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Background and Objectives@#DNA methyltransferases (Dnmts) play an important role in regulating DNA methylation during early developmental processes and cellular differentiation. In this study, we aimed to investigate the role of Dnmts in neural differentiation of embryonic stem cells (ESCs) and in maintenance of the resulting neural stem cells (NSCs). @*Methods@#and Results: We used three types of Dnmt knockout (KO) ESCs, including Dnmt1 KO, Dnmt3a/3b double KO (Dnmt3 DKO), and Dnmt1/3a/3b triple KO (Dnmt TKO), to investigate the role of Dnmts in neural differentiation of ESCs. All three types of Dnmt KO ESCs could form neural rosette and differentiate into NSCs in vitro. Interestingly, however, after passage three, Dnmt KO ESC-derived NSCs could not maintain their self-renewal and differentiated into neurons and glial cells. @*Conclusions@#Taken together, the data suggested that, although deficiency of Dnmts had no effect on the differentiation of ESCs into NSCs, the latter had defective maintenance, thereby indicating that Dnmts are crucial for self-renewal of NSCs.
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Objective@#Ossification of the posterior longitudinal ligament (OPLL) can progress even after cervical spine surgery and may cause neurological injury as a result of minor trauma. The purpose of this study was to investigate the preventive factors associated with OPLL progression after anterior cervical discectomy and fusion (ACDF), a procedure commonly performed in clinical practice. @*Methods@#We retrospectively investigated 295 male soldiers who underwent ACDF surgery between 2012 and 2017. Patients who were followed up for >12 months using dynamic radiography and computed tomography (CT) were included in the study. Radiological parameters investigated included OPLL progression, C2-C7 angles on dynamic radiography, segmental angles, C2-C7 cervical sagittal vertical axis (C2-C7 SVA), and the T1 slope. These parameters were measured preoperatively and 1 year postoperatively. @*Results@#A total of 49 patients were enrolled, and 10 patients were confirmed to have OPLL progression. Comparison between the OPLL progression and non-progression groups showed no statistically significant differences in pre- and postoperative cervical range of motion. However, statistically significant differences were observed in the postoperative neutral C2-C7 angle (progression −3.9°±6.4° vs. non-progression −13.4°±7.9°, p=0.001) and the SVA change (progression 5.8±7.9 mm vs. non-progression −3.7±6.3 mm, p=0.00). The cutoff values were −8.01° for the postoperative neutral C2-C7 angle and 1.4 mm for SVA changes. @*Conclusion@#Increased SVA (>1.4 mm) and a small postoperative neutral C2-C7 angle (>−8.01°) 1 year after ACDF were associated with OPLL progression. It is important to be mindful of these factors during follow-up after ACDF, because additional surgical treatment may be necessary for OPLL progression due to neurological injury caused by minor trauma.
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Approximately two-thirds of glioblastoma (GBM) patients progress to leptomeningeal spread (LMS) within two years. While 90% of LMS cases are diagnosed during the progression and/or recurrence of GBM (defined as secondary LMS), LMS presentation at the time of GBM diagnosis (defined as primary LMS) is very rare. 18 F-fluorodeoxy glucose positron emission tomography computed tomography ( 18F-FDG PET/CT) study helps to diagnose the multifocal spread of the malignant primary brain tumor. Our patient was a 31-year-old man with a tumorous lesion located in the right temporal lobe, a wide area of the leptomeninges, and spinal cord (thoracic 5/6, and lumbar 1 level) involvement as a concurrent manifestation. After the removal of the right temporal tumor, the clinical status progressed rapidly, showing signs of increased intracranial pressure and hydrocephalus caused by LMS. He underwent a ventriculoperitoneal shunt a week after craniotomy. During management, progression of cord compression, paraplegia, bone marrow suppression related to radiochemotherapy, intercurrent infections, and persistent ascites due to peritoneal metastasis of the LMS through the shunt system was observed. The patient finally succumbed to the disease nine months after the diagnosis of simultaneous GBM and LMS. The overall survival of primary LMS with GBM in our case was nine months, which is shorter than that of secondary LMS with GBM. The survival period after the diagnosis of LMS did not seem to be significantly different between primary and secondary LMS. To determine the prognostic effect and difference between primary and secondary LMS, further cooperative studies with large-volume data analysis are warranted.
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Background and Objectives@#In recent years, brain organoid technologies have been the most innovative advance inneural differentiation research. In line with this, we optimized a method to establish cerebral organoids from feeder-free cultured human pluripotent stem cells. In this study, we focused on the consistent and robust production of cerebral organoids comprising neural progenitor cells and neurons. We propose an optimal protocol for cerebral organoid generation that is applicable to both human embryonic stem cells and human induced pluripotent stem cells. @*Methods@#and Results: We investigated formation of neuroepithelium, neural tube, and neural folding by observing the morphology of embryoid bodies at each stage during the cerebral organoid differentiation process. Furthermore, we characterized the cerebral organoids via immunocytochemical staining of sectioned organoid samples, which were prepared using a Cryostat and Vibratome. Finally, we established a routine method to generate early cerebral organoids comprising a cortical layer and a neural progenitor zone. @*Conclusions@#We developed an optimized methodology for the generation of cerebral organoids using hESCs and hiPSCs. Using this protocol, consistent and efficient cerebral organoids could be obtained from hiPSCs as well as hESCs. Further, the morphology of brain organoids could be analyzed through 2D monitoring via immunostaining and tissue sectioning, or through 3D monitoring by whole tissue staining after clarification.
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PURPOSE@#Patients' gender, which can be one of the most important determinants of traumatic brain injury (TBI) outcomes, is also likely to interact with many other outcome variables of TBI. This multicenter descriptive study investigated gender differences in epidemiological, clinical, treatment, mortality, and variable characteristics in adult TBI patients.@*METHODS@#The selection criteria were defined as patients who had been diagnosed with TBI and were admitted to the hospital between January 1, 2016 and December 31, 2018. A total of 4468 adult TBI patients were enrolled at eight University Hospitals. Based on the list of enrolled patients, the medical records of the patients were reviewed and they were registered online at each hospital. The registered patients were classified into three groups according to the Glasgow coma scale (GCS) score: mild (13-15), moderate (9-12), and severe (3-8), and the differences between men and women in each group were investigated. The risk factors of moderated and severe TBI compared to mild TBI were also investigated.@*RESULTS@#The study included 3075 men and 1393 women and the proportion of total males was 68.8%. Among all the TBI patients, there were significant differences between men and women in age, past history, and GCS score. While the mild and severe TBI groups showed significant differences in age, past history, and clinical symptoms, the moderate TBI group showed significant differences in age, past history, cause of justice, and diagnosis.@*CONCLUSION@#To the best of our knowledge, this multicenter study is the first to focus on gender differences of adult patients with TBI in Korea. This study shows significant differences between men and women in many aspects of adult TBI. Therefore, gender differences should be strongly considered in TBI studies.
Subject(s)
Adult , Female , Humans , Male , Brain Injuries , Brain Injuries, Traumatic/epidemiology , Glasgow Coma Scale , Prospective Studies , Sex FactorsABSTRACT
Cervical spontaneous spinal epidural hematoma (CSSEH) is a rare condition that can be potentially fatal if not properly diagnosed and managed. While prompt surgical decompression and evacuation of the hematoma are generally considered as the first line of treatment, mild cases that were managed through observation and conservative treatment have been reported. Our patient was a 24-year-old man who experienced two CSSEH events 8 months apart, both of which were managed conservatively. This was a rare case of recurrent CSSEH in which recovery was achieved without surgical intervention. We believe conservative treatment with close observation may be effective in CSSEH patients presenting with mild neurologic symptoms who have a tendency towards spontaneous neurologic improvement.
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C2–3 disc herniation is rare and a definitive treatment of choice has not been established.The purpose of this case report is to suggest posterior approach as one of the best options.A 49-year-old man visited our clinic with a 7-year history of neck pain and occipital headache and a 2-month history of right arm pain. C2–3 intervertebral disc herniation of the central type was diagnosed on magnetic resonance imaging (MRI), and surgery was performed, including C1 laminectomy, C2–3 laminoplasty, and C2–3 posterior fixation. The posterior approach was used because the patient's neck was difficult to operate anteriorly. After 3 months postoperatively, MRI showed widened cerebrospinal fluid space at the C2–3 level.The visual analogue scale score for pain improved in the occipital area and right arm.However, the untouched protruded central disc, subjective weakness in right hand grasping, and numbness persisted. In conclusion, this case highlights posterior decompression and fixation as a good treatment of choice for decompression at the C2–3 level disc herniation, from where it is difficult to remove compressive lesions directly via the anterior corridor.
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This case report showed a young soldier complained of low back pain during military training. Intramuscular hematoma accompanied by the lumbar compression fracture was observed in computed tomography. However, the possibility of intramuscular tumors could not be ruled out through additional examinations, and thus surgically removed, and was diagnosed as cavernous hemangioma. This report is a rare and instructive case in which a hemangioma mimicked bleeding with the lumbar fracture.
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Objective@#We aimed to determine whether bone marrow-derived mesenchymal stem cells (BDMSCs) effectively attenuate the degeneration of human nucleus pulposus cells (NPCs). @*Methods@#Four NPC lines were obtained from 3 subjects who underwent spinal surgery for cervical disc herniation (n=1) or lumbar disc herniation (n=2). For co-culture wells without contact, BDMSCs and adipose-derived mesenchymal stem cells (ADMSCs) were seeded on tissue culture plates and maintained for 3 days. Senescence-associated β-gal (SA-β-gal) staining was represented as a percentage of the total number of stained cells (%). The cells with intracellular lipid droplets (LDs) were represented as the percentage of the number of cells with LDs. Glycosaminoglycan (GAG) secretion was measured at 450 nm, using a commercial kit, to analyze optical density. @*Results@#The ratio of cells stained with SA-β-gal to the total number of cells reduced significantly when co-cultured with BDMSCs and ADMSCs (p<0.001 vs. p<0.001). The proportion of NPCs containing LDs was lower when co-cultured with BDMSCs than with ADMSCs (p<0.001). The optical density related to GAG secretion was lower in BDMSCs and ADMSCs co-cultured with NPCs than in the controls (p<0.001 vs. p<0.001). @*Conclusion@#SA-β-gal staining showed significant attenuation of degenerative changes in NPCs co-cultured with BDMSCs. Moreover, the unexpected increase in LDs was significantly higher in NPCs co-cultured with ADMSCs than in those co-cultured with BDMSCs. However, GAG secretion was significantly decreased in NPCs co-cultured with MSCs.
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OBJECTIVE@#To investigate the clinical efficacy and safety of miniscalpel-needle (MSN) treatment for tension-type headache (TTH).@*METHOD@#Seven medical databases were searched to identify randomized controlled trials (RCTs) evaluating the effect and safety of MSN treatment. All articles published up to November 15, 2018 were retrieved. A meta-analysis was conducted for the included studies, and the risk of bias was assessed. Primary outcomes were visual analogue scale (VAS) or numeric rating scale (NRS) score. Secondary outcomes were clinical effective rates including total effective rate (TER), markedly effective rate (MER), and totally cured rate (TCR) determined by improvement in clinical symptoms or VAS scores, the frequency of adverse events (AEs) that occurred during the study, and participant quality of life (QOL).@*RESULTS@#Seven RCTs involving 724 participants were included. MSN treatment showed significantly higher MER and TCR [relative risk (RR) 1.27, 95% confidence interval (CI) 1.01 to 1.61; RR 1.31, 95% CI 1.09 to 1.57, respectively], but not TER (RR 1.03, 95% CI 0.96 to 1.10) compared to acupuncture. MSN treatment plus conventional treatment showed significant lower VAS and higher TER, MER, and TCR (mean difference -3.54, 95% CI -3.80 to -3.28; RR 1.14, 95% CI 1.06 to 1.23; RR 2.31, 95% CI 1.50 to 3.58; RR 3.01, 95% CI 2.25 to 4.02, respectively) compared to conventional treatment.@*CONCLUSIONS@#According to current evidence, MSN treatment as a monotherapy or as an adjunctive treatment to other existing treatments might have benefits on treating TTH. However, since the number and the sample size of studies included were both small and the methodological quality was poor, the findings of this review should be interpreted with great caution, and our confidence in the results is low. A high quality RCT using objective outcomes should be performed on this topic.
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OBJECTIVE@#investigate the current usage of terminologies related to acupotomy through systematic search and analyze the pros and cons of each for proposing a standard terminology.@*METHODS@#Seven medical journal databases were searched including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Oriental Medicine Advanced Searching Integrated System, KoreaMed, and Korean studies Information Service System using 10 candidate terminologies as searching terms. All studies published from their inception to July 26, 2017 were collected. Articles were included if the title stated one of the 10 candidate terminologies consistent with the definition of acupotomy. Priorly established frequency and consistency of each candidate terminology from medical databases were calculated and evaluated. Moreover, the pros and cons of each were analyzed to propose a standard terminology.@*RESULTS@#A total of 112 studies in English databases, 1,129 studies in Chinese database, and 44 studies in Korean databases were included. The most frequently used terminologies were needle knife (35.71%), acupotomy (48.54%) and acupotomy (90.90%) in English, Chinese and Korean database, respectively. Overall, acupotomy and needle knife were the most frequently used. Others like acupotomology, needle scalpel, miniscalpel acupuncture and miniscalpel needle were used within 10% of the total searched literature. Acupotome, stiletto needle, sword like needle, and Xiaozhendao were rarely used. Acupotomy had the advantages of high frequency and consistency but lacked representativeness. Needle knife also showed a high frequency, but the consistency was poor. Though miniscalpel acupuncture and miniscule needle were used less frequently, they had advantages of inclusiveness and clarity.@*CONCLUSION@#A debate for standardization of the terminology is necessary. This preliminary research can provide a basic outline for the standardization consensus process, and we believe it is noteworthy to discuss miniscalpel needle and miniscalpel acupuncture along with acupotomy and needle knife on the subject.
Subject(s)
Acupuncture Therapy , Databases as Topic , Reference Standards , Research , Terminology as TopicABSTRACT
OBJECTIVE: Total disc replacement (TDR) is frequently performed anterior approaching method for the patients diagnosed with cervical disc herniation. This study aimed to assess the degree of ossification of the posterior longitudinal ligament (OPLL) progression after cervical TDR. METHODS: Twenty-two male soldiers who underwent cervical TDR surgery from 2009 to 2016 and were followed-up for more than 12 months were enrolled. The enrolled patients were classified as; 1) patients with pre-existing OPLL and without; and 2) patient showing progression of OPLL or not. RESULTS: Twenty-two men were included in the analysis. The mean follow-up period from the surgery was 41.4 months (range, 12–114 months). The mean age of all patients was 40.7 years (range, 31–52 years). TDR-only was used in 7 cases, and the hybrid surgery (TDR+ACDF) was used in 15 cases. The incidence of progression or newly development of OPLL was significantly higher in pre-existing OPLL group (p=0.01). In 11 cases showing the progression of the OPLL, the mean size of OPLL progression was 4.16 mm (range, 0.34–18.87 mm) in the longitudinal height and 1.57 mm (range, 0.54–3.91 mm) in thickness. CONCLUSION: The progression of OPLL after cervical TDR was more frequent in patients with pre-existing OPLL than in patients without OPLL. Even though TDR is a major alternative to the treatment of cervical lesions to preserve vertebral segmental motion, careful attention should be paid to whether TDR should be used in patients with OPLL and this should be fully explained to the patient.
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Female , Humans , Male , Cervical Vertebrae , Disease Progression , Follow-Up Studies , Incidence , Longitudinal Ligaments , Methods , Military Personnel , Ossification of Posterior Longitudinal Ligament , Total Disc ReplacementABSTRACT
No abstract available.
Subject(s)
Humans , Cadaver , Hypernatremia , Liver , Liver Transplantation , Myelinolysis, Central Pontine , Tissue DonorsABSTRACT
OBJECTIVE: The incidence of spontaneous spinal epidural hematoma (SSEH) is rare. Patients with SSEH, however, present disabling neurologic deficits. Clinical outcomes are variable among patients. To evaluate the adequate treatment method according to initial patients' neurological status and clinical outcome with comparison of variables affecting the clinical outcome. METHODS: We included 15 patients suffered from SSEH. Patients were divided into two groups by treatment method. Initial neurological status and clinical outcomes were assessed by the American Spinal Injury Association (ASIA) impairment scale. Also sagittal hematoma location and length of involved segment was analyzed with magnetic resonance images. Other factors such as age, sex, premorbid medication and duration of hospital stay were reviewed with medical records. Nonparametric statistical analysis and subgroup analysis were performed to overcome small sample size. RESULTS: Among fifteen patients, ten patients underwent decompressive surgery, and remaining five were treated with conservative therapy. Patients showed no different initial neurologic status between treatment groups. Initial neurologic status was strongly associated with neurological recovery (p=0.030). Factors that did not seem to affect clinical outcomes included : age, sex, length of the involved spinal segment, sagittal location of hematoma, premorbid medication of antiplatelets or anticoagulants, and treatment methods. CONCLUSION: For the management of SSEH, early decompressive surgery is usually recommended. However, conservative management can also be feasible in selective patients who present neurologic status as ASIA scale E or in whom early recovery of function has initiated with ASIA scale C or D.
Subject(s)
Humans , Anticoagulants , Asia , Hematoma , Hematoma, Epidural, Spinal , Incidence , Length of Stay , Magnetic Resonance Spectroscopy , Medical Records , Neurologic Manifestations , Recovery of Function , Spinal InjuriesABSTRACT
BACKGROUND: In cardiac surgery with cardiopulmonary bypass (CPB), hyperlactatemia (HL) is common and is associated with postoperative morbidity and mortality. At present, the cause of HL during CPB is proposed to be tissue hypoxia. Tissue perfusion and oxygen delivery can be impaired to varying degrees during CPB. Although surgery involving CPB apparatus is associated with increased pro-inflammatory mediators, such as TNF-alpha and IL-6, tissue hypoxia that occurs during CPB may be an additionally potent stimulus to inflammation. We hypothesized that hypoxic patients during CPB that experience elevated serum lactate levels, may be related to higher serum cytokine level after CPB than normoxic patients during CPB with normal serum lactate levels. METHODS: Levels of TNF-alpha and IL-6 were measured by ELISA in a) Time 1; before initiation of CPB, b) Time 2; 30 min after aortic de-clamping, c) Time 3; 24 hrs after aortic de-clamping. Levels of lactate was measured at a) Time A; before initiation of CPB, b) Time B; 30 min after aortic de-clamping. Postoperative ICU stay, intubation time and oxygen index were evaluated as postoperative morbidity scale. RESULTS: There were no statistical differences between HL (n = 43, lactate > or =3 mMol/L at time B) and normal lactate group (NL) (n = 63, lactate <3 mMol/L at time B) in demographic data, preoperative left ventricular ejection fraction, CPB time, and aortic cross-clamp time. Level of IL-6 in HL at time 3 was higher than that of NL. The ICU stay and intubation time were longer in HL. The oxygen index on 1st postoperative day was lower in HL. CONCLUSIONS: Our results suggest that hyperlactatemia after weaning from CPB may be related to IL-6 hypercytokinemia, and therefore related to postoperative morbidity.
Subject(s)
Humans , Hypoxia , Cardiopulmonary Bypass , Enzyme-Linked Immunosorbent Assay , Inflammation , Interleukin-6 , Intubation , Lactic Acid , Oxygen , Perfusion , Stroke Volume , Thoracic Surgery , Tumor Necrosis Factor-alpha , WeaningABSTRACT
OBJECTIVE: To evaluate the effects of SB Charite III(R) artificial disc implantation on the biomechanics of functional spinal units. METHODS: A nonlinear intact osteoligamentous three-dimensional finite element model of L4-L5 was developed using 1-mm CT scan data from a human volunteer, and the material properties of each element were determined. The model was validated using biomechanical data. A model that was implanted with SB Charite III(R) artificial discs via an anterior approach was also developed. The stresses and strains of the vertebral bodies and surrounding spinal ligaments were investigated. The implanted model was compared to the intact model in terms of range of motion, force on facet joints with flexion-extension, lateral bending, and axial rotation under 400 N preloading. RESULTS: There were no significant differences between the findings of this finite element study and other reports in the literature. Our analytical method proved useful method for the biomechanical evaluation of the effects of artificial disc implantation. The implanted model revealed an increased range of motion in flexion-extension, lateral bending, and axial rotation compared to the intact model. The stresses on facets were greater in the implanted model than in the intact model. CONCLUSION: The model that was implanted with artificial discs showed increased segmental motion and stress on the facet joints compared to the intact model. We hypothesize that the removal of the anterior longitudinal ligament is the major cause of increased segmental motion and stress on the facet joints in the implanted model. The development of new artificial discs should focus on compensating for these unwanted results.
Subject(s)
Biomechanical Phenomena , Finite Element Analysis , Human Experimentation , Ligaments , Longitudinal Ligaments , Range of Motion, Articular , Zygapophyseal JointABSTRACT
In adults, eosinophilic granuloma of the spine is a rare, benign osteolytic lesion. In a case of a 33-year-old man with neurologic deterioration, magnetic resonance imaging (MRI) showed an osteolytic lesion of the T4 vertebra with spinal cord compression. Involvement of the left pedicle of T4 and paravertebral soft tissue was also observed. On the second day after a fluoroscopic percutaneous needle biopsy, the patient abruptly developed paraplegia. He underwent an emer- gency operation with posterior decompression, followed by anterior stabilization and corpectomy several days later. Histological examination of the tissue, including the paravertebral soft tissue, showed features of eosinophilic granuloma. After surgery, the patient returned to full activity. Eosinophilic granuloma of the spine is a rare disease in adults and may affect all the vertebral structures. Surgical treatment seems necessary for cases specifically involving progressive neurologic deficits.
Subject(s)
Adult , Humans , Biopsy, Needle , Decompression , Eosinophilic Granuloma , Eosinophils , Magnetic Resonance Imaging , Neurologic Manifestations , Paraplegia , Rare Diseases , Spinal Cord Compression , SpineABSTRACT
Since 1966 the first metal ball shape implant was inserted into the cervical and lumbar areas by Dr. Fernstrom, numerous attempts and prostheses have been tried to maintain physiologic range of motion and prevent adjacent segment degeneration (ASD) after surgery. However fusion itself is not a single causative factor of ASD and other biologic factors including natural progression of degenerative process and mechanical factors also contribute in the development of ASD. Several well designed prospective randomized control studies for Bryan disc and Prodisc C have been recently documented preservation of spinal motion, superior or, at least, equivalent clinical outcome in comparing with anterior cervical arthrodesis, and less adverse postoperative events both in frequency and severity. Still remained or undetermined problems in cervical arthroplasty are heterotopic ossifications, segmental kyphosis of implanted levels, MR imaging compatibility, vertebral body fracture by keeled prostheses and long term wear properties. In spite of these unsolved problems and incompleteness of prosthetic design, cervical arthroplasty is now considered as one of standard methods in surgical management of one or two level cervical disc diseases and its indication may be broader in near future.
Subject(s)
Arthrodesis , Arthroplasty , Biological Factors , Intervertebral Disc , Kyphosis , Prostheses and Implants , Range of Motion, ArticularABSTRACT
OBJECTIVE: Clinical and radiological results of posterior dynamic stabilization using interspinous U (ISU, Coflex(TM), Paradigm Spine Inc.(R), NY, USA) were analyzed in comparison with posterior lumbar interbody fusion (PLIF) in degenerative lumbar spinal stenosis (LSS). METHODS: A retrospective study was conducted for a consecutive series of 61 patients with degenerative LSS between May 2003 and December 2005. We included only the patients completed minimum 24 months follow up evaluation. Among them, 30 patients were treated with implantation of ISU after decompressive laminectomy (Group ISU) and 31 patients were treated with wide decompressive laminectomy and posterior lumbar interbody fusion (PLIF; Group PLIF). We evaluated visual analogue scale (VAS) and Oswestry Disability Index (ODI) for clinical outcomes (VAS, ODI), disc height ratio disc height (DH), disc height/vertebral body length x100), static vertebral slip (VS) and depth of maximal radiolucent gap between ISU and spinous process) in preoperative, immediate postoperative and last follow up. RESULTS: The mean age of group ISU (66.2 +/- 6.7 years) was 6.2 years older than the mean age of group PLIF (60.4 +/- 8.1 years; p = 0.003 ). In both groups, clinical measures improved significantly than preoperative values (p 18.6 +/- 5.9%), however decreased significantly in last follow up (13.8 +/- 6.6%, p = 0.027). Vertebral slip (VS) of spondylolisthesis in group ISU increased during postoperative follow-up (2.3 +/- 3.3 --> 8.7 +/- 6.2, p = 0.040). Meanwhile, the postoperatively improved DH and VS was maintained in group PLIF in last follow up. CONCLUSION: According to our result, implantation of ISU after decompressive laminectomy in degenerative LSS is less invasive and provides similar clinical outcome in comparison with the instrumented fusion. However, the device has only transient effect on the postoperative restoration of disc height and reduction of slip in spondylolisthesis. Therefore, in the biomechanical standpoint, it is hard to expect that use of Interspinous U in decompressive laminectomy for degenerative LSS had long term beneficial effect.
Subject(s)
Humans , Follow-Up Studies , Laminectomy , Postoperative Period , Retrospective Studies , Spinal Stenosis , Spine , SpondylolisthesisABSTRACT
OBJECTIVE: We report experiences and clinical outcomes of 61 cases with spinal canal meningiomas from January 1970 through January 2005. METHODS: Thirty-eight patients were enrolled with follow-up duration of more than one year after surgery. There were 7 male and 31 female patients. The mean age was 52 years (range, 19 to 80 years). All patients underwent microsurgical resection using a posterior approach. RESULTS: Twenty-nine (79.4%) cases experienced clinical improvement after surgery. The extent of tumor resection at the first operation was Simpson Grade I in 10 patients, Grade II in 17, Grade III in 4, Grade IV in 6, and unknown in one. We did not experience recurrent cases with Simpson grade I, II, or III resection. There were 6 recurrent cases, consisting of 5 cases with an extent of Simpson grade IV and one with an unknown extent. The mean duration of recurrence was 100 months after surgery. Radiation therapy was administered as a surgical adjunct in four patients (10.5%). Two cases were recurrent lesions that could not be completely resected. The other two cases were malignant meningiomas. No immediate postoperative death occurred in the patient group. CONCLUSION: We experienced no recurrent cases of intraspinal meningiomas once gross total resection has been achieved, regardless of the control of the dural origin. Surgeons do not have to take the risk of causing complication to the control dural origin after achieving gross total resectioning of spinal canal meningioma.