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Erickson I, Heaton W, Gornet M, Beal D, Davis T, Coric D, LaBagnara M, Krull A, Depalma M, Hsieh P, Mallempati S, Foley K. Hematopoietic Stem/Progenitor Cells and Engineering: Late Breaking Abstract: ONE YEAR CLINICAL RESULTS IN DOUBLE-BLIND PLACEBO CONTROLLED STUDY OF DISC PROGENITOR CELL THERAPY. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Nij Bijvank J, Petzold A, Coric D, Tan H, Uitdehaag B, Balk L, van Rijn L. Saccadic delay in multiple sclerosis: A quantitative description. Vision Res 2020; 168:33-41. [DOI: 10.1016/j.visres.2020.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 01/02/2020] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
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Coric D, Ometto G, Montesano G, Keane PA, Balk LJ, Uitdehaag BMJ, Petzold A, Crabb DP, Denniston AK. Objective quantification of vitreous haze on optical coherence tomography scans: no evidence for relationship between uveitis and inflammation in multiple sclerosis. Eur J Neurol 2019; 27:144-e3. [PMID: 31342606 PMCID: PMC6916624 DOI: 10.1111/ene.14048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/22/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE The occurrence of intermediate uveitis, which is characterized by the presence of vitreous haze (VH), in patients with multiple sclerosis (MS) may be a sign of coexistent inflammatory central nervous system (CNS) disease activity. Using an automated algorithm to quantify VH on optical coherence tomography (OCT) scans, the aim was to investigate whether VH in MS patients is associated with signs of inflammatory CNS disease activity. METHODS Vitreous haze was quantified on OCT macular volume scans of 290 MS patients and 85 healthy controls (HCs). The relationship between VH and clinical, retinal OCT and magnetic resonance imaging parameters of inflammatory disease activity was investigated using generalized estimating equations. RESULTS Mean VH scores did not differ between patients and HCs (P = 0.629). Six patients (2.1%) showed values higher than the highest of the controls by HCs. VH scores did not differ between the different disease types or between eyes with and without a history of optic neuritis (P = 0.132). VH was not associated with inner nuclear layer volume on OCT (P = 0.233), cerebral T2 lesion load on magnetic resonance imaging (P = 0.416) or the development of new relapses (P = 0.205). CONCLUSION In this study, OCT-based automated VH estimation did not detect increased vitreous inflammation in MS patients compared to HCs and did not find an association with CNS inflammatory burden.
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Affiliation(s)
- D Coric
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Dutch Expertise Center for Neuro-ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands
| | - G Ometto
- Optometry and Visual Sciences, City, University of London, London, UK
| | - G Montesano
- Optometry and Visual Sciences, City, University of London, London, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - P A Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - L J Balk
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Dutch Expertise Center for Neuro-ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands
| | - B M J Uitdehaag
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - A Petzold
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Dutch Expertise Center for Neuro-ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands.,Moorfields Eye Hospital, London, UK.,National Hospital for Neurology and Neurosurgery, London, UK
| | - D P Crabb
- Optometry and Visual Sciences, City, University of London, London, UK
| | - A K Denniston
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Panneman EL, Coric D, Tran LMD, de Vries-Knoppert WAEJ, Petzold A. Progression of Anterograde Trans-Synaptic Degeneration in the Human Retina Is Modulated by Axonal Convergence and Divergence. Neuroophthalmology 2019; 43:382-390. [PMID: 32165897 DOI: 10.1080/01658107.2019.1599027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 03/06/2019] [Accepted: 03/20/2019] [Indexed: 10/26/2022] Open
Abstract
In the visual pathway of patients with multiple sclerosis (MS), the inner nuclear layer (INL) of the retina is a tight barrier for retrograde trans-synaptic degeneration. In this observational, retrospective cross-sectional study, segmented macular spectral domain optical coherence tomography (OCT) volume scans were reviewed to investigate if this observation also holds true for anterograde trans-synaptic degeneration. Significant thinning was found in all retinal layers in patients with outer retinal diseases compared with the healthy controls, while there was no significant attenuation of the outer retina in patients with MS. In contrast to the tight barrier function observed with retrograde trans-synaptic degeneration, the INL appears to be more permissive for the propagation of anterograde trans-synaptic degeneration. We speculate that this may be due to the size of the area affected and be explained by convergence and divergence of axons within the retinal layers. These findings are likely relevant to future restorative stem cell treatment of the outer retinal layers, as time may matter.
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Affiliation(s)
- E L Panneman
- Expertisecentre Neuro-Ophthalmology, Departments of Neurology and Ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands
| | - D Coric
- Expertisecentre Neuro-Ophthalmology, Departments of Neurology and Ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands.,MS Centre Amsterdam, Department of Neurology, Amsterdam UMC, Amsterdam, The Netherlands
| | - L M D Tran
- Expertisecentre Neuro-Ophthalmology, Departments of Neurology and Ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands
| | - W A E J de Vries-Knoppert
- Expertisecentre Neuro-Ophthalmology, Departments of Neurology and Ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands
| | - A Petzold
- Expertisecentre Neuro-Ophthalmology, Departments of Neurology and Ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands.,MS Centre Amsterdam, Department of Neurology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Neuro-ophthalmology, Moorfields Eye Hospital, City Road & National Hospital for Neurology and Neurosurgery, London, UK
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Coric D, Bullard DE, Patel VV, Ryaby JT, Atkinson BL, He D, Guyer RD. Pulsed electromagnetic field stimulation may improve fusion rates in cervical arthrodesis in high-risk populations. Bone Joint Res 2018; 7:124-130. [PMID: 29437635 PMCID: PMC5895946 DOI: 10.1302/2046-3758.72.bjr-2017-0221.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Pulsed electromagnetic field (PEMF) stimulation was evaluated after anterior cervical discectomy and fusion (ACDF) procedures in a randomized, controlled clinical study performed for United States Food and Drug Administration (FDA) approval. PEMF significantly increased fusion rates at six months, but 12-month fusion outcomes for subjects at elevated risk for pseudoarthrosis were not thoroughly reported. The objective of the current study was to evaluate the effect of PEMF treatment on subjects at increased risk for pseudoarthrosis after ACDF procedures. METHODS Two evaluations were performed that compared fusion rates between PEMF stimulation and a historical control (160 subjects) from the FDA investigational device exemption (IDE) study: a post hoc (PH) analysis of high-risk subjects from the FDA study (PH PEMF); and a multicentre, open-label (OL) study consisting of 274 subjects treated with PEMF (OL PEMF). Fisher's exact test and multivariate logistic regression was used to compare fusion rates between PEMF-treated subjects and historical controls. RESULTS In separate comparisons of PH PEMF and OL PEMF groups to the historical control group, PEMF treatment significantly (p < 0.05, Fisher's exact test) increased the fusion rate at six and 12 months for certain high-risk subjects who had at least one clinical risk factor of being elderly, a nicotine user, osteoporotic, or diabetic; and for those with at least one clinical risk factor and who received at least a two- or three-level arthrodesis. CONCLUSION Adjunctive PEMF treatment can be recommended for patients who are at high risk for pseudoarthrosis.Cite this article: D. Coric, D. E. Bullard, V. V. Patel, J. T. Ryaby, B. L. Atkinson, D. He, R. D. Guyer. Pulsed electromagnetic field stimulation may improve fusion rates in cervical arthrodesis in high-risk populations. Bone Joint Res 2018;7:124-130. DOI: 10.1302/2046-3758.72.BJR-2017-0221.R1.
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Affiliation(s)
- D Coric
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, USA
| | - D E Bullard
- Triangle Neurosurgery, 1540 Sunday Drive, Suite 214, Raleigh, North Carolina 27607, USA
| | - V V Patel
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, 13001 East 17th Place, Aurora, Colorado 80045, USA
| | - J T Ryaby
- Clinical Affairs Department, Orthofix, Inc., 3451 Plano Parkway, Lewisville, Texas 75056, USA
| | - B L Atkinson
- Atkinson Biologics Consulting, Highlands Ranch, Colorado, USA
| | - D He
- Analytical Solutions Group, Inc, North Potomac, Maryland, USA
| | - R D Guyer
- TBIRF, Texas Back Institute, 6020 West Parker Road Suite 200, Plano, Texas 75093, USA
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Coric D, Smith NA. Postoperative troponin measurement as a screening tool for adverse cardiac events in adult patients undergoing moderate or major non-cardiac surgery. Anaesth Intensive Care 2017; 45:683-687. [PMID: 29137577 DOI: 10.1177/0310057x1704500606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Elevated troponin levels within three days of surgery are strongly linked to major adverse cardiac events (MACE). However, the value of screening with troponin measurements is controversial. The extent to which this is done in routine practice is uncertain. We examined the medical records of all patients ≥45 years of age undergoing moderate or major non-cardiac surgery in our tertiary referral hospital over a six-month period. We determined how many patients had a troponin (TnT) measurement recorded in the first three days postoperatively, how many of these were abnormal, and the occurrence of MACE within 30 days. Two thousand and two hundred patients underwent 2,577 operations that met the study criteria. A postoperative TnT was measured after 4.5% of operations. Thirty-eight percent of patients with a recorded TnT measurement, and 44% of those with an abnormal measurement, experienced a MACE within 30 days. The sensitivity of an abnormal TnT to detect MACE was 86%. The specificity was low at 32% with a false positive rate of 56%. Patients with an abnormal TnT result had an increased risk of MACE (23%). The 'number needed to measure' to detect one patient with MACE was 4.4. In our institution, postoperative TnT levels were rarely measured and were used as a diagnostic rather than as a screening tool. The high false positive rate for MACE prediction limits its potential value as a screening tool. The test could be considered useful if it leads to further investigation, and may be best considered as one component of a multivariate approach to cardiac risk evaluation and diagnosis.
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Affiliation(s)
- D Coric
- Medical student, Western Sydney University, Sydney, New South Wales
| | - N A Smith
- Specialist Anaesthetist, Department of Anaesthesia, The Wollongong Hospital, Honorary Clinical Associate Professor, Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales
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Coric D, Balk LJ, Uitdehaag BMJ, Petzold A. Diagnostic accuracy of optical coherence tomography inter-eye percentage difference for optic neuritis in multiple sclerosis. Eur J Neurol 2017; 24:1479-1484. [DOI: 10.1111/ene.13443] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/31/2017] [Indexed: 11/30/2022]
Affiliation(s)
- D. Coric
- Department of Neurology; VU University Medical Center Amsterdam; Amsterdam the Netherlands
- Expertise-Center Neuro-Ophthalmology; VU University Medical Center Amsterdam; Amsterdam the Netherlands
| | - L. J. Balk
- Department of Neurology; VU University Medical Center Amsterdam; Amsterdam the Netherlands
- Expertise-Center Neuro-Ophthalmology; VU University Medical Center Amsterdam; Amsterdam the Netherlands
| | - B. M. J. Uitdehaag
- Department of Neurology; VU University Medical Center Amsterdam; Amsterdam the Netherlands
| | - A. Petzold
- Department of Neurology; VU University Medical Center Amsterdam; Amsterdam the Netherlands
- Expertise-Center Neuro-Ophthalmology; VU University Medical Center Amsterdam; Amsterdam the Netherlands
- Moorfields Eye Hospital; London UK
- The National Hospital for Neurology and Neurosurgery; Queen Square London UK
- UCL; Institute of Neurology; London UK
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Veraart JKE, Coric D, van der Erf M, Braam AW. [The type of agent auto-intoxication and the degree of suicidal intent]. Tijdschr Psychiatr 2015; 57:441-445. [PMID: 26073838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The type of the agent used for auto-intoxication may increase or decrease the degree of suicidal intent. AIM To find out whether the type of agent used for auto-intoxication is linked to the degree of suicidal intent at the moment when a patient is given a psychiatric assessment in a general hospital. METHOD We studied the files of 211 patients who had been assessed following auto-intoxication. The files provided us with information about the type of agent used, the suicidal intent of the patient at the time and about other recent, relevant risk factors. RESULTS At the time of the assessment, benzodiazepines were the only auto-intoxication agents used which seemed to predict suicidal intent. CONCLUSION Although the results need to be verified in further studies, it can be concluded that auto-intoxication induced only by benzodiazepines can be seen as a serious expression of an individual's wish to die.
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Abstract
Lumbar spinal stenosis is often the result of advanced degeneration of motion segments of the lumbar spine. Loss of disc height, facet displacement and hypertrophy, spondylosis, and spondylolisthesis, as well as buckling of the ligamentum flavum and annulus fibrosus, all contribute to impingement on the spinal canal and intervertebral foramen in lumbar stenosis. There is a subgroup of patients with spinal stenosis in whom the spine is unstable preoperatively or becomes destabilized following decompression who would benefit from an initial fusion procedure. Posterior lumbar interbody fusion (PLIF) addresses several aspects of the multifactorial pathophysiology responsible for spinal stenosis and may arrest the degenerative changes at the fused level. Fusion, in particular PLIF, should be considered in complex cases of lumbar spinal stenosis, most notably in patients with postlaminectomy stenosis or stenosis associated with spondylolisthesis.
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Affiliation(s)
- D Coric
- Department of Neurosurgery, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157-1029, USA
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Coric D, Wilson JA, Regan JD, Bell DA. Primary stenting of the extracranial internal carotid artery in a patient with multiple cervical dissections: technical case report. Neurosurgery 1998; 43:956-9. [PMID: 9766328 DOI: 10.1097/00006123-199810000-00139] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Spontaneous dissection of the extracranial internal carotid artery (ICA) and vertebral artery (VA) is a well-documented cause of stroke in young, previously healthy patients. The majority of patients with spontaneous dissection are successfully treated with antiplatelet or anticoagulation therapy, but a significant proportion of patients progress to suffer devastating morbidity and mortality. Surgical intervention has primarily consisted of proximal ligation, extracranial-intracranial bypass, or endarterectomy. Generally, these procedures are technically demanding and yield disappointing clinical results. CLINICAL PRESENTATION/INTERVENTION A 36-year-old man without a significant medical history initially presented with a several-day history of episodic right upper extremity weakness and numbness and visual obscurations. Cerebral angiography revealed bilateral ICA long segment narrowing (95%), distal left VA high-grade (95%) stenosis compatible with dissections, and right VA proximal occlusion. While therapeutically anticoagulated on heparin, the patient continued to experience crescendo episodes of right upper extremity paresis and paresthesias as well as aphasia. The patient underwent primary stenting of the left ICA, using a series of six overlapping stents (three Gianturco-Roubin coronary stents and three Palmaz-Schatz coronary stents). The patient remained symptom-free without neurological complications, and subsequent angiography performed at the 9-month follow-up examination confirmed continued patency of the stented left ICA as well as recanalization of the right ICA and VA. CONCLUSION Neurovascular stents offer a minimally invasive and potentially efficacious treatment for the prevention of cerebral ischemia in patients with spontaneous extracranial dissection who remain symptomatic despite therapeutic anticoagulation.
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Affiliation(s)
- D Coric
- Department of Neurosurgery, Wake Forest University Baptist Medical Center, Winson-Salem, North Carolina 27157-1029, USA
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Abstract
OBJECT The optimal treatment of Type II odontoid fractures is controversial. Various therapies have been used, including nonrigid immobilization, halo orthosis, posterior atlantoaxial arthrodesis, and odontoid screw fixation. Of these, odontoid screw fixation is the only treatment modality that provides immediate stabilization and preserves normal motion at C1-2. It has been suggested in cadaveric biomechanical studies that there is no advantage to using more than one screw for anterior odontoid fixation. The authors compared the clinical safety and efficacy of one- and two-screw anterior odontoid fixation. METHODS The authors retrospectively reviewed the medical records and radiographs of 42 consecutive patients who had undergone fixation for treatment of odontoid fractures at a single institution between 1989 and 1995. The group treated with a single screw consisted of 20 patients (11 males and nine females) with an average age of 54 years. The union rate in this group, as determined by postoperative dynamic radiographs, was 81%. The group treated with two screws consisted of 22 patients (13 men and nine women) with an average age of 64 years, whose union rate was 85%. CONCLUSIONS Anterior odontoid screw fixation is a safe and efficacious treatment for odontoid fractures. In the authors' experience there was no significant difference in the successful union rates achieved with either the one- or two-screw fixation techniques (81% and 85%, respectively; chi(2) = 0.09, p = 0.76).
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Affiliation(s)
- J D Jenkins
- Department of Neurosurgery, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157-1029, USA
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Abstract
Anterior cervical discectomy and fusion is an efficacious procedure used to treat a variety of cervical spinal disorders, including spondylosis, myelopathy, herniated discs, trauma, and degenerative disc disease. Pseudarthrosis, or failure of fusion, may be the most common complication of spinal fusion procedures. Nineteen consecutive patients with symptomatic pseudarthrosis following failed anterior cervical fusions were treated with anterior cervical revision using iliac crest allografts and either the Cervical Spine Locking Plate system (10 patients) or the Trapezial Osteosynthetic Plate system (nine patients). The mean age of the nine men and 10 women undergoing treatment was 49.1 years (range 25-72 years). Eleven patients (57.9%) exhibited pseudarthrosis at one level, six (31.5%) at two levels, and two (10.5%) at three levels. The indications for revision were intractable neck pain with radiculopathy (17 patients) or myelopathy (two patients), with evidence of pseudarthrosis on plain cervical radiography as well as computerized tomography (CT) or single-photon emission computerized tomography (SPECT) scanning, or both. All eight patients evaluated with SPECT showed increased focal uptake consistent with pseudarthrosis, which was subsequently confirmed intraoperatively in all eight. The average follow-up period was 22.4 months (range 12-42 months). Solid osseous fusion was achieved over all 28 levels in all 18 patients available for follow-up review (100%). One patient died 4 months postoperatively from myocardial infarction related to preexisting coronary artery disease. There were no intraoperative complications; postoperatively, two patients (10.5%) experienced transient hoarseness. Anterior revision of failed cervical fusions using allograft interbody fusion material and anterior plating is a safe and efficacious procedure. In this series, the use of allografts avoided donor site morbidity without adversely affecting fusion rates. Rigid internal fixation was achieved by means of anterior plating without increasing surgical morbidity rates. The SPECT imaging technique has the potential to reliably confirm the diagnosis of pseudarthrosis.
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Affiliation(s)
- D Coric
- Department of Neurosurgery, The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157-1029, USA
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Abstract
Current treatment regimens for hangman's fracture, or traumatic spondylolisthesis of the axis, emphasize rigid immobilization using a halo orthosis. A retrospective study was undertaken to assess the safety and efficacy of nonrigid immobilization in the treatment of these fractures. Records of 64 patients with hangman's fracture treated over a 19-year period (1975-1994) at one institution were reviewed. Thirty-nine of these patients presented with a displacement of C-2 onto C-3 measuring less than 6 mm and no contiguous cervical fractures. All these patients were treated with nonrigid immobilization, consisting primarily of a Philadelphia hard collar worn for 10 to 14 weeks; all showed stable fracture healing on follow-up flexion-extension radiographs. None of the patients experienced neurological sequelae or significant disability at follow-up review. The results of this series indicate that the majority of patients with hangman's fractures, including all patients with displacement measuring less than 6 mm and no contiguous fractures, may be treated successfully with nonrigid immobilization. This management regimen avoids the increased morbidity and cost associated with rigid immobilization using a halo orthosis.
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Affiliation(s)
- D Coric
- Department of Neurosurgery, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina, USA
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Coric D, Branch CL, Wilson JA, Robinson JC. Arteriovenous fistula as a complication of C1-2 transarticular screw fixation. Case report and review of the literature. J Neurosurg 1996; 85:340-3. [PMID: 8755766 DOI: 10.3171/jns.1996.85.2.0340] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A case is reported of a vertebral artery-to-epidural venous plexus fistula as a complication of posterior atlantoaxial facet screw fixation. The use of transarticular screws to stabilize the C1-2 joint has become an increasingly popular fixation technique, most notably for atlantoaxial instability due to trauma or rheumatoid disease. Despite the fact that this approach is technically challenging, there have been few reports of complications associated with C1-2 transarticular fixation. Although damage to the vertebral artery is a documented hazard of transarticular fixation at this level, a symptomatic arteriovenous fistula resulting from the procedure has not been described previously. The etiology, presentation, and treatment of this unusual complication are discussed.
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Affiliation(s)
- D Coric
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Branch CL, Coric D, Olds W, Eksktrand K. Stereotactic radiosurgery. A review of "gamma knife" and "linac knife" technology and the unit at the Wake Forest University Medical Center. N C Med J 1992; 53:395-9. [PMID: 1513382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C L Branch
- Department of Neurosurgery, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157
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