Effect of elastic oral appliance chewing on frontal lobe activity.

OBJECTIVES: Chewing increases frontal lobe activity, resulting in improved memory, learning ability, and response reaction time. This study aimed to assess the effects of elastic oral appliance chewing on the activities and functions of the frontal lobe. METHODS: The study participants were 15 healthy men with full dentulous (mean age, 27.4 ± 4.1 years). A prospective crossover design was used to assess frontal lobe activities and functions. Changes in frontal lobe activities were measured with near-infrared spectroscopy (NIRS). At baseline, the participants were assessed in the resting state. Changes in channels #7, representing right frontal lobe activities by NIRS, and #10, representing left frontal lobe activities, during the first and second chewing periods in a total of two periods were evaluated. Frontal lobe functions were measured using the Trail Making Test Part A (TMT-A) in the resting state and after elastic oral appliance or gum chewing. These values were compared with each period. RESULTS: Elastic oral appliance chewing caused significant differences between the baseline and first chewing periods for channel #7 (p = .032) and significant differences between the baseline and second chewing periods for channels #7 and #10 (p < .001 and p < .001, respectively) using NIRS. Moreover, significant differences were found in the TMT-A results between the resting state and elastic oral appliance chewing (p = .04). CONCLUSIONS: Elastic oral appliance chewing improves frontal lobe activities to a level similar to that obtained with gum chewing.

Surgical Treatment of Rotational Vertebral Artery Syndrome Induced by Spinal Tumor: A Case Report and Literature Review.

Vertebrobasilar insufficiency (VBI) provoked by physiological head rotation is known as rotational vertebral artery syndrome (RVAS) or Bow Hunter syndrome. RVAS most often occurs at C1-2 level with head rotation and presents with symptoms of VBI. Several previously published studies have reported RVAS at subaxial sites (V2 segment), however, tumor-induced RVAS has never been reported. The authors report the first case of RVAS at V2 segment due to compression from a spinal tumor. A 71-year-old man presented with symptoms of dizziness provoked by head rotation or neck extension. computed tomography (CT) angiography and dynamic cerebral angiography revealed circumferential stenosis with neutral neck position and complete occlusion of the left dominant vertebral artery (VA) at C5 level with his neck extended or rotated to the left. Complete neurological recovery was achieved after removal of a spinal osteochondroma and surgical decompression of the left VA via an anterior approach. Spinal tumors should be included in the differential diagnosis in cases of RVAS. Spinal degenerations or sarcomatous transformation of the tumor could lead to clinical manifestations of RVAS in cases with spinal osteochondroma. Complete removal of the tumor with or without spinal fusion would be the treatment of choice, in addition to medical treatment in the cases of acute stroke.

Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Disorders: Mini-open TLIF and Corrective TLIF.

Minimally invasive transforaminal lumbar interbody fusion (TLIF) as a short fusion is widely accepted among the spine surgeons. However in the long fusion for degenerative kyphoscoliosis, corrective spinal fixation by an open method is thought to be frequently selected. Our objective is to study whether the mini-open TLIF and corrective TLIF contribute to the improvement of the spinal segmental and global alignment. We divided the patients who performed lumbar fixation surgery into three groups. Group 1 (G1) consisted of mini-open TLIF procedures without complication. Group 2 (G2) consisted of corrective TLIF without complication. Group 3 (G3) consisted of corrective TLIF with instrumentation-related complication postoperatively. In all groups, the lumbar lordosis (LL) highly correlated with developing surgical complications. LL significantly changed postoperatively in all groups, but was not corrected in the normal range in G3. There were statistically significant differences in preoperative and postoperative LL and mean difference between the pelvic incidence (PI) and LL between G3 and other groups. The most important thing not to cause the instrumentation-related failure is proper correction of the sagittal balance. In the cases with minimal sagittal imbalance with or without coronal imbalance, short fusion by mini-open TLIF or long fusion by corrective TLIF contributes to good clinical results if the lesion is short or easily correctable. However, if the patients have apparent sagittal imbalance with or without coronal imbalance, we should perform proper correction of the sagittal spinal alignment introducing various technologies.

Outcomes and complications following posterior long lumbar fusions exceeding three levels.

The outcomes and complications of posterior-only lumbar instrumented long fusions exceeding three segments with selective segmental transforaminal lumbar interbody fusion for the treatment of degenerative lumbar scoliosis, kyphosis, or both combined with spondylolisthesis were analyzed to investigate risk factors associated with surgical instrumentation failure. Fifteen consecutive patients with degenerative lumbar scoliosis, kyphosis, or both combined with spondylolisthesis were studied retrospectively. There were 5 male and 10 female patients, with a mean age of 71.8 years. All the patients were followed for a mean duration of 19.4 months postoperatively. Radiographic evaluation included coronal Cobb angle, lumbar lordosis (LL) angle, pelvic incidence (PI), and pelvic tilt (PT). The clinical outcomes were assessed by means of Japanese Orthopedic Association (JOA) score. Patients were divided into two groups: group 1-7 patients with surgical complications; group 2-8 patients without complications. The preoperative and postoperative coronal Cobb's angle were not significantly different between groups 1 and 2. The LL highly correlated with developing surgical complications. There were statistically significant differences in preoperative and postoperative LL and the mean difference between PI and the LL (PI-LL) between groups 1 and 2. Linear correlation and regression analysis showed that there was no correlation between JOA score and the coronal Cobb angle in degenerative scoliosis patients. However, we found a positive correlation between JOA and LL. Our series of long lumbar fusions had a high complication and instrumentation failure. Creating adequate LL angle in harmony with PI was a key to prevent surgical complications and attain neurological improvement.