The management of lumbar synovial cysts (LSC) has been a controversial topic for many years. Whereas many authors label LSC as markers of instability and thus necessitating fusion, others suggest ...that decompression alone without fusion is a viable initial treatment option. Our objective was to clarify outcomes in patients undergoing decompression alone and decompression with fusion for symptomatic LSC and identify factors for cyst recurrence.
A retrospective case series was performed of all patients undergoing initial treatment for LSC at a single institution ranging from January 1999 to February 2020. Surgical treatment included either decompression with cystectomy or decompression with cystectomy and a fusion procedure. Preoperative symptoms were collected and included radicular pain, motor deficits, sensory deficits, or bowel/bladder changes. Radiographic data were calculated individually and confirmed with radiology reports. Categorical variables were assessed using χ2 analysis and continuous variables were assessed with the 2-sample t test.
In total, 161 patients were identified as presenting with symptomatic LSC. Of these, 104 patients underwent decompression alone versus 57 who underwent decompression and fusion. In the decompression group 11 patients required reoperation at the level of the cyst compared with none in those undergoing fusion as their initial procedure (10.5% vs. 0%, P = 0.012). On subgroup analysis of those undergoing decompression as their initial procedure, patients with cyst recurrence demonstrated a statistically significant greater coronal facet inclination angle compared with those without cyst recurrence (52.4° vs. 40.6°, P = 0.02).
Decompression alone is a reasonable choice for the initial management of LSC, although it does carry a significant risk of same-level reoperation due to cyst recurrence and spondylolisthesis. Preoperative coronal facet inclination angle may be a useful measurement in predicting cyst recurrence following decompression.
Glycogen synthase kinase-3 (GSK-3) is a serine/threonine kinase which plays a center role in the phosphorylation of a wide variety of proteins, generally leading to their inactivation. As such, GSK-3 ...is viewed as a therapeutic target. An ever-increasing number of small organic molecule inhibitors of GSK-3 have been reported. Phenylmethylene hydantoins are known to exhibit a wide range of inhibitory activities including for GSK-3β. A family of fourteen 2-heterocycle substituted methylene hydantoins (
,
-
) were prepared and evaluated for the inhibition of GSK-3β at 25 μM. The IC
values of five of these compounds was determined; the two best inhibitors are 5-(4'-chloro-2-pyridinyl)methylenehydantoin (IC
= 2.14 ± 0.18 μM) and 5-(6'-bromo-2-pyridinyl)methylenehydantoin (IC
= 3.39 ± 0.16 μM). The computational docking of the compounds with GSK-3β (pdb 1q41) revealed poses with hydrogen bonding to the backbone at Val135. The 5-(heteroaryl)methylenehydantoins did not strongly inhibit other metalloenzymes, demonstrating poor inhibitory activity against matrix metalloproteinase-12 at 25 μM and against human carbonic anhydrase at 200 μM, and were not inhibitors for
pyruvate carboxylase at concentrations >1000 μM.
Abstract
BACKGROUND
Anterior lumbar spine procedures such as anterior lumbar interbody fusion (ALIF) are used commonly to treat multiple pathologies, including pseudoarthrosis and degenerative disk ...disease. It is generally a safe and effective procedure, but an anterior approach to the lumbar spine requires critical navigation of the surgical window to avoid delicate structures. An operative technique should maximize the exposure without an increased risk of iatrogenic injury.
OBJECTIVE
To describe in detail a retroperitoneal exposure of the anterior lumbar spine.
METHODS
This surgical approach is a unique variation of standard anterior lumbar spine exposure techniques. This technique is described and illustrated in detail with an accompanying Supplemental Digital Content: video. Institutional Review Board (IRB) approval was not required because this is a variation of current techniques. Patient consent was obtained for the procedure and use of operative pictures and videos.
RESULTS
Precise details of the technique are described. The surgical video demonstrates the technique for the L5-S1 ALIF approach.
CONCLUSION
This technique is a novel variation of the standard retroperitoneal exposure of the anterior lumbar spine. The incision placement, size, and dynamic blunt retraction of this approach limit tissue disruption and provide an efficient exposure that has not been previously described in the literature.
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A variety of 17α-triazolyl and 9α-cyano derivatives of estradiol were prepared and evaluated for binding to human ERβ in both a TR-FRET assay, as well as ERβ and ERα agonism in ...cell-based functional assays. 9α-Cyanoestradiol (5) was nearly equipotent as estradiol as an agonist for both ERβ and ERα. The potency of the 17α-triazolylestradiol analogs is considerably more variable and depends on the nature of the 4-substituent of the triazole ring. While rigid protein docking simulations exhibited significant steric clashing, induced fit docking providing more protein flexibility revealed that the triazole linker of analogs 2d and 2e extends outside of the traditional ligand binding domain with the benzene ring located in the loop connecting helix 11 to helix 12.
The presence of symptomatic lumbar facet cysts has been associated with segmental instability. Given this association, decompression versus decompression with fusion is a frequently debated topic. ...Multiple grading scales have been devised to identify patients at high risk for development of cyst recurrence; however, there exists no external evaluation of these scales.
A retrospective review of 54 patients undergoing initial treatment for lumbar synovial cysts at a single institution over the past 12 years was conducted. Surgical treatment consisted of decompression with cystectomy without fusion. Patients were assessed and classified according to the NeuroSpine Surgery Research Group (NSURG) and Rosenstock Classification systems. Five neurosurgeons reviewed the preoperative magnetic resonance images, and results were classified. Interrater reliability was assessed using both Gwet’s AC1 coefficient and Krippendorff’s alpha. A 1-way analysis of variance was used to evaluate predictive ability of both classification systems.
In total, of the 54 patients who underwent decompression, 7 had cyst recurrence. Overall cyst recurrence was most common in NSURG grade 2 cysts (3/12, 25%) followed by grade 1 cysts (4/27, 14.8%). Of the NSURG grade 3 and 4 patients, none had cyst recurrence. In the Rosenstock grades the most common recurrence was in grade 3 cysts (1/4, 25%) followed by grade 1 cysts (5/26, 19.2%). Interrater reliability demonstrated good reproducibility on Gwet’s AC1 and Krippendorff’s alpha on both grading scales. Neither score was predictive of cyst recurrence (P > 0.05).
The Rosenstock and NeuroSpine scores demonstrate good overall interrater reliability but are inconsistent in their ability to predict recurrence of lumbar facet cysts.
Background: The use of bicycle helmets in preventing traumatic brain injuries (TBI) is frequently cited but data remain inconclusive. Additionally, the effects of helmets on cervical spine injuries ...(CSI) are debated.
Methods: We performed a retrospective review of all adult patients with bicycle crashes presenting to one level 1 trauma center in Wisconsin from 2010 to 2016. Patients were divided into two groups: helmeted and un-helmeted.
Results: In total 287 patients were included; 149 un-helmeted (51.9%) and 138 helmeted (48.9%). Helmeted riders had radiographic evidence of traumatic brain injury in 20.3% of cases compared to 40.3% of un-helmeted (p < 0.001). On average, helmeted riders had a similar injury severity score of 7.80 (standard deviation (SD) = 7.18) compared with 8.25 (SD = 9.98) in the un-helmeted group (p = 0.68). CSI occurred in 16 (10.7%) un-helmeted patients compared with 15 (10.9%) helmeted patients (p = 0.707). Of the un-helmeted group, four patients (2.7%) were found to have a cervical spine fracture compared with 12 (8.7%) helmeted patients (p = 0.037).
Conclusion: Helmet use demonstrated a statistically significant advantage in the prevention of traumatic brain injuries. No significant difference was found regarding the incidence of severity of cervical spine injuries. These results do not demonstrate any statistically significant benefit in the prevention of cervical spine injuries with helmet use. In contrast, helmet use was found to convey a significant protective advantage in the prevention of traumatic brain injuries compared to no helmets.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Neurosurgical patients are aging as the general population is becoming older.
A retrospective review of patients ≥65 years of age who underwent an elective craniotomy from 2007 to 2015 to identify ...risk factors for 30-day morbidity/mortality was conducted. Key preoperative variables included age, comorbidities, and functional status based on the Karnofsky Performance Status score and modified Rankin Scale score. Outcome variables included long-term care (LTC) complications, neurologic complications, systemic/infectious complications, length of stay, functional outcomes, and mortality.
A total of 286 patients ≥65 years underwent elective craniotomy at Loyola University Medical Center over 8 years. Seventy-two patients had a preoperative neurologic deficit and 95 had a systemic morbidity before surgery. Postoperative neurologic and systemic morbidity was 14% and 23%, respectively. 7% of patients experienced a LTC complication and 5 patients (1.7%) died. Worse preoperative scores on both the Karnofsky Performance Status and modified Rankin Scale predicted increased length of stay and mortality (P < 0.05). Univariable and multivariable analyses showed that patients with preoperative motor deficit, altered mental status, congestive heart failure, smoking history, and chronic steroid use were all more likely to have an LTC complication, and increased anesthesia time and estimated blood loss increased risk for LTC, neurologic, and systemic/infectious complications.
This study identifies factors that predict perioperative complications for elderly patients undergoing elective craniotomies, particularly congestive heart failure, smoking history, chronic steroid use, anesthesia time, and estimated blood loss. Age alone should not preclude elective craniotomy.
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Through a structure-based drug design project (SBDD), potent small molecule inhibitors of pyruvate carboxylase (PC) have been discovered. A series of α-keto acids (7) and ...α-hydroxycinnamic acids (8) were prepared and evaluated for inhibition of PC in two assays. The two most potent inhibitors were 3,3′-(1,4-phenylene)bis2-hydroxy-2-propenoic acid (8u) and 2-hydroxy-3-(quinoline-2-yl)propenoic acid (8v) with IC50 values of 3.0 ± 1.0 μM and 4.3 ± 1.5 μM respectively. Compound 8v is a competitive inhibitor with respect to pyruvate (Ki = 0.74 μM) and a mixed-type inhibitor with respect to ATP, indicating that it targets the unique carboxyltransferase (CT) domain of PC. Furthermore, compound 8v does not significantly inhibit human carbonic anhydrase II, matrix metalloproteinase-2, malate dehydrogenase or lactate dehydrogenase.
•Endoscopic endonasal skull base surgery (EESBS) provides minimally invasive corridors to intracranial lesions.•The use of antibiotic prophylaxis for patients undergoing EESBS is quite variable.•Our ...antibiotic prophylaxis protocol led to low rates of postoperative meningitis.•Dural reconstruction has added to low rates of CSF leaks and infection.•Possible changes to our protocol would be to decrease the duration of prophylaxis.
Endoscopic endonasal approaches to the skull base provide minimally invasive corridors to intracranial lesions; however, enthusiasm for this new approach is always tempered by the recognition that this route requires passage through a nonsterile sinonasal corridor. Despite an increasing number of patients undergoing these surgeries, there remains no consensus on the use of perioperative antibiotics. A retrospective review of consecutive patients undergoing endoscopic endonasal skull base surgery (EESBS) at Loyola University Medical Center by the same neurosurgeon and otolaryngologist team between February 2015 and October 2016 was performed. Antibiotic regimens, presence of an intraoperative or postoperative cerebrospinal fluid (CSF) leak, dural reconstruction method, and rates of sinusitis, meningitis, and/or intracranial abscess were analyzed. 39 patients who underwent a total of 41 EESBSs with a mean age of 46 years were identified. A vascularized nasoseptal flap was used for dural reconstruction when high flow CSF leaks were encountered intraoperatively (n = 17); otherwise, reconstruction mostly consisted of allografts and/or free mucosal grafts. There were zero postoperative cases of CSF leaks, meningitis, or intracranial infection. Our current antibiotic prophylaxis protocol coupled with the use of variable dural reconstruction techniques dictated by intraoperative findings has led to low rates of postoperative CSF leaks, intracranial infections, and meningitis. A survey was also distributed to Neurological Surgery Residency Programs to gain a better understanding of the EESBS protocols that are being used nationally. The practice of antibiotic prophylaxis for patients undergoing EESBS is quite variable and this study should provide the impetus for multi-institutional comparison studies.
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