 anesthetized dogs, we cannulated a branch of the middle cerebral artery and identified collateral-dependent tissues using the shadow flow technique.

Scoliosis in pediatric Chiari malformations without myelodysplasia.

A prospective study was undertaken in 1985 to better understand how the surgical manipulation of hindbrain herniation affected abnormal spinal curvature. Eleven patients under 16 years of age with Chiari malformation (not associated with myelodysplasia) and scoliosis of at least 15 degrees were studied. The mean curve angle at the time of original treatment was 29 degrees, with the convexity to the right in seven patients.