A. Rahimizadeh, Saber Zafarshamspour, W. Williamson, Mahan Amirzadeh, Shaghayegh Rahimizadeh
Background and Importance: Idiopathic spinal cord herniation (ISCH), or spontaneous spinal cord herniation, is a rare but serious condition that can cause progressive myelopathy and irreversible neurological deficits if left untreated. The condition is marked by the gradual herniation of the spinal cord through a ventral defect in the dura, leading to compromised blood flow and neurological deficits. Common symptoms include Brown-Séquard syndrome or asymmetrical paraparesis. Treatment options typically focus on reducing the strangulated spinal cord and closing the dural defect with a synthetic patch. Case Presentation: We present the case of an adult woman with progressive asymmetrical weakness of the lower limbs compatible with spastic paraparesis. Thoracic magnetic resonance imaging (MRI) revealed characteristic features of ISCH at the T3-T4 level. Intraoperative neurophysiological monitoring was used during the surgical intervention, which involved a 3-level laminectomy, dura opening, excision of the dentate ligament, and reduction of the cord across the dural defect. The defect was then filled with an autogenous piece of muscle, followed by the closure of the defect with an artificial dural patch and dural closure. At the 6-month follow-up, the patient showed favorable improvement. Conclusion: Patients with slowly progressive paraparesis or Brown-Séquard syndrome should consider the possibility of ISCH as a potential cause, despite its rarity. In symptomatic cases, the preferred treatment option often involves reducing the incarcerated spinal cord followed by covering the dural defect.
{"title":"Idiopathic Ventral Spinal Cord Herniation: An Illustrative Case and Literature Review","authors":"A. Rahimizadeh, Saber Zafarshamspour, W. Williamson, Mahan Amirzadeh, Shaghayegh Rahimizadeh","doi":"10.32598/irjns.9.22","DOIUrl":"https://doi.org/10.32598/irjns.9.22","url":null,"abstract":"Background and Importance: Idiopathic spinal cord herniation (ISCH), or spontaneous spinal cord herniation, is a rare but serious condition that can cause progressive myelopathy and irreversible neurological deficits if left untreated. The condition is marked by the gradual herniation of the spinal cord through a ventral defect in the dura, leading to compromised blood flow and neurological deficits. Common symptoms include Brown-Séquard syndrome or asymmetrical paraparesis. Treatment options typically focus on reducing the strangulated spinal cord and closing the dural defect with a synthetic patch. Case Presentation: We present the case of an adult woman with progressive asymmetrical weakness of the lower limbs compatible with spastic paraparesis. Thoracic magnetic resonance imaging (MRI) revealed characteristic features of ISCH at the T3-T4 level. Intraoperative neurophysiological monitoring was used during the surgical intervention, which involved a 3-level laminectomy, dura opening, excision of the dentate ligament, and reduction of the cord across the dural defect. The defect was then filled with an autogenous piece of muscle, followed by the closure of the defect with an artificial dural patch and dural closure. At the 6-month follow-up, the patient showed favorable improvement. Conclusion: Patients with slowly progressive paraparesis or Brown-Séquard syndrome should consider the possibility of ISCH as a potential cause, despite its rarity. In symptomatic cases, the preferred treatment option often involves reducing the incarcerated spinal cord followed by covering the dural defect.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138596372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ekouele Mbaki Hugues Brieux, Loko Ruben Ange Florice, Boukaka Kala Rel Gerald, Ngackosso Olivier Brice, Kinata Bambino Sinclair Brice, Boukassa Leon
Background and Aim: Spinal cord trauma is a public health problem. The subaxial cervical spine is the most frequent seat of such injuries. This study aims to describe the treatment of subaxial cervical spine injuries at the University Hospital Center of Brazzaville, the Republic of Congo. Methods and Materials/Patients: This descriptive study was conducted for 7 years, from 2015 to 2021 in the Department of Multipurpose Surgery at the University Hospital Center of Brazzaville, Congo. The research included all patients hospitalized for subaxial cervical spine injury. The surgery was performed on 32 cases (53.3%). Results: A total of 90 cases with subaxial cervical spine injuries were reported with a frequency of 3.2% and included 60 cases. The median age was 37 years and the sex ratio (male/female) of 3.6. The trauma was because of a road accident in 68.3% of the cases. The affected vertebral level was C5-C6 in 18 cases (30%). It was a luxation in 30% and fracture luxation in 26.7% of the subjects. Surgery was indicated in 51 patients and 32(53.3%) were operated. The median time between admission and surgery was 288 hours. A total of 31(96.9%) cases were operated by the anterior approach alone. Anterior osteosynthesis was performed in all cases. Meanwhile, 18(56.3%) cases had a favorable evolution, 7(21.9%) had a worsening of the deficit, 5(15.6%) experienced a postoperative infection, 5(15.6%) showed deep pressure ulcers, and 7(22%) cases died. In both univariate and multivariate analysis, an unfavorable American Spine Injury Association score (between A and B) was associated with the occurrence of complications with a significant statistical difference (P<0.05). Conclusion: Therapeutic care is delayed due to insufficient financial means for patients who lack health insurance. The surgery consists of neural decompression, arthrodesis then osteosynthesis, particularly by an anterior approach.
{"title":"Treatment of Subaxial Cervical Spine Injuries at the University Hospital Center of Brazzaville, Congo","authors":"Ekouele Mbaki Hugues Brieux, Loko Ruben Ange Florice, Boukaka Kala Rel Gerald, Ngackosso Olivier Brice, Kinata Bambino Sinclair Brice, Boukassa Leon","doi":"10.32598/irjns.9.24","DOIUrl":"https://doi.org/10.32598/irjns.9.24","url":null,"abstract":"Background and Aim: Spinal cord trauma is a public health problem. The subaxial cervical spine is the most frequent seat of such injuries. This study aims to describe the treatment of subaxial cervical spine injuries at the University Hospital Center of Brazzaville, the Republic of Congo. Methods and Materials/Patients: This descriptive study was conducted for 7 years, from 2015 to 2021 in the Department of Multipurpose Surgery at the University Hospital Center of Brazzaville, Congo. The research included all patients hospitalized for subaxial cervical spine injury. The surgery was performed on 32 cases (53.3%). Results: A total of 90 cases with subaxial cervical spine injuries were reported with a frequency of 3.2% and included 60 cases. The median age was 37 years and the sex ratio (male/female) of 3.6. The trauma was because of a road accident in 68.3% of the cases. The affected vertebral level was C5-C6 in 18 cases (30%). It was a luxation in 30% and fracture luxation in 26.7% of the subjects. Surgery was indicated in 51 patients and 32(53.3%) were operated. The median time between admission and surgery was 288 hours. A total of 31(96.9%) cases were operated by the anterior approach alone. Anterior osteosynthesis was performed in all cases. Meanwhile, 18(56.3%) cases had a favorable evolution, 7(21.9%) had a worsening of the deficit, 5(15.6%) experienced a postoperative infection, 5(15.6%) showed deep pressure ulcers, and 7(22%) cases died. In both univariate and multivariate analysis, an unfavorable American Spine Injury Association score (between A and B) was associated with the occurrence of complications with a significant statistical difference (P<0.05). Conclusion: Therapeutic care is delayed due to insufficient financial means for patients who lack health insurance. The surgery consists of neural decompression, arthrodesis then osteosynthesis, particularly by an anterior approach.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138595848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the context of academic medical education, mentorship has been known to play an undeniable role in academic and personal development of junior mentees, as well as guiding them through their carrier, research, and education. Here in, we enumerated the qualities and characteristics of a good mentor, through introducing an exemplary mentor in neurosurgery: Professor Abbas Amirjamshidi. He had been an exemplary mentor with professional mentorship characteristics including altruistic and understanding, accessible and punctual, knowledgeable and experienced, able to assist mentees in defining and reaching goals, senior and well-respected in the field, sincerely dedicated to developing an important relationship with the mentee. Professor Amirjamshidi had been a role model as a mentor steering his mentees in changing their professional life by directing them in the right direction. To achieve this coveted goal, Professor Amirjamshidi would invest time and energy to ascertain that his mentees achieve the loftiest goals in their professional career. He has been present both at the national and international forums as an invited speaker, and has served as a member of the editorial boards of reputed journals. Besides, he has innumerable publications to his credit in peer-reviewed journals.
{"title":"Professor Abbas Amirjamshidi: A Mentor Par-excellence","authors":"Sara Hanaei, Z. Hussain Khan, Mehdi Zeinalizade","doi":"10.32598/irjns.9.30","DOIUrl":"https://doi.org/10.32598/irjns.9.30","url":null,"abstract":"In the context of academic medical education, mentorship has been known to play an undeniable role in academic and personal development of junior mentees, as well as guiding them through their carrier, research, and education. Here in, we enumerated the qualities and characteristics of a good mentor, through introducing an exemplary mentor in neurosurgery: Professor Abbas Amirjamshidi. He had been an exemplary mentor with professional mentorship characteristics including altruistic and understanding, accessible and punctual, knowledgeable and experienced, able to assist mentees in defining and reaching goals, senior and well-respected in the field, sincerely dedicated to developing an important relationship with the mentee. Professor Amirjamshidi had been a role model as a mentor steering his mentees in changing their professional life by directing them in the right direction. To achieve this coveted goal, Professor Amirjamshidi would invest time and energy to ascertain that his mentees achieve the loftiest goals in their professional career. He has been present both at the national and international forums as an invited speaker, and has served as a member of the editorial boards of reputed journals. Besides, he has innumerable publications to his credit in peer-reviewed journals.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138595532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seyed Reza Mousavi, Majidreza Farrokhi, Navid Kalani, Tina Mosalanezhad, Fatemeh Karimi, O. Eilami, A. Kazeminezhad
Background and Aim: SARS-COV-2 can present with pulmonary, renal, gastrointestinal, hematological, and neurological manifestations. Neurological manifestations may occur after or before COVID-19 symptoms and signs. Spine and spinal cord complications are documented as neurological complications of COVID-19. Spinal cord pathology following COVID-19 showed inflammatory myelopathy and suspected cord ischemia. The most frequent presentation of COVID-19 myelitis is non-enhancing central expansile cord T2 signal changes, but it can present with lateral and dorsal column-specific disease and in some cases with negative magnetic resonance imaging (MRI). There is no known documented mechanism for spinal cord involvement in COVID-19 infection, but it seems as a post-infectious immunological and post-inflammatory disorder and reaction. Viral infection of SARS-CoV-2 can cause demyelination of the brain and spinal cord and also can exacerbate the known primary demyelinating disorders. Methods and Materials/Patients: This is a narrative study about the spinal cord complications of COVID-19. To provide up-to-date information, we precisely reviewed COVID-19 articles on spine and spinal cord complications. Based on the keywords COVID-19, SARS-CoV-2, spine, and spinal cord, all the related articles were taken from Google Scholar, PubMed, and Medline and were precisely studied. Results: There are reported cases of COVID-19 spine and spinal cord involvement. There is no documented mechanism for these involvements but the possible mechanisms are direct invasion, cytokine storm, coagulopathy, and an autoimmune response. The routine therapy of such complications is the treatment of these complications with other primary causes with a poor and unsatisfactory response of myelopathy to treatment; however, early diagnosis and vigilance of such involvement improve outcome. Conclusion: COVID-19 can cause spine and spinal cord complications in some patients without a known incidence rate of such complications. The pathogenesis is not completely known; therefore, more conclusive studies are obligatory to improve our information on COVID-19 spinal cord and spine complications.
{"title":"Investigating Spine and Spinal Cord Complications of COVID-19","authors":"Seyed Reza Mousavi, Majidreza Farrokhi, Navid Kalani, Tina Mosalanezhad, Fatemeh Karimi, O. Eilami, A. Kazeminezhad","doi":"10.32598/irjns.9.21","DOIUrl":"https://doi.org/10.32598/irjns.9.21","url":null,"abstract":"Background and Aim: SARS-COV-2 can present with pulmonary, renal, gastrointestinal, hematological, and neurological manifestations. Neurological manifestations may occur after or before COVID-19 symptoms and signs. Spine and spinal cord complications are documented as neurological complications of COVID-19. Spinal cord pathology following COVID-19 showed inflammatory myelopathy and suspected cord ischemia. The most frequent presentation of COVID-19 myelitis is non-enhancing central expansile cord T2 signal changes, but it can present with lateral and dorsal column-specific disease and in some cases with negative magnetic resonance imaging (MRI). There is no known documented mechanism for spinal cord involvement in COVID-19 infection, but it seems as a post-infectious immunological and post-inflammatory disorder and reaction. Viral infection of SARS-CoV-2 can cause demyelination of the brain and spinal cord and also can exacerbate the known primary demyelinating disorders. Methods and Materials/Patients: This is a narrative study about the spinal cord complications of COVID-19. To provide up-to-date information, we precisely reviewed COVID-19 articles on spine and spinal cord complications. Based on the keywords COVID-19, SARS-CoV-2, spine, and spinal cord, all the related articles were taken from Google Scholar, PubMed, and Medline and were precisely studied. Results: There are reported cases of COVID-19 spine and spinal cord involvement. There is no documented mechanism for these involvements but the possible mechanisms are direct invasion, cytokine storm, coagulopathy, and an autoimmune response. The routine therapy of such complications is the treatment of these complications with other primary causes with a poor and unsatisfactory response of myelopathy to treatment; however, early diagnosis and vigilance of such involvement improve outcome. Conclusion: COVID-19 can cause spine and spinal cord complications in some patients without a known incidence rate of such complications. The pathogenesis is not completely known; therefore, more conclusive studies are obligatory to improve our information on COVID-19 spinal cord and spine complications.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138606395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Aim: Emotion dysregulation (ED) after traumatic brain injury (TBI) can exacerbate a wide range of symptoms, including problems in restraining emotions and behaviors, executive function disorders, and diminished emotional awareness and expression. This study aims to systematically review these studies on emotion dysregulation (ED) in people with TBI. Methods and Materials/Patients: PubMed, Web of Science, Scopus, as well as Google Scholar, were systematically searched for required articles published between 1997 and 2023. The eligibility of identified literature was determined by screening the titles and abstracts by two autonomous researchers, denoted as the first author and the second author. Only those studies that reported either emotional regulation or expressive suppression in their findings of TBI adults were included in this review. The abstract and full text of search results were screened by Rayyan QCRI (Qatar Computing Research Institute) intelligent systematic review. Subsequently, the two researchers independently assessed the full-text versions of the residual articles to determine their admissibility. Disputes at each stage were amicably resolved through discourse and consultation. Results: Of the 773 articles identified, 361 studies remained after removing duplicate studies. A final 58 studies were retrieved for full-text screening based on inclusion criteria. So that after the renewed screening, 34 studies were included in this review, which indicated the existence of emotional problems in patients with TBI in all severities. Conclusion: Even though numerous effective factors either physical or psychological aspects made brain injuries more complicated, long-term outcomes associated with post-injury emotional and mental distress and dysregulation have rarely been analyzed in terms of TBI treatment. Hence, by considering medical and clinical psychology care, a more comprehensive approach can be adopted to treat people with TBI and improve their quality of life.
背景与目的:创伤性脑损伤(TBI)后的情绪失调(ED)可加重多种症状，包括抑制情绪和行为的问题、执行功能障碍以及情绪意识和表达的减少。本研究旨在系统回顾这些关于创伤性脑损伤患者情绪失调(ED)的研究。方法和材料/患者:系统检索PubMed、Web of Science、Scopus以及Google Scholar，检索1997 - 2023年间发表的论文。确定文献的资格是由两位自主研究人员通过筛选标题和摘要来确定的，分别表示为第一作者和第二作者。只有那些在TBI成人中发现情绪调节或表达抑制的研究被纳入本综述。检索结果的摘要和全文通过Rayyan QCRI(卡塔尔计算研究所)智能系统评审进行筛选。随后，两位研究者独立评估了剩余文章的全文版本，以确定其可采性。每个阶段的争议都是通过对话协商友好解决的。结果:在确定的773篇文章中，剔除重复研究后，仍有361篇研究。最后检索了58项研究，根据纳入标准进行全文筛选。因此，在重新筛选后，本综述纳入了34项研究，这些研究表明，所有严重程度的TBI患者都存在情绪问题。结论:尽管身体或心理方面的许多有效因素使脑损伤更加复杂，但在TBI治疗方面，与伤后情绪和精神困扰以及失调相关的长期结果很少被分析。因此，结合医学和临床心理护理，可以采取更全面的方法来治疗TBI患者，提高其生活质量。
{"title":"Emotion Dysregulation Following Traumatic Brain Injury: A Systematic Review","authors":"Sajjad Rezaei, Maryam Jafroudi","doi":"10.32598/irjns.9.20","DOIUrl":"https://doi.org/10.32598/irjns.9.20","url":null,"abstract":"Background and Aim: Emotion dysregulation (ED) after traumatic brain injury (TBI) can exacerbate a wide range of symptoms, including problems in restraining emotions and behaviors, executive function disorders, and diminished emotional awareness and expression. This study aims to systematically review these studies on emotion dysregulation (ED) in people with TBI. Methods and Materials/Patients: PubMed, Web of Science, Scopus, as well as Google Scholar, were systematically searched for required articles published between 1997 and 2023. The eligibility of identified literature was determined by screening the titles and abstracts by two autonomous researchers, denoted as the first author and the second author. Only those studies that reported either emotional regulation or expressive suppression in their findings of TBI adults were included in this review. The abstract and full text of search results were screened by Rayyan QCRI (Qatar Computing Research Institute) intelligent systematic review. Subsequently, the two researchers independently assessed the full-text versions of the residual articles to determine their admissibility. Disputes at each stage were amicably resolved through discourse and consultation. Results: Of the 773 articles identified, 361 studies remained after removing duplicate studies. A final 58 studies were retrieved for full-text screening based on inclusion criteria. So that after the renewed screening, 34 studies were included in this review, which indicated the existence of emotional problems in patients with TBI in all severities. Conclusion: Even though numerous effective factors either physical or psychological aspects made brain injuries more complicated, long-term outcomes associated with post-injury emotional and mental distress and dysregulation have rarely been analyzed in terms of TBI treatment. Hence, by considering medical and clinical psychology care, a more comprehensive approach can be adopted to treat people with TBI and improve their quality of life.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135817678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Aim: This study aims to provide information about the common complications of adult spinal deformity (ASD) surgery that requires revision surgery and proximal junctional kyphosis (PJK) as the most common complication. We emphasized crucial protective factors that reduce the risk of post-operative PJK, especially the careful selection of the upper instrumented vertebra (UIV) and gradual transitional zone on the proximal end of the construct. Methods and Materials/Patients: This study is a retrospective review of the adult population with spinal deformity who underwent posterior instrumentation surgery and requires revision surgery due to post-operative complications, such as disc herniation, screw loosening, rod breakage, distal junctional failure, and symptomatic PJK. Fifteen ASD patients requiring revision surgery were included. We evaluated the ratio of age, gender, the prevalence of postoperative complications, and the most common complication of PJK based on Cobb angle and patient symptoms. Results: This study included 15 patients with ASD who underwent posterior spinal instrumentation surgery and experienced post-operative complications requiring revision surgery. As a result, 6 patients out of 15 (40%) had PJK, four patients (26.6%) had disc herniation and canal stenosis, two patients (13.3%) had screw loosening, one patient (6.6%) had rod breakage and two patients (13.3%) had distal junctional failure required revision surgery. Conclusion: In our study, PJK is at the top of the complications and two risk factors have a great impact on predisposing ASD surgery to the post-operative PJK, that is, the UIV level, and gradual transitional zone at the proximal end of the construct, therefore the risk of this unfortunate outcome can be significantly minimized by carefully selecting UIV and hooks using a smooth gradual transitional zone along with other protective factors.
{"title":"Protective Factors of Preventing Proximal Junctional Kyphosis as the Most Common Complication of Adult Spinal Deformity Surgery","authors":"Mohsen Nabiuni, Jaber Hatam, Susan Haghbin","doi":"10.32598/irjns.9.19","DOIUrl":"https://doi.org/10.32598/irjns.9.19","url":null,"abstract":"Background and Aim: This study aims to provide information about the common complications of adult spinal deformity (ASD) surgery that requires revision surgery and proximal junctional kyphosis (PJK) as the most common complication. We emphasized crucial protective factors that reduce the risk of post-operative PJK, especially the careful selection of the upper instrumented vertebra (UIV) and gradual transitional zone on the proximal end of the construct. Methods and Materials/Patients: This study is a retrospective review of the adult population with spinal deformity who underwent posterior instrumentation surgery and requires revision surgery due to post-operative complications, such as disc herniation, screw loosening, rod breakage, distal junctional failure, and symptomatic PJK. Fifteen ASD patients requiring revision surgery were included. We evaluated the ratio of age, gender, the prevalence of postoperative complications, and the most common complication of PJK based on Cobb angle and patient symptoms. Results: This study included 15 patients with ASD who underwent posterior spinal instrumentation surgery and experienced post-operative complications requiring revision surgery. As a result, 6 patients out of 15 (40%) had PJK, four patients (26.6%) had disc herniation and canal stenosis, two patients (13.3%) had screw loosening, one patient (6.6%) had rod breakage and two patients (13.3%) had distal junctional failure required revision surgery. Conclusion: In our study, PJK is at the top of the complications and two risk factors have a great impact on predisposing ASD surgery to the post-operative PJK, that is, the UIV level, and gradual transitional zone at the proximal end of the construct, therefore the risk of this unfortunate outcome can be significantly minimized by carefully selecting UIV and hooks using a smooth gradual transitional zone along with other protective factors.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135817063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prakash Goswami, Raj S. Chandran, Sharmad Mohammed Haneefa, Arun Sathyababu, Rajmohan Bhanu Prabhakar
Background and Aim: Adjacent segment disease (ASD), radiological and clinical, is observed in many of the patients who undergo cervical inter-body fusion with/without graft, and with/without plating. This study aims to evaluate the proportion of ASD among patients who underwent cervical spine fusion surgery, to study the severity of degenerative radiographic findings at adjacent levels, and to determine sites and patterns of ASD. Methods and Materials/Patients: A descriptive study was performed on patients who underwent a previous cervical arthrodesis procedure in the last 2-5 years and continued follow-up as neurosurgery outpatients. A total of 59 patients who qualified for the inclusion criteria were included in the study. Results: Spine fixation was commonly performed at a single level mostly with sample size (54.2%, n=32) then at two levels (42.4%, n=25) and three levels (3.4%, n=2). Adjacent segment degeneration was present in the spine fixation level subgroup at a single level of 9 cases (28.12%), two levels of 9 cases (36%), and three-level fixations of 2 cases (100%). Six patients (10.2%) out of 59 patients developed radiculopathy. Among twenty-two cases (37.3%) with new changes at adjacent levels, reduced disc height was the most common one (18.6%, n=11). Anterior and posterior osteophytes with reduced disc height were found in 2 cases. Therefore, actual new changes were present in 20 cases only. The most common level of C4-C5 was observed for the development of ASD (13.6%, n=8). ASD developed at cranial to fusion in 13 cases (22%), caudal to fusion in 5 cases (8.5%), and at both levels in 2 patients. Conclusion: Adjacent segment disease was observed in a significant number of patients who underwent cervical spine surgery as evident from the results but only 6 out of 20 cases with radiological evidence of ASD were symptomatic. Changes were observed commonly at the C4/C5 level.
{"title":"Clinical and Radiological Changes at the Adjacent Segments Following Cervical Spine Surgery: A Retrospective Study","authors":"Prakash Goswami, Raj S. Chandran, Sharmad Mohammed Haneefa, Arun Sathyababu, Rajmohan Bhanu Prabhakar","doi":"10.32598/irjns.9.12","DOIUrl":"https://doi.org/10.32598/irjns.9.12","url":null,"abstract":"Background and Aim: Adjacent segment disease (ASD), radiological and clinical, is observed in many of the patients who undergo cervical inter-body fusion with/without graft, and with/without plating. This study aims to evaluate the proportion of ASD among patients who underwent cervical spine fusion surgery, to study the severity of degenerative radiographic findings at adjacent levels, and to determine sites and patterns of ASD. Methods and Materials/Patients: A descriptive study was performed on patients who underwent a previous cervical arthrodesis procedure in the last 2-5 years and continued follow-up as neurosurgery outpatients. A total of 59 patients who qualified for the inclusion criteria were included in the study. Results: Spine fixation was commonly performed at a single level mostly with sample size (54.2%, n=32) then at two levels (42.4%, n=25) and three levels (3.4%, n=2). Adjacent segment degeneration was present in the spine fixation level subgroup at a single level of 9 cases (28.12%), two levels of 9 cases (36%), and three-level fixations of 2 cases (100%). Six patients (10.2%) out of 59 patients developed radiculopathy. Among twenty-two cases (37.3%) with new changes at adjacent levels, reduced disc height was the most common one (18.6%, n=11). Anterior and posterior osteophytes with reduced disc height were found in 2 cases. Therefore, actual new changes were present in 20 cases only. The most common level of C4-C5 was observed for the development of ASD (13.6%, n=8). ASD developed at cranial to fusion in 13 cases (22%), caudal to fusion in 5 cases (8.5%), and at both levels in 2 patients. Conclusion: Adjacent segment disease was observed in a significant number of patients who underwent cervical spine surgery as evident from the results but only 6 out of 20 cases with radiological evidence of ASD were symptomatic. Changes were observed commonly at the C4/C5 level.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135816194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Z. Naseri, Fariba Mamoudi, A. Abdolmaleki, M. Soluki
Background and Aim: Sciatic nerve injury is a common condition that can lead to significant functional deficits. Although current treatments are effective in reducing symptoms, more effective and safer treatments are still required. In this research, the effect of trans-anethole (TA) was investigated on improving the sciatic nerve function in a rat model. Methods and Materials/Patients: Twenty-eight adult male Wistar rats were divided into four groups. Animals were subjected to deep anesthesia. Then, to create a model of the sciatic nerve, the right leg of the rats was compressed above the location of the trifurcation of the nerve. The control and negative groups received saline. Trans-anethole 125 mg/kg and 250 mg/kg were injected intraperitoneally into two groups of the sciatica model. Finally, muscle histological changes were evaluated. Results: The results indicated that the injection of TA improved motor recovery in rats. The highest recovery rate was related to the dose of 250 mg/kg. The morphometric analysis suggested that the number of fibers and the thickness of the myelin sheath were significantly higher in the group treated with TA compared with the control group. An increase in muscle mass and a decrease in muscle atrophy were observed in the groups treated with TA compared with the negative control group. Conclusion: These data showed that TA improves nerve damage and can be used as an option to improve inflammation-induced sciatica.
{"title":"Neuroprotective Potential of Trans-Anethole Following Crush Injury of the Sciatic Nerve in Rats","authors":"Z. Naseri, Fariba Mamoudi, A. Abdolmaleki, M. Soluki","doi":"10.32598/irjns.9.13","DOIUrl":"https://doi.org/10.32598/irjns.9.13","url":null,"abstract":"Background and Aim: Sciatic nerve injury is a common condition that can lead to significant functional deficits. Although current treatments are effective in reducing symptoms, more effective and safer treatments are still required. In this research, the effect of trans-anethole (TA) was investigated on improving the sciatic nerve function in a rat model. Methods and Materials/Patients: Twenty-eight adult male Wistar rats were divided into four groups. Animals were subjected to deep anesthesia. Then, to create a model of the sciatic nerve, the right leg of the rats was compressed above the location of the trifurcation of the nerve. The control and negative groups received saline. Trans-anethole 125 mg/kg and 250 mg/kg were injected intraperitoneally into two groups of the sciatica model. Finally, muscle histological changes were evaluated. Results: The results indicated that the injection of TA improved motor recovery in rats. The highest recovery rate was related to the dose of 250 mg/kg. The morphometric analysis suggested that the number of fibers and the thickness of the myelin sheath were significantly higher in the group treated with TA compared with the control group. An increase in muscle mass and a decrease in muscle atrophy were observed in the groups treated with TA compared with the negative control group. Conclusion: These data showed that TA improves nerve damage and can be used as an option to improve inflammation-induced sciatica.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42682589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seyed-Abolghasem Mortazavi, H. Digaleh, H. Saffar, H. Ebrahimi, Hossein Kazemi, Elham Madreseh
Background and Aim: Smoking has been extensively investigated in oncology, and controversial associations with brain tumor incidence have been reported. Caspase-3 and matrix metalloproteinases (MMPs) belong to an important cascade in tumor vasculogenesis. We aim to study the smoking impact on these signaling molecules in nontumoral rat brain tissue. Methods and Materials/Patients: A total of 60 Wistar rats were divided into two groups: treatment (cigarette smoke/electronic cigarette) and control groups with subgroups of male and female rats. After general anesthesia and decapitation, their brains were collected, and 3-μm thick coronal sections were prepared. Following immunohistochemical staining with rabbit anti-MMP-2 and anti-caspase-3 antigens, protein expressions were analyzed by selecting two fields at 400x magnification. Results: Our data suggest that the expression of MMP-2 was not significantly different between the studied groups. However, the significant inductive activity of cigarette smoking was observed on caspase-3. Conclusion: Cigarette smoking indicates pro-tumoral signaling impact in normal tissue with activation of caspase-3 in rat brain tissue.
{"title":"Smoking and Brain Neoplasm: An Immunohistochemical Data Evaluating Caspase-3 and MMP-2 in Rat Brain","authors":"Seyed-Abolghasem Mortazavi, H. Digaleh, H. Saffar, H. Ebrahimi, Hossein Kazemi, Elham Madreseh","doi":"10.32598/irjns.9.15","DOIUrl":"https://doi.org/10.32598/irjns.9.15","url":null,"abstract":"Background and Aim: Smoking has been extensively investigated in oncology, and controversial associations with brain tumor incidence have been reported. Caspase-3 and matrix metalloproteinases (MMPs) belong to an important cascade in tumor vasculogenesis. We aim to study the smoking impact on these signaling molecules in nontumoral rat brain tissue. Methods and Materials/Patients: A total of 60 Wistar rats were divided into two groups: treatment (cigarette smoke/electronic cigarette) and control groups with subgroups of male and female rats. After general anesthesia and decapitation, their brains were collected, and 3-μm thick coronal sections were prepared. Following immunohistochemical staining with rabbit anti-MMP-2 and anti-caspase-3 antigens, protein expressions were analyzed by selecting two fields at 400x magnification. Results: Our data suggest that the expression of MMP-2 was not significantly different between the studied groups. However, the significant inductive activity of cigarette smoking was observed on caspase-3. Conclusion: Cigarette smoking indicates pro-tumoral signaling impact in normal tissue with activation of caspase-3 in rat brain tissue.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42826785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Rahimizadeh, S. Ahmadi, H. Soufiani, W. Williamson, Mahan Amirzadeh, Shaghayegh Rahimizadeh
Background and Importance: Ossification of the ligamentum flavum (OLF) is a pathological condition that affects the yellow ligaments, mostly in adult males between the ages of 45 to 70. Ossification is more common in the thoracolumbar region with an accompanying progressive neurological deficit, and its occurrence within the cervical spine is quite rare. Ossification of the yellow ligament is so common in East Asian countries that it is regarded as a frequently occurring aging pathology in the people of this region. Its existence in other ethnic groups is significantly lower. Case Presentation: A 68-year-old Iranian woman with progressive quadriparesis is presented. Cervical computerized tomography and MRI scans revealed two-level, bilateral, posteriorly located, ossified masses occurring at the C4-C5 and C5-C6 levels, which coincided with the ossification of the yellow ligament. Cervical laminectomy and excision of both masses were undertaken and the patient gradually recovered from his resultant neurological symptoms. Conclusion: Symptomatic cervical OLF is a markedly rare pathological finding and is typically illustrated as a medical case report. In a careful review of the literature including the presented patient, we could uncover only 77 cases involving a documented symptomatic cervical OLF.
{"title":"Ossification of the Ligamentum Flavum of the Cervical Spine in an Iranian Woman: Report of a Case With Myelopathy and Review of the Literature","authors":"A. Rahimizadeh, S. Ahmadi, H. Soufiani, W. Williamson, Mahan Amirzadeh, Shaghayegh Rahimizadeh","doi":"10.32598/irjns.9.17","DOIUrl":"https://doi.org/10.32598/irjns.9.17","url":null,"abstract":"Background and Importance: Ossification of the ligamentum flavum (OLF) is a pathological condition that affects the yellow ligaments, mostly in adult males between the ages of 45 to 70. Ossification is more common in the thoracolumbar region with an accompanying progressive neurological deficit, and its occurrence within the cervical spine is quite rare. Ossification of the yellow ligament is so common in East Asian countries that it is regarded as a frequently occurring aging pathology in the people of this region. Its existence in other ethnic groups is significantly lower. Case Presentation: A 68-year-old Iranian woman with progressive quadriparesis is presented. Cervical computerized tomography and MRI scans revealed two-level, bilateral, posteriorly located, ossified masses occurring at the C4-C5 and C5-C6 levels, which coincided with the ossification of the yellow ligament. Cervical laminectomy and excision of both masses were undertaken and the patient gradually recovered from his resultant neurological symptoms. Conclusion: Symptomatic cervical OLF is a markedly rare pathological finding and is typically illustrated as a medical case report. In a careful review of the literature including the presented patient, we could uncover only 77 cases involving a documented symptomatic cervical OLF.","PeriodicalId":53336,"journal":{"name":"Iranian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41537531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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