Spinal arachnoiditis can occur as a delayed sequel of meningitis. Cerebrospinal fluid flow distur... more Spinal arachnoiditis can occur as a delayed sequel of meningitis. Cerebrospinal fluid flow disturbances and adhesive loculations can cause cord compression and traction on roots causing the symptoms. The surgical treatment of this condition is often considered a limited option, because of the high chances of recurrence of symptoms and adhesions, often considered as surgical failure. Here, we report a patient with extensive lumbar–sacral adhesive arachnoiditis successfully treated with limited adhesiolysis under neuromonitoring and cystoperitoneal shunt placement.
Introduction: To report a case of monoparesis caused by a vertebral artery (VA) anomaly and foram... more Introduction: To report a case of monoparesis caused by a vertebral artery (VA) anomaly and foraminal stenosis treated with microvascular decompression by the posterior approach. Material and Methods: A 51-year-old man was referred because of a 4-year history of progressive left shoulder pain refractory to other forms of treatment and a 7-month history of arm weakness. Clinical and radiologic evaluation showed an abnormally tortuous loop of left C5-6 cervical foramina with foraminal stenosis causing direct C6 nerve root compression. Results: Left posterior cervical C5-6 facetectomy and fusion was done to decompress the nerve root. The C6 nerve root was identified and well decompressed. The patient’s symptoms resolved after surgery, supporting the posterior decompression of a cervical nerve root compressed by a vertebral artery loop and stenosis for the relief of pain and weakness. Conclusion: Cervical root compression by an anomalous extracranial VA accompanied with foraminal stenos...
A large series of split cord malformation (SCM). Over the last 22 years, we have operated more th... more A large series of split cord malformation (SCM). Over the last 22 years, we have operated more than 1500 patients of SD, of which over 450 are (SCM), and 300 are with various lipomatus malformations. About 55% type II and 45% type I SCM. A separate sub-classification of type I SCM (a,b,c and d), is presented which alter the surgical approach and influence the results. Overall improvement following surgery in patients with SCM was observed in 94%. Fifty percent patients improved and 44% remained stable. However, deterioration was noticed in 6%, mostly with composite type of SCM. A paradigm for management of SCM is provided taking into consideration also the author’s large experience.
OBJECT Spondyloptosis represents the most severe form of spondylolisthesis, which usually follows... more OBJECT Spondyloptosis represents the most severe form of spondylolisthesis, which usually follows high-energy trauma. Few reports exist on this specific condition, and the largest series published to date consists of only 5 patients. In the present study the authors report the clinical observations and outcomes in a cohort of 20 patients admitted to a regional trauma center for severe injuries including spondyloptosis. METHODS The authors performed a retrospective chart review of patients admitted with spondyloptosis at their department over a 5-year period (March 2008–March 2013). Clinical, radiological, and operative details were reviewed for all patients. RESULTS In total, 20 patients with spondyloptosis were treated during the period reviewed. The mean age of the patients was 27 years (range 12–45 years), and 17 patients were male (2 boys and 15 men) and 3 were women. Fall from height (45%) and road traffic accidents (35%) were the most common causes of the spinal injuries. The ...
Despite an increasingly large body of work advancing our understanding of flow interactions occur... more Despite an increasingly large body of work advancing our understanding of flow interactions occurring at the interface of a turbulent flow overlying a permeable bed, little is known concerning how such flow may be affected by the presence of biofilms, which exist in nearly all aquatic environments. This study quantifies the effects on flow exerted by biofilms grown over experimental laboratory permeable beds until biofilm detachment, and then compares this to the residual effects after its detachment. The investigation is conducted in a flow channel by immersing two‐dimensional permeable beds with idealized geometry and different porosities in order to explore different bed permeabilities. Sequences of increasingly higher flow velocity conditions, followed by lower flow, were considered to explore the effect of detachment. Measurements were performed using particle image velocimetry. The total wall shear stress and friction velocity were found to increase in the presence of pregrown...
Although permeable sediments dominate the majority of natural environments past work concerning b... more Although permeable sediments dominate the majority of natural environments past work concerning bed form dynamics has considered the bed to be impermeable, and has generally neglected flow between the hyporheic zone and boundary layer. Herein, we present results detailing numerically modeled flow which allow the effects of bed permeability on bed form dynamics to be assessed. Simulation of an isolated impermeable bed form over a permeable bed shows that flow is forced into the bed upstream of the dune and returns to the boundary layer at the leeside, in the form of returning jets that generate horseshoe‐shaped vortices. The returning flow significantly influences the leeside flow, modifying the separation zone, lifting the shear layer adjoining the separation zone away from the bed. Simulation of a permeable dune on a permeable bed reveals even greater modifications as the flow through the dune negates the formation of any flow separation in the leeside. With two dunes placed in ser...
Spinal cord injury is one of the most debilitating injuries in patients with spinal trauma. Cord ... more Spinal cord injury is one of the most debilitating injuries in patients with spinal trauma. Cord injury may range from simple cord edema to frank transection. Cord transection is the most severe form of cord injury as it results in complete and irreversible loss of all neural functions. Generally, it is a result of unstable spinal fractures with associated spondylolisthesis or spondyloptosis. Generally, the level of cord transection corresponds to the level of spinal fracture/spondylolisthesis. However, here we are presenting a case having a traumatic spinal fracture with spondylolisthesis where the level of cord transection was much higher than the level of the spinal fracture. Due to the traumatic traction, the cord distal to transection is displaced inferior leaving behind a long segment of the empty thecal sac.
Multi-segmental cervical spondylotic myelopathy (MS-CSM) can be dealt with by either anterior or ... more Multi-segmental cervical spondylotic myelopathy (MS-CSM) can be dealt with by either anterior or posterior approaches. The aim of study was to analyze the surgical outcomes of MS-CSM treated by either anterior cervical discectomy with fusion and cervical plating (ACDF) or cervical laminoplasty (LP). Sixty-five patients with MS-CSM (two or more levels) underwent either ACDF (n=13) or LP (n=52). ACDF was performed in patients having these criteria: (i) three or less levels involved, (ii) myeloradiculopathy, (iii) pre-dominant anterior compression radiologically, (iv) <50 years age. LP was chosen in: (i) more than three levels involved (ii) posterior compression radiologically, (iii) >50 years age. Patients were evaluated pre- and post-operatively on the basis of modified Japanese Orthopedic Association (mJOA) scoring and Hirabayashi formula. Thirty-five patients were followed up (8 in ACDF group and 27 in LP group). The mean follow-up period was 37.5 months (12.5-54 months). The...
Spinal arachnoiditis can occur as a delayed sequel of meningitis. Cerebrospinal fluid flow distur... more Spinal arachnoiditis can occur as a delayed sequel of meningitis. Cerebrospinal fluid flow disturbances and adhesive loculations can cause cord compression and traction on roots causing the symptoms. The surgical treatment of this condition is often considered a limited option, because of the high chances of recurrence of symptoms and adhesions, often considered as surgical failure. Here, we report a patient with extensive lumbar–sacral adhesive arachnoiditis successfully treated with limited adhesiolysis under neuromonitoring and cystoperitoneal shunt placement.
Introduction: To report a case of monoparesis caused by a vertebral artery (VA) anomaly and foram... more Introduction: To report a case of monoparesis caused by a vertebral artery (VA) anomaly and foraminal stenosis treated with microvascular decompression by the posterior approach. Material and Methods: A 51-year-old man was referred because of a 4-year history of progressive left shoulder pain refractory to other forms of treatment and a 7-month history of arm weakness. Clinical and radiologic evaluation showed an abnormally tortuous loop of left C5-6 cervical foramina with foraminal stenosis causing direct C6 nerve root compression. Results: Left posterior cervical C5-6 facetectomy and fusion was done to decompress the nerve root. The C6 nerve root was identified and well decompressed. The patient’s symptoms resolved after surgery, supporting the posterior decompression of a cervical nerve root compressed by a vertebral artery loop and stenosis for the relief of pain and weakness. Conclusion: Cervical root compression by an anomalous extracranial VA accompanied with foraminal stenos...
A large series of split cord malformation (SCM). Over the last 22 years, we have operated more th... more A large series of split cord malformation (SCM). Over the last 22 years, we have operated more than 1500 patients of SD, of which over 450 are (SCM), and 300 are with various lipomatus malformations. About 55% type II and 45% type I SCM. A separate sub-classification of type I SCM (a,b,c and d), is presented which alter the surgical approach and influence the results. Overall improvement following surgery in patients with SCM was observed in 94%. Fifty percent patients improved and 44% remained stable. However, deterioration was noticed in 6%, mostly with composite type of SCM. A paradigm for management of SCM is provided taking into consideration also the author’s large experience.
OBJECT Spondyloptosis represents the most severe form of spondylolisthesis, which usually follows... more OBJECT Spondyloptosis represents the most severe form of spondylolisthesis, which usually follows high-energy trauma. Few reports exist on this specific condition, and the largest series published to date consists of only 5 patients. In the present study the authors report the clinical observations and outcomes in a cohort of 20 patients admitted to a regional trauma center for severe injuries including spondyloptosis. METHODS The authors performed a retrospective chart review of patients admitted with spondyloptosis at their department over a 5-year period (March 2008–March 2013). Clinical, radiological, and operative details were reviewed for all patients. RESULTS In total, 20 patients with spondyloptosis were treated during the period reviewed. The mean age of the patients was 27 years (range 12–45 years), and 17 patients were male (2 boys and 15 men) and 3 were women. Fall from height (45%) and road traffic accidents (35%) were the most common causes of the spinal injuries. The ...
Despite an increasingly large body of work advancing our understanding of flow interactions occur... more Despite an increasingly large body of work advancing our understanding of flow interactions occurring at the interface of a turbulent flow overlying a permeable bed, little is known concerning how such flow may be affected by the presence of biofilms, which exist in nearly all aquatic environments. This study quantifies the effects on flow exerted by biofilms grown over experimental laboratory permeable beds until biofilm detachment, and then compares this to the residual effects after its detachment. The investigation is conducted in a flow channel by immersing two‐dimensional permeable beds with idealized geometry and different porosities in order to explore different bed permeabilities. Sequences of increasingly higher flow velocity conditions, followed by lower flow, were considered to explore the effect of detachment. Measurements were performed using particle image velocimetry. The total wall shear stress and friction velocity were found to increase in the presence of pregrown...
Although permeable sediments dominate the majority of natural environments past work concerning b... more Although permeable sediments dominate the majority of natural environments past work concerning bed form dynamics has considered the bed to be impermeable, and has generally neglected flow between the hyporheic zone and boundary layer. Herein, we present results detailing numerically modeled flow which allow the effects of bed permeability on bed form dynamics to be assessed. Simulation of an isolated impermeable bed form over a permeable bed shows that flow is forced into the bed upstream of the dune and returns to the boundary layer at the leeside, in the form of returning jets that generate horseshoe‐shaped vortices. The returning flow significantly influences the leeside flow, modifying the separation zone, lifting the shear layer adjoining the separation zone away from the bed. Simulation of a permeable dune on a permeable bed reveals even greater modifications as the flow through the dune negates the formation of any flow separation in the leeside. With two dunes placed in ser...
Spinal cord injury is one of the most debilitating injuries in patients with spinal trauma. Cord ... more Spinal cord injury is one of the most debilitating injuries in patients with spinal trauma. Cord injury may range from simple cord edema to frank transection. Cord transection is the most severe form of cord injury as it results in complete and irreversible loss of all neural functions. Generally, it is a result of unstable spinal fractures with associated spondylolisthesis or spondyloptosis. Generally, the level of cord transection corresponds to the level of spinal fracture/spondylolisthesis. However, here we are presenting a case having a traumatic spinal fracture with spondylolisthesis where the level of cord transection was much higher than the level of the spinal fracture. Due to the traumatic traction, the cord distal to transection is displaced inferior leaving behind a long segment of the empty thecal sac.
Multi-segmental cervical spondylotic myelopathy (MS-CSM) can be dealt with by either anterior or ... more Multi-segmental cervical spondylotic myelopathy (MS-CSM) can be dealt with by either anterior or posterior approaches. The aim of study was to analyze the surgical outcomes of MS-CSM treated by either anterior cervical discectomy with fusion and cervical plating (ACDF) or cervical laminoplasty (LP). Sixty-five patients with MS-CSM (two or more levels) underwent either ACDF (n=13) or LP (n=52). ACDF was performed in patients having these criteria: (i) three or less levels involved, (ii) myeloradiculopathy, (iii) pre-dominant anterior compression radiologically, (iv) <50 years age. LP was chosen in: (i) more than three levels involved (ii) posterior compression radiologically, (iii) >50 years age. Patients were evaluated pre- and post-operatively on the basis of modified Japanese Orthopedic Association (mJOA) scoring and Hirabayashi formula. Thirty-five patients were followed up (8 in ACDF group and 27 in LP group). The mean follow-up period was 37.5 months (12.5-54 months). The...
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